BOARD MEETING OF THE GOVERNING BODY TO BE HELD ON TUESDAY, 9 MARCH 2021 AT 1.00 PM
AGENDA
PART 1
No. Agenda Item Lead officer
1. Welcome and Chair’s Opening Remarks
2. Apologies for Absence –
3. Public Questions and Answers
4. Declarations of interest All present
5. a Minutes of the meeting held on 8 December 2020 b Action sheet from the meeting held on 8 December 2020
6. Matters arising
7. Chief Officer Briefing Jo Webster
8. Reducing the Burden and releasing capacity to Ruth Unwin respond to the COVID 19 pandemic
9. Chief Officer Decisions Update report Jo Webster
10. White Paper: Integration and Innovation: working Jo Webster together to improve health and social care for all
11. Governing Body: Membership Re-appointments Ruth Unwin
12. The Wakefield health and care system response to Pat Keane Covid-19
13. COVID Vaccination Programme Update Dr Colin Speers/Joanne Fitzpatrick
14. Wakefield Mental Health Alliance – 2021/22 Priorities Melanie Brown/ Sean Rayner 1
15. Safeguarding Annual Reports
a Wakefield Safeguarding Children Partnership Jonathan Giordano (WSCP) Annual Report 2019-2020 (Wakefield Safeguarding Children Partnership)
b The Health of Children in Care, Annual Report, Suzannah Cookson 1st April 2019 – 31st March 2020
16. NHS Wakefield CCG Risk Register Update Ruth Unwin
17. Performance, Quality and Assurance Report Jonathan Webb/ Suzannah Cookson
18. Finance Report Month 10 2020/21 Jonathan Webb
19. NHS Wakefield Clinical Commissioning Group Ruth Unwin Community and Patient Panel
20. Recommendation from Remuneration Advisory Ruth Unwin Panel
21. Receipt of minutes and items for approval
a Audit Committee (i) Minutes of meeting held on 8 October 2020 (ii) Minutes of meeting held on 15 December 2020 b Clinical Strategy Group (i) Minutes of meeting held on 19 November 2020 (ii) Minutes of meeting held on 26 January 2021 c Connecting Care Executive (i) Minutes of meeting held on 10 September 2020 d Finance Committee (i) Minutes of meeting held on 26 November 2020 e Patient and Community Panel (i) Minutes of meeting held on 28 August 2020 (ii) Minutes of meeting held on 5 November 2020 f Primary Care Commissioning Committee (i) Minutes of meeting held on 29 September 2020 g Quality, Performance & Governance Committee (i) Minutes of meeting held on 26 November 2020 h West Yorkshire & Harrogate Joint Committee of CCGs (i) Summary of key decisions - 12 January 2021 2 i Decisions of the Chief Officer – verbal update
22. Any other business
The Board is recommended to make the following resolution: “That representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest” (Section 1 (2) Public Bodies (Admission to Meetings) Act 1970)”.
23. Date and time of next Public meeting:
Tuesday, 8 June 2021 at 1.00 pm
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Agenda item: 5a
NHS Wakefield Clinical Commissioning Group GOVERNING BODY BOARD MEETING
Minutes of the meeting held on 8 December 2020
Present: Suzannah Cookson Chief Nurse Dr Deborah Hallott GP, New Southgate Surgery Diane Hampshire Nurse Member Dr Clive Harries GP, Chapelthorpe Medical Centre Anna Hartley Director of Public Health Dr Pravin Jayakumar GP, Trinity Medical Centre Hany Lotfallah Secondary Care Consultant Dr Adam Sheppard CCG Chair Richard Watkinson Lay Member Jonathan Webb Chief Finance Officer/Deputy Chief Officer Jo Webster Chief Officer
In attendance: Dr Nigel Artis MYHT Cardiology Consultant and Head of Clinical Service (item 20/188) Melanie Brown Director Commissioning Integrated Health and Care Dr Ann Carroll Chair of the Integrated Care Partnership (item 20/193) Angela Peatfield Minute taker Dr Colin Speers GP Partner, Healthcare First Partnership (item 20/188) Amrit Reyat Governance & Board Secretary Suzie Tilburn Associate Director HR&OD (item 20/192) Ruth Unwin Director of Corporate Affairs
20/181 Welcome and Chair’s Opening Remarks
Dr Adam Sheppard welcomed everyone to the meeting and referred to the NHS England/Improvement Oversight Framework and the significant achievement of the CCG being awarded ‘outstanding’ in delivering against the health and social care assessment.
Dr Adam Sheppard extended thanks on behalf of the Governing Body to Jo Webster and the Senior Leadership Team on this achievement. The CCG is one of 22 organisations nationally who have achieved this standard.
Dr Sheppard referred to the vaccine programme currently being progressed in addition to the significant transformation that has already taken place to deliver services in a different way.
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Dr Sheppard congratulated Local Authority Governing Body member Andrew Balchin on his appointment to Chief Executive of the Local Authority, commenting that this will be a real opportunity to build on the excellent working partnership with the Local Authority.
20/182 Apologies for Absence
Apologies for absence were received from:
Richard Hindley – Lay Member (Deputy Chair)
20/183 Public Questions and Answers
No public questions were received prior to this meeting.
20/184 Declarations of Interest
The GP members of the Governing Body declared an interest regarding the papers relating to primary care, it was acknowledged that none of these are decision making items. The Chair acknowledged the declaration and it was confirmed that the GP members could take part in the discussion of these agenda items.
20/185 Minutes of the meeting held on 8 September 2020
The minutes of the meeting held on 8 September 2020 were agreed as a correct record.
20/186 Action sheet from the meeting held on 8 September 2020
The action sheet from the meeting held on 8 September was noted.
20/187 Matters arising
There were no matters arising.
20/188 Shared Routine Referral Pathway
Dr Adam Sheppard welcomed Dr Nigel Artis and Dr Colin Speers to the meeting to give this detailed presentation on the progress of the Shared Routine Referral Pathway.
The development of the pathway is a clinically led initiative relying on collaboration across primary and secondary care to form a consensus about how the pathway should be implemented in each speciality. The focus being to ensure the patient has the right care by the right person in the right place in the most appropriate method.
It was noted that the Cardiology pathway went live on 27 July 2020,
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Paediatrics went live on 17 August 2020, Respiratory went live in Wakefield on 24 September 2020 and the Gynaecology pathway went live on 28 September 2020. Patient stories were shared for each speciality highlighting the improvements gained by the new pathway.
As part of the future planned work, Primary Care clinical surveys have been sent out and so far 13 responses have been received. A Secondary Care clinical survey and primary care admin survey are currently being developed and discussions will also take place involving the CCG Patient Forums.
A discussion followed and it was acknowledged that the case studies were helpful in demonstrating the work that has taken place and the data collection of diagnostics. It was noted that the improvement in diagnostics may not be as easy to demonstrate in some specialties.
Thanks were extended to all colleagues who were involved in developing this work, acknowledging it is the right thing to do for patients and a good example of clinical leadership.
It was RESOLVED that:
(i) members noted the content of the presentation
20/189 Chief Officer Briefing
Jo Webster presented the Chief Officer briefing commenting on the CCG being officially recognised as ‘outstanding’ – the highest possible ranking in the annual ratings of the health and social care assessment published by NHS England. The CCG also secured a ‘green star’ rating for the Patient and Community Engagement indicator with the highest possible rating of 15. Jo Webster commented this was an outstanding achievement and everyone should be proud of what has been achieved over the last three years.
NHS England and NHS Improvement Board has agreed to seek views on proposals for legislative changes that will pave the way for new arrangements for commissioning and support greater integration of health and care services.
There are two legislative options for giving ICSs a firmer footing in legislation likely to take effect from April 2020 (subject to Parliamentary decision). The two legislative options proposed would lead to either; Integrated Care Systems becoming statutory organisations or a single CCG which operates at an ICS footprint.
Both options fit with the current direction of travel. Strengthening the legal framework in line with the ambitions set out in the NHS Long Term Plan to support greater integration of health and care services is to be welcomed.
Engagement on the proposals will run until 8 January 2021 for interested parties to give views with the intent that this will be reflected in 2021/22
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planning guidance for full implementation by April 2022. It is anticipated that West Yorkshire & Harrogate Health and Care Partnership will coordinate a collective response, which all the partner organisations will contribute to.
Stephen Hardy echoed the congratulations to all staff on receiving the ‘outstanding’ and ‘green star’ achievements. Referring to the future of commissioning Stephen Hardy raised a concern of no mention of how patients will be involved in the decision making and the lack of clinical leadership involvement. Dr Adam Sheppard agreed with the comments and suggested these concerns should be considered.
Jo Webster ended the briefing referring to the first person in the country receiving the COVID-19 vaccination today, an achievement that should be celebrated.
It was RESOLVED that:
(i) members noted the content for information and support on-going developments outlined in the content of the report
20/190 Record of urgent decisions - update
Jo Webster presented this update which provides an update on the urgent decisions approved by the Chief Officer in line with the Standing Orders exercise of such powers being reported for noting by the Governing Body.
It was RESOLVED that:
(i) members noted the update on urgent decisions taken by the Chief Officer
20/191 The Wakefield health and care system response to COVID-19
Jo Webster presented this report detailing a summary of the health and care system response to COVID-19 describing how services have been adapted to control the spread of infection, maintain resilience, protect the most vulnerable and prioritise care for the most seriously ill. Jo Webster commented that there has been an unprecedented level of activity seen at the Trust and the remarkable response is a credit to all staff involved. Activity levels are starting to stabilise but are still higher that during the first wave.
Following on from the first person in the country receiving their vaccination today. It is anticipated that Wakefield will be commencing the vaccination programme next week.
Anna Hartley advised that infection rates are coming down due to the recent lockdown but slower than before. It was noted that the number of cases in those aged 75 years and over is not reducing as quickly. Lateral flow testing is taking place at the Trust but there needs to be a cautious approach to the lateral flow testing results. A letter and statement is being prepared to issue
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to care homes in relation to allowing lateral flow testing, acknowledging that the vaccine is the better option.
Ruth Unwin advised that the CCG has continued to seek and respond to feedback from the public to understand the impact of changes to services during the pandemic. Engagement work has been undertaken in relation to people’s experience of using primary care services during the pandemic, there has been a survey of people attending A&E and Maternity Services and a survey conducted by Healthwatch to assess people’s experience of health services during the pandemic. The results of this engagement work has helped to adapt how services are delivered and ensure the messages to the public are clear when changes to services have been made.
Primary care colleagues have been pro-active in prioritising work to ensure vulnerable groups, those with learning difficulties, the BAME community, homeless people and those in deprived areas have access to healthcare and seek to contact those patients directly or their carers to explain what is available to them where necessary.
It was RESOLVED that:
(i) members noted the contents of the report
20/192 Black, Asian and Minority Ethnic Workforce (BAME) Update
Suzie Tilburn joined the meeting to present this update in relation to supporting the CCG’s BAME Workforce and highlighted the progress to date.
Following the appointment of Dr Pravin Jayakumar as the Governing Body Workforce Champion. A BAME Network has been established and a development session was held on 3 December 2020 to agree terms of reference, learn from other local BAME Networks and shape the vision of the network.
Suzie also advised that in support of improved access to career developmental opportunities at senior levels across the NHS, an internal employee has been allocated a place on the WYH BAME Fellowship programme.
A discussion followed and Dr Pravin Jayakumar advised that the network is still developing to ensure people are not discriminated against and the leadership represents the local population. Dr Jayakumar advised that MYHT have been really helpful in supporting the development of the Network and it was suggested that all sectors across Wakefield come together to work on developing the Networks together. Anna Hartley commented that the CCG has shown good leadership in progressing this work in such a short space of time. Discussions are taking place on what actions can be taken from a Public Health perspective and it was suggested that a meeting of the Networks set up across the local sectors would be helpful to share stories, progress etc. Anna Hartley agreed to share Local Authority BAME network
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contact details in the new year.
It was RESOLVED that:
(i) members noted the progress of actions in relation to supporting our BAME workforce; and (ii) support the implementation of further actions as referenced within the Workforce Race Equality Scheme (WRES) action plan.
20/193 Wakefield Integrated Care Partnership Report
Melanie Brown presented this report detailing the progress made on delivery of the Wakefield Integrated Care Partnership (ICP) priorities identified in June 2020 and progress on the priorities are detailed in the report:
The paper also describes changes that have been made to the ICP Terms of Reference. At the 28 July 2020 meeting of the Wakefield ICP it was agreed that a light touch review of the terms of reference would be undertaken. It is recognised that further work on the terms of reference is required before April 2021.
Dr Ann Carroll joined the meeting and commented on the collaborative work that has taken place to support patient flow work with local care homes and this work will continue. Dr Carroll also referred to the work involving Wakefield District Housing in supporting patients and homeless residents across the system.
Dr Adam Sheppard acknowledged the rapid development of partnership working and the transformation that has taken place during the pandemic.
It was RESOLVED that:
(i) members approved the Integrated Care Partnership revised terms of reference; and (ii) considered the progress of the Integrated Care Partnership outlined in this report.
20/194 Performance, Quality and Assurance Report
Jonathan Webb presented this report which provides a summary of the report that was presented at the Quality, Performance & Governance Committee in November 2020.
The report includes the following:
• Constitutional measures – September 2020 • Mental Health – September 2020 • Demand and Activity – October 2020 • Latest Care Quality Commission ratings – Glynn Residential Home and
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Springfield Grange • GP Practice Patient Survey – July 2020 • Adult Inpatient Survey – 2019
Jonathan Webb acknowledged that the information in the report was from some time ago and provided an update on the current issues.
Following the second wave admissions at MYHT the CCG focus has been on the discharge of patients out of hospital and into the community or care homes as appropriate.
The Referral to Treating waiting times has been broadly static with some increase through November but still below target. The 18 week performance did see an improvement in October but it is expected to decline for November.
32 and 52 week breaches have occurred mainly at MYHT with some at Leeds Teaching Hospitals Trust. The CCG continue to work with the Trust to see what support can be offered.
Diagnostic 6 weeks performance reports below target but is showing signs of improvement and work is underway with MYHT and North Kirklees CCG to look at activity plans for next year.
The detail regarding the November performance information will be presented to the Quality, Performance & Governance Committee at its meeting in January 2021.
Suzannah Cookson advised that the CCG and partner SWYFT have been successful in an application for funding through ‘Fund for Innovation’ programme with a joint project (CCG & SWYFT) on reducing unplanned hospital admissions and recognising respiratory conditions as a complex need in Learning Disability primary care nursing. The project will run from January 2021 until December 2021 and has the support of the Queen’s Nursing Institute to guide the joint project through the work.
Suzannah referred to the Quality and Assurance section of the report and highlighted the following; the CCG is working hard to remain on track with the Learning Disabilities Mortality Reviews (LeDeR) advising there have been difficulties receiving access to the family or relevant information during the pandemic. There are currently 11 reviews (from a total of 31) to be completed by 31 December 2020.
Work continues with Care Homes under enhanced surveillance as part of a virtual support team and the Quality Team have weekly meetings with Care Homes as appropriate.
There have been four 12 hour breaches reported by MYHT relating to patients awaiting admission to an acute mental health bed. There was no harm to the patients and their nutrition and hydration needs were met during their time in
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the Emergency Department.
It was RESOLVED that:
(i) members noted the current CCG performance against the Single Performance Framework (NHS Constitutional standards, Oversight Framework and CCG Long Term Plan metrics); (ii) noted those indicators where performance is below target and the mitigating assurance/actions provided; and (iii) acknowledged the actions agreed by the Quality, Performance and Governance Committee.
20/195 Finance Report Month 7 2020/21 and COVID-19 costs update
Jonathan Webb presented this update advising that it is expected the CCG will break-even by the year end. NHS England/Improvement (NHSE/I) reporting requirements prevent the CCG from accounting/forecasting for some future income streams until they are received. A deficit position is therefore currently being reported.
Month 7 financial reporting has been prepared in line with the October 2020 to March 2021 temporary finance regime set out by NHSE/I.
The CCG now have a full year forecast for COVID-19 costs and details of the COVID-19 costs and Hospital Discharge Programme schemes are shown in Appendix 2 of this paper.
Jonathan Webb commented that regular reports are presented to the Finance Committee detailing the progress of the financial framework for the remainder of the 2020/21.
It was RESOLVED that:
(i) members noted the contents of the report
20/196 Financial Plan – Note of decision made under Standing Order 9.1
Jonathan Webb presented this paper advising that the West Yorkshire & Harrogate ICS (WY&H ICS) was given a system financial envelope for the second half of 2020/21and details are included in Appendix 1. Following a review by Audit Yorkshire and presentation to the October 2020 Audit Committee for assurance, it was agreed to present to the Governing Body for approval.
WY&H ICS plan submission The deadline for submission of the WY&H ICS plan to NHSE/I was 5 October 2020. Under the powers reserved for urgent decisions of the Governing Body a meeting was held on 1 October to approve the plan prior to submission. Wakefield CCG submitted its plan to the ICS on 1 October with a deficit of £3m. The notes of the meeting are shared for information.
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Wakefield CCG organisational plan On 20 October a further meeting was held as an urgent decision of the Governing Body to seek approval of the organisational plan prior to submission to NHSE/I on 22 October. It was resolved that Wakefield CCG would submit a breakeven plan for the second half of 2020/21 albeit that some future income/allocation streams were specifically excluded from the NHSE/Is planning submission template. The notes of the meeting are shared for information.
It was RESOLVED that:
(i) members noted the approval of the West Yorkshire and Harrogate ICS Financial Governance arrangements for the NHS financial envelope months 7-12 2020/21; and (ii) noted the approval of the organisational Financial Plan 2020/21, for months 7 to 12, under the powers reserved for urgent decisions on 20 October 2020
20/197 EU Exit Operational Readiness Guidance from the Department of Health and Social Care
Ruth Unwin presented this paper noting that the Department of Health and Social Care has advised the health and social care system in England to make preparations for the eventuality that the UK may not secure a trading agreement with the EU prior to its exit on 1 January 2021.
Potential areas of risk are identified as:
• supply of medicines and vaccines • supply of medical devices and clinical consumables • supply of non-clinical consumables, goods and services • workforce • reciprocal health care • research and clinical trials • data sharing, processing and access
This paper provides an update on national and local contingency arrangements. Ruth Unwin advised that we currently do not know what impact on tariffs there will be and confirmed that this will be monitored through the Finance Report.
It was RESOLVED that:
(i) members noted the actions being taken in the local system to prepare for the potential of Britain leaving the EU without a deal, which reflects current government guidance
20/198 Wakefield and District Safeguarding Adults Board Annual Report 2019/20
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Suzannah Cookson introduced this report which describes the role and function of the Safeguarding Adults Board and how Wakefield District has carried out these functions during 2019/20.
Suzannah commented that the Governing Body were fortunate that Diane Hampshire who is a member of the CCG’s Governing Body is also the Chair of the Wakefield and District Safeguard Adults Board (WDSAB). The CCG has excellent representation on the Board along with all other health partnerships across the district. This provides a clear line of sight to the Board to be able to manage transition between the Safeguarding Children and Adult Boards with an opportunity to share learning, patient stories and legal case studies to ensure that the appropriate systems and processes are in place.
Diane Hampshire referred to the Section 42 enquiries and advised that a task and finish group is to be established to look at the number of enquiries where they do not progress to a Section 42 enquiry.
Work will continue to renew the strategic plan by the end of 2021 to ensure that this correctly reflects the work undertaken.
It was RESOLVED that:
(i) members noted the content of this report.
20/199 NHS Wakefield CCG Governing Body Assurance Framework
Ruth Unwin presented this paper advising that the previous version of the Governing Body Assurance Framework (GBAF) was approved at the Governing Body on 10 March 2020.
Since then the GBAF has been through a complete revision prior to the transfer to the electronic GBAF system and mirrors the Risk Register system.
The transfer has been discussed by the Senior Leadership Team who approved the GBAF Objectives. The GBAF details seven objectives based on the CCG Statutory Duties together with a supplementary objective connected to the COVID-19 pandemic. There is at least one principal risk for each objective and the risks have been scored and target scores agreed.
The GBAF was presented to the Quality, Performance and Governance Committee who reviewed and recommended that the Governing Body approve the GBAF as a true record. The GBAF will also be presented to the Audit Committee in December 2020 for assurance.
The electronic GBAF reflects matrix working and allows for entries to be linked to the Risk Register to reflect any gaps in controls or assurance.
It was RESOLVED that:
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(i) members approved the revised Governing Body Assurance Framework for NHS Wakefield Clinical Commissioning Group: (ii) noted the controls, assurances and gaps in control or assurance provided in the Governing Body Assurance Framework.
20/200 Audit Committee
The minutes of the Audit Committee were presented.
It was RESOLVED that:
(i) members noted the minutes of the Audit Committee meeting held on 26 May 2020
20/201 Clinical Strategy Group
The minutes of the Clinical Strategy Group were presented.
It was RESOLVED that:
(i) members noted the minutes of the Clinical Strategy Group meetings held on 20 August, 17 September and 15 October 2020
20/202 Connecting Care Executive
The minutes of the Connecting Care Executive were presented.
It was RESOLVED that:
(i) members noted the minutes of the Connecting Care Executive meeting held on 9 July 2020
20/203 Finance Committee
The minutes of the Finance Committee were presented.
It was RESOLVED that:
(i) members noted the minutes of the Finance Committee meetings held on 27 August and 22 October 2020
20/204 Patient and Community Panel
The minutes of the Patient and Community Panel were presented.
It was RESOLVED that:
(i) members noted the minutes of the Patient and Community Panel meeting held on 28 August 2020
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20/205 Primary Care Commissioning Committee
The minutes of the Primary Care Commissioning Committee were presented.
It was RESOLVED that:
(i) members noted the minutes of the Primary Care Commissioning meeting held on 30 June 2020
20/206 Quality, Performance and Governance Committee
The minutes of the Quality, Performance and Governance Committee were presented.
It was RESOLVED that:
(i) members noted the minutes of the Quality, Performance and Governance Committee meetings held on 23 July and 24 September 2020
20/207 Health and Well Being Board
The minutes of the Health and Well Being Board were presented.
It was RESOLVED that:
(i) members noted the minutes of the Health and Well Being Board meetings held on 9 July and 24 September 2020
20/208 West Yorkshire and Harrogate Joint Committee of CCGs
The minutes of the West Yorkshire and Harrogate Joint Committee of CCGs were presented.
It was RESOLVED that:
(i) members noted the minutes of the West Yorkshire and Harrogate Joint Committee of CCGs meetings held on 7 July and 6 October 2020.
20/209 Decisions of the Chief Officer
There were no additional decisions by the Chief Officer.
20/210 Any other business
No other business.
20/211 Date of next meeting Tuesday, 9 March 2021 at 1.00 pm
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Agenda item : 5b NHS Wakefield Clinical Commissioning Group GOVERNING BODY BOARD MEETING
Action Points from the Meeting held on Tuesday, 8 December 2020
Minute Topic Action Required Who Date for Progress No Completion 20/192 BAME Update • Share Local Authority BAME Anna Hartley December Completed network contacts details 2020
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Title of Governing Body Agenda 7 meeting: Item:
Date of 8 March 2021 Public/Private Meeting: Section: Public Paper Title: Chief Officer Briefing Private N/A
Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Ruth Unwin, Director of Corporate Affairs Title: Responsible Clinical Not applicable Lead: Responsible Jo Webster, Chief Officer Governing Board Executive Lead: Recommendation:
• To note the content for information and support on-going developments outlined in the content of the report.
Executive Summary:
The report covers:
• Q3 NHS England regulatory meeting • Staff survey update • Health inequalities and launch of the West Yorkshire academy • Population Health Management • Staff suicide campaign
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts Not applicable of Interest Assurance departments/ CCG Leadership Team organisations who will be affected have been consulted: Previously presented at A Chief Officer Report is presented at every Governing Body committee / governing meeting. body:
Reference document(s) / Quarter 3 Regulatory meeting letter enclosures:
Risk Assessment: Not applicable
Finance/ resource Not applicable implications:
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Quarter 3 regulatory meeting with NHS England
The CCG and the Wakefield Health and Care System received very positive feedback in the quarterly regulatory meeting with the NHS England regional team and ICS leadership. The feedback has been captured in a letter (attached), which describes Wakefield as having a very mature system that is recognised at a national level, strong, committed PCNs, good provider collaboration and a firm foundation for further collaboration. The letter also commends the work to establish the Mental Health Alliance and describes our approach to workforce as exemplary.
Annual staff survey
Results from the annual NHS staff survey carried out in autumn 2020 will be formally published on 11 March and are currently under embargo. The CCG has had advance sight of the results which show some significant improvements in terms of the experience of staff, which is a testament to the work that has been done by the leaders across the organisation to ensure a strong focus on staff well-being through a very challenging period. The full report will be presented to the Quality, Performance and Governance Committee in March.
Health Inequalities
In September 2020, the Wakefield system produced a planning submission which included a response to 8 urgent actions set out by NHSE/I to tackle health inequalities.
The Wakefield Integrated Care Partnership is taking forward this work and the Executive Leads for Health Inequalities from a number of local organisations have agreed to develop a joint strategy. A mapping exercise is now well underway and the Local Authority has recruited to a dedicated post to support the whole system.
There has been considerable work done locally, including measures to address the impact of COVID. Some examples are described below:
• Digital inclusion:
Whilst digital solutions reduce barriers for some not everyone can access, or afford to access digital solutions. Community scheme donations help to address this. A six week engagement was launched in July to find out about people’s experience of using primary care during the pandemic. The survey identified that digital technology was more likely to be problematic for disabled people and those aged over 65 years.
• Population Health Management (PHM)
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A data warehouse is now available to ensure that sources of local (health and social care) data can be linked, to maximise the impact of targeted interventions and risk stratification of particular cohorts. Data is generated at PCN-level to enable them to prioritise decisions for their population. A system-wide overview is maintained to ensure that inequalities are not inadvertently exacerbated between geographies.
• Key role of the VCS
VCSE organisations are providing targeted outreach to communities to identify cohorts and facilitate access to services. Community hubs: have been essential to pandemic response.
• Cradle to grave targeted actions
Reducing smoking in pregnancy improves the health of mother and baby by reducing low birth weight and associated complications.
The CCg and WMDC are jointly funding a multi-agency Time2Reflect’ voluntary programme for vulnerable mothers who have experienced or are at risk of repeat removals of children from their care to reduce the number of repeat pregnancies where mothers have had previous children removed into care.
The Children and Young People Partnership Board has agreed four priorities:
• Wakefield Families Together, Early Help and Intervention
• Best Start in Life and Happy, Health and Safe
• Inclusive Education and Transition to Adulthood
• Emotional and Mental Wellbeing
Wakefield district has also adopted a programme developed in Bradford ‘50 things to do before you’re 5’: sharing ideas and activities targeted at families with children under 5 years of age and early year’s providers (e.g. nurseries, childminders) and is primarily delivered via a smartphone app. Its activities offer experiences that aim to foster skills, build language and support brain development in young children, as well as being great fun. A target of 1200 50 things smartphone app downloads by Wakefield District residents within the first year was set, and this was achieved in just under 4 months. Downloads by early December had reached 1327.
Wakefield Families Together ‘Team around’ approach has developed referral pathways, with Team around the Young Person providing co-ordinated targeted support for vulnerable young people at risk of statutory intervention and team around the school identifying children/young people and liaising with families to link them to Children First Hubs, Future in Mind Partnership and 0-19 Service. Team around the
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Early Years is linked to the Early Years strategy and joins up access to Support Services.
Mental Health & Wellbeing is a priority for the children and young people’s partnership. A joint SWYPFT/CCG lead has worked with CAMHs services between October 2019 and May 2020 and has delivered significant improvements across the service including reduced waiting lists.
Wakefield Autism Support Project (WASP) is a pilot project run by KIDS and funded by the CCG supports families of young people either on the Autistic Spectrum (diagnosed or under investigation) or who have other neuro-developmental conditions.
There are an estimated 23,115 new unpaid carers as a result of pandemic in Wakefield. Many new carers are women already in poverty, usually younger and juggling caring alongside paid employment. Referrals for Carers Wakefield & District (CWD) were 60% down on the same time last year. A database sweep to capture carers contacted in the past had been undertaken, with approximately 1,500 welfare calls having been made. Posters have been sent to GPs, hospitals and advertised on social media to get messages out.
Carers Wakefield & District to work in partnership with Age UK Wakefield to support the most vulnerable/isolated carers and other vulnerable people to physically attend vaccinations as they are offered them.
In 2020 the Housing Needs Service took 2715 homeless applications from people at risk of or experiencing homelessness. 942 new placements into temporary or emergency accommodation were made. The HNS has worked to reduce numbers in temporary or emergency accommodation by securing suitable move on accommodation and as at 15/1/21 there are 238 households in temporary/emergency accommodation which includes 36 in hotels.
Wakefield Council commissions Riverside to provide a rough sleeper support service to find, engage and resolve homelessness for those sleeping rough in the district. Additional funding granted for 20/21 has paid for staff to work with rough sleepers to resolve issues impacting on finding accommodation, retaining accommodation and improving outcomes for those being assisted.
69 people were verified as rough sleeping during the period, April 2020 - December 2020. Of these 59 were accommodated/helped into accommodation. Three were reconnected to family/friends/to other districts without the use of accommodation and
Each year the Council submits an annual snapshot figure and demographic information to the government to indicate the number of people sleeping rough in their area on a 'typical night' on a single date chosen by the local authority between 1st October and 30th November. In 2020 the snapshot figure was 4 which was
5 significantly lower than the 13 submitted the previous year. The reduction does not indicate that the numbers of people experiencing rough sleeping is dropping but that more timely interventions to resolve homelessness take place.
A bid supported by the CCG is funding health assessments for rough sleepers and single people in emergency accommodation.
Wakefield hosts Urban House, regional accommodation centre for Asylum Seekers whilst applications are processed and can accommodate c.300 residents in normal circumstances. Health checks and access to nurse-led treatment are provided on site as well as support with basic needs and translation services.
The Index of Multiple Deprivation (IMD) 2019 shows that 54,200 people in Wakefield district live in neighbourhoods that are amongst the top-10% most deprived in England. This is 15.7% of the district’s population. There is a strong correlation with being in private rented accommodation (12.4% of all households in Wakefield) and in poverty. WDH’s Cash Wise team provide budgeting advice to all Wakefield residents through the More Money in My Pocket and Healthier Wealthier Wakefield Families programmes, and to WDH tenants.
WDH Carelink in partnership with YAS, responds to people who suffer falls at home: 32 fallers who initially contacted the ambulance service were assessed as not needing any medical intervention.
A range of initiatives to tackle loneliness are being supported such as Age UK Cuppa Club – Befriending Project (Reaching Communities), Live Well Social Prescribing and Spectrum Social Prescribing
• West Yorkshire and Harrogate Health Inequalities Academy
The Wakefield health inequalities leadership will link closely with the West Yorkshire and Harrogate Health and Care Partnership Health Inequalities Academy, which was launched in February.
The on-line launch event included eminent national and local speakers, including people with lived experience, and attracted over 400 colleagues from across the area and beyond took part. The Academy brought together learning, experiences and plans for further action to be delivered by the health, care, community and voluntary services organisations that make up the partnership
The Partnership has allocated £500,000 this year to tackle inequalities. VCSE organisations were invited to bid for grants up to £50,000 each to fund innovative and sustainable projects to support communities worst affected by the pandemic. Organisations will be encouraged to share their learning across the sector.
6
West Yorkshire Health and Care Partnership Improving Population Health Programme
The Improving Population Health Board received an update at its February meeting on initiatives around climate change, diabetes, health and housing, health inequalities, prevention and reducing violent crime.
Voluntary, community and public sector organisations have been submitting their applications for the Green Social Prescribing Grant Fund which launched earlier this month and is designed to support innovative projects that connect people with nature, improve physical and/or mental well-being and reduce health inequalities.
Referrals to the Healthier You NHS Diabetes Prevention Programme have increased significantly, largely thanks to the joint working of the partnership project managers and GP practices to target those at risk of type 2 diabetes. The partnership is also routinely achieving the targets set by NHS England for reaching Black, Asian and Minority Ethnic communities. Work has also started with learning disability health and care champions to access structured education for the prevention of diabetes.
A housing and mental health collaboration agreement is being put in place to look at housing developments for people with complex needs; and compile evidence to help address inequalities for people with learning disabilities and the disproportionate impact of COVID.
Work continues at pace to deliver a range of initiatives as part of the West Yorkshire Violence Reduction Unit to reduce serious violence and exploitation, especially among victims aged 25 or under. This will include the launch of the Adversity, Trauma and Resilience Knowledge Exchange from Monday 22 to Wednesday 24 March 2021.
West Yorkshire staff suicide campaign
The CCG has joined forces with organisations across West Yorkshire and Harrogate to be part of a campaign aimed at preventing staff suicide in our organisation. The aim is to highlight that suicide is preventable and to create a working culture where looking after our own and our colleagues’ mental wellbeing is a priority.
In England there were 5,316 confirmed deaths to suicide in 2019, this is an average of 102 people dying every week. Suicide is the biggest killer of people under the age of 35 and the biggest killer of men under the age of 50. The aim is to reduce the stigma associated with mental health and to eliminate judgement by making suicide prevention and mental health part of everyday workplace conversations.
The Check-In campaign not only aims to bring organisation together to tackle suicide but also provides training and support at staffcheck-in.co.uk. Through this website, colleagues, partners and volunteers will have access to tools and resources aimed at 7 supporting them with their own mental wellbeing or enabling them to support a colleague with theirs. We are asking everyone in our organisation to take the Zero Suicide Alliance 20-minute training which will provide people with a better understanding of the signs to look out for and the skills we all need to approach someone who is struggling.
8
16 February 2021
To: Members of Wakefield Health and Care Leaders Group
via email
Dear Colleagues
WAKEFIELD QUARTERLY REVIEW MEETING, 25 JANUARY 2021
Thank you for joining colleagues from West Yorkshire and Harrogate Health and Care Partnership for the Wakefield Place meeting on 25 January. This was the latest of our regular quarterly meetings to discuss the progress the partners in Wakefield are making with your shared priorities, the risks and issues associated with them, and any action or support that might be required from the partnership. The meetings replace the traditional quarterly assurance discussions that NHS England and NHS Improvement previously had with individual NHS organisations, providing a clearer focus on collaboration, integration across the whole place and mutual support and accountability.
We discussed a number of issues, including your collective response to the pandemic, progress with your partnership priorities and the delivery of core business, and agreed a number of areas for further action:
1. The number of covid patients in hospital was rising again following the relaxation of social restrictions over Christmas. Mid Yorkshire Hospitals Trust (MYHT) had 257 patients, having dropped as low as 109 on 24 December. The current data was showing a slight increase in cases in the over-65 age group. A significant part of this increase was because of difficulties in discharging patients, particularly complex cases. The Trust was developing a new model for covid care, including changing the roles of Dewsbury and Pontefract hospitals.
2. You have increased access, across services, to oximeters and have also established, a COVID19 virtual ward which supports early discharge. Post-COVID19 follow-up pathways have been embedded into primary care and you are currently scoping out delivery of Long COVID MDT assessment clinics. The new GP Care Model that you have established is ensuring consistent messaging occurs along with the establishment of 2 COVID19 community assessment units and extended GP capacity in Wakefield. You
have also been collaborating with LCD and MYHT to transform outpatients via e- consultation, improving home visiting services and looking further into the safe re- direction of patients from ED.
3. You are promoting PCR testing and improving the accessibility to these tests. Two further walk-in venues are currently being scoped in addition to the site at Wakefield Waterfront. Your local test and trace system is presently contacting 50% of contacts passed from the national team. You acknowledged that further work is required in this area. You are rolling out Lateral Flow Tests, using this type of test within specific populations.
4. The local model for implementation of the vaccination programme is proving successful. It is being delivered through 3 hospital sites and 5 PCNs, with a community pharmacy site open and a further one planned in Pontefract. You also have a community vaccination site which was going live at Navigation Walk. The current programme was on track to deliver the targets by mid-February and you had already vaccinated 73% of the over-80 population. You have a plan in place to support vaccination of under-served populations, including those not registered with a GP practice.
5. It was good to hear about the approach you are taking to improve the uptake of vaccine in domiciliary care and by specific groups that would not normally access national programmes. Having tailored an approach used in other parts of West Yorkshire you are working with over 105 trusted community leaders comprising; local residents, elected members, VCS groups, Healthwatch and faith leaders. The approach provides weekly briefings to the community leaders helping to answer questions from their communities. A simple script is provided with the main facts about the vaccine programme which they can add their personalised message to. Thank you for agreeing to sharing the materials you have produced with us.
6. You outlined how you are strengthening the current working arrangements between Wakefield Council and Wakefield CCG. Considerable work had been undertaken on developing Wakefield’s Integrated Care Partnership (ICP) with further ICP organisational development sessions planned in February and March 2021. As part of the response to NHS England and Improvement (NHSE&I) November 2020- Jan 2021 consultation the ICP has asked NHSE&I to consider the future role of clinical leadership, the need to retain flexibility for local decisions as the legislation passes, the need to retain an approach that supports distributed leadership and also the need to look after staff during the transition period.
7. We commended you on the wide range of targeted work you are undertaking to reduce health inequalities and how this forms the focus of all core business. Examples included:
• Children and Young People – an area where you have been successful in reducing smoking in maternity, are undertaking an 18 month pilot called ‘Time 2 Reflect’ which is about providing support to mother whose children have been removed from them, or with mothers whose children are regularly removed and returned.
• You have also adopted the Bradford programme, 50 things to do before you are 5, within early years and schools. Your target was for the app to be downloaded by 12,000 people and you currently have had 13,027 downloads in 3 months. • Within CAMHS you have completed a significant and innovative piece of work which has seen a drastic decrease in referral backlog. You have also set up a project called WASP which will support families in crisis. • Working age adults – you updated us on the work you were undertaking with unpaid carers and people who are homeless. You are currently piloting with Spectrum the provision of physical and mental health checks to all homeless people. • You outlined the support you are providing to Urban House and the migrant population. • Older people – you provided an overview of key actions to address poverty and housing in Wakefield. And what you are doing to assist in tackling loneliness
8. We commended you on the work that you have done with the development of your place people plan, how you are looking after the psychological, emotional and physical wellbeing of your people through the Wakefield health and care hub website and your health and wellbeing checks programme. You provided an overview on the work that you are doing to enhance and grow the systems leadership and how you were tackling inequalities within the workforce. We noted that the strength of the workforce through this period has been commendable which reflects the effective leadership within the system and ask you to pass on our thanks. It may be helpful to link with Bradford regarding the Kinnair review recommendations.
9. You demonstrated a clear focus on mental health services, having achieved your ambition is to eliminate all acute Out of Area usage for the last 12 months for acute bed usage (although there had been one acute placement recently due to 2 simultaneous ward closures associated with Covid outbreaks). You continue to manage challenging service demands through a coordinated OAP programme with strong community co- working, patient flow coordination, and initiatives to support appropriate lengths of stay. There are some challenges with PICU in relation to gender specific placements, though current numbers have reduced.
10. We discussed MYHT performance. RTT continues to be on an upward trajectory and cancer performance, except against 62-day standard, has been maintained. You reported that the work you have completed on shared care referral pathways has reduced the number of people needing to attend hospital for appointments. You plan to roll these pathways out to the remainder of Wakefield and Kirklees. This is an area of learning that could be shared with others.
11. There have been issues with ambulance handovers, but you stated you had a recovery plan in place. You have increased the number of red wards as there is an increase in the number of new Covid-19 patients coming into hospital.
12. You reported concerns about the rising number of P2 patients within orthopaedic hip revisions. You reflected that there is an increasing backlog that needs to be looked at
across WYAAT. Finally, concerns were raised about the reduced capacity in independent sector providers and the impact this will have on activity levels. We reflected that this is a common theme from the place reviews that would be looked at as an ICS.
13. Wakefield has made excellent progress with the LeDeR reviews. However, you acknowledged that further improvement was required in providing annual health checks to people with learning disabilities. MYHT has strengthened its VIP passport which informs hospital staff of the key information about a patient. SWYPFT identified the need for additional respiratory support and has made inroads into improving this situation. YAS is moving forwards with their pictorial community leaflets and general practice are focusing on completing annual health checks. It would be helpful for you to share your good practice on the LD work completed by your system and actions you have taken to embed LeDeR health checks.
14. You provided a financial overview which was subject to national confirmation on a number of assumptions. Your financial risks were being managed and you expected to catch up in quarter 4, maximising the use of AQP capacity. We will continue to maintain a focus on longer term financial challenges, including the structural financial support required by MYHT
In summary, Wakefield has a very mature system which is recognised at a national level. You have strong, committed PCNs, good provider collaboration and, with the joint posts between the CCG and Local Authority have a firm foundation for further collaboration. Your work to establish the Mental Health Alliance is to be commended and the work you have done regarding workforce is exemplary. Thank you for a positive discussion, and for your continuing hard work and commitment as leaders in Wakefield, both in response to the huge pressures of the pandemic and in tackling the longer term strategic challenges which face Wakefield as a place.
Yours faithfully,
Rob Wester CBE Lead Chief Executive, West Yorkshire and Harrogate Health and Care Partnership
To: Wakefield Place:
Jo Webster Wakefield CCG Mel Brown Wakefield CCG Karen Parkin Wakefield CCG Joanne Fitzpatrick Wakefield CCG Ruth Unwin Wakefield CCG Suzanne Cookson Wakefield CCG Gemma Gamble Wakefield CCG Ann Carroll Wakefield CCG Dr Greg Connor GP and Wakefield CCG Dr Adam Shephard GP and Wakefield CCG Martin Barkley Mid Yorkshire Hospitals NHS Trust Trudie Davies Mid Yorkshire Hospitals NHS Trust Jane Hazelgrove Mid Yorkshire Hospitals NHS Trust Debbie Newton Mid Yorkshire Hospitals NHS Trust Sean Rayner South West Yorkshire Partnership NHS Foundation Trust Anna Hartley DPH, Wakefield Council Dr Linda Harris Spectrum Community CIC David Hamilton Wakefield Council cc: Ian Holmes WY&H Health and Care Partnership Lou Auger NHS England and NHS Improvement Jonathan Webb Wakefield CCG and ICS Finance Lead Tasnim Ali BAME Network representative Dr Peter Davies Clinical Forum representative
Title of Governing Body Agenda 8 meeting: Item:
Date of 8 March 2021 Public/Private Meeting: Section: Public Paper Title: Reducing the burden & releasing capacity Private to respond to the COVID 19 pandemic N/A
Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Ruth Unwin, Director of Corporate Affairs Title: Responsible Clinical Not applicable Lead: Responsible Jo Webster, Chief Officer Governing Board Executive Lead: Recommendation:
• To approve the recommended changes to frequency and assurance reports to committees to release capacity to respond to the pandemic • To note that further work will be required to review governance arrangements in the light of the NHS White Paper and the transition to integrated working arrangements at ICS and place level
Executive Summary:
In January 2021, NHS England issued a letter to NHS providers and CCGs advising organisations to take steps to release capacity to support the front line response to the pandemic by reducing non-essential activities.
The attached paper sets our proposals for how the CCG might approach this which would require a temporary change to elements of our approved Governance arrangements and committee terms of reference.
It should be noted that the arrangements proposed are a short term solution to reduce pressure so that clinical and leadership time ca be focused on responding to the pandemic.
A comprehensive review of governance arrangements will be required over the coming months as functions of the CCG transition into new integrated commissioning arrangements, to ensure robust assurance to the Governing Body.
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts Not applicable of Interest Assurance departments/ CCG Leadership Team organisations who will be affected have been consulted: Previously presented at The Governing Body has previously discussed future committee / governing arrangements for Integrated Care Systems in formal and body: development sessions
Reference document(s) / enclosures:
Risk Assessment: Not applicable
Finance/ resource Not applicable implications:
2
NHS England has issued a series of guidance notes during the pandemic aimed at enabling Trusts and CCGs to identify ways of reducing non-essential activities to enable them to focus on responding to Covid-19. In January 2021, NHSE issued a third such letter to NHS providers and CCGs.
Whilst the majority of the guidance is directed at provider organisations, the following apply to NHS CCGs.
Board and Committee meetings
CCGs should continue to hold board meetings but streamline papers, focus agendas. There will be no sanctions for technical quorum breaches (e.g. because of self-isolation). Trust quality committees should continue to meet but consideration should be given to scaling back other committee meetings.
Government social isolation requirements constitute ‘special reasons’ to avoid face to face gatherings as permitted by legislation and therefore all Board and system meetings should be virtual by default.
Organisations are required to advise audit firms on the impact of this on compliance with standing orders.
Annual accounts and audit
NHSE wrote to the sector on 15 January advising of the timeline for submission of accounts. There is no significant change to the requirement to submit accounts or the timing. However, the guidance does allow some elements of the Annual Report to be omitted – specifically the performance data and workforce information sections. The CCG will still need to submit the Performance Overview, Annual Governance Statement and Financial Accounts and these will be required to go through the usual audit cycle.
Decision-making processes
While having regard to their constitutions and agreed internal processes, organisations need to be capable of timely and effective decision making. This will include using specific emergency decision-making arrangements.
Operational planning
The 2021/22 planning and contracting round will be delayed; it will not be initiated before the end of March 2021 and the current financial arrangements will be rolled over into Q1 21/22.
Long Term Plan: System by Default development work (including work on CCG mergers) has been restarted. NHSEI actively encourages system working where it can help manage the response to COVID-19. This work will remain under review to 3 ensure it continues to enable collaborative working and does not create undue capacity constraints on systems. NHSE/I will maintain the investment guarantees for Mental Health and Learning Disability and systems should continue to expand services in line with the LTP.
CCG staff deployment
CCGs should review internal needs in order to retain a skeleton staff for critical needs and redeploy the remainder to the frontline. CCG Governing Body GP should be focused on primary care provision. Non-clinical staff should focus on supporting primary care and providers to maintain and restore services. CCGs to enact business critical roles to include, for example, support and hospital discharge, EPRR.
In order to optimise capacity to respond to the pandemic and deploy staff to support the COVID 19 response, the following recommendations are proposed:
• QPGC to continue to meet bi-monthly with a streamlined agenda focused on performance and quality.
• The frequency of routine assurance reports to be reduced to annually unless required for specific purposes (eg: GDPR toolkit, Safeguarding). Committees to receive reports on gaps in assurance in the intervening period by exception
• The level of detail in reports to Finance Committee to be kept under review by the committee to ensure that it is proportionate to the current circumstances
• All policy reviews to be extended to April 2022 unless required by exception to respond to a change in circumstances or legislation
• Focus on full achievement of NHSEI mandatory audit reviews and review other discretionary internal audit activity to determine the extent to which they can be carried out on a desk-top basis and without significant involvement of CCG managers/teams.
• Clinical Strategy Group to continue to be scheduled monthly but to be stood down if no items of significance for discussion
• Patient and Community Panel to continue to meet bi-monthly
• Primary Care Commissioning Committee to be scheduled quarterly but stood down if there are no items that present a conflict of interest to be considered (all other items to be presented to Governing Body or QPGC)
• Consider reducing Connecting Care Executive meetings to quarterly (subject to approval by committee members)
• No change to Governing Body or Audit Committee 4
• Consideration to be given to reducing other routine executive meetings and reports to be determined by the Chief Officer.
5
Title of Governing Body Agenda 9 meeting: Item:
Date of 9 March 2021 Public/Private Section: Meeting: Public Private Paper Title: Chief Officer - Record of urgent decisions N/A update.
Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Amrit Reyat, Governance and Board Secretary Title: Responsible Clinical Dr Adam Sheppard, Chair and Clinical Leader Lead: Responsible Jo Webster, Chief Officer Governing Board Executive Lead: Recommendation:
It is recommended that the Governing Body:
• Note the update on Urgent decisions taken by the Chief Officer
Executive Summary:
The attached log provides an update on the urgent decisions approved by the Chief Officer. In the main these decisions relate to the temporary closure of GP practice sites in line with the site closure approval process.
In line with the Standing Orders, exercise of such powers are being reported to this meeting of the Governing Body for noting.
As at the 28 February 2021 all of the practices which requested closure have now re-opened.
The attached log also provides details of an urgent decision in relation to the Mental Health Investment Standards (MHIS) Statement of Compliance.
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Not applicable Not applicable
Management of Conflicts The approval of decisions is based on the daily Situation Report of Interest: received from practices in line with Opel escalation levels
Assurance departments/ Senior Leadership Team organisations who will Chief Finance Officer/Deputy Chief Officer be affected have been Director of Corporate Affairs consulted: Director of Integrated health and Care Head of Primary Care
Previously presented at NHS Wakefield CCG Board Paper 8 September 2020 committee / governing body:
Reference document(s) / Table of urgent decisions – approval of temporary site closures enclosures:
Risk Assessment: Not applicable
Finance/ resource None implications:
Issue Site New arrangements Contact with practice Decision by Chief Officer Date Update
Staff issues request to close branch to Southmoor and Church View Staff moved to South Kirby (Park Green) Amrit spoke to PM and confirmed CO Arrangement approved 25/03/2020 15/04/20 Park Green/Southmoor The staff have been split into two teams and decrease transmission approval alternate one week working in the practice and one week working from home. The practice manager thinks this is working really well to maintain capacity and resilience through the avoidance of cross site working. 13/05/20 Still closed. Considering options to re-open, no specific date agreed. Will want to re-open as a ‘super green’ site. 28/05/20 Still closed. Planning to re-open as a ‘green’ site on 15 June 2020 but the car-park is closed due to construction of new housing development. Will review safety prior to re-opening, may need input from CCG. Update - Surgery Open
Staff issues request to close branch South Hiendley Staff moved to Rycroft Amrit spoke to PM and confirmed CO Arrangement approved 25/03/2020 11/06/20 Spoken with Rycroft, and they plan to re-open South Hiendley on approval Monday, 15 June as a Green site. They will offer morning appointments only for a while but move to full days asap. Update - South Hiendley open
Received a request from Sharlston branch Sharlston All services provided at the branch are also Amrit discussed with Practice Manager Arrangement approved 02/04/2020 15/04/20 The branch closure is maintaining resilience. There is a member of part of Crofton surgery to close during the provided at Crofton main site. Branch surgery is 2 and established they are requesting staff on reception at Sharlston each day and patients can be seen there if pandemic. miles away from Crofton. Branch closed its doors closure so they can manage staffing necessary on a case by case basis. Phones have gone to the main site for to patients on Monday and are seeing walk-ins at capacity at Crofton Surgery, part of the years. They have created a facebook page for patients and have received main site. Communications updated on website Trinity Assessment Hub. nothing but praise for the way they are managing the practice including from and social media. Sharlston patients. They are intending to re-open when usual work practice resumes so we agreed to review in three weeks time. 12/05/20 Plans to re-open as a ‘green’ site from 18 May 2020. 21/05/20 Patients who need to see a nurse can go to Sharlston but patients wanting to see a doctor will need to go to Crofton 28/05/20 Reopened as a ‘green’ site on 18 May 2020.
Closure of practice Good Friday and Bank Castleford Health Centre Resources to be diverted to their other sites Amrit emails with Sarah Ramsden and Arrangement approved 07/04/2020 13/05/20 Only closed one day – Bank Holiday 8 May. Now re-opened. No Holiday Monday including: CO to seek approval negative comments received from patients. If practice is open on next Bank Pinfold Surgery, Holiday, the practice would again wish to close branch. Ferrybridge, 28/05/20 Castleford Health Centre is open to see patients. Elizabeth Court Surgery Update - Surgery Open Queen Street & Park View Surgery The closure is to stabilise the other practices (above) during this time.
We would like to request permission for the Sandal Castle Branch Surgery Patients will be made aware that should they need Chris Skelton, Head of Primary Care Co- Approved 30/04/2020 13/05/20 Only closed one day – Bank Holiday 8 May. Now re-opened. No closure of our Branch Surgery at Sandal to be seen for urgent care they may have to attend Commissioning negative comments received from patients. If practice is open on next Bank Castel Medical Centre on 8 May. We are Trinity Medical Centre on 8 May 2020 Bank Holiday Holiday, the practice would again wish to close branch. confident that all our patients urgent needs Friday (one day only) 28/05/20 Closed Bank Holiday, 8 May. can be dealt with by opening TMC only. Our Now re-opened. No negative comments received from patients. phone lines will be open as required, we have access to our clinical assessment unit and we have facilities to see patients face to face if required. Our patients are aware that should they need to be seen for urgent care they may have to attend TMC site, this is made clear to them at the point of registration. We would ensure patients were made aware of this prior to 8 May.
We believe closing Sandal will (whilst still providing urgent care to our patients) enable us to give more of our clinicians and staff the opportunity to take much needed rest. Issue Site New arrangements Contact with practice Decision by Chief Officer Date Update
Consider the proposal from WHA PCN to Queen Street and Elizabeth Court Queen Street will be available every morning and Mel Brown received email request from Approved 06/05/2020 The current arrangements for registered patients with Healthcare First practice reduce opening hours at both Elizabeth Elizabeth Court will be open every afternoon Christine Sanderson and emailed the call a central call centre. They are then triaged by clinicians at any site including Court and Queen Street surgeries- it looks request to Jo Webster video/telephone appointments. If they require an appointment they will be offered like a very pragmatic solution- both sites with any site with a free appointment slot. Healthcare First will try to accommodate rota support from all practices are splitting any requests for a particular location if this is possible. the morning and afternoon sessions. Queen Street will be available every morning and Elizabeth Court will be open every afternoon.
For 2018/19 CCGs were required to appoint On 25 June 2020, NHSE/I requested that all CCG’s Not applicable Approved 08/07/2020 In line with the Standing Orders, the powers reserved for an urgent decision were an independent reporting accountant to carry publish their MHIS results on 9 July 2020. KPMG exercised on the 8 July 2020 to recommend the signing of the MHIS out a reasonable assurance engagement on required a MHIS Management Representation Management Representation Letter (appendix 1) on behalf of the Governing their Mental Health Investment Standard Letter to be signed on behalf of the Governing Body and it is brought to this meeting for noting the action taken. Please refer to (MHIS) Statement of Compliance. Body prior to providing their opinion. Agenda item 11a for full details.
NHSE/I withdrew the original publishing date and auditors were required to await confirmation from NHSE/I prior to issuing their opinions.
Request received for Southmoor surgery to Southmoor Practice The Practice Manager has suggested that in order Chris Skelton, Head of Primary Care Co- Approved 17/09/2020 Arrangements to be reviewed in two weeks - contact will be made on 1 October close in the short term as the practice has to manage this the practice would like to revert Commissioning has been liaised with the 2020 one member of staff who has tested psotive back to dividing the team again, which will allow the PM and is supportive of the measures. 14/10/20 Southmoor surgery re-opened and staffed with locums for COVID, following this Test and Trace main branch, Park Green, to be manned. This will have contacted 4 members of the reception be for a minimum of two weeks. The website staff who are now in self-isolation. The provides information for patients including contact Practice Manager is also waiting for another details for Park Green to arrange an appointment. staff member's results today which if positive The surgeries are approximately 2.5 miles from will have an impact on staffing levels. each other which makes access to the main branch manageable.
Due to Staffing issues a further request has Southmoor Practice Patients will be informed about the arrangements Natalie Knowles, Primary Care Approved 12/11/2020 Southmoor re-opened 23/11/20 been received from Park Green to close via the practice website. During previous closure Development Manager Southmoor branch surgery until 23 the practice confirmed that there were no concerns November. This is due to reduced GP raised by patient as the alternative arrangements capacity (1 GP off following a heart attack where patients contacting the practice by telephone and 1 GP currently with a broken ankle) due were directed to the main Park Green surgery and to this the practice are currently having to those requiring a face to face consultation were staff Southmoor with locums but are not also seen there which is situated 2.5 miles away. seeing large number of patients face to face. The same arrangements will apply for this closure.
Based on the detail provided and in line with the Emergency and Urgent Decisions (SO9) provision would you be please review the request. Issue Site New arrangements Contact with practice Decision by Chief Officer Date Update
WY&H ICS plan submission. The deadline N/A Meeting held to inform lay membrs of the plan N/A Meeting held on 1 October 01/10/2020 Decision reported to 8 December Governing Body (Agenda item 13b) for submission of the WY&H ICS plan arrangements. Under the powers reserved for 2020 with lay members to submission to NHSE/I was 5th October urgent decisions of the Governing Body the plan approve plan prior to 2020. As the ICS plan is a consolidation of was approved virtually prior to submission. submisison organisational plans, Wakefield CCG submitted its plan to the ICS on the 1st October 2020 with a deficit of £3m. A meeting was held on the 1st October 2020 to inform lay members of the plan arrangements. Following this meeting, under the powers reserved for urgent decisions of the Governing Body, the plan was approved virtually prior to submission. It was expected that the ICS financial position would not be accepted at this time and in view of this, Wakefield’s plan would also change.
Wakefield CCG organisational plan N/A Meeting held 20 October 2020 to approve the N/A Meeting held on 20 October 20/10/2020 Decision reported to 8 December Governing Body (Agenda item 13b) On 20th October 2020, a further meeting organisational plan prior to submission to NHSE/I 2020 to approve the was held as an urgent decision of the on 22 October 2020. organisational plan prior to Governing Body was required to approve the submission on 22 October organisational plan prior to submission to 2020. It was resolved that NHSE/I on 22nd October 2020. It was Wakefield CCG would submit resolved that Wakefield CCG would submit a a breakeven plan for the breakeven plan for the second half of second half of 2020/21. 2020/21 albeit that some future income/allocation streams were specifically excluded from the NHSE/I’s planning submission template.
Permission requested by Trinity Medical Sandal Branch Surgery Note on door to ensure Patients are directed as Discussed at Tactical and Jo Webster Approved 20/01/2021 Branch surgery re-opened on 1 February 2021 Centre to temporarily close Sandal Branch necessary. has agreed to closure of Sandal Branch Surgery due to staff absence Surgery
Title of Governing Body Agenda 10 meeting: Item:
Date of 9 March 2021 Public/Private Meeting: Section: Public Paper Title: White Paper: Integration and Innovation: Private working together to improve health and N/A social care for all
Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Ruth Unwin, Director of Corporate Affairs Title: Responsible Clinical Not applicable Lead: Responsible Jo Webster, Chief Officer Governing Board Executive Lead: Recommendation:
• To note the report to the West Yorkshire Partnership Board setting out the proposals in the White paper and the implications for Integrated Care Systems • To agree any follow up action for the CCG
Executive Summary: The White Paper setting out the Department of Health and Social Care’s legislative proposals for a Health and Care Bill has been published on 11 February, 2021.
We have been expecting proposals for legislative change since 2019 when the NHS Long Term Plan was published. The paper 'Next Steps for Integrated Care Systems', which was considered by NHS England's Board in November 2020, launched a formal 8-week engagement, which concluded on 8 January and the White paper incorporates feedback from that process.
A briefing paper which was presented to the West Yorkshire Integrated Care Partnership on 2 March 2021 is attached. The paper summarises the proposals for legislative change and how that relates to the work that is already well-progressed in West Yorkshire to develop integrated approaches to working across health and social care.
Publication of the White Paper signals the beginning of the Parliamentary process to introduce legislation, which is expected to come into effect in 2022.
The White Paper describes a vision of an outward-looking, more connected and integrated health and care system focused on population health, public wellbeing and innovation, reflecting how much has changed since the last legislative changes in 2012 and in particular how the pandemic has shaped our understanding that integration is the way forward.
All of this is very familiar to NHS Wakefield CCG as we have been at the forefront of driving collaboration work to secure the best health outcomes for our population as part of a wider integrated care partnership with the local authority, NHS and VCSE providers in Wakefield and as part of the West Yorkshire Integrated Care System. The introduction of legislation to facilitate and enable those more integrated approaches that we have been developing over many years is to be welcomed.
However, we also understand that change will create uncertainty for colleagues at a time when we are already struggling with the impact of the pandemic on our personal and professional lives. The impact for staff is acknowledged in the White Paper, which gives a commitment to seek to provide stability of employment and to work with NHS England and staff representatives to manage the process.
The CCG and partners in the Wakefield system and West Yorkshire will work across the system to manage the transition in a fair and transparent way and will support our very valued and valuable staff through this process. National guidance on arrangements for managing the workforce transition is due to be issued in April.
The CCG will also provide regular updates to staff and external stakeholders whenever there are decision points or new information to share through our existing communication channels.
Much of the detail of what it will mean for CCG colleagues is still to be worked through. The White Paper sets out proposals that Integrated Care Systems will be established as statutory organisations, which will absorb many of the functions currently carried out by CCGs. Each ICS will have a decision-making Board and a Health and Care Partnership, ensuring strong representation of Health and Wellbeing Boards from all the places that make up the ICS.
This will mean a single Integrated Care System for West Yorkshire complemented by place-based arrangements for assessing health needs and planning for population health between the NHS, local authorities and providers. The proposal reinforces a commitment in previous documents that it should be left to local organisations to agree how this will work in practice.
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
2
Outcome of Integrated Not applicable Impact Assessment completed IIA() Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts Not applicable of Interest Assurance departments/ CCG Leadership Team organisations who will be affected have been consulted: Previously presented at The Governing Body has previously discussed future committee / governing arrangements for Integrated Care Systems in formal and body: development sessions
Reference document(s) / enclosures:
Risk Assessment: Not applicable
Finance/ resource Not applicable implications:
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WY&H Health and Care Partnership Board 2 March 2021
Summary report Item No: 08/21 Item: Government White Paper: “Integration and Innovation: Working together to improve integration and innovation for all” - Implications for our partnership Report author: Ian Holmes, Director WY&H Health and Care Partnership Presenter: Ian Holmes, Director WY&H Health and Care Partnership Executive summary
The government produced its NHS White Paper “Integration and Innovation: Working together to improve integration and innovation for all” on 11 February 2021. The White Paper sets out a range of proposals for health legislation, including how Integrated Care Systems (ICSs) will be established in statute.
This paper provides a summary of the key proposals for Integrated Care Systems set out in the White Paper and the implications for our partnership. We recognise that much of what is being proposed through the White Paper is already a reality in West Yorkshire and Harrogate, however there will be a number of specific implications for our partnership, including the abolition of Clinical Commissioning Groups (CCGs).
The paper then sets out the work that we are undertaking in response to the White Paper to ensure that out working arrangements remain as effective as possible beyond April 2022.
Recommendations and next steps
The WY&H Partnership Board is asked to:
note the changes to Integrated Care Systems set out in the government White Paper; and consider the next steps set out and confirm support for this approach.
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Government White Paper: “Integration and Innovation: Working together to improve integration and innovation for all” - Implications for our partnership
Purpose
1. Over recent months NHS England / NHS Improvement (NHSE/I) and the Department of Health and Social Care have published documents which set out the future direction of travel and legislative proposals for Integrated Care Systems (ICSs).
2. The purpose of this paper is to:
• set out the key aspects of these proposed changes for ICSs, and their likely implications for our system; and • describe the work we are doing in response to these proposals.
Background and context
NHSE/I publication and consultation
3. NHSE/I published ‘Integrating Care: next steps to building strong and effective Integrated Care Systems’ in late November 2020. This document sets out the future direction of travel for ICSs and options for legislative changes to put ICSs on a statutory footing.
4. The direction of travel described is one that is familiar to our ways of working. There is much greater emphasis on collaboration at neighbourhood, place and system; there is a clearer role for provider collaboration in place and across systems; and there is a strong emphasis on closer partnership working between the NHS, local government and the voluntary and community sector.
5. In addition to this, the document sets out options for establishing a statutory footing for ICSs to provide greater clarity and accountability.
6. Our partnership produced a series of responses to the consultation including an overall ICS response plus responses from Joint Committee of CCGs, the acute collaborative, the mental health, learning disability and autism collaborative and the Clinical Forum. These are available on our website here. Places and some individual organisations have also responded.
7. Collectively these responses clearly articulate what is important to us. Some of the unifying themes are as follows:
• The importance of place as the primary unit of planning and collaboration. Future arrangements need to support this place focus, irrespective of organisational structure. • That ICSs are much broader than the NHS, and to realise their potential there needs to be effective partnership with local government, the voluntary and community sector and communities. • That ICSs are uniquely placed to focus collective effort on health inequalities,
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Item 08/21
through a population health focus and integrated working at neighbourhood level. The COVID-19 pandemic has brought these inequalities into sharp focus. • Throughout the document there is a welcome emphasis on creating flexibility and permissiveness within the arrangements to allow systems to develop arrangements that make sense locally. It will be essential that this approach survives the legislative process when there may be a greater appetite for specificity. • There is significant concern about the impact on staff affected by these changes, particularly during the pandemic response. Providing clarity and certainty for these staff as soon as possible should be a priority.
Integration and Innovation White Paper
8. Following this engagement and consultation exercise, government published ‘Integration and Innovation: Working together to improve integration and innovation for all’ on 11 February 2021. This White Paper confirmed this direction of travel and set out the intention to legislate to create statutory arrangements for ICS. Some of the important aspects of this are as follows:
9. A statutory ICS will be formed made up of a statutory ICS NHS body and a separate statutory ICS Health and Care Partnership, bringing together the NHS, Local Government and partners. The ICS NHS body will take on the commissioning functions of the CCGs and some of those of NHS England within its boundaries. Each ICS NHS body will have a board, which will be responsible for:
• developing a plan to meet the health needs of the population within their defined geography; • developing a capital plan for the NHS providers within their health geography; • securing the provision of health services to meet the needs of the system population
10. ICSs will be able to delegate significantly to place level and to provider collaboratives. The ICS Board will, as a minimum, include a chair, the CEO, and representatives from NHS trusts, general practice and local authorities, and others determined locally including non-executives. The Board will be directly accountable for NHS spend and performance within the system, with its Chief Executive becoming the Accounting Officer for the NHS money allocated to the NHS ICS Body.
11. To support the ambition for ICSs to also address broader health outcomes (including improving population health and tackling inequalities) an ICS Health and Care Partnership will be made up of a wider group of organisations than the ICS NHS Body. This Partnership will develop a plan to address the health, social care and public health needs of their system. Each ICS NHS Board and Local Authority will have to have regard to this plan. Members can be drawn from a number of sources including Health and Wellbeing Boards, partner organisations with an interest in health and care (e.g. Healthwatch, voluntary and independent sector partners and social care providers), and organisations with a wider interest in local priorities. The membership and detailed functions for the ICS Health and Care Partnership will be up to local areas to decide.
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12. Place-based arrangements between local authorities, the NHS and providers of health and care will be left to local organisations to arrange. The statutory ICS will work to support places to integrate services and improve outcomes. Health and Wellbeing Boards will continue to have an important responsibility at place level to bring local partners together, as well as developing the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy.
13. ICSs will be able to decide how they can align their allocation functions with place, for example through joint committees. While NHS provider organisations will remain separate statutory bodies and retain their current structures and governance, they will be expected to work in close partnership with other providers and with commissioners or budget holders to improve outcomes and value. NHS England will have an explicit power to set a financial allocation or other financial objectives at a system level. There will be a duty placed on the ICS NHS Board to meet the system financial objectives which require financial balance to be delivered. NHS providers within the ICS will retain their current organisational financial statutory duties, but this will also be supplemented by a new duty to compel them to have regard to the system financial objectives.
14. Duty to collaborate: A new duty will be introduced to promote collaboration across the healthcare, public health and social care system. This proposal will place a reciprocal duty to collaborate on NHS organisations and local authorities. A shared duty will require ICSs, NHS England and NHS providers of care to have regard to the ‘Triple Aim’ of better health and wellbeing for everyone, better care for all people, and sustainable use of NHS resources.
15. Joint Committees: It will be made easier for organisations to work closely together through joint committees. Provisions will set out the governance of these joint committees and the decisions that could be delegated to them; and separately, allowing NHS providers to form their own joint committees. Both types of joint committees could include representation from other bodies such as primary care networks, GP practices, LAs or the voluntary sector.
16. Competition and procurement: The powers of the Competition and Markets Authority (CMA) to review mergers involving Foundation Trusts (FT) will be removed. NHS England will have a new role to ensure that decisions are always made in the best interests of patients. NHS Improvement’s specific competition functions and its general duty to prevent anti-competitive behaviour will be removed. Commissioners will be given more discretion over when to use procurement processes to arrange healthcare services. A new provider selection regime will provide a framework for NHS bodies and local authorities to follow when deciding who should provide healthcare services.
17. Reconfigurations intervention power: Most service changes happen locally by consent - planned reconfigurations are developed at local or regional levels by commissioners. The current system for reconfigurations works well for most service changes, and will remain in place for the majority of day-to-day transactions. New proposals broaden the scope for potential ministerial intervention in reconfigurations by allowing the Secretary of State to intervene at any point of the reconfiguration process. The Secretary of State will be required to seek appropriate advice in advance of their decision, including in relation to value for money. 4
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18. Social care: Guidance will be published on how ICS Health and Care Partnerships can be used to align operating practices and culture with the legislative framework to ensure ICSs deliver for the Adult Social Care (ASC) sector. There will be a more clearly defined role for Social Care within the structure of an Integrated Care System NHS Board, which will give ASC a greater voice in NHS planning and allocation.
19. Public health: Measures will make it easier for the Secretary of State to direct NHS England to take on specific public health functions (complementing the enhanced general power to direct NHS England on its functions); help tackle obesity by introducing further restrictions on the advertising of high fat, salt and sugar foods; as well as a new power for Ministers to alter certain food labelling requirements. The process for the fluoridation of water in England will be streamlined by moving responsibilities for doing so from local authorities to central government.
Implications for WY&H
20. The proposals reflect much that is already in place in WY&H. They include the primacy of place and the key role of Health and Well Being Boards and provider collaboratives. It is helpful that the White Paper places greater emphasis on the role of HWBs than the NHSE/I document did. It recognises the need for inclusive partnerships that reach beyond health and social care and focus on population health and reducing health inequalities.
21. Importantly, the proposals emphasise the importance of ICSs having the flexibility to develop their own arrangements: ‘we are giving ICS NHS boards and ICS Health and Care Partnerships the flexibility to develop processes and structures which work most effectively for them’. The proposals allow systems to decide how much or how little to do at the different levels and will also allow them to vary these arrangements over time as the system matures and adapts.
22. Notwithstanding the emphasis on local flexibility, the document is almost silent on some of the key issues raised in our response to the NHSE/I consultation, including the impact of the abolition of CCGs on accountability, clinical leadership and public and patient engagement at place level. The document also says little about the disruptive impacts of the changes and the need to support our staff.
23. Our working arrangements are well developed and provide a good platform for the future. Clearly there is further development work to be undertaken in line with this direction, as well as specific work to implement organisational changes that will result – particularly if ICSs are established as statutory bodies. What is critical in this is that our values, inclusivity, relationships and positive behaviour towards one another will be essential to our future success, and we must maintain and further build on this ethos.
24. These changes represent further evolution of our partnership, rather than a change in direction. This evolution will necessarily be an iterative process over the next 12 months, as the legislative process runs its course and policy is further developed. Significant work which addresses the key issues is already underway:
• The ICS operating model review work will look at the structure and operation of the ICS and the interaction between sectors, programmes and places –in doing so it will align with the national direction of travel. 5
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• As the foundations of the ICS operating model, the Integrated Care Partnership (ICP) development framework will describe the essential features and working arrangements of place level ‘integrated care partnerships’ building on best practice across WY&H, designed to support place based partnership arrangements in their ongoing development. Again this work was started prior to publication of the national document – we now propose that we broaden its scope to describe in more detail the potential governance and operating models for ICPs. • The Finance Forum is developing proposals for a new financial framework. This will cover the flow and distribution of NHS funding, how financial accountability will work and the payments and incentives regime that can be used to support integration and improved outcomes. • The Clinical Forum is developing proposals for system clinical leadership arrangements at place and ICS level. • On workforce, the national Interim People Plan described ICSs taking on a greater leadership role on workforce planning and strategy and we understand there will be a new workforce duty in the Bill. Our People Board is leading work to set out how these arrangements will work in the future. In parallel, CCG human resources leads have been working together to develop a common human resources framework to support the organisational change process. • On commissioning, the commissioning futures work connects the ICS operating model, ICP development and workforce workstreams, setting the framework for future working at ICS, place and neighbourhood level. We are also beginning conversations with the NHSE/I team about future arrangements for these services, building on the work to date on specialist mental health services and the Leeds Teaching Hospitals arrangements.
25. These workstreams are six parts of the same whole which together will describe how our partnership will function from April 2022. In taking this forward there are some specific governance questions which will be addressed, such as:
• Establishing the clear governance relationship between the NHS ICS Board and the wider ICS Partnership so that accountability for NHS matters is clear, but there is no perception of a ‘two-tier’ partnership. • Determining how delegation and accountability will work between the places, provider collaboratives and the statutory ICS body. • Building an arrangement to maintain clear leadership and accountability at place level. In governance terms this is likely to be a joint committee, but agreeing arrangements for employment of staff working at place level is key.
Conclusion
26. The WY&H Partnership Board is asked to:
• note the changes to ICSs set out in the government White Paper; and • consider the next steps set out and confirm support for this approach.
Ian Holmes Director, WY&H Health and Care Partnership
6
Title of Governing Body Agenda 11 meeting: Item:
Date of 9 March 2021 Public/Private Section: Meeting: Public Private Paper Title: Governing Body Reappointments N/A If private, insert here reason for
inclusion as a private paper Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Amritpal Reyat, Governance and Board Secretary Title: Responsible Clinical Dr Adam Sheppard, Chair and Clinical Leader Lead: Responsible Jo Webster, Accountable Officer Governing Board Executive Lead: Recommendation : The Governing body are asked;
• To note the recommendations for reappointments to the Governing Body where the tenure of appointments are coming to an end.
Executive Summary:
This paper provides an update on the recommendation from the Nominations Committee held on 7 January 2021on the following eight roles of the Governing Body:
a) Lay Member - Audit; b) Independent Registered Nurse; c) Chair and Clinical Leader; d) GP members of the Governing Body; e) Secondary Care Doctor
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts Following the letter from NHS England and Improvement re CCG of Interest: Constitutional Changes the recommendations following the Nominations Committee held on 7 January 2021 will be for the Board to ‘note’ not to ‘discuss’. Therefore no conflicts are required to be managed at the meeting.
Assurance departments/ Nominations Committee organisations who will Human Resources be affected have been Hill Dickinson consulted: LMC Previously presented at Nominations Committee committee / governing body:
Reference document(s) / Appendix a: Governing Body Tenure log enclosures: Appendix b: letter from NHS England and Improvement Re CCG Constitutional Changes. 1 March 2021
Risk Assessment: Failure to appoint to the roles of the Governing Body would cause a risk to the organisation
Finance/ resource Resource implications are discussed with the paper implications:
Governing Body
9 March 2021
Membership Reappointments
Background
Following publication of the NHS White Paper, it is expected that the current CCGs will continue as statutory bodies until 31 March 2022. Under the legislation changes it is not yet clear what CCG responsibilities will transfer to the ICS ahead of these changes.
In light of the current CCG landscape and to ensure stability during this period the following eight reappointments were considered by the Nominations held on 7 January 2020 and the following recommendations were proposed.
Conflicts were managed during the meeting and in the sharing of the papers in order to ensure that conflicts were managed appropriately. The meeting of the Nominations committee was therefore chaired by Dr Lotfallah and Dr Adam Sheppard respectively.
Dr Lotfallah chaired to consider the reappointments of the following roles which are due to come to an end of their term of office (appendix a):
a) Lay Member - Audit; b) Independent Registered Nurse; c) Chair and Clinical Leader; d) GP members of the Governing Body;
Dr Adam Sheppard Chaired when considering the reappointment of the following role: e) Secondary Care Doctor;
On 1 March 2021, a guidance letter issued by NHS England and NHS Improvement regarding Constitutional Changes stated that following the publication in February of the White Paper Integration and Innovation: working together to improve health and social care, 2021/2022 will serve as a preparatory and transition year for the ICS including CCGs, to ready themselves for the proposed new arrangements and to develop strategic commissioning through systems with a focus on population health outcomes.
For CCGs in North East & Yorkshire, where the tenure of positions within the Governing Body and of lay members will end in March 2021. CCG leads, supported by the ICS leads, will be able to roll over the tenure of these posts for a further 12 months while holding any vacancies where it does not create any risk to the governance of the CCG.
Ordinarily, this arrangement may require a change to the CCG’s Constitution. However, given the current pressures and the extensive process for CCGs to undertake to make constitutional changes, the most pragmatic response is not to require CCGs to make changes to their constitutions during this time (appendix b).
It should be noted that ordinarily approval of appointments of Governing Body members including Clinical Leaders (through election) is reserved to the Governing Body following recommendation from the Nominations Committee.
The Nominations Committee was established to support the Governing Body and ensure that there is a formal, rigorous and transparent procedure for appointments and the elections of the positions of the Governing Body.
However, given the arrangements as described above from NHS England and Improvement the Governing Body are asked to ‘note’ the recommendations of the Nominations Committee.
Reappointments
a) Lay Member – Audit
In line with the CCGs Standing Orders:
SO 2.9.3 - Term of Office: Maximum of three terms of office and of no more than a 10 year tenure in total. Each term of office should be of a suggested period of up to three years with the option to extend the final period in order to maintain external perspective
SO 2.9.4 - Eligibility for reappointment: The Lay Person – The current Lay Member shall be deemed eligible to stand for re- appointment provided that:
i) They continue to meet the eligibility criteria; and, ii) Have not given grounds for removal.
The Lay Member (Audit Chair), Richard Watkinson, has served one term of office of a three year tenure, which comes to an end in May 2021 (2018-2021).
Recommendation
The board is asked to note the recommendation that Richard Watkinson is reappointed for a second term of office of up to a 10 month tenure, until 31 March 2022, allowing the CCG to consider any legislative reforms and make recommendations accordingly. Given the CCG landscape this re-appointment will ensure that stability and an external perspective is maintained on the board.
b) Independent Registered Nurse: In line with Standing Orders:
2.6.1 Eligibility for appointment: the Independent Registered Nurse must be registered on the Nursing and Midwifery Council (NMC) register. The Independent Registered Nurse cannot be an employee or member of, or a partner in, a provider of primary medical services, or a provider with whom the CCG has made significant commissioning arrangements
2.6.3 Term of office: maximum of three terms of office and of no more than a ten year tenure in total. Each term of office should be of a suggested period of upto three years with the option to extend the final period in order to maintain external perspective
The Independent Registered Nurse, Diane Hampshire, has served two terms of office (2017-2021). The first term of office was of a one year tenure and the second term of a three year tenure.
Recommendation The board is asked to note the recommendation that Diane Hampshire’s tenure from the first term of office is extended until 31 March 2022.
c) General Practitioner Members of the Governing Body: In line with the Standing Orders:
2.4.8 Term of office: maximum of three terms of office and of no more than a 10 year tenure in total. Each term of office should be of a suggested period of upto three years with the option to extend the final period in order to maintain external perspective.
The term of office for Dr Clive Harries ends in March 2021. Dr Harries has served three terms of office with the first term of a two year tenure; the second and third term of office both of a three year tenure, serving eight year in office in total.
The term of office for two of the GP Governing Body members, Dr Deborah Hallott and Dr Pravin Jayakumar, ends in June 2021. Both GP board members have served two terms of office both of a three year tenure.
Recommendations: In light of the current CCG landscape and to ensure stability during this period the governing body is asked to note the recommended that:
• Dr Harries’ first term of office is extended for a further year until March 2022.
• Dr Hallott and Dr Jayakumar’s second term of office is managed as the ‘final’ term of office and that the term is extended by a nine months, until March 2022. This is in line with the Standing Orders which allow for an extension to the final term of office.
This would ensure that during this critical period the CCG would not be required to go through an expression of interest and election process to elect two General Practitioner members on the Governing Body, ensuring stability is maintained for the board during this period of change for CCGs and while awaiting any further legislative reforms.
Legal advice has also been sought on the matter of not undertaking an election process given the fact that CCGs will no longer be operating as a legal entity post April 2022. Therefore in the application of the ‘final term’ scenario for the appointment of the two GP Governing Body Members the group would not be operating outside of its Standing Orders.
d) Chair and Clinical Leader: In line with the CCGs Standing Orders:
2.4.8 Term of office: maximum of three terms of office and of no more than a ten year tenure in total. Each term of office should be of a suggested period of upto three years with the option to extend the final period in order to maintain external perspective. This would be from the date the candidate is approved as Chair and Clinical Leader by the Members (on a one GP one vote basis).
2.4.9 Eligibility for reappointment: The current Chair shall be deemed eligible to stand for re-election provided that they: i) Continue to meet the eligibility criteria; and ii) Have not given grounds for removal.
The current term of office for the Wakefield CCG Chair and Clinical Leader, Dr Adam Sheppard comes to an end on 30 June 2021, having served eight years in office. Dr Sheppard has served three terms of office (2013 – 2021). The first term of office was of a two year tenure. The second and third terms were both of a three year tenure.
The current term of office for the Wakefield CCG Chair and Clinical Leader, Dr Adam Sheppard comes to an end on 30 June 2021.
Recommendation In light of the current CCG landscape and to ensure stability during this period the governing body are asked to note the recommendation that Dr Sheppard’s tenure is extended for a further 9 months, until 31 March 2022.
e) Independent Secondary Care Doctor: In line with CCG Standing Orders:
Term of office: maximum of three terms of office and of no more than a ten year tenure in total. Each term of office should be of a suggested period of upto three years with the option to extend the final period in order to maintain external perspective
The current term of office for the Independent Secondary Care Doctor, Mr Hany Lotfallah ends in March 2021. Mr Lotfallah has served two three year terms of office (2013 - 2019). The third term of office has been of a two year tenure upto March 2021. The CCG’s standing orders allow the Secondary Care Consultant to serve up to three terms of office of three years.
Recommendation Members of the Governing Body are asked to note the recommendation that the tenure is extended for a further year making the final term a three year term until March 2022.
Amritpal Reyat Governance and Board Secretary March 2021 Appendix A - Terms of Office 2021 Role 1st Term 2nd Term 3rd Term
Independent 1 year 3 years Registered Nurse (March 2017-18) (March 2018-2021)
Lay Member - 3 years Audit/ Conflicts of (June 2018-21) Interest Guardian
Chair and Clinical 2 years 3 years 3 years Leader (April 2013-15) (April 2015-2018) (April 2018-21) Appointed Chair of CCG 1 July 2019) General 2 years 3 years 3 years Practititioner (April 2013 - 2015) (April 2015-2018) (April 2018-21) Member General 3 years 3 years Practitioner (July 2015 - 2018) Ext - July 2018 -2020 Member Ext for 1 year to 2021
General 3 years 3 years Practitioner (July 2015 - 2018) Ext - July 2018 -2020 Member Ext for 1 year to 2021
Secondary Care 3 years 3 years 2 years Consultant (April 2013-16) (April 2016-19) Ext - April 2019-20 Ext - April 2020-21
To: CCG Accountable Officers NHS England and NHS Improvement 6th Floor Quarry House Quarry Hill Leeds LS2 7UE
1 March 2021
Dear CCG Accountable Officers,
CCG Constitutional Changes
On 11 February, the Department of Health and Social Care published the White Paper Integration and Innovation: working together to improve health and social care. The proposed legislation builds on the work already in progress to bring health and care services closer together to improve care and tackle health inequalities.
2021/2022 will serve as a preparatory and transition year for the ICS including CCGs, to ready themselves for the proposed new arrangements and to develop strategic commissioning through systems with a focus on population health outcomes.
For CCGs in North East & Yorkshire, where the tenure of positions within the Governing Body and of lay members will end in March 2021. CCG leads, supported by the ICS leads, will be able to roll over the tenure of these posts for a further 12 months while holding any vacancies where it does not create any risk to the governance of the CCG.
Ordinarily, this arrangement may require a change to a CCG constitution should it be determined by the CCG. However, given the current pressures as a result of the COVID pandemic response and the extensive process for CCGs to undertake to make constitutional changes, the most pragmatic response is not to require CCGs to make changes to their constitutions during this time. Therefore, unless the proposed changes are business critical, then changes to CCG constitutions should be kept to a minimum.
NHS England and NHS Improvement
I hope this assists with your plans over the next 12 months.
Yours sincerely
Andrew Morgan Head of Planning and Regulation – North East & Yorkshire
Copy to: NEY Locality Directors
Title of Governing Body Agenda 12 meeting: Item:
Date of 9 March 2021 Public/Private Meeting: Section: Public Paper Title: The Wakefield health and care system Private response to Covid-19 N/A
Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Ruth Unwin, Director of Corporate Affairs Title: Responsible Clinical Not applicable Lead: Responsible Jo Webster, Chief Officer Governing Board Executive Lead: Recommendation:
• To note the update on the Wakefield health and care system response to Covid-19
Executive Summary:
This paper provides an update on the Wakefield health and care system response to Covid-19 on the following areas:
• Current infection rates • Vaccination • Test and trace • Support for vulnerable people • Care homes and home care • Primary Care • Hospital services • Mental Health and Learning Disability Services • Long Covid • Wakefield Recovery Board
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessments completed (IIA) Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts Not applicable of Interest Assurance departments/ CCG Leadership Team organisations who will be affected have been consulted: Previously presented at committee / governing body:
Reference document(s) / enclosures:
Risk Assessment: Not applicable
Finance/ resource Not applicable implications:
2
The Wakefield health and care system response to Covid-19
Current infection rates
The Wakefield district, in common with many parts of the country, experienced a sharp rise infection rates and hospital admissions during the first two months of 2021. The number of people with Covid has reduced following the introduction of the national lockdown in January. Wakefield continues to have a higher rate of infection than much of the country. Latest weekly data can be found on the Wakefield Council website here.
Vaccination
The district responded swiftly to the roll out of the national vaccination programme. Five local primary care network vaccination centres are operating, as well as a mass vaccination centre at Navigation Walk, in Wakefield, and two pharmacy run sites at Pontefract and Lupset. Vaccinations are also being delivered direct to staff and residents in care homes, to housebound people in their own homes and to health care staff. Full details of the vaccination roll out are provided in a separate paper.
Test and trace
Wakefield Council continues to operate a local Contact Tracing Service to follow up people who have been in contact with someone who has had a positive test. The local service works alongside the national Test and Trace scheme and will contact people by telephone or by visiting them at home if they are unable to reach them.
They can also advise people who have tested positive and their contacts about how to get practical support if it is difficult for them to self-isolate.
The district’s first static public Covid testing site has been established at the Waterfront Car Park, near the Hepworth Gallery, in Wakefield. This will complement temporary testing facilities which are provided at different locations around the district.
Support for vulnerable people
The Government announced changes to the criteria for people who should be regarded as being at higher risk from Covid in February. The criteria reflects a wider definition to include factors such as ethnicity, deprivation (by postcode) and weight to work out a person's risk of becoming seriously ill if they were to catch Covid. It also looks at age, underlying health issues and prescribed medications. All adults who have an identified learning disability will be included. GPs received guidance in December asking them to ensure that registered patients with a learning disability had been offered an annual health check to ensure their risk status had been properly recorded.
Nationally this meant that some 1.7 million people nationally were added to the shielded patients list.
These additional people will now be given priority for vaccination and will be eligible for support that is already provided to shielded patients, such as priority access to food deliveries.
Specific guidance has been issued to GPs and hospitals. People who meet the criteria are being contacted directly and CCGs receive a weekly updated list of people in their area to facilitate work with the local authority to support them and planning.
Wakefield Council working with the voluntary sector through Nova has established 13 community hubs which are operating across the district to support people made more vulnerable as a result of the pandemic.
Care homes and home care
The nursing and care home sector continues to play a central role in the health and care system. The Council and CCG has provided additional support to the sector throughout the pandemic.
The Continuing Healthcare Team, working with social care teams, has re-orientated its work to support timely discharge of people from hospital, ensuring those with on- going care needs are placed in an appropriate care setting or provided with a support package at home.
All care homes have a nominated GP practice to provide telephone advice and video or face to face consultation, where required.
A number of care homes have been supported by the CCG and Wakefield Council to secure CQC approval to take patients who have tested positive for Covid-19 but no longer require hospital care and one care home in Wakefield is providing a dedicated facility for people who have tested positive for Covid but are ready for discharge from hospital. The Wakefield Intermediate Care Unit (WICU) was temporarily re-purposed in autumn 2020 to provide a dedicated unit for Covid positive patients in advance of care homes securing approval to take Covid positive patients into designated areas. The WICU service has now been reinstated as a non-Covid step down facility to support timely discharge of patients from hospital.
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Primary Care
Primary care has coped well with the additional demands posed by the roll out of the vaccination programme alongside traditional winter pressures. GP contacts have averaged 50,000 per week since the Christmas period.
Triage arrangements remain in place in all practices continue to have triage arrangements in place to help manage the spread of infection and where appropriate patients are offered offering telephone or video consultation as an alternative to face to face appointment if this is not required. All practices continue to deliver a consistent offer for patients in line with the protocol agreed in the autumn, which requires proactive care including support to care homes, palliative and end of life care, preventative screening and immunisation, support to people with vulnerabilities including learning disability, mental health and homeless patients, and ensuring patients with urgent primary care needs have access to a same day consultation.
A number of practices have experienced problems due to staff having to self-isolate and have been supported through mutual aid from practices within the PCN and CCG staff. All practices and branch surgeries currently open (end February position).
GP referrals into secondary care services are down 2.6% compared with the same period last year. However, work between primary care and secondary care clinicians to develop robust alternative arrangements for managing patients with more complex needs has continued with the range of specialties and number of patients being managed in this way increasing.
Arrangements are also in place for primary care to refer patients directly into clinical assessment services to enable patients to by-pass A&E.
Hospital services
In common with hospital services across the country, the Mid Yorkshire Hospitals NHS Trust experienced a peak in activity throughout January and February, although activity did not reach the levels experienced in November 2020.
There has been a steady increase in demand for hospital care, both Covid and non- Covid related since the Christmas period.
Covid patients are being cared for at both Pinderfields and Dewsbury Hospitals and it has been necessary to open additional surge beds and move services within the hospital sites to flex capacity according to demand. Pontefract Hospital has been maintained as a Covid free site and continues to provide dedicated facilities for cancer diagnostics and treatment.
A whole health and care system response has been required to manage people with more complex conditions in their own homes and to support timely discharge of medically optimised patients to free up beds and facilitate patient flow. The wide
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health and care system has also supported the hospital by redeploying workforce, including clinical staff from primary care, to cover staff absence and administrative staff to support with discharge and family liaison.
A&E attendances have continued to rise during February 2021 and a range of initiatives are in place to ensure capacity in A&E is prioritised for the most acutely ill patients whilst enabling safe distances to be maintained. This has included targeted communications to redirect people to other, more appropriate services.
Both the Walk in Centre at Wakefield and the Urgent Treatment Centre, at Pontefract continue to be under-utilised. A pilot scheme to divert patients arriving at A&E who could be seen elsewhere has had minimal impact.
Additional capacity for planned care has been maintained in the independent sector, including redirecting patients to Any Qualified Providers (AQP) in the district to carry out diagnostic procedures and to Spire Methley Park for routine surgery. The process is managed by Mid Yorkshire Hospitals NHS Trust to ensure continuity of care for the patient.
However, it has been necessary to delay some routine care to prioritise beds and staff for patients with more urgent clinical needs, which has led to an increase in the number of people waiting for treatment and the length of time waited. Deployment of theatre staff to support high acuity areas and the need to maintain social distancing for patients remain limiting factors.
Pinderfields currently has 10 of its 15 theatres open compared. Priority is being given to acute, urgent, trauma and sub-acute activity and cancers. from this need to be agreed and signed off via bronze.
Additional theatre capacity for orthopaedics, gynaecology and ophthalmology is gradually being reopened at Pontefract with the aim of having all four theatres fully operational by mid-March. & 12th March where we will run 2 GA day case lists for Gynaecology and Ophthalmology for gynaecology for urgent cases. This is addition to cancer diagnostics and surgery. Work is continuing to extend activity in the six theatres at Dewsbury Hospital.
Further details of the current waiting lists and times and actions to address this are provided in the performance report.
Mental Health and Learning Disability Services
The Wakefield Mental Health Alliance has co-ordinated provision of a range of additional services to support people whose mental health has been affected by the pandemic. This has included significant investment in voluntary and community organisations to provide support for people experiencing mental ill health, including the opening of a ‘safe space’ to offer face to face support for people in crisis.
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During the most recent lock down, mainstream services have continued with care being offered via telephone or video where clinically possible and suitable, with a focus on maintaining service continuity. Non-essential group sessions and workshops have been suspended but face to face appointments and home visits are continuing where necessary.
Long Covid
In November there was a national announcement including a commitment to £10 million funding, setting out a strategy to address Long COVID. Nice Clinical Guidance on supporting patients with Long COVID was released in December. One of the central tenets of the announcement was the development of Long COVID clinics. The national guidance emphasised the need to develop an MDT approach, recognising that there were a range of symptoms associated with long COVID Wakefield’s allocation from the national fund was £60k for 20/21. There was no additional resource for MDT development. Initially the intention was to set up regional assessment clinics and use national funding to finance these. In January NHSE and the ICS confirmed that clinics should now be coordinated on a place footprint. Local systems were directed to develop clinics on a place footprint. The national guidance includes a proposed referral pathway that contains 3 key elements: diagnosis, clinical review and condition management. The West Yorkshire HCP Respiratory Network is overseeing implementation across CCGs (recognizing that the pathway is not exclusively a respiratory one). A local task and finish group has been established has agreed to locate the clinic in the community with an Allied Health Professional lead. MYHT agreed to coordinate an internal group to develop a local model. This is scheduled to report back shortly. Wakefield Recovery Board The Wakefield Recovery Board was established in July 2020 to focus on supporting residents and businesses in the district to recover from the COVID-19 pandemic. At the Board's latest meeting members of the Economic Recovery Group highlighted how they are working closely to understand the support businesses may need and develop initiatives to fill any gaps, such as developing webinars and a business portal to allow easy access to advice. Plans for Wakefield Business Week in May are also underway - with the working title of Bounce Back Week. A lot of work has been undertaken over the last year to provide grants to businesses to help during periods of lockdown or enhanced restrictions. Business grants have included:
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• Local restrictions support grant: Up to 11 February 10,747 payments have been made totalling £22.74m.
• Discretionary additional restrictions grant: Up to 11 February 1,210 payments have been made totalling £5.38m.
• Christmas support payments for wet-led pubs: Up to 11 February 310 payments have been made totalling £310k. The district's nine local Help at the Hub centres have stayed accessible to communities throughout the lock down with advice services and help available to residents. Support has included 18,000 winter poverty food vouchers given to children, and £65,000 used to help residents access food and warmth vouchers. Work is also underway to explore creating a more accessible and informal network of support based within community hotspots for those who would not seek advice and support from Hub venues. The Group is planning for the future of the Hub initiative, considering the support that may be needed in the Hubs in the coming months to help residents facing many challenges. Work is also underway with a number of partners to explore the provision of more local access to their support services. The Kickstart Board which first met formally in December 2020 - is helping young, unemployed people under the age of 24, to get back into the work place by making sure they get the right opportunities by matching young people with jobs.
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Title of Wakefield CCG Governing Body Agenda 13 meeting: Item:
Date of 9 March 2021 Public/Private Section: Meeting: Public Private Paper Title: COVID Vaccination Programme Update N/A
Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Jo Fitzpatrick, Senior Responsible Officer, COVID Vaccination Title: Programme, Wakefield Responsible Clinical Dr Colin Speers, Clinical Lead for COVID Vaccination Lead: Programme, Wakefield Responsible Jo Webster, Accountable Officer, Wakefield CCG Governing Board Executive Lead: Recommendation: It is recommended that Governing Body note the progress of the COVID Vaccination Programme in Wakefield and associated future work streams Executive Summary: • The COVID vaccination programme is a national programme that rolls out vaccine supply across the country to designated vaccination sites • In West Yorkshire, each place has an SRO who is responsible for ensuring that the eligible population can access vaccination services and that there is sufficient uptake; and to take direct action to improve uptake or increase access • The programme in Wakefield is accountable to the Integrated Care Partnership Board • The next targets within the programme are to have offered a first dose to all over 50s, high risk, frontline health and care workers, unpaid carers, and clinically extremely vulnerable by mid-April; and then to have vaccinated all over 18s by the end of July • To date cohort penetration (i.e.: vaccine uptake) has been very good across the board • Direct action is being taken in those places where there is slight variation of lower cohort penetration in particular lower super output areas (LSOAs) • A lot of work has been focused on site set-up at pace to deliver the vaccines; now these are operational more resource can be spent on medium to long term programme planning • Key work streams are focused on: o Sustainable workforce recruitment, on-boarding and training according to need o Minimising health inequalities: understanding and ensuring, where practical, that access is right for all of our eligible population and using innovative ways and creative thinking to address that o Vaccinating the underserved populations using roving vaccination models o How the vaccination programme will eventually become business as usual
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated An Equality Impact Assessment has been produced for the Impact Assessment vaccination programme in Wakefield and is continually updated completed (IIA) (appendix A) Outline public Public engagement has occurred as part of the national engagement – clinical, programme. In Wakefield engagement has taken place with stakeholder and community champions, local faith leaders, and through partners public/patient: such as Healthwatch and the community and voluntary sector. Clinical engagement has taken place through various means such as Primary Care Network and provider trust clinical meetings. Stakeholder engagement has been through Integrated Care Partnership Board, Council Management Team and District Partnership Tactical Meetings.
Management of Conflicts No conflicts of interest of Interest:
Assurance departments/ Not applicable organisations who will be affected have been consulted: Previously presented at Not applicable committee / governing body:
Reference document(s) / enclosures:
Risk Assessment: Risks associated with the programme are logged with the West Yorkshire Vaccine Operations Centre, the CCG and the Health and Social Care Tactical risk logs
Finance/ resource Finances are reported to West Yorkshire Vaccine Operations implications: Centre
Wakefield Clinical Commissioning Group Governing Body
9 March 2021
COVID-19 Vaccination Programme Progress Report
Purpose
1. The purpose of this paper is to: a. Provide an update on progress of the vaccination programme in vaccinating the eligible population of Wakefield as set out by the Joint Committee of Vaccination and Immunisation (JCVI) b. Detail the ongoing work streams that play an integral part in the medium to long term planning of the programme 2. The CCG Governing Body are asked to: a. Note the progress of the vaccination programme to date b. Consider and discuss the ongoing work involved in long to medium term planning
Background and Approach
The COVID-19 vaccination programme began at the end of October 2020. The National Vaccination Operations Centre (NVOC) was set up at NHS England and Improvement in response to the impending marketing authorisation of the first vaccine manufactured by Pfizer. Each Integrated Care System was appointed as a System Vaccine Operations Centre (SVOC) that in turn reported to the Regional Vaccine Operations Centre (RVOC) at North East and Yorkshire who then report to NVOC. As part of the distributed leadership model across West Yorkshire, each place was asked to appoint a Senior Responsible Officer to ensure that the eligible population of each place had good access to the vaccine. In addition to this, each place was asked to nominate a Lead Place Provider that would be responsible for corporate, financial and clinical governance of hospital sites and the community vaccination centre, as well as supporting workforce provision across place. An outline of the roles and responsibilities across West Yorkshire can be found at Appendix 1.
The Senior Responsible Officer set up a programme team that consists of a Programme Lead and Project Support Officer. This work is supported closely by the Clinical Lead for the Programme, as well as the CCG Primary Care Network team, HR, communications, and IM&T. A steering group has been set up that meets twice a week; and each vaccination site has its own operational and delivery groups in place. The programme is accountable locally to the Integrated Care Partnership Board and system-wide to the West Yorkshire System Vaccine Operations Centre, and governance reports are produced for both on a regular basis.
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Site Establishment
Each place was asked to identify various sites that would be designated for vaccination provision. These were as follows:
1. Community Vaccination Centre: this is a site that is capable of vaccinating larger numbers of people (at least 6,000 per week). Navigation Walk, hosted by Spectrum CIC, was identified as a suitable site.
2. Local Vaccination Services: Primary Care Networks worked together with the CCG to provide vaccine provision under an enhanced service with NHSEI. 5 sites across Wakefield were identified that were both clinically and geographically suitable: a. Castleford Civic Centre b. Church View Health Centre, South Kirkby c. Sandal RUFC d. St Swithun’s Community Centre, Eastmoor e. King’s Medical Practice, Normanton
3. Hospital Sites: these would be single acute trust provider sites that provide vaccinations for frontline health and social care workers and a small number of inpatients. These three sites were identified at: a. Pinderfields General Hospital, Mid Yorkshire Hospitals Trust b. Fieldhead, South West Yorkshire Foundation Partnership Trust c. Springhill, Wakefield, Yorkshire Ambulance Service
4. Community Pharmacy: community pharmacies were asked for expressions of interest for nominated sites across the country. The place programme worked with NHSEI to identify suitable sites, and these are: a. Pontefract Squash Club b. Morrison’s car park, Dewsbury Road, Wakefield.
Each of the sites were required to meet standard fitness criteria submitted to NHSEI, including clinical safety, patient access, and value for money tests. They are also registered with the Care Quality Commission.
An equality impact assessment has been developed in order to identify and mitigate any potential inequalities or quality impact that may arise during the course of the programme. This is a document that is continually viewed and reviewed in order to keep it current with the changing guidance that is issued.
Sites became operational in a staged manner from 16th December 2020, a week after the Pfizer vaccine gained its license. The Oxford Astra Zeneca vaccine gained its license on 31st December 2020 and has also been in use at vaccination centres.
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JCVI Cohort Penetration
The Joint Committee of Vaccination and Immunisation (JCVI) issued guidance in December 2020 on vaccine prioritisation. This advice was developed with the aim of preventing as many deaths as possible, and it focussed on evidence of groups of people who had worse outcomes if they contracted COVID-19. This guidance is reviewed and updated regularly and can be found here: https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid- 19-vaccination-advice-from-the-jcvi-30-december-2020
Cohorts were booked in various ways, as detailed below:
Cohort Description 1st dose Setting number Target Date 1 Residents in a care home for 31/01/21 Roving vaccinator teams older adults and their carers from LVS for residents and carers. Carers at hospital hubs 2 All those 80 years of age and 31/01/21 Over 80s by LVS; frontline over and frontline health and HSCW predominantly at social care workers hospital hubs with support from CVC, CP, and LVS 3 All those 75 years of age and 14/02/21 LVS, CVC and CP over 4 All those 70 years of age and 14/02/21 LVS, CVC and CP over and clinically extremely vulnerable individuals 5 All those 65 years of age and 15/04/21 LVC, CVC and CP over 6 All individuals aged 16 years to 15/04/21 LVC, CVC and CP 64 years with underlying health conditions which put them at higher risk of serious disease and mortality and unpaid carers 7 All those 60 years of age and 15/04/21 LVC, CVC and CP over 8 All those 55 years of age and 15/04/21 LVC, CVC and CP over 9 All those 50 years of age and 15/04/21 LVC, CVC and CP over 10 All those aged 18 to 49 years of 31/07/21 LVC, CVC and CP age
The diagram below shows cohort penetration data for Wakefield as of 24 February 2021:
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It shows that cohort penetration for cohorts 1 to 3 is very high. Cohort 4 penetration was over 90% but has now reduced slightly due a denominator change as extra people were identified through the QCOVID population risk tool that was released w/c 22 February.
Overall, over 100,000 people in Wakefield have received a first dose of COVID vaccine, with population coverage of 32%. The first dose vaccination rate by lower super output area (LSOA) is shown below:
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It shows that generally there is good uptake; however there are two areas that have a slightly lower cohort penetration at City Centre and Eastmoor. Detailed work is underway with population health colleagues at Wakefield Council to understand the characteristics of the population that live in those areas in order to tailor engagement and vaccine access in order to encourage even better uptake.
It should also be noted that there is a low decline rate across the cohorts at present. There is work ongoing to invite people for vaccine again when they have first declined or been hesitant for whatever reason; alongside communications targeted to those who may have refused first time to inform that this does not mean you can never receive the vaccine.
Second doses are about to start to be offered 11 weeks after the 1st dose, and each site has recall plans for every person that was vaccinated by them alongside dedicated vaccination supply in the corresponding timeframe.
The date for offering a first dose to all of the population aged over 18 years (n= 306,060) is set as end of July 2021, with second dose expected to be completed by end of September 2021. Vaccine supply is expected to steadily increase to meet this demand; and a plan is in place to ensure that capacity of various sites can meet the demand required.
Current Workstreams
1. Minimising Health Inequalities Using the EIA and cohort penetration surveillance data, there is a working group that are looking at understanding why some people are not able to come forward for a vaccine. This is both proactive and reactive engagement that will use rich intelligence as it presents to the group. This group is working well across the system with good stakeholder engagement from all key partners.
2. Wakefield Workforce Cell The Wakefield Workforce Cell is led by Mid Yorkshire NHS Trust as Place Lead Provider and focuses on the following areas: a. Planning and modelling of workforce required for ongoing vaccination provision that allows current workforce to return to substantive posts and core healthcare b. Recruitment and onboarding of suitably-skilled workforce using the pipelines of supply as recommended by NHSEI and also local initiatives such as community and voluntary sector
3. Underserved Populations A key piece of work is to reach out to the underserved populations through proactive engagement and a roving vaccination team to ensure that this part of our population are not missed.
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4. Medium to Long Term Planning A capacity and demand plan is in place, working with the Wakefield Workforce Cell, to ensure that the 31 July vaccination target can be met; and that all 2nd doses can be administered. A time out is planned for key stakeholders in early March to discuss what the vaccination programme will look like as a ‘business as usual’ model going forward as part of an annual vaccination to most of the population.
Conclusion
The COVID vaccination programme is the largest and most complex vaccination programme that the NHS has ever had to deliver. Vaccine supply initially was unpredictable leading to swift adaptations to delivery models, and identification of all frontline health and social care workers was a challenge, however all of this has been overcome to be able to offer vaccines to people on time.
The programme continues to demonstrate what can be achieved through the tremendous power of partnership working across system with adaptive leadership and one clear objective.
Cohort penetration has been good and the programme has clear goals in what it needs to do to reach out to ensure all of the eligible population of Wakefield are offered a vaccine.
Jo Fitzpatrick
SRO COVID Vaccination Programme
Wakefield
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Title of CCG Governing Body Agenda 14 meeting: Item:
Date of 9 March 2021 Public/Private Section: Meeting: Public Private Paper Title: Wakefield Mental Health Alliance - N/A 2021/2022 priorities If private, insert here reason for inclusion as a private paper
Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Sean Rayner - Chair of the Wakefield MH Provider Alliance & Title: Director of Provider Development, SWYPFT
Michele Ezro - Associate Director – Mental Health Transformation (Wakefield Mental Health Alliance)
Charlotte Whale – Transformation Manager (Wakefield Mental Health Alliance)
Responsible Clinical Dr Adam Sheppard, Chair Wakefield CCG Lead: Responsible Governing Board Mel Brown, Commissioning Director for Integrated Care, Executive Lead: Wakefield CCG
Recommendations:
It is recommended that the Governing Body:
1. Note the update on 2020/21 scheme; 2. Note the additional 2020/21 schemes funded by financial slippage, prioritised through delegated authority to the Chair of the CCG, Director of Integration and Chair of the Wakefield Mental Health Alliance; 3. Note the process taken to develop the proposed work programme; 4. Approve the investment priorities for the Mental Health Alliance work programme for 2021/22 as recommended by the Wakefield Integrated Care Partnership; and 5. Approve delegated authority on behalf of the CCG Governing Body to the Chair of the CCG, the Director of Integrated Commissioning in the CCG and the Chair of the Mental Health Alliance in SWYPFT for the allocation of any financial slippage in 2021/22.
Executive Summary:
The Paper provides
• Progress against 2020/21 priorities
Examples are given of the positive outcomes of the proposals that were prioritised in 2020/21 through the Wakefield Mental Health Alliance. An additional 14 proposals that were prioritised through financial slippage in 2020/21 are also listed. Further Alliance achievements and activity throughout 2020/21 is also detailed in this section.
• The 2021/22 prioritisation process
The paper provides an overview of the process taken to prioritise the Alliance work programme for 2021/22 and highlights the developments that have been made following the 2020/21 process. The proposals that align to NHS Long Term Plan priorities are highlighted alongside those proposals that focus on priorities that have been identified locally. Wider context is provided with strategic considerations and additional programmes of transformation for crisis alternatives and Community Mental Health due to commence in 2021/22.
• Summary of proposed priorities
The full list of recommended proposals for 2021/22 is provided following the Alliance prioritisation process. Those proposals that have not been prioritised will be reconsidered if there is any financial slippage against prioritised proposals.
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Outline public Engagement has been detailed within each of the individual engagement – clinical, alliance proposals. stakeholder and public/patient: Management of Conflicts The process outlined was designed to manage and mitigate of Interest: against conflicts of interest through maximising involvement.
Assurance departments/ Insert details of the people you have worked with or consulted organisations who will during the production of this paper: be affected have been In the CCG: consulted: Senior Finance Manager (Partnerships) Senior Commissioning Manager for Children and Young People Senior Commissioning Manager for Adult Mental Health Senior Contracts Manager
Wakefield Mental Health Alliance members: South West Yorkshire Partnership NHS Foundation Trust Nova Wakefield Mid Yorkshire Hospitals NHS Trust Alzheimer’s Society Turning Point Talking Therapies Wakefield MDC Wakefield Safe Space Wakefield PCNs Kooth Young Lives Wakefield Clinical Commissioning Group
Previously presented at Not applicable committee / governing body:
Reference document(s) / Not applicable enclosures:
Risk Assessment: Not applicable
Finance/ resource As outlined. implications:
Proposed Work Programme 2021/2022
Wakefield CCG Governing Body– 9th March 2021
1 Overview
Progress against 2020/21 priorities
The 2021/22 prioritisation process
Summary of priorities
Next steps
Recommendations
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Significant improvements have been seen in Child & Adolescent Mental Health Services (CAMHS) waiting times. In some cases, waits have reduced from 51 to 5 weeks.
An enhanced virtual Increasing Access to Psychological Therapy (IAPT) service offer is now available through Turning Point Talking Therapies including an extensive menu of online workshops.
Maximum Electroconvulsive Therapy (ECT) service offer has been available despite the Coronavirus pandemic.
South West Yorkshire Partnership Foundation Trust (SWYPFT) Patient Flow team have managed challenging cases and admissions from the Emergency Department (ED) successfully. No use of Out of Area (OOA) beds due to capacity constraints in Wakefield despite increased demands of covid outbreaks and covid related staffing issues.
4 Mid Yorkshire NHS Trust have been able to progress with the development of the 0- 18 Autistic Spectrum Disorder (ASD) diagnosis pathway and is maintaining a NICE compliant assessment , meeting the 1st appointment timeframe and a 26 week timeframe from acceptance of referral to diagnosis.
Increased online therapy has been delivered via the Kooth Platform for Children and Young People.
The perinatal service continues to provide a full service for all new referrals and existing service users. The team has been very proactive with the alternative means of providing support and have led on using the available technology to maintain contact in addition to telephone and face to face where indicated.
5 2 Primary Care Mental Health practitioners for physical health checks for people with Severe Mental Illness
Safer staffing of Wakefield Acute Mental Health wards (covid -19 response)
Keeping Older People Connected (Age UK)
First Contact Mental Health practitioners in Primary Care
Advance project (IAPT delivery through the Well Women’s Centre)
SWYPFT Schemes including acute inpatients, discharge coordinators and community capacity
Psychology support for Covid inpatients in Mid Yorkshire NHS Trust
6 Wakefield and District Safe Space Intensive Home Based Treatment (IHBT) team clinical support
Check in and Chat
Wakefield Autism Support Project (WASP)
Service Director- Health & Wellbeing, Wakefield Metropolitan District Council
Additional Consultant Psychiatrist capacity into Wakefield Older Peoples Mental Health Services
Ministry of Justice Restrictions training
Keeping Older People Connected, Phase 2
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The Development and Mobilisation of the Wakefield Safe Space through an inclusive co-produced partnership approach. ◦ Confirmation recently received of West Yorkshire & Harrogate Crisis Alternatives transformation funding, enabling delivery of a 7 day service.
Peer support and a coordinated approach to communications throughout the Coronavirus pandemic awareness raising of support options available.
Emergency Department (ED) Task and Finish Group formed to support a multi organisational approach to the management of individuals with a Mental Health presentation in ED. ◦ Informed the implementation of Wakefield Mental Health Winter Pressures priorities
8 Wakefield Community Mental Health Transformation submission (in context of national requirements) driven by a systemwide approach based upon the Connecting Care ethos.
Grant Funded 38 Voluntary and Community Sector (VCS) schemes through the Emotional and Mental Wellbeing Fund hosted by Nova, 22 of which were to ensure the delivery of support through Covid. 3 of which focused specifically on working with the Black Asian Minority Ethnic community.
9 Feedback gathered by Wakefield Healthwatch on Health and Care Services during Covid was fed through the alliance to inform our work.
Contribution to a number of West Yorkshire wide schemes during Covid, including: ◦ West Yorkshire Bereavement Support line ◦ West Yorkshire Health and Care Staff Support line ◦ West Yorkshire 24/7 Mental Health helpline
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Alliance 2021/22 prioritisation process
11 NHS Long Term Plan
West Yorkshire and Harrogate Health and Care Partnership Mental Health, Learning Disability & Autism Strategy
Wakefield Children and Young People’s Plan 2019-2022
Wakefield Health and Wellbeing Board priorities
Wakefield Mental Health Alliance Case for Change
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NHS England advancing mental health equalities strategy
The NHS White paper
The Community Mental Health Framework for Adults and Older Adults
West Yorkshire & Harrogate Tackling health inequalities for Black, Asian and minority ethnic communities and colleagues review
Wakefield Families Together transformation programme
Wakefield ICP priorities.
The Nova Wakefield Funding Framework
Wakefield & West Yorkshire Covid mental health and care tactical response
13 Crisis Alternatives ◦ £227,000 (2021/22) ◦ 3 Year Transformation programme ◦ Year 1 will focus on the expansion of the Wakefield Safe Space to 7 nights.
Community Mental Health ◦ £614,059 (2021/22 Wakefield Allocation) ◦ 3 Year Transformation programme ◦ Transformation of a new, inclusive generic community-based offer based on redesigning community mental health services in and around Primary Care Networks. ◦ Year 1 will focus on piloting the new model in 2 Primary Care Networks alongside an all- age mental health needs assessment for Wakefield.
Mental Health Workers in Primary Care ◦ Embedded Full Time Equivalent mental health practitioner, employed and provided by the PCN’s local provider of community mental health services. ◦ Joint funding model, 50% Automatic Role Reimbursement Scheme (ARRS) 50% Mental Health provider.
14 Open and transparent process where each Alliance member organisation provided an equal set of scores.
Proposals welcomed from both Alliance members and stakeholders.
Each of the proposals were scored against the following:
◦ Supports achievement of the NHS Long Term Plan
◦ Evidence of demand/need
◦ Clearly articulated benefits and outcomes
◦ Deliverability
◦ Financially proportional to expected return
15 With learning from last year’s process and feedback from Alliance members and stakeholders, the following changes were introduced:
An informative workshop for Alliance members and Stakeholders in October covering: ◦ Wakefield population data ◦ West Yorkshire and Harrogate Integrated Care System priorities ◦ Feedback from Service users received through the Coronavirus pandemic. ◦ The NHS Long Term Plan ambitions for mental health ◦ The application and scoring process
All applicants were invited to present their proposals to both Alliance members and Stakeholders and answer any points of clarification.
Feedback from Stakeholders on proposals was shared with Alliance members to support the scoring process.
16 Perinatal Mental Health increase in activity target
Improving Access to Psychological Therapies (IAPT) for patients of Mid Yorkshire Hospital Trust to support the IAPT access target
Turning Point Talking Therapies Expansion increase in access target
Wakefield Individual Placement and Support (IPS) Service (New for 2021)
Child and Adolescent Mental Health Services (CAMHS) Learning disability and Neurodevelopmental pathway to increase access
CAMHS Enhanced Outreach Team (EOT) expansion to increase access
17
Dementia Connect Wakefield
Increasing Consultant capacity in Older Peoples services
In-Patient Pharmacist Prescribers
Children and Young People’s Bereavement support
Workforce bereavement training
Adult online mental health platform
18 Commitment Amount Anticipated funding envelope £ 61,280,254.00 Committed expenditure (contracts -£ 58,466,443.00 etc) 1.3% contract “uplift” -£ 715,493.00 Legacy commitments (16-25), PCNs -£ 475,000.00 Legacy commitments (CAMHS) -£ 100,295.00 Legacy commitments (Yorkshire -£ 152,537.00 Ambulance Service) Legacy commitments Section 12 -£ 15,000.00 Total Available £ 1,256,354
19 The group considered different ways to prioritise proposals based upon: Age Recurrent vs non-recurrent Weighted scores based on link to the Long Term Plan
It was agreed to:
Prioritise proposals in order of total scores awarded.
Remove the highest and lowest scores from each proposal’s scores to mitigate against the sensitivity of potential impact of organisational understanding/approach.
20 The following principles are proposed (introduced in 2020/21):
Funding to follow spend If a work programme does not spend funding as planned, any slippage will come back to the Alliance to fund further priorities.
Balancing national priorities and local need The Alliance considered current performance against mandated targets as part of the scoring criteria. Where savings are made against national priorities this provides us with an opportunity to fund local initiatives. This maximises the value of the ‘Wakefield pound’.
21 22
Proposed work programme Investment required STAR Bereavement Practitioner Bid £261,200
Advanced Clinical Practitioners on £271,554 Mental Health Inpatient Wards Acute Inpatient £698,855 Wakefield Qwell (Whole Population £79,800 Mental Health) In-Patient Pharmacist Prescribers £33,956.00 Workforce Bereavement Training - £33,047.37 Wakefield Council
We will consider elements of these proposals for prioritisation against non-recurrent spend in 2021/22.
23 Applications received through both Alliance slippage and 2021/22 work programme prioritisation processes have highlighted the need to greater understand the bereavement support offer available in Wakefield.
Bereavement support schemes have been funded throughout the pandemic on both a West Yorkshire and Wakefield footprint.
The Alliance proposes that there be a review of current all age bereavement support provision across Wakefield to identify potential gaps and inform future commissioning of these services.
The Alliance are pursuing this review through the Wakefield Integrated Care Partnership as agreed at the 23rd February ICP meeting.
24 Perinatal Mental Health • Increased capacity to meet Long Term Plan (LTP) commitments and embed extension of the service to mothers up to 24 months after birth. • Supports achievement of LTP Perinatal access rates Total investment required for 21/22: £122,044.00
Child and Adolescent Mental Health Services (CAMHS) Learning disability and Neurodevelopmental pathway • Deliver a new pathway to meet the needs of more children with Learning Disabilities and Neurodevelopment issues and their families. • Supports achievement of LTP – Children and Young People’s access rates Total investment required for 21/22: £235,625.00
25 CAMHS Enhanced Outreach Team (EOT) expansion • Increased capacity to maintain current waiting list times, return more children to care within Wakefield. A complex care manager would track Wakefield Children out of area. • Supports achievement of LTP-CYP access rates Total investment required for 21/22: £157,962.00
Improving Access to Psychological Therapies (IAPT) for patients of Mid Yorkshire Hospitals Trust (MYHT) • Develop and deliver a new service to increase uptake of IAPT for MYHT patients • Supports achievement of LTP – IAPT access rates Total investment required for 21/22: £62,410.00
26 Dementia Connect Wakefield • Increased capacity in telephone and community-based support for people with dementia. This includes welfare calls and focused outreach to Black Asian Minority Ethnic communities in Wakefield. • Supports locally identified need. Total investment required for 21/22: £133,985.00
Turning Point Talking Therapies Expansion • Increased capacity on core Increasing Access to Psychological Therapy (IAPT) provision to meet demand and Long Term Plan (LTP) targets, increasing Cognitive Behavioural Therapy group-based programmes. • Supports achievement of LTP – IAPT access rates Total investment required for 21/22: £85,302.00
27 Increasing Consultant capacity in Older Peoples services • Increased Consultant level capacity for inpatient and community Older People’s mental health services to meet standards of care • Supports care closer to home provision and living independently for longer. • Total investment required for 21/22: £154,690.00
Wakefield Individual Placement and Support (IPS) Service • Implementing an evidence-based model of employment support to improve employment rates for people with severe mental illness who have a personal goal to find and retain employment • Supports achievement of Long Term Plan to provide access to IPS Total investment required for 21/22: £211,493.25
28 Safer Staffing • Programme of transformation to better understand and meet the increasing demands and rise in acuity within mental health inpatient services. Total investment required for 21/22: £100,000
29 Communication of confirmed work programme
Ensure systems and processes in place to ensure effective monitoring of implementation and benefits with reporting to Integrated Care Partnership
Identify support required from ICP ‘enabler’ work streams e.g. digital, workforce, housing
Consider system wide impact and learning e.g. West Yorkshire and Harrogate
30 . Note the update on 2020/21 schemes.
. Note the additional 2020/21 schemes funded by financial slippage, prioritised through delegated authority to the Chair of the CCG, Director of Integration and Chair of the Wakefield Mental Health Alliance.
. Note the process taken to develop the proposed work programme.
. Approve the investment priorities for the Mental Health Alliance work programme for 2021/22 as recommended by the Wakefield Integrated Care Partnership.
. Approve delegated authority on behalf of the CCG Governing Body to the Chair of the CCG, the Director of Integrated Commissioning in the CCG and the Chair of the Mental Health Alliance in SWYPFT for the allocation of any financial slippage in 2021/22.
31 32 33 34
Title of Governing Body Agenda 15a meeting: Item:
Date of 9 March 2021 Public/Private Section: Meeting: Public Private Paper Title: Wakefield Safeguarding Children N/A Partnership (WSCP) Annual Report 2019- If private, insert here reason for inclusion as a private paper 2020
Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Sarah Booth, Designated Nurse Safeguarding Children and Title: Children in Care
WSCP Annual Report Author: Jonathan Giordano, WSCP Manager Responsible Clinical Dr Debbie Hallott Lead: Responsible Suzannah Cookson, Chief Nurse Governing Board Executive Lead: Recommendation: It is recommended that the Governing Body note the WSCP Annual Report September 2019 - August 2020, the executive summary below including the areas for development going into 2021. Executive Summary:
• WSCP was established in September 2019, following the Sir Alan Wood National Review and the revised Working Together to Safeguard Children (WTSC, 2018). The legislation stood down Wakefield Safeguarding Children Board (WSCB) and this report reflects a year of transition from WSCB to WSCP.
• The new multi-agency safeguarding arrangements changed significantly in relation to the governance which saw the replacement of the board function with a streamlined executive, and the appointment of an Independent Scrutineer who provides challenge and holds the partnership to account.
• Three statutory partners (from the Local Authority, Police, Wakefield Clinical Commissioning Group) alongside the Independent Scrutineer, Stuart Smith work in partnership with all relevant agencies, with children and young people and with local communities to promote the welfare of all Wakefield children and to ensure they are effectively safeguarded.
• WSCP joint working arrangements are monitored and measured in Wakefield to assess whether they are working effectively to keep children safe. This approach is used to independently scrutinise multi-agency safeguarding arrangements to: • Highlight areas of good practice; • Highlight areas which require improvement; • Examine how effective arrangements are for practitioners; • Decide what we need to examine in more detail; • Determine what difference WSCP has made to outcomes for children and to practice; • Support and challenge partners to improve practice and; • Inform standards and agreements for joint working.
• WTSC (2018) states services should ensure that staff are supported and undertake safeguarding training in particular to identify children and families who would benefit from early help. WSCP utilises learning from previous multiagency safeguarding children training; learning and action plans from national and local Child Safeguarding Practice Reviews; CDOP; Section 11 and multi-agency audit; new and amended legislation/policy/practice/guidance; feedback from practitioners and managers; training needs analysis findings; further review of the traditional training offer and consideration of the alternative approach to learning and development.
• The WSCP Strategic Priorities have been identified from the Ofsted Children’s Services Focused visit in February 2018, the Ofsted Inspection of Children’s Services in June 2018, the Improving Wakefield Services for Children Plan in July 2018 and practice issues recognised through recent national and local Child Safeguarding Practice Reviews. The voice of the child in understanding, identifying problems and developing services is integral in successfully meeting all of the priorities detailed below: • Ensure that thresholds across the partnership are fully understood so children receive the right help at the right time; • Improve WSCP’s effectiveness in reducing the harm to children in vulnerable groups, with particular focus on children and young people at risk of sexual or criminal exploitation; • Improve WSCP’s effectiveness in reducing the harm and protecting children and adolescents who are experiencing neglect; • Improve WSCP’s effectiveness in reducing the harm and protecting children experiencing problems with emotional health and wellbeing and; • Review and evaluate the effectiveness of the partnership to safeguard and promote the welfare of children and young people in the Wakefield District, and respond to any areas for change and development through the transition to the new arrangements.
• Looking ahead into 2020/21 WSCP has recognised the following areas would benefit from further development to ensure priority areas are progressed accordingly: • Develop service user involvement from children and families; • Broaden approaches to communicate safeguarding children developments to service workforce; • Monthly safeguarding children e-bulletin; • Increase WSCP generated activity to highlight safeguarding developments; • Updated WSCP website to enable guidance, procedures and resources to be accessible more readily; • Further develop relationships with Wakefield Safeguarding Adults Board and Community Safety Partnership, with a focus on transitional arrangements between children and adult services; • Consider workforce development needs in light of Wakefield Families Together model and impact upon multi-agency practice; • Develop a WSCP Quality Assurance and Learning Improvement Framework and; • Review and establish the Wakefield Child Death process, including CDOP and
compliance Child Death Review Meeting.
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts Not applicable of Interest:
Assurance departments/ Not applicable organisations who will be affected have been consulted: Previously presented at Not applicable committee / governing body:
Reference document(s) / https://www.wakefieldscp.org.uk/getfile/annual-report-2019-2020 enclosures:
Risk Assessment: Not applicable
Finance/ resource Not applicable implications:
Annual Report September 2019 - August 2020 Table of Contents
Foreword 3 Introduction 5 Wakefield Context 6 Independent Scrutiny, Assurance, Learning & Improvement 7 Chapter I: Scrutiny & Assurance 9 1. Overview 9 2. Scrutiny & Assurance: Child Death Overview Panel 10 3. Scrutiny & Assurance: Section 11 Audit 16 4. Scrutiny & Assurance: Multi-Agency Case Audit 18 5. Scrutiny & Assurance: Safeguarding Effectiveness Group 20 6. Scrutiny & Assurance: Safeguarding Practice Review Challenge Events 20 7. Scrutiny & Assurance: Multi-Agency Child Exploitation (MACE) 21 Chapter II: Learning & Improvement 22 1. Overview 22 2. Learning & Improvement: Rapid Reviews and Child Safeguarding Practice Reviews 22 3. Learning & Improvement: Multi-agency Safeguarding Training & e-Learning 23 4. Learning & Improvement: Safeguarding Advisor for Education 28 5. Learning & Improvement: Procedures, Resources, Guidance and Toolkits 29 6. Learning & Improvement: Communication 31 7. Impact of WSCP during Covid-19 32 8. Future Areas for WSCP to Consider 36 Appendix 1 – WSCP Structure 37 Appendix 2 – Relevant Agencies 38 3 Foreword training sessions and the Safeguarding Week Conference continued very successfully despite It is my pleasure to introduce the first annual the need for remote working. It is quite clear that report of the Wakefield Safeguarding Children for some learning and awareness raising remote Partnership (WSCP) under the new multi- technology has enabled a much wider audience agency safeguarding arrangements as set out than the traditional travel to the ‘classroom’ venue in the statutory guidance, Working Together to for the session. I am sure we will learn from this Safeguarding Children, 2018 (WTSC, 2018). year and incorporate travel free remote access to many important sessions in the future. It is In Wakefield the new arrangements were clear that this is less disruptive for some key staff operationally effective from September 1st 2019. and enables them to participate even within the These new arrangements include the need for context of their pressured timetable. It is possible Independent Scrutiny and I have fulfilled that role that this approach might also be more suitable from the outset. for some professionals to participate in statutory Obviously, no one involved quite expected the meetings too and partners will need to consider year we have experienced. From my independent this into the future. perspective I have witnessed WSCP being During this first year I have provided four reports drawn even more closely together in many to the Safeguarding Partnership Executive as areas and adopting and adapting practices to planned. I have attended and observed strong cater for remote working and the various other commitment from partners at all of the sub- restrictions that those working with children groups that form the partnership structure and have experienced since March. Throughout this operational arrangements. The partnership has period the additional vigilance, communication maintained its focus across its 5 priority areas as and awareness raising in respect of children who detailed in this report. may be made more vulnerable during the various lockdown restrictions we have experienced has There are a number of statutory requirements been evident. of the partnership and these include effective multi agency challenge via the review of serious The partnership have provided regular and cases. I am able to report that the partnership has detailed updates to the ways in which agency undertaken appropriate reviews and produced activities and delivery of services has altered, the relevant recommendations specific to agencies Wakefield partnership’s approach to these issues in relation to their practice. I have also witnessed has been well received and been adopted by others the subsequent follow up activity ensuring that in the region as an example of good practice. In these recommendations have been implemented some areas, particularly the approach to learning across staff teams etc. In addition, multi-agency and development we have found that some of the case file audits and the Section 11 audit process adaptions to our normal routine have proven to have been completed during the year. be more successful than our normal approach. For instance, the partnership has held remote 4
The Partnership has worked hard to develop its around the Child/family arrangements and close core data set, this is an essential set of data, the links between social care agencies and schools analysis of which provides focus and direction to are continuing to develop in the prevention arena. the most vulnerable children and families, where I am optimistic that the partnership can promote safeguarding is of most importance. This data and these arrangements significantly during 20/21. the subsequent process presents a continuing Finally, I would like to thank all of the staff and challenge for the partnership and will remain a volunteers of the many different agencies priority into the forthcoming year. that have allowed me access to their data and The National Review Panel has published this meetings as observer and occasionally contributor year an overview report after considering a too! The partnership has been open to positive series of serious cases of criminal exploitation. observations, challenge and constructive criticism The recommendations arising from this national equally making effective scrutiny possible. review have been widely circulated in Wakefield and the importance of identifying the young people most vulnerable to this type of exploitation has been reinforced with partnership members. I know that schools, Academies and colleges in Wakefield are particularly aware of the correlation between this type of exploitation and those excluded or missing from education as a result of these recommendations. In a similar area of concern, I have pressed Police colleagues to provide data relating to their work to disrupt and prevent perpetrators of child exploitation. Recently this data has been comprehensively provided to the core data set and is again an example of best practice. During the year I have observed new voluntary organisations welcomed into the Partnership Stuart Smith OBE adding to the overall Safeguarding capacity. Independent Scrutineer and Children’s Services Parents Against Child Exploitation (PACE) and St Improvement Advisor Giles Trust are examples of this. As a district Wakefield is working hard to develop approaches to early help and prevention, Wakefield is ranked No1 in the region for its ‘Troubled Families’ successful outcomes. Partners are increasingly collaborating to Team 5 Introduction In 2019, WSCP developed principles and aims to locally implement WTSC 2018. The following WSCP was established in September 2019, principles have guided WSCP through this following the Sir Alan Wood National Review transition: and the revised WTSC 2018. The legalisation • Maintain a high quality of safeguarding stood down Wakefield Safeguarding Children across the district Board (WSCB) and this report reflects a year of transition from WSCB to WSCP. • Develop an effective form of independent scrutiny The new multi-agency safeguarding arrangements changed significantly in relation • Creatively engage with and seek the voice of to governance which saw the replacement of young people the board function with a streamlined executive, • Creatively engage with the wider community and the appointment of an Independent • Ensure that all relevant agencies continue to Scrutineer who provides challenge and holds be involved in WSCP activities the partnership to account. • Develop regional activity where they are The changes offered opportunity to build on the consistent with our vision strong system working in Wakefield, to adopt new approaches and ensure culture of learning The executive drives the business of WSCP and development is embedded. The structure and promotes ownership from the statutory of WSCP can viewed within appendix 1. partners. Joining the statutory partners to form the executive is primary, secondary and special Three statutory partners (from the Local Authority, educational needs school representation along Police, Wakefield Clinical Commissioning Group) with the Director of Public Health. The statutory alongside the Independent Scrutineer, Stuart partners are accountable, open to challenge and Smith work in partnership with all relevant have worked with the Independent Scrutineer to agencies (see appendix 2), with children and robustly and independently examine the function young people and with local communities to and delivery of WSCP, its sub-groups and work promote the welfare of all Wakefield children streams. The role of the Independent Scrutineer and to ensure they are effectively safeguarded. has ensured that multi-agency safeguarding arrangements are fit for purpose, are consistent with WTSC 2018 and that learning, evidence, research and community engagement inform policy and practice. 6 Wakefield Context The deprivation profile is most shaped by high levels of education and skills deprivation and Wakefield District covers 350 km2 and is one high levels of crime deprivation. of 5 local authorities that make up the West Yorkshire region. The district is made up of a number of towns and villages, located on the outskirts of the City of Wakefield. The district is well served by transport links, being located on 2 major motorways (M62 and M1). It borders Leeds to the North East, Barnsley and Doncaster to the South and Kirklees to the West. Beate Wagner Director of CYPS In 2019, 345,000 people lived in the Wakefield Wakefield Metropolitan District Council local authority area making this the 20th largest local authority area in England. The latest figures for 2019 show that there were 79,500 children and young people aged 0-19 in Wakefield representing 23% of the total population with 51% being male and 49% being female. The percentage of children and young people has grown by 3.5% in the last 4 years.
Wakefield’s population is becoming increasingly Mark McManus ethnically diverse with 15% of school aged Chief Superintendent children now being from black and minority West Yorkshire Police ethnic communities. The non-white British populations most heavily represented in the district are white non British (likely European migrants in the main) and Asian Pakistani. The Index of Multiple Deprivation (IMD) 2015 placed Wakefield as the 65th most deprived district in England (out of 326 Districts). Comparing the IMD for 2015 and 2019 Wakefield has become (relative with other local Suzannah Cookson authorities) more deprived; Wakefield is the Chief Nurse 54th most deprived district in England (out of Wakefield CCG 317 districts, 7th out of Yorkshire and Humber) and 54,200 people are living in neighbourhoods amongst the top 10% most deprived in England. 7
WSCP aligns itself and influences the strategies Independent Scrutiny, and priorities from other strategic partnerships Assurance, Learning and such as: • the Safeguarding Adult Board (which is Improvement jointly staffed by the same Secretariat) Governance: Funding, Resource • the Community Safety Partnership and Alignment • the Health and Wellbeing Board • the Domestic Abuse Strategic Group The three statutory partners direct WSCP The Strategic Priorities have been identified through a Safeguarding Partnership from the Ofsted Children’s Services Focused Executive (SPE) which meets bi monthly visit February 2018, the Ofsted Inspection of although the meetings have taken place Children’s Services June 2018, the Improving every three weeks since March 2020 and Wakefield Services for Children Plan July 2018 the beginning of the Covid -19 pandemic. and practice issues recognised through recent Attendance at SPE comprises of the three national and local Child Safeguarding Practice statutory partners and head teacher Reviews. The voice of the child in understanding, representatives from the schools sector, identifying problems and developing services special schools, primary schools and is integral in successfully meeting all of the secondary schools, alongside key senior priorities detailed below: leads from Health and the Local Authority. • Ensure that thresholds across the partnership The primary role of SPE is to set the strategic are fully understood so children receive the priorities across the partnership. Strategic right help at the right time direction is informed through reporting from the • Improve WSCP’s effectiveness in reducing Sub Group Chairs via the Safeguarding Children the harm to children in vulnerable groups, Partnership Manager, an understanding of with particular focus on children and quality and performance and key drivers and young people at risk of sexual or criminal challenges for Wakefield informed by focussed exploitation. attention to areas of practice. The group agrees the annual report and • Improve WSCP’s effectiveness in reducing implements the Senior Leadership Visiting the harm and protecting children and Programme across the partnership. adolescents who are experiencing neglect. The SPE receives quarterly reports from the • Improve WSCP’s effectiveness in reducing Independent Scrutineer of the effectiveness the harm and protecting children of WSCP in safeguarding and promoting the experiencing problems with emotional welfare of children. health and wellbeing. • Review and evaluate the effectiveness of the partnership to safeguard and promote the welfare of children and young people in the Wakefield District, and respond to any areas for change and development through the transition to the new arrangements.
8
A county-wide work stream led by WSCP work streams are split in this report, into West Yorkshire Police has been key in two chapters covering ‘Scrutiny and Assurance’ progressing the transformation from and ‘Learning and Improvement’ as follows: Safeguarding Children Boards to Multi Agency Safeguarding Arrangements across Scrutiny and Assurance: the county. The Independent Scrutineer and 1. Overview Safeguarding Children Partnership Manager 2. Child Death Overview Panel have led the Wakefield involvement with the 3. Section 11 Audit cooperation from the 3 statutory partners. 4. Multi-Agency Case Audit Significantly, several functions of the partnerships 5. Safeguarding Effectiveness Group across West Yorkshire have been unified across 6. Safeguarding Practice Review Challenge the county, to rationalise resource and simplify Events processes for partners. This has included a 7. Multi-Agency Child Exploitation uniformed approach to Rapid Reviews, the (MACE) Group ongoing development of a single portal and joint process for Section 11 / Safeguarding Adults Learning and Improvement: Audit and identified leads for each county- 1. Overview wide work stream (Child Death Overview Panel, 2. Rapid Reviews and Child Safeguarding communications, Risk and Vulnerability, regional Practice Reviews trainer’s network and procedures). 3. Multi Agency Training and e-Learning The partnership employs various methods to 4. Safeguarding Advisor for Education drive improvement and seek assurance children 5. Procedures, Resources, Guidance and are safeguarded in Wakefield effectively. The Toolkits following sections provide detail about the 6. Communication approached employed, the functionality of 7. Impact of WSCP during Covid -19 WSCP and how WSCP has steered multi-agency 8. Future Areas for WSCP to Consider system and practice development. 9 Chapter 1: Scrutiny and Assurance 1. Overview WSCP arrangements explain how joint working arrangements are monitored and measured in Wakefield to assess whether they are working effectively to keep children safe. This approach is used to independently scrutinise multi-agency safeguarding arrangements to: • highlight areas of good practice; • highlight areas which require improvement; • examine how effective arrangements are for practitioners; • decide what we need to examine in more detail; • determine what difference WSCP has made to outcomes for children and to practice; • support and challenge partners to improve practice and; • inform standards and agreements for joint working
Wakefield Safeguarding Children Partnership Independent Scrutiny and Assurance Framework
Quantitative Data (Multi-agency and single-agency performance Learning and Improvement management)
Quantitative Evidence Engagement with Front Line Staff (Multi-agency audits, independent scrutiny, (The views of practitioners, line managers and CSPRs, Section 11) safeguarding leads) 10 Chapter 1: Scrutiny and Assurance 2. Scrutiny and Assurance: Child Death Overview Panel
The Child Death Overview Panel (CDOP) has continued to meet regularly to review all deaths of children in Wakefield. The Panel itself has undergone transformation from a solely Wakefield panel to also include North Kirklees on the Mid Yorkshire Local Authority Footprint. The Wakefield cases haves continued to be considered by the multi-agency panel and serviced by a Child Death Review Coordinator. This focus and thoroughness has resulted in learning for individual agencies and systems as a whole where modifiable factors have been identified.
What has happened during this year?
• 3 CDOPs took place in Wakefield. 2 joint panels were undertaken with Kirklees and 1 panel was held in isolation to discuss Wakefield cases, a total of 14 cases were considered and completed. 1 panel was scheduled to take place in April but was cancelled due to Covid -19. • New national data collection forms and appendices were published that required considerably variable different and additional information requests. This development enables National Child Mortality Database to report directly to the Department of Health to identify national trends. • eCDOP has now been adopted in Wakefield, this measure now ensures that all 3 joint CDOP partners are using a consistent database and processes. 11
Total number of deaths notified and reviewed for Wakefield District
Notifications
• Wakefield CDOP were notified of 20 deaths occurring between 1 April 2019 and 31 March 2020 • Of those notified 13 were under 1 year of age, 5 being 0 - 27 days and 8 being 28 - 364 days • The remaining 7 were aged 1 - 18 (Due to the wide distributions within the ages for the basis of this report a detailed age breakdown cannot be provided to order to uphold anonymity)
Age Number 0 - 27 days 5 28 days - 364 days 8 1 - 4 years * 5 - 9 years * 10 -14 years * 15 -17 years *
NB It is important to note not all cases that are notified are discussed in the same year a death has occurred. This can be for a number of reasons, such as investigations and inquiries in relation to the circumstances of the death. As a result, these processes need to reach completion before CDOP is completed. 12
Reviews carried out
During 1 April 2019 and 31 March 14 cases discussed at CDOP panel.
Comparatively to previous years there were no significant pattern regarding the gender of children discussed at panel:
Gender breakdown of cases discussed at CDOP panel during 2019 - 2020 Male 9 Female 5
Modifiable factors
• Modifiable factors occur where it is possible to identify a factor that may be linked to the infant/ child/young person death • 50% of cases reviewed had identified modifiable factors of these the majority were under 1 year (both 0 -27 days and 28 days - 364 days) and aged 15 -17 years
Some modifiable factors identified this year included:
• Intrinsic to the child • Alcohol abuse, child’s age, child’s emotional health and well-being • Intrinsic to social environment • Co-sleeping, alcohol/substance misuse by a parent/carer, smoking by the parent/carer in household, Housing, domestic violence, parenting/supervision, Child abuse/neglect • Intrinsic to physical environment • Domestic abuse, parenting/supervision, child abuse/neglect • Intrinsic in relation to service provision • Difficulty in engagement
Of the 14 cases discussed 12 were identified as being white British, the remaining two did not have an identified ethnicity recorded. 13
What were the main causes of death? There are two categories for recorded deaths; expected and unexpected. Expected deaths may include cases where there was a pre-existing medical condition which lead to a death. Unexpected deaths are where something happened which could not have been predicted or expected for example, a car accident or Sudden Infant Death:
Expected / Unexpected deaths Expected deaths 8 Unexpected deaths 6 Not recorded whether expected/unexpected 0 Total 14
Causes of death Of the deaths reviewed this year, they covered deaths that had occurred 2017-18, 2018-19 and 2019-20 the top three categories of deaths were; 1/ Perinatal/neonatal event (an event around the time of birth and up to 28 days afterwards) 2/ Chromosomal, genetic and congenital anomalies (conditions which are inherited or are present at birth) 3/ Suicide or deliberate self-inflicted harm
Could anything have been done differently? CDOP considered all the factors in a child’s life to see if any action could have been taken to prevent death. Only a very small number of child deaths each year are considered preventable, and within each case there are often a range of factors to consider. Due to the small numbers involved the data has been grouped together over a five year period.
Lifestyle factors Maternal and parental smoking, alcohol consumption were identified as contributing factors. Maternal smoking has previously been a particular issue in Wakefield. During 2019-20 it did appear less common in the cases discussed this year. Co-ordinated actions have taken place in the promoting prevention of smoking are continuing to ensure progress regarding smoking prevention and the positive benefits for children and family. 14
What have CDOP undertaken to in relation to Bereavement support these factors? Wakefield Mental Health Alliance has Unsafe sleeping practices commissioned Wakefield Star Bereavement There were a high number of notifications of service to support children and young people child deaths related to unsafe sleeping / co- who have been bereaved. This service will sleeping practices that occurred during 2019- support children and young people bereaved 2020 more than a normal year. A small number through the loss of siblings or adults. of referred deaths were associated with co- Mental Health Provider Alliance, based with sleeping and other risky sleeping practices such Young Lives Consortium and working closely with as sharing an unsafe surface with a child, after Star Bereavement. The Postvention Practitioner consuming alcohol. will specifically support families, friends, and communities where a young person under 25 Bradford District Care NHS Foundation Trust has taken or suspected to have taken their own 0-19 services use Lullaby Trust information life. promoting safe sleeping, safe sleeping advice is also available for mothers-to-be when accessing CDOP have continued to work with partners Mid Yorkshire Hospital NHS Trust Midwifery such as the police and local hospices to ensure portal. that the panel’s knowledge is up to date on areas like sudden infant death and bereavement Due to the higher numbers of referred deaths services. For example Martin House Hospice this year associated with co-sleeping or unsafe currently offer some support, while there is sleeping practices a multidisciplinary task specific support for newly bereaved mothers and finish group with representation from all provided by bereavement midwives. organisations has been established to look at training all professionals involved in the care of families and babies. Due to Covid -19 this training will be online delivered by the Lullaby Trust and funded by Public Health. In addition to the training, the group are looking at consistent ongoing messages being given and resources to support this work. 15
Recommendations for future actions 1. Continue to work with partners to reduce the underlying risk factors for neonatal deaths mainly maternal/ parental smoking 2. Maintaining awareness of the need to be highly vigilant for any deaths that have any possible Covid -19 links; and if any, they are immediately notified to CDOP to enable the speedy notification of the National Child Mortality Database and the Department of Health 3. eCDOP was adopted in July 2020, this will need introduction and training for panel members and agencies that supply information, including expanding agencies where requests will be sent 4. Continue using the National Child Mortality Database and complete all cases currently held on this system 5. Development of Child Death Review Meetings to occur prior to the CDOP process meeting
3. Scrutiny and Assurance: Section 11 Audit 16
This year’s Section 11 Audit took place in July 2020 and overall there was a good response received from services who work with children in Wakefield.
A total of 12 completed audit tools were received by:
Wakefield Children and Young People’s Service NHS Wakefield CCG South West Yorkshire Partnership Trust West Yorkshire Police Mid Yorkshire Hospital Trust Wakefield Youth Offending Team National Probation Service Barnardo’s Spectrum Bradford District Care Foundation Trust Wakefield Arts, Culture and Leisure British Transport Police
It is noted that 5 agencies did not return a completed self-assessment tool. WSCP acknowledges agencies were requested to carry out this audit during Covid -19 and as a result this had an impact on the ability for service’s to respond within the timeframe.
Services completed a self-assessment tool in relation to their respective safeguarding arrangements covering: • Leadership and management • Reflections and accountability • Policies, procedures and systems • Induction, training and support • Safer recruitment and allegation management • Multi-agency working • Recording, storing and sharing information • Person centred approach • Engagement with WSCP 17
Generally services reported strong • Ensuring local safeguarding policy compliance across their self-assessment reflects up to date national legislation tool: • Ensuring Wakefield Families Together is • Senior managers expressed a strong embedded commitment to safeguarding through agency • Transitional provision arrangements for strategic plans, policies and procedures. children entering adulthood Roles and responsibilities are also reportedly well-defined and developed. Staff have an Overall WSCP can take assurance that agencies understanding of their role in safeguarding are aware of their duties under Section 11 and have access to support them in their and have continued to improve upon their roles. arrangements since the 2017 audit. However the absence of a challenge event needs to be • Areas such as training and safer recruitment addressed by the partnership as it poses a were recognised by partners as key question as to the level WSCP can be assured arrangements and these are in place across of agencies safeguarding arrangements based the service area. on the completion of a self-assessment as a • All agencies which are providing services standalone exercise for this audit. to children noted they were engaged in The development of Section 11 process will assessment processes and generally all continue to be further considered by WSCP. agencies reported as having arrangements West Yorkshire Safeguarding Partnerships to listen to and act upon the views of children. and Safeguarding Adult Boards are currently • A persistent area for development discussing whether one online system can identified across recent national and local be adopted across the region using the Safeguarding Practice Reviews has been Wakefield approach to a joint child and adult in relation to information sharing between self-assessment tool to further reduce the agencies. Whilst generally good compliance requirement for partners to complete multiple was reported agencies recognised the audits and improve consistency across the requirement for partnership wide information county. sharing agreement to further increase effectiveness. • Agencies identified specific areas for development for their service which included: • Ensuring training needs are met by staff undertaking WSCP training to gain local understanding of safeguarding procedure and practice in Wakefield • Clearer access to safer recruitment 4. Scrutiny and Assurance: Multi-Agency training Case Audit 18
WSCP seeks to assure itself that partnership • Children in care had an identified advocate work to safeguard children is of good quality, from the Barnardo’s CAPS Service; however, keeps children happy, healthy, achieving this did not extend to advocacy with CAMHS and safe; improves outcomes and makes a which would be beneficial. difference; and is carried out by well-informed • As part of this audit a Practitioner event took skilled practitioners who are properly supported place involving the practitioners who were by line managers, organisations and the wider working with the children whose situations partnership arrangements. Multi-Agency Case had been considered. The practitioners who Audits (MACAs) is one approach WSCP uses attended the event were skilful, committed to carry out this assurance. The audits ensure and demonstrated real passion for the child WSCP has a view across a child’s journey, but they were supporting. with a focus on the effectiveness of safeguarding arrangements. The following areas for development were noted: During the year under review, September 2019 to August 2020 two MACAs were undertaken • Some key professionals were not routinely on Mental Health and Neglect. involved in the assessment and planning for children. This in particular resulted in gaps The Quarter 3 Audit, October to December in key information and some professionals 2019 was based upon the JTAI audit theme of who were regularly seeing children were ‘children’s mental health, children who are living not regularly and routinely updated about with mental ill health and in receipt of services’. CAMHS involvement, planning, and progress The audit considered six cases which met the of therapy, this was particularly of note in criteria in the JTAI guidance. one case where the GP was regularly seeing The following strengths were identified in the child. the multi-agency work: • Routine contact with School Nursing Services • School records demonstrated a clear (BDCFT) as part of a Section 47 investigation involvement in multi-agency planning, a was not always apparent although it was clear understanding of the plan and the role noted that health information had been of the staff within school settings was clearly shared as part of the strategy discussion. understood. • Transition arrangements to Adult services • All children who were attending school had for young people who have ongoing mental an identified lead practitioner within the health support needs were not clear. school setting who was co-ordinating the response to the plan within the school and all children had an identified adult within the school setting to whom they could go to for support. The Quarter 1 Audit 2020 was delayed as a • Effective partnership work was leading to result of the Covid -19 pandemic and took significantly improved outcomes for the children. place in July 2020. It was based upon the 19
JTAI theme of children at risk of Neglect. The JTAI programme examined the multi-agency response to older children who are experiencing neglect and published its report ’Growing Up Neglected’ in July 2018. The same methodology as the previous audit was followed and a sample group of children and young people who fall within the scope of the guidance were identified and audits were requested from across the partnership. • The findings from the audit were similar to the previous audit with it noting that in some cases there was an absence or contact or involvement with some key professionals. Learning from audit continues to be a key method of seeking assurance in relation to multi-agency practice to safeguard children in Wakefield. The learning and findings from the audits are shared across the partnership and actions taken forward by the Safeguarding Effectiveness and Learning and Development sub-groups.
5. Scrutiny and Assurance: 20
Safeguarding Effectiveness Group The Safeguarding Effectiveness Group (SEG) has met regularly throughout the year and has lead on the multi-agency audits, the analysis of performance data across the partnership and the updating of policy and procedures across the partnership. The opportunity for the partnership to refine its data set has been considered over the year with advice from the Independent Scrutineer implemented. A revised approach to data collation and analysis has been agreed which allows for a deeper understanding across the partnership of key areas. SEG has led the thematic approach to assurance activity with deep dive areas considering children vulnerable to exploitation, children experiencing neglect and children experiencing mental ill health. The deep dive approach has included senior leadership visits to front line areas of practice, quality assurance audit activity and a consideration of performance data relating to the area of practice to provide a holistic picture of the quality of practice and journey of a child. The approach is informed by local and national emerging issues and focuses on areas which have been identified as requiring further development or emerging areas of multi-agency safeguarding practice. Holistic self-assessment through data analysis, multi-agency audit, and observation of practice, feedback from service users and practitioners and comparator intelligence provides an accurate account to assess interventions effectiveness in Wakefield. The reports derived from in- depth reviews provide assurance and identify areas for further development.
6. Scrutiny and Assurance: Safeguarding Practice Review Challenge Events In January and February 2020 a series of challenge events took place following the completion of previous national and local Safeguarding Practice Reviews. Two panels consulted with a number of professionals from across the partnership to seek assurance appropriate actions had been taken in implementing learning identified within the respective reviews. The panels reported to the SPE and Child Safeguarding Practice Review Group to provide feedback on the progress of the implementation of learning and completion of outstanding action plans. 21
This year has seen the merging of the Multi- New performance frameworks are in place and Agency Child Exploitation (MACE) group helping us to monitor impact. and Risk and Vulnerability Group, across the The partnership have identified that children partnership we have reviewed and refreshed who are missing increase their risk of the membership quorum and terms of reference exploitation and harm, the district has worked providing renewed focus around partnership hard to understand these issues and seek to objectives. This work increased representation implement appropriate interventions. This has across all sectors and welcomed new seen the Police identify repeat missing people organisations and areas to this structure. This and working with partners to intervene and group have led change across the partnership, prevent missing occurrences. Hotspot locations improving flagging of vulnerable children within have been identified and police and partners are all organisations to ensure more cohesive working to address specific issues. Collectively and effective information exchange and allow this has seen a reduction in missing people in earlier identification and intervention when risks Wakefield by 60%. are apparent. The partnerships first children vulnerable to exploitation problem profile has The partnership is aware of future challenges been developed, utilising a range of data sources around risks to young people through online we have identified key areas to practically focus crime as young people spend more time online partnership resources. The bus station was through Covid -19 restrictions. A focus this identified as a risk area, youth services and joint year has been around Children who are not working was commissioned through the MACE educated within a school setting and ensuring and provided targeted interventions in line with that interventions and support is appropriate to partnership needs. their needs. Moving forwards we will continue to utilise the problem profile to identify and The co-location of police and local authority address issues as they arise. services continues to positively impact on the service provision for children vulnerable to exploitation. The partnership have established risk assessment meetings which are victim focused. A range of partners meet to share information and agree appropriate interventions with young people at risk seeking to reduce this risk. This has proved successful and continues to develop. The district has also established a perpetrator risk assessment meeting, this is seeking to share information and develop tactics to disrupt and convict those who are seeking to exploit children within the district. 22 Chapter 2: Learning and Improvement 2. Learning and Improvement: Rapid 1. Overview Reviews and Child Safeguarding WTSC 2018 states services should ensure that Practice Reviews staff are supported and undertake safeguarding WTSC 2018 guidance revised the terminology training in particular to identify children and from Serious Case Reviews (SCR) to Child families who would benefit from early help. Safeguarding Practice Reviews (CSPR). The WSCP utilises learning from previous multi- partnership has developed a CSPR Group Terms agency safeguarding children training; learning of Reference and updated arrangements in line and action plans from national and local Child with national legislation to support and facilitate Safeguarding Practice Reviews; CDOP; Section Rapid Reviews and the completion of CSPR as 11 and multi-agency audit; new and amended required. legislation/policy/practice/guidance; feedback WSCP has completed five Rapid Reviews from practitioners and managers; training during the year resulting in two CSPR which are needs analysis findings (2019); further review ongoing. WSCP has ensured that for each Rapid of the traditional training offer and consideration Review and the ongoing CSPR that the learning of the alternative approach to learning and from the reflection and consideration of the development. circumstances that lead to the serious incident have been shared across the partnership and contributed to the development of learning through written briefings to professionals working with children in Wakefield and through multi agency training sessions. 23
3. Learning and Improvement: WSCP courses are updated regularly to ensure Multi-agency Safeguarding Training the content reflects the current local and and e-Learning national information and statistics. A number Multi-Agency Training 2019/20 of courses were updated in 2019, these included: Neglect Including an introduction to WSCP aims to make a difference in the lives the Wakefield Toolkit; Compromised Parenting of children and continue to promote the including an introduction to Adverse Childhood message that ‘Safeguarding is Everyone’s Experiences (ACE’s); Disguised Compliance Business’. This crucial message is given and The Role of Professional Curiosity. In 2019 throughout the delivery of all multi-agency WSCP also advertised a range of training training and conferences arranged and courses about Children and Young People’s coordinated by WSCP. Mental Health which were delivered by Future in WSCP have provided training for professionals Minds practitioners from CAMHS. WSCP training and volunteers from the public, voluntary and courses were delivered to 1711 practitioners community sector. In 2019/20 the training from across statutory and voluntary services, brochure which included 84 training courses between 1/4/19 - 31/3/20; this is a substantial and briefings covering a range of topics, 9 increase on the previous year. courses were cancelled during the period mostly Due to the pandemic, WSCP had to consider in March due to Covid -19. WSCP included a how training could be delivered virtually and number of new courses for 2019/20: what other support and guidance could be • Mental Health First Aid provided. WSCP were aware children were less • Reducing Parental Conflict visible to services and to the community, there was a need to ensure that safeguarding children • Reducing Parental Conflict - Training for was at the forefront of everyone’s mind and the Trainers partnership continued to raise awareness of • Restorative Practice the issues affecting children. With this in mind • Introduction to Safeguarding Supervision WSCP renewed the contract with Virtual College and extended the number of e-learning licences • County Lines from 2000, to 5000. The partnership also added • Drifting into Cyber Crime courses and utilised Virtual College’s updated • YGAM - Digital Resilience in Gambling and courses. Social Gaming • Technology and Children - Potential Issues Affecting Young People Online • Pornography Impact, Research and Resources 24 WSCP’s Safeguarding Campaign was There were three key launched in April 2020 to raise awareness of child safeguarding and neglect, encourage messages: the reporting of concerns and to build a • Ownership - everyone seeing sense of social responsibility in the public safeguarding as part of their community around safeguarding. responsibility A campaign was produced, this included • Spotting - understanding the increased posters, leaflets and social media graphics. potential for harm and understanding The target audience was workers coming into the signs contact with families during lockdown i.e. • Reporting - encouraging people to act community volunteers, supermarket workers, when they have a concern delivery drivers, mail officers etc. whilst those who typically work with children were not seeing The campaign promoted the MASH telephone children as frequently. number as well as directing traffic to WSCP website.
The Campaign emphasised what to do if you have a concern, with the message; if it doesn’t feel right or you have a concern don’t ignore it - report it: Call 03458 503503. 25
Conferences 2019/20 new Multi-agency Perpetrator Risk Assessment WSCP had its inaugural Conference on 2nd Meetings, he also gave thanks to colleagues for December 2019 at the Westfield Centre in South keeping Safeguarding Children at the forefront Elmsall. It was attended by partners from across of everyone’s minds during the pandemic. This the partnership including Early Years, West was followed by Chief Nurse from Wakefield Yorkshire Police, Schools, Health organisations Clinical Commissioning Group Suzannah and the Local Authority. Cookson, who talked about Partnership Working in a pandemic. The event was opened by Stuart Smith, WSCP Independent Scrutineer, who set out the new There was a keynote presentation from Clinical Safeguarding Partnership arrangements. This Researcher and Child/Adult Psychotherapist was followed by a presentation about the new Cath Knibbs on ‘Trauma Informed Practice: Practice Model Connecting Practice and the Child Trauma: Repl’ACE’ing the context’. Karron way this links to the new ways of working - Zelei, WSCP Training Coordinator, provided Wakefield Families Together. The presentation a session on Multi-agency Safety Planning: was supported by 3 workshops which related SMART Planning. West Yorkshire Police and to the three Safeguarding Partnership priorities Crime Commissioner - Mark Burns Williams of responding to Neglect, children and young and Detective Superintendent Chris Gibson people criminally exploited and responding to discussed Safeguarding Issues and Advice the emotional health and wellbeing of children during Covid -19. The Conference had over and young people. The Conference closed with 150 views from a wide ranging multi-agency a presentation by young people who produced a audience. video about their experiences of bullying. The next WSCP Conference is 10th December In February 2020 WSCP arranged and 2020. Further details about this will be coordinated a conference; Learning from forthcoming in the Autumn, there will be a focus Sienna’s Story: A child who died in an adoptive on Neglect as this has featured in two recent placement. 80 practitioners from agencies CSPRs. across Wakefield attended. Speakers at the event included Peter Maddox (author of multiple CSPR in Wakefield), One Adoption Deputy Manager and an Independent Reviewing Officer. WSCP Virtual Conference was delivered as part of Safeguarding Week in June 2020. The Conference was opened by Stuart Smith, WSCP Independent Scrutineer, who provided an overview his role and the role of WSCP during the pandemic. Chief Superintendent, Mark McManus, gave an update from West Yorkshire Police covering the role of the Police and the 26
Virtual Safeguarding Week 22 - 26 June 2020 The live sessions proved to be very popular Safeguarding Week was delivered in June 2020 with 169 practitioners attending. These were virtually. Providing a wealth of workshops as Cyber Security Awareness: Addressing Risk well as support for practitioners to engage with. and Reducing Vulnerabilities; YGAM: Building The sessions were provided by professionals Resilience around Gaming and Gambling; Drugs, from agencies across Wakefield and West what’s it all about, your chance to ask awkward Yorkshire all with extensive knowledge and difficult questions that you always wanted experience in their subject. Additional pre- to ask; and Challenging Stereotypes about recorded resources were also made available Children in Care. The Challenging Stereotypes from nationally recognised speakers on a range session was led by young people. Virtual of topics including Contextual Safeguarding, Safeguarding Week was a huge success, which Online Safety, Trauma and Neglect. was evidenced through the incredible number of hits on the individual YouTube sessions and the There were over 80 different learning increased traffic on WSCP website. The YouTube opportunities offered, which included six live videos commissioned by WSCP generated sessions, narrated PowerPoints, webinars, 2020 views, There were 3 sessions which were videos, podcasts, pre-recorded masterclasses shared across West Yorkshire these had 1588 and Ted Talks. The learning opportunities views which totals 3608. Hits on WSCP website gave practitioners the opportunity to enhance increased from 2,475 in June 2019 to 3302 in their knowledge, skills and understanding on June 2020. a variety of safeguarding topics and themes. There was strong partnership collaboration, the message publicised throughout the week was ‘Safeguarding is Everyone’s Business.’
2020 27 e-Learning Package During the pandemic period there were 2081 Throughout 2019/20 WSCP continued to offer new users of Virtual College and 6,598 courses an e-Learning package to practitioners in completed. This is a 145% increase in the Wakefield. 10 key courses were available to number of courses completed during April - partner agencies and schools provided by the August 2020 than the whole of last year. Virtual College. Courses include Awareness of In 2019 WSCP also introduced Relationship Child Abuse and Neglect, Awareness of Domestic Matters/Reducing Parental Conflict as an Abuse, Safeguarding Children in Education, e-learning option which 81 practitioners have Introduction to FGM, Spirit Possession and completed. Honour Based Violence. During 2019/20 1,856 professionals completed 2,692 online courses accessed via WSCP website, which is a significant increase on the previous year. WSCP decided to significantly increase the number of licences from Virtual College from March 2020 to 5,000, identifying that practitioner requests for this type of training would increase due to the lack of face to face training sessions due to Covid -19. WSCP also updated the courses to the new formats from Virtual College. Courses now include in the package are; Level 1 Safeguarding Children; Level 2 Safeguarding Children; Level 3 Safeguarding Children; Safeguarding Children in; Awareness of Domestic Violence and Abuse; Child Sexual Exploitation; Suicidal Thoughts; Toxic Trio - Hidden Harm, Parental Mental Health, Parental Substance Misuse; FGM and Abuse linked to Faith or Belief; Gang related issues and County Lines; Radicalisation and Extremism; Modern Slavery and Trafficking; eSafety and LBBTQ Awareness; Parents against Child Sexual Exploitation (PACE) online awareness course; ECPAT UK Training on Child Trafficking.
4. Learning and Improvement: Safeguarding 28
Advisor for Education The role of the Safeguarding Advisor for Education is to support all schools and colleges in Wakefield District to safeguard their pupils. This requirement is met through a comprehensive offer of safeguarding training, the annual 175/ independent school regulations audit and provision of general advice and support. Further information is available under the Education tab on WSCP website, including policy templates. Highlights this year include; • A continuation of excellently evaluated training and DSL forums. Including Basic Level Refresher, Advanced Designated Safeguarding Lead (DSL), Strategic Level - Governor, Safer Working Practices, Managing Allegations against Staff, Safer Recruitment and Impact of Pornography. Over 3000 School staff were trained in the Wakefield District. • Successful continuation of Operation Encompass to all schools in the district, including during Covid -19 lockdown. Where notifications of police attended Domestic abuse incidents are sent to schools. • Safeguarding Advisor for Education won the directorate Excellent Employee Award 2019. • A well-attended and evaluated WSCP Education Engagement session in July 2019. 29
Impact of Covid -19 and WSCP Response: • The annual audit was cancelled due to additional pressures on schools and government guidance being updated. • Updated temporary safeguarding policies and checklists were produced for schools in the district. • Regular Covid -19 updates were available via the website. • All face to face training was postponed. However DSL’s and school staff were provided with read through alternatives and DSL specific top ups. Emergency advanced training was produced for schools to access in an emergency e.g. DSL staff sickness, therefore ensuring continuity of safeguarding cover in schools. • Courses were produced virtually including updates on new guidance for schools. This, plus the wealth of other virtual training, was accessed by school staff as part of Safeguarding Week 2020. • Safeguarding Advisor is linked into new Cluster locality meetings as part of Wakefield Families Together and is part of multi-agency audit meetings and subcommittees of the partnership.
5. Learning & Improvement: Procedures, Resources, Guidance and Toolkits 30
West Yorkshire Multi Agency Safeguarding Procedures The following updates have been made during the previous 12 months: Chapter Name Details Initial Child Information in relation to the timescales for submitting reports to the Chair of the Child Protection Protection Conference has been updated to reflect processes in each of the consortium areas. Conferences Child Protection Information in relation to the timescales for submitting reports to the Chair of the Child Review Protection has been updated to reflect processes in each of the consortium areas. Conferences Resolving A new Section 4, Immediate / 24 hour Escalation has been added to explain the process for Multi Agency escalation when a professional is concerned that the situation presents a significant risk to the Professional child and the usual escalation process of 5 days is not viable. Section 3, Process of Resolving Disagreements and Professional Disagreements, has been amended to allow 14 working days for the resolution Escalation of disagreements at step 6 in the process. Steps 1 -5 in the process should not exceed 5 working days. Fabricated or This guidance has been completely rewritten and added to the procedures manual. Please Induced Illness note - The Royal College of Paediatrics and Child Health (RCPCH) guidance ‘Fabricated or Induced Illness (FII) by Carers - A Practical Guide for Paediatricians’ 2009 is currently being updated. Once this review is complete the following guidance will be reviewed and updated as required in line with the revised RCPCH guidance. Pre Birth This guidance which provides information for practitioners on what to do if they have concerns about a pregnant woman and /or her unborn baby has been added to the procedures. Child Abuse This guidance has been reviewed and refreshed as required. In the further information section, and Information a link has been added to the Catch 22 publication Social Media as a Catalyst and Trigger for Communication Youth Violence. Technology Child Abuse This guidance has been reviewed throughout and extensively updated. and Information Communication Technology Harmful Sexual This chapter has been reviewed throughout and extensively updated. Information was added Behaviour with regard to Technology-assisted harmful sexual behaviour (TA-HSB) and Keeping Children Safe in Education (KCSIE) 2018. The Further Information section has been reviewed and updated. This includes the link to the Wakefield Harmful Sexual Behaviour Tool. (Updated April 2019)
Parents with Parents with Learning Disabilities Learning Disabilities
Deprivation of These new online resources provide information on Mental Capacity and Deprivation of Liberty Liberty online in relation to children and young people. Mental Capacity Act online 31
6. Learning and Improvement: Communication Safeguarding children Communication with wider partners is everyone’s business. WSCP uses different methods to communicate During this pandemic children may be out of sight to different audiences. From WSCP Members, but they might not be out of harm’s way. Got concerns? wider safeguarding partners, managers and Don’t ignore it. front line practitioners, to the general public, Report it. children and young people, families, parents, carers and communities groups. The many different ways of communicating to these audiences has been scrutinised during the year and has been agreed that improvements are needed. As has been seen throughout this report, WSCP undertakes a lot of work and Call 03458 503 503 For immediate risk always contact the Police. produces a lot of information through reports, briefings, action plans, adverts, emails, face to face in meetings and newsletters. 237918 Safeguarding Poster 2.indd 1 01/05/2020 15:20 32
7. Impact of WSCP during Covid -19 • Safeguarding Children Vulnerability Tracker Partnership Approach during Covid -19 • Communicating with the wider partnership WSCP developed extensive guidance • Seek assurance locally via audit auditing Safeguarding Children during Covid -19 on national reports from Children’s Pandemic. The guidance sets out how agencies Commissioner and data performance in Wakefield continue to support children and • Developing multi-agency documents setting families during the pandemic which includes: out adjustments to services • Principles of working together during the This approach taken by the executive ensured pandemic senior decision makers were able to respond to • Developing a partnership wide overview of the safeguarding needs of children and families vulnerable children through locality working in a rapid manner by making suitable adjustments • Summary of current offer aligned to the level to multi-agency safeguarding arrangements. The of need for children and families impact of the statutory service’s response to the pandemic was as follows: • WSCP governance group arrangements Response from Children and Young People’s • Individual service arrangements Services The arrangements WSCP coordinated ensured • Children’s Social Care, Children First and there was a clear understanding across the Youth Services remained open and continued partnership as to how children and families to support children and families. This are continuing to be supported throughout the included home, garden and door stop visits. pandemic. The arrangements have been best Schools also provided outreach provision practice across the region for neighbouring which included home visits to those who districts to adopt. were not attending school and free school Safeguarding Partnership Executive meal support WSCP Safeguarding Partnership Executive has • Established local weekly safeguarding a provided a co-ordinating and leading role in forums and vulnerability trackers to provide the response to the pandemic to ensure children assurance to the Safeguarding Partnership and families received support. Executive vulnerable children were being As part of this response the executive increased monitored. This required close partnership the frequency of meetings from bi-monthly working on the frontline across services and to 3-weekly to enhance and strengthen included: governance. Areas of oversight have included: • Locality Safeguarding Teams • Service offer and updates from Children • Children First Hubs and Youth Services and Young People’s Service, Wakefield CCG, • Schools West Yorkshire Police, Public and Education • School Improvement Team 33
• In order to support the above, the School Response from Health Services Improvement Team overnight adjusted their • NHS Wakefield CCG led Silver Tactical roles to focus specifically on safeguarding Children and Young People meetings which which was key in actioning responses to were chaired by the Chief Nurse and included matters arising from monitoring vulnerable representation from health and social care children’s school attendance providers and commissioners across the • Youth Work team undertook a programme of Wakefield Footprint detached outreach work with neighbourhood • CAMHS Improvement plan continues to policing to engage with young people and see support being available more timely for encourage understanding and cooperation young people in Wakefield with restrictions. Some Youth Workers were redeployed to Children Homes to ensure • Mental Health Alliance commissioned they remained open and to create staffing Voluntary Community Sector organisations resilience in our communities to deliver Emotional Well-Being services at a community level • Strengthened the online offer to children early on in Covid -19 wave one and families with daily online chat and group facilities with the launch of WF I Can and the • Team Around the School model piloted with updated Care4Us 9 schools that included input from leads of Emotional Well-being services • Our Family Our Future Programme with the Voluntary and Community Sector. Additional • Mental Health Alliance investment in work took place with the VCS through local 2020/21 is supporting Primary Care community hubs: Networks to develop innovative ‘upstream’ approaches to providing mental health • Supporting on how to make a support for 16-25 age group safeguarding referral • Monthly meetings established between • Children First Hub link worker for each providers of health visiting, maternity area of the district services, Family Nurse Partnership, • Linked to Production Park to provide safeguarding, public health leads and additional food to Food Banks commissioning leads to share information • Partnered with libraries for activity packs and ensure care pathways meet the needs to be included with food parcel deliveries of high risk women and babies and pre- school children. • Established contact with NOVA to keep up to date with any additional need • Multi-Agency Pregnancy Liaison and from Children’s Services bid to support Assessment Group (MAPLAG) which ensures funding application a co-ordinated multi-agency response for high risk women and families has continued to meet virtually 34
• Perinatal Mental Health Services have Response from West Yorkshire Police remained in place with a mix of telephone, • WYP have continued to deliver services as video and face to face appointments for normal in respect of child safeguarding risks. the most at risk. Latest data for specialist services has shown increases in face to face • WYP have sought to maximise the use of appointments technology with partners to facilitate multi agency meetings such as the RAM meetings • Provision of 6 - 8 week baby checks and maintain attendance at ICPC and Strategy continuing in primary care, baby weighing meetings also recommended to take place at these checks • WYP have worked with LAC and Private providers to support the management of • Actions from Wakefield Safeguarding vulnerable children through lockdown / Children’s Partnership “Lockdown Babies” restriction periods report include: • Neighbourhood and YOT officers have worked • Prioritising contacts for families not in double-crewed vehicles to support young previously known to services to be people and deal with related calls seen at face to face appointments in community health services as part of • Committed to partnership working / early help restoration plans; provision around the locality hub model • Prioritise MDT meetings facilitated by • Providing quarterly outcome performance GP practices with virtual safeguarding data relating to offences against children practice meetings with health visitors and midwives, • Guidance to mental health providers to ask whether service users have children and sharing information where appropriate 35
Safeguarding Vulnerable Children Tracker The tracker demonstrated multiple examples of The WSCP Safeguarding Vulnerable Children positive impact to safeguard children, develop Tracker was a key mechanism to monitor those relationships between services, children children who were in receipt of Early Help, Child accessing school: In Need, Child Protection who were eligible for a • Schools were able to highlight issues of school place between March and July 2020. Data non-attendance of children with Children was regularly provided to monitor attendance of and Young People’s Services who made those children and services continually followed contact with families and supported return up with those children who were not attending to schools school to maintain contact. • Arrangements were made with taxi contracts The 6 locality cluster meetings across the to provide transport to children where district aligned to Secondary School pyramids families felt uncomfortable using public and catchment areas which enabled Children’s transport. This supported children accessing Services to organise support around schools school and the children they had on roll around this. • Via the locality cluster meetings schools were • Actions were identified through the tracker to able to highlight safeguarding concerns for ensure plans were put in place accordingly children not previously known to Children via the cluster meetings, this included: and Young People Services which allowed • Co-ordinated support for children and conversations to take place and appropriate families over the summer holidays action identified. • Summer holiday food and activities provided via Our Families Our Future • Schools identified children who may require additional support and details were shared with Early Help Link Workers, the Youth Service and CAMHS 36
8. Future Areas for WSCP to consider WSCP will maintain the commitment to deliver within the 5 priority areas:
1 2 3
Ensure that thresholds Improve the WSCP’s Improve the WSCP’s across the partnership are effectiveness in reducing the effectiveness in reducing the fully understood so children harm to children in vulnerable harm and protecting children receive the right help at the groups, with particular focus on and adolescents who are right time. children and young people at risk of sexual or criminal experiencing neglect. exploitation.
4 5 Review and evaluate the Improve the WSCP’s effectiveness of the partnership effectiveness in reducing to safeguard and promote the the harm and protecting welfare of children and young children experiencing problems people in Wakefield and district, and with emotional health respond to any areas for change and and wellbeing. development through the transition to the new arrangements.
Looking ahead into 2020/21 WSCP has recognised the following areas would benefit from further development to ensure priority areas are progressed accordingly: • Develop service user involvement from children and families • Broaden approaches to communicate safeguarding children developments to service workforce: • Monthly safeguarding children e-bulletin • Increase WSCP generated activity to highlight safeguarding developments • Updated WSCP website to enable guidance, procedures and resources to be accessible more readily • Further develop relationships with Wakefield Safeguarding Adults Board and Community Safety Partnership, with a focus on transitional arrangements between children and adult services • Consider workforce development needs in light of Wakefield Families Together model and impact upon multi-agency practice • Develop a WSCP Quality Assurance and Learning Improvement Framework • Review and establish the Wakefield Child Death process, including CDOP and compliance Child Death Review Meeting 37 Appendix 1 - WSCP Structure 38 Appendix 2 - Relevant Agencies
Wakefield Council Adult Services CAFCASS The Mid Yorkshire Hospitals NHS Trust (MYHT) Wakefield College Bradford District Care NHS Foundation Trust (BDCFT) NOVA (Voluntary and community Sector) Wakefield Council Early Help Services National Probation Service (NPS) NHS England Wakefield District Housing Education (Primary and Secondary and Special Schools) Community Rehabilitation Company (CRC) Public Health - Wakefield Council The South West Yorkshire Partnership NHS Foundation Trust (SWYPFT) Yorkshire Ambulance Service West Yorkshire Fire Service Inspiring Recovery - Turning Point Youth Offending Team (YOT) Spectrum Community Health CIC Child and Adolescent Mental Health Services (CAMHS) SWYPFT
Authors Bev Paris Wakefield Safeguarding Children Partnership Manager (2019 - 2020) Jonathan Giordano Wakefield Safeguarding Children Partnership Manager (2020 - Present)
Title of Governing Body Agenda 15b meeting: Item:
Date of 9 March 2021 Public/Private Section: Meeting: Public Private Paper Title: The Health of Children in Care, Annual N/A Report, 1st April 2019 – 31st March 2020 If private, insert here reason for inclusion as a private paper
Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Sarah Booth, Designated Nurse Safeguarding Children and Title: Children in Care
Annual Report Authors: Dr Bala Seshadri, Consultant Community Paediatrician and Designated Doctor for Children in Care, and Emma Pye, Lead Nurse Children in Care, MYHT Responsible Clinical Dr Debbie Hallott Lead: Responsible Suzannah Cookson, Chief Nurse Governing Board Executive Lead: Recommendation : It is recommended that the Governing Body note the contents of the Children in Care Annual Report 2020. Executive Summary:
This annual report, for the period 1st April 2019 to 31st March 2020, is an update on the current health of ‘Children in Care and Young People’ (CIC & YP) to NHS Wakefield CCG Governing Body. The purpose of the report is to review the work undertaken by the Children in Care Health Team, including the challenges and gaps in service provision and plans in place to redress this. It will make recommendations for improvements for future care delivery as recommended by the Statutory Guidance on “Promoting the Health and Well Being of Looked after Children”, Department of Health, 2015.
As of 31st March 2020, there were 639 children under care of Wakefield Local Authority, compared to 612 on 31st March 2019. In the year ending 31st March 2020, 236 children were taken into care compared to 260 in previous year. Between 1st April 2019 and 31st March 2020, there were 217 children continuously in care compared to 344 in the previous year.
Of the children in care from Wakefield, 256 were placed out of Wakefield District. There were also 356 children in care from other local authorities in care placements in Wakefield District.
During the year ending 31st March 2020: • 231 who were looked after by Wakefield authority ceased to be looked after; • 51 children were approved for adoption; • 37 children were matched with adopters; • There were 135 care leavers - aged between 16 and 19 years, and 117 above 19 years
In the year ending 31st March 2020: • 238 initial health assessments (IHA) were undertaken in the Wakefield area; • Due to covid situation 19 IHAs were done by telephone consultation • There were 15 children who did not attend appointment and there were 4 late cancellations.
93% of children were seen within the stipulated time of 28 days of coming into care. This is an improvement from the previous year when 86.2% were seen in the stipulated time.
In the year ending 31st March 2020, 755 review health assessments were carried out in Wakefield. Children aged 0-5 years require two reviews a year, and children aged 6-18 require one review a year. 95% of the RHAs were done in the recommended time scales.
Recommendations identified within the report for further developments:
1. To improve data gathering and sharing between health and social services regarding mental/emotional health and lifestyle concerns of children in care.
2. In regard to adoption, NHS Wakefield CCG to develop a children in care specification for the service required from MYHT to ensure that the Trust can fulfil the requirements of the contract
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts Not applicable of Interest:
Assurance departments/ Not applicable organisations who will be affected have been consulted: Previously presented at Not applicable committee / governing body:
Reference document(s) / Not applicable enclosures:
Risk Assessment: Not applicable
Finance/ resource Not applicable implications:
The Health of Children in care
Annual Report 1st April 2019 – 31st March 2020
Author: Dr Bala Seshadri, Consultant community paediatrician and Designated Doctor for Children in Care Mrs Emma Pye – Lead Nurse Children in Care
Clinical Lead: Dr Debbie Hallott Executive Lead: Suzannah Cookson, Chief Nurse
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Contents
Chapter Page Introduction 3 Executive summary 4 Background of CiC 6 Children in Care in Wakefield 7 Commissioning/ Provider Arrangements 9 Structure of CiC health team 10 Function of CiC health team 10 Role of Universal Services 12 Role of YOT 12 Health Assessments 13 Spectrum Community Health CiC 15 Mental Health of Children in Care 16 High Risk Behaviour 18 Dental and Eye Checks 18 Drug and Alcohol Services 19 Leaving Care 20 Fostering 20 Adoption 20 Recommendations 22 References 23
Appendix 24
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Introduction
Most children become looked after as a result of abuse and neglect. Although they have many of the same health issues as their peers, the extent of these is often greater because of their past experiences. For example, almost half of children in care have a diagnosable mental health disorder and two-thirds have special educational needs. Delays in identifying and meeting their emotional well-being and mental health needs can have far reaching effects on all aspects of their lives, including their chances of reaching their potential and leading happy and healthy lives as adults. (Statutory Guidance on Promoting the Health and Well Being of Children in care, Department of Health, March 2015)
This annual report, for the period 1st April 2019 to 31st March 2020, is an update on the current health of ‘Children in Care and Young People’ (CIC & YP) to NHS Wakefield CCG Governing Body. The purpose of the report is to review the work undertaken by the Children in Care Health Team, including the challenges and gaps in service provision and plans in place to redress this. It will make recommendations for improvements for future care delivery as recommended by the Statutory Guidance on “Promoting the Health and Well Being of Looked after Children”, Department of Health, 2015.
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Executive Summary
The revised “Statutory Guidance on Promoting the health and wellbeing of looked after children” (2015) requires an annual report on the delivery of services and the progress achieved for the health and wellbeing of children in care who have vulnerabilities over and above those of the general population to be submitted to the Clinical Commissioning Group. The health of children in care (CiC) is monitored through initial and review health assessments and the development of an individual health plan.
As of 31st March 2020, there were 639 children under care of Wakefield Local Authority, compared to 612 on 31st March 2019. In the year ending 31st March 2020, 236 children were taken into care compared to 260 in previous year. Between 1st April 2019 and 31st March 2020, there were 217 children continuously in care compared to 344 in the previous year.
Of the children in care from Wakefield, 256 were placed out of Wakefield District. There were also 356 children in care from other local authorities in care placements in Wakefield District.
During the year ending 31st March 2020: • 231 who were looked after by Wakefield authority ceased to be looked after; • 51 children were approved for adoption; • 37 children were matched with adopters; • There were 135 care leavers - aged between 16 and 19 years, and 117 above 19 years
Initial Health Assessments
In the year ending 31st March 2020: • 238 initial health assessments (IHA) were undertaken in the Wakefield area; • Due to covid situation 19 IHAs were done by telephone consultation • There were 15 children who did not attend appointment and there were 4 late cancellations.
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93% of children were seen within the stipulated time of 28 days of coming into care. This is an improvement from the previous year when 86.2% were seen in the stipulated time.
Review Health Assessments:
In the year ending 31st March 2020, 755 review health assessments were carried out in Wakefield. Children aged 0-5 years require two reviews a year, and children aged 6-18 require one review a year. 95% of the RHAs were done in the recommended time scales.
The Health Informatics service provides the children in care health team with a monthly report on the number of initial and review health assessments undertaken, the report also highlights whether the assessments have been completed within timescales. The health informatics service set the process up however the CIC team admin run reports.
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Background – Health of Children in care
Children and young people in care are particularly vulnerable to poorer health outcomes than their peers. Information obtained from the Office for National Statistics highlights that:
• Approximately two thirds of all children in care have at least one physical health complaint. • Children in care are more likely to experience problems including speech and language problems, nocturnal enuresis, co-ordination difficulties and eye or sight problems than their peers. • Around 60% of children in care in England have been reported to have emotional and mental health problems; this is four times as many as the population in general.
The health needs of children and young people in care are often linked to their experiences, including the circumstances in which they became looked after and their experiences of being in care.
• Children and young people in care are more likely than their peers to have experienced the death of a parent or sibling. • Nearly a quarter of young people in care aged 11 -17 report having experienced some form of sexual abuse. • Around 5% of children in care are unaccompanied asylum seekers.
Children in care may need additional help to look after their own health because of their complex health needs and experiences:
• Children in care are around 10 times more likely than their peers to have significant learning needs, which for many will have implications for how they can best be supported to understand health promotion messages, manage risk, and be engaged in decisions about their health. • Children and young people in care are around 3 times more likely to drink regularly and more likely to smoke than their peers. They are around 4 times more likely to simultaneously be a smoker, regular drinker and drug user. • Risky behaviour such as unprotected sex also appears to be particularly prevalent. Both looked after young women and young men are more likely to become teenage parents than their peers.
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CHILDREN IN CARE IN WAKEFIELD DISTRICT Children in Care as at 31/03/2020 Number of children taken into care during the year: 236 Number of children leaving care during the year: 231 Number of children in care as at 31/03/2020: 639 Number of children who were in continuous care during the year: 217 Number of Wakefield children placed out of area: 256 Number of children from other LA’s placed in Wakefield: 356
Age Groups Total
Under 1 47
1-4 Years 146 5-9 Years 113 10-15 Years 241 16+ Years 92
Placement Type Total A3 - Placed for adoption with parental/guardian consent with current 0 foster carer A4 - Placed for adoption with parental/guardian consent not with current 2 foster carer A5 - Placed for adoption with placement order with current foster carer 2 A6 - Placed for adoption with placement order not with current foster 19 carer H5 - Residential accommodation not subject to children’s homes 4 regulations K1 - Secure unit 0 K2 - Childrens homes 55 P1 - Placed with own parents or other person with parental responsibility 56 P2 - Independent living with or without formal support 30 R1 - Residential care home 13 R2 - NHS/ Health trust or establishment providing medical or nursing care 0 R3 - Family centre or mother and baby unit 0 S1 - All residential schools , except where dual-registered as a school and 0 children’s home T0 - All types of temporary move 0 U1 - Foster placement with a relative or friend 32 U3 - Fostering placement with relative or friend who is not long term or 58 FFA U4 - Foster placement with other foster carer - long term fostering 165 7 U5 - Foster placement with other foster carer who is an approved 10 adopter U6 - Foster placement with other foster carer - not long term or FFA 193 Grand Total 639
How many care leavers were there during the year? 252
Age Total 17 0 18 66 19 69 20 64 21 53
How many children in secure units and Childrens homes at year end? 55 How many children in care lived with foster carers at year end? 458 Number of asylum seeking children during the year? 41
Commissioning Arrangements
Statutory guidance sets out responsibility for commissioning health care for children and young people in care up to the age of 18 (Statutory Guidance on Promoting the Health and Well Being of Looked after Children, Department of Health, March 2015)
The originating Clinical Commissioning Group remains the responsible commissioner even when a child is placed outside the local authority boundary.
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Where a CCG or a local authority, or both where they are acting together, arrange accommodation for a Child in Care in the area of another CCG, the “originating CCG” remains the responsible commissioner for any health services required for the child.
Provider Arrangements
NHS Wakefield CCG commission Mid Yorkshire Hospitals NHS Trust (MYHT) to provide health services for Children in Care via joint commissioning arrangements. South West Yorkshire Partnership Foundation Trust provides Child and Adolescent Mental Health Services for children in care.
The Bradford District Care Trust 0-19 Service provides specialist and universal health services for children and young people in care living in Wakefield who are looked after by Wakefield Local Authority.
Children who reside outside the Wakefield boundary but who are looked after by Wakefield Local Authority either have services provided or co-ordinated by the Specialist Nurse Advisors - dependent on their location. The MYHT Children in Care team undertake health assessments and provide health services for children looked after by other authorities placed within the Wakefield boundary; charges are made to the originating CCG for this by MYHT service under the Standard Charging Tariff.
Medical input into the needs of children in care are provided by the MYHT Community Paediatric Team; this includes Initial Health Assessments and the provision of several services to which children in care and young people can be referred to, e.g. Child development clinics, Attention Deficit Hyperactivity Disorder (ADHD) and Autistic Spectrum Disorder (ASD) assessments. If specific health problems are identified during the health assessments children are referred to the appropriate specialists or followed up in community paediatric clinics.
Structure of the Children in Care Health Team
Mid Yorkshire Hospitals NHS Trust Children in Care health team consists of:
• One Designated Doctor for Children in Care 1.5PA per week • 1 full time lead nurse – who is also doing her masters along with her role in CiC team. 9
• 1 - full time band 6 • 1 - 26 hours a week band 6 • 1 – 22.5 hours a week band 5 • There is currently a full-time vacancy. • One Children in Care admin who is full time (37.5)
The NHS Wakefield CCG Head of Safeguarding is the Designated Nurse for Children in Care and supports the Children in Care health team by acting as a link between commissioners, provider servicers, Wakefield and District Safeguarding Children Board as well as the Local Authority.
Although Community Paediatricians working in MYHT see the children in the IHA clinics, the Trainee Doctors posted to Community Paediatric Department also do the IHA after with adequate training and supervision. This is part of their training and helps meet the service needs of the department.
Function of the Children in care Health Team The role of the Children in Care (CiC) Health Team is to provide the link between the Local Authority Family Services, health and other professionals so that Children in Care receive high quality health care provision. This includes health assessments, interventions and health promotion.
The CiC Health Team: • Initiates and coordinates Initial Health Assessments within 28 days of a child being received into care of the Local Authority; • Initiates and coordinates Review Health Assessments: 6 monthly for children aged under 5 years, and annually for children 5 and over; • Operate an Initial Assessment Clinic conducted by a Community Paediatrician/ paediatric trainee doctors • Provide training and support for practitioners to complete health assessments and implement recommendations for follow up interventions; • Determine the quality of all health assessments undertaken using a national quality assurance tool; • Contribute to CIC reviews; • Offer health advice and support to children, young people, carers, residential staff, social workers and the leaving care team; • Undertake individual or group health promotion to promote healthy, safer lifestyles and minimise more risky behaviours; • Register young people for “C card” and provide condoms; 10
• Contribute health expertise to panels such as Complex Care, Corporate Parenting Panels, Risk Assessment Meetingsl and Children in Care Strategy and Operational Group • Undertake pre-adoption medicals; • Receive three monthly group safeguarding supervision facilitated by a MYHT Named Nurse for Safeguarding Children in line with MYHT Safeguarding Supervision policy.
The Nurse Advisors – CiC undertake review health assessments and ongoing interventions where children in care fulfil specific criteria including:
• Young people in residential care • Young people aged 16 – 19yrs • Children or young people referred by a Social Worker to Specialist Nurses • Children or young people not engaged in education • Children or young people who are not accessing universal services • Children looked after by Wakefield who reside outside the Wakefield boundary (up to a 50-mile radius from the centre of Wakefield)
All review health assessments completed by the 0-19 service, health visitors and school nurses, are also quality assured by CiC nurses. This process is a robust quality assurance having previously identified inconsistencies in quality and completeness of review assessments. The Lead Nurse for CiC has offered further and ongoing bespoke training sessions to all the 0-19 health visitors and school nurses focusing on what is expected from a review health assessment.
Trainee doctors are given training on carrying on initial health assessments by the designated doctor and lead nurse in the CiC team. Supervision and advice are also provided to the trainees by the community paediatricians when needed.
The role of universal services
Universal 0-19 health services provided by the Bradford District Care Trust offer the Healthy Child Programme to all children and young people including those who are in care. School nurses and health visitors undertake review health assessments which may identify the need for interventions and services beyond the universal provision of the Healthy Child Programme. In these instances, the school nurse or health visitor will plan and deliver interventions or refer to other appropriate services to meet identified health needs.
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Training for health assessments for new staff is provided by the nurse advisors from the CiC team who support and mentor new staff around health assessments.
All training is aligned to the competences for health staff working with children in care (RCN, RCPCH, 2015). Health practitioners in universal services and the CiC Health Team liaise and work together to ensure the health needs of all children in care are met and that there is robust case management and oversight. This is facilitated through effective communication which can be face to face, written and utilisation of the shared electronic patient record.
The Role of Youth Offending Service
The Specialist Nurse – Youth Offending Service (YOS) offers a dedicated health service to children and young people who are involved with youth justice services. The Youth Offending team works across the district with 10 to 17-year olds who are in the youth justice system. The Health Advisor offers health advice and helps with any other health needs. They do this by offering therapy or working with other appropriate healthcare teams to ensure the right care is provided. The Specialist Nurse – Youth Offending Service works very closely with the children in care health team to ensure the health needs of this vulnerable group of children and young persons are met. There are quarterly meetings between the lead nurse and YOS nurse in order to coordinate services for children in care.
Health Assessments- Initials and Reviews
Statutory guidance provides a framework by which to assess and meet the health needs of children in care. In line with this guidance the MYHT CiC Health Team undertakes an initial health assessment on all children/young people coming into care. From this assessment a health plan is formulated to inform the child, parent, carer, agency and Independent Reviewing Officer of the health needs of the child and the interventions required to ensure these needs are met. The plan also identifies the person who is responsible for 12
delivering the agreed interventions, and the timescales in which these will be achieved.
Local Performance Measures are in place to ensure completion of initial health assessment within the statutory 28 days of a child coming into care.
Statistics on Initial Health Assessments
In Wakefield, initial health assessments are undertaken on a weekly basis, with four appointments per clinic. During 2019/2020 there were:
IHA’s undertaken between April 2019 – March 2020 238 Number of clinics offered 91 Total number of clinic slots 262 Utilized clinic slots 257 Of those 257 utilized slots how many undertaken via telephone due to Covid-19 between March 2020 – April 2020 19 Blanks slots 5 DNAs 15 Late cancellation 4
93% of children were seen within the stipulated time of 28 days of coming into care The main reasons for the breach in the time scales for IHA are delayed notification and children not being brought for the appointments.
Statistics on Review Health Assessments
During the year 2019/2020, 755 review health assessments were done. 95% of the children had the health assessment completed in the time scale. The average number of health assessments performed per month was 62. Please note this is counting some patient more than once as children younger than 5 had more than one assessment.
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The CiC nurses provide a service to Wakefield children placed by the local authority within a 50 mile radius from the centre of Wakefield. There can be delays in the conduct of RHA for children placed beyond this distance. For these children, the local health service is requested to undertake the assessment. There have been delays due to other CiC team’s capacity. The area to which the request has been sent may have clinics which are not flexible, so a child has to wait for an appointment to become available or that the authority requests the child’s GP to complete the review health assessment leading to delay.
Quality Assurance of Health Assessments
In Wakefield, all health assessments are quality assured by the Specialist Nurse Advisors, using a nationally approved quality assurance tool. The purpose of this being to: • Ensure that children in care receive a robust and accurate assessment of their health needs, with planned interventions to meet these needs • Provide feedback to individual practitioners to improve the quality of health assessments • Identify training and development needs • Data collection for Commissioning Services
Review health assessments and initial health assessments which do not meet all the criteria in the quality assurance tool are returned to the practitioners with recommendations as to the improvements that are required in the quality of the assessment, or plan. This can result in delays in the final completion of the assessment report.
Spectrum Community Health CIC Spectrum delivers the Integrated Sexual Health Service, Relationships and Sex Education and Child Sexual Exploitation Support in the Wakefield District. Integrated Sexual Health Service The delivery of contraception and sexually transmitted infection management to all, regardless of age, gender, sexuality and postcode. The intention is that the services are easily accessible to ensure that onward transmission of infection is minimised,
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and the risk of unwanted pregnancy is minimised, as contraception can be commenced as soon as the patient attends (medical history permitting). Services provided: • Provide C-Card training to professionals working with young people. This enables young people to access free condoms. • Postal testing for chlamydia and gonorrhoea • STI testing and treatment • Contraception • Emergency contraception (morning after pill) • Advice and referral regarding unplanned pregnancy • Outreach clinics in Normanton, Castleford, Pontefract and South Kirby Referrals: • Walk-in clinics • Telephone for an appointment Relationships and Sex Education Specialist Relationship and Sex Education (RSE) team who deliver classes and events to secondary schools, colleges and youth groups with structured learning and education. The lessons use evidenced based behaviour change techniques which are underpinned with local data around social norms, teenage pregnancy and STI’s. Referrals: • Young people must attend a school, college or youth group to receive this service. Child Sexual Exploitation Support Specially designed therapeutic group sessions to support young people in Wakefield who are either experiencing, at risk of, or coming to terms with, sexual exploitation. Group sessions consist of up to 6 young people and are held on a weekly basis, for 6-8 consecutive weeks. Sessions can take place at schools, youth clubs, pupil referral units or other community settings. Each session presents RESPECT values: Relationships, Sexual health, Positivity, Exploitation, Consent and Trust. Referral criteria: • Young people aged 11-18 • Not currently receiving CSE support from social care or other organisations • Referrals can be made by parents/carers, schools, any professionals working with the young person and self-referrals
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Mental Health of Children in care in Wakefield- Emotional Well Being Team
Children in care are four times more likely to experience poor emotional wellbeing and mental health difficulties compared to children living with their birth families (Tarren-Sweeney & Vetere, 2014). By virtue of the fact they have been separated from their significant family members and often placed with what they would see as strangers, can often be as traumatic at the time as the lived experiences of the child/young person. There are several policies that highlight the priority for the provision of services to support the emotional wellbeing of children in care, for example guidance published by the Department of Education and Department of Health in 2015. Most of these policies and guidance also highlight the need for local authorities and health services to work together to provide these services. Additionally, given the above it is imperative that children in care should have the right to the support they need to promote healthy emotional wellbeing at the earliest opportunity as opposed to waiting for a crisis to occur (NSPCC, 2015).
The Wakefield Emotional Wellbeing Team (EWBT) has been redesigned to improve the Local Authority’s offer of emotional, behavioural and mental health provision for children in care and their foster carers/caregivers and professional team around them. In doing so it is envisaged that children/young people should receive timely service, with the appropriate assessed level of intervention and ongoing support provided from everyone involved in their day to day care. This will inevitably avoid unwanted placement breakdowns and create a safer, more stable and secure environment for the child/young person to live in.
The EWBT support children and young people aged 0-18 who are in the care of Wakefield Local Authority and their caregivers (including foster carers, connected carers and residential staff). The team provide therapeutic support to children and young people who are experiencing social, behavioural, mental and emotional wellbeing difficulties which are having an impact on their ability to function in everyday life and placement stability. They work directly with children and young people, and/or their caregivers to assess their therapeutic needs and provide interventions to assist with building resilience and recovery from everyday stresses, traumatic experiences and attachment-based difficulties. The team understand that to help children reduce their fear and shame and promote self-regulation they need to be parented in a therapeutic way. As such, the team provide attachment focused parenting support to caregivers, in order to assist the forming of a trusting and connected relationship with the child or young person. 16
The EWBT are the Single Point of Access for referrals for Wakefield children in care (with the exception of those young people presenting in crisis and requiring specialist mental health assessment and/or intervention) and EWBT are responsible for triaging these referrals. The EWBT now operates within a Joint Agency Pathway with the new Enhanced Outreach Team (EOT) based within Wakefield CAMHS, the joint offer is to provide emotional and mental health support for Wakefield children in care and their caregivers in a timely manner and at the most appropriate level of intervention required. A representative from EOT attends a joint service meeting on a weekly basis to discuss any new referrals or any active cases which require transition from either EWBT or EOT and the reasons why that level of intervention is required. This ensures a smooth and timely movement of cases between the services and to avoid unnecessary delay for children and young people. The EWBT have adopted a new working model being the Team Around the Children approach, which ensures that any package of intervention incorporates direct support with the child/young person, caregiver alongside upskilling and consulting with the professionals involved in the care package, to ensure they are able to offer the required level of support both during and post EWBT involvement. This should assist in early intervention from the professionals already involved if future situations arise and avoid placement instability. Alongside this the referral pathway and operational processes have also been redesigned incorporating new timeframes, SDQ required with referrals, evaluations including SDQ at case closure and performance measures. This is all still within its infancy and in development stages but is already demonstrating an improvement in joint working arrangements, timeliness of service provision and positive outcomes for children in care. EWBT and EOT offer joint monthly consultations to the Wakefield Local Authority residential homes for children in care. Additionally, EWBT offer consultation, advice and support to social worker and other professionals both case related and professional practice development. EWBT have assisted with developing the new pathway in relation to SDQ’s and will be involved in offering joint training to social workers, fostering social worker and foster carers in relation to SDQ’s. This should ensure that all the above have a clear understanding of what is an SDQ, the process for completing this assessment, the scoring criteria, what needs to happen next and where this is recorded for data to be captured. Future development is currently being explored for EWBT to work jointly with the Child in Care Nursing Team in offering SDQ Clinic’s to social workers for scores in the borderline and high range, to ensure support, referrals and/or intervention is provided to the child/young person from the most appropriate service at the earliest opportunity.
High risk behaviour among Wakefield Children in care
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SystmOne can now capture data on life-style choices for children in care which have health implications. During the last year
69 different patients coded for one of the following:
Number of CYP Current drinker 21 Ex-drinker 6 Ex-smoker 12 Smoker 55 Misused drugs in past 22
34 patients had only one code recorded. 23 had 2 of the codes and 12 had 3 codes applied.
Dental and eye checks
76% of children had a dental check and 22% of children were examined by an optician. During the IHAs and RHAs children have an oral health examination.
School going children have hearing and eye checks done by school nurses and only if there are concerns these children will be seen by opticians.
Immunisations During this period, 92% of the children have their immunisations up to date.
Wakefield Young People's Drug & Alcohol Service - CGL
CGL are commissioned to deliver a substance misuse service for children and young people aged 10 to 17 years inclusive (up to 24 for those young people who are leaving care, with learning difficulties and/or disabilities) and their families.
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This is provided through tailored packages of interventions for children, young people and their families who:
• Reside in Wakefield
• Are identified as vulnerable to or experiencing substance use or impacted by parental substance misuse
• Are known to the Youth Offending Team and/or Children First Hubs. The service is available to children and young people who are in the care of the Council. The service will take most of its referrals from the YOT and Children First Hubs using a dedicated referral pathway and these referrals take priority in terms of allocation for screening, assessment and case management, although currently there is no waiting list.
• Will work flexibly to provide the required support at a venue to best suit the needs of the individual case
• Referrals are allocated to a case worker within 5 days of a referral being received. All service users will have a substance misuse treatment intervention in place within 15 days of a referral
The overall outcome for the Young Persons substance use service is to improve the resilience of children, young people and their families in order to increase abilities to navigate risk taking behaviours within the changing nature of substance use amongst children and young people. There is a team of three community workers and one worker co-located in the Youth Offending Team. We have a single point of contact and anyone can make a referral or request advice – this includes young people or other concerned persons.
Leaving Care
Children who have lived in the care of the local authority often have no knowledge of their family health (for example inherited health conditions and traits). To assist them, a ‘Leaving Care Health Summary’ has been devised information in consultation with the Wakefield Children in Care Council (CiCC) and the format was been updated in 2016/17. The CiCC have had input into the design. This is a 2-page document and a copy is given to the young person, the GP and the Local Authority Leaving Care Team. A detailed leaflet is also given with summary on how young person can access services independently.
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In the year ending 31.3.2020, there were 252 care leavers who were between the ages of 16 to 21. Of these 135 were 19 years and below and 117 were between above 19 and below 21 years.
Fostering
The statistics for 2019/2020
There were 22 Fostering Panels in total.
There were 51 Approvals in total. • 19 Mainstream approvals • 31 Connected Person approvals • 1 Connect/Short Break approval
There were 24 Deregistration’s in total. • 10 Mainstream carers • 13 Connected Person carers • 1 Connect/Short Break carer
Adoption in Wakefield
One Adoption West Yorkshire is the agency which provides adoption services for the region.
One Adoption West Yorkshire is made up of the 5 separate Local Authority adoption agencies which individually provided adoption services for the West Yorkshire area. Bradford, Leeds, Calderdale, Kirklees and Wakefield have joined to form the largest adoption agency in the North of England. This new agency is designed to offer an innovative and adopter friendly approach to adoption recruitment, adoption support, and family finding for children and prospective adopters as well as high quality training Since setting up of regional service the adoption panels are now held in Leeds, Bradford and Huddersfield.
One Adoption West Yorkshire currently provides the following services:
• Recruitment and assessment of adopters; • Family finding for children; • A range of adoption support services; 20
• Panel management; • Education support for adopted children; • Increase adopter involvement; and • Would be funded by contributions from individual agencies.
2019/2020Data on Adoption
• 51 Wakefield children had a SHOBPA decision in 2019/20. • 37 children from Wakefield were matched at adoption panel • 14 households were approved as prospective adopters • There was 1 child from Wakefield where there was breakdown of adoptive placement. There has been marked decrease in the number of households who were approved as prospective adoptive parents. There were 109 households approved as adopters in previous year.
As per the regional guidelines, children need to have had a medical examination or update within 3 months of adoption panel.
This is considered good practice as many children are seen when very young when developmental or other medical problems are not always evident. This is a period when there is rapid change in infants and in order to provide detailed information the children are now offered a review pre-adoption medical. The medical advisors are also required to meet the prospective parents and their social workers face to face in the clinic to discuss the child’s medical background and the implications of this for the child in the long term. Despite the increase demand the children had their pre-adoption medical reports submitted in required timescales.
In the year 2019/2020, there were 90 pre-adoption clinics and 146 children were seen.
Year Pre-adoption medical 2017-2018 78 2018-2019 109 2019-2020 146
The data indicates the growing demand for pre-adoption medical services.
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Recommendations
1. To improve data gathering and sharing between health and social services regarding mental/emotional health and lifestyle concerns of children in care.
2. In regard to adoption, NHS Wakefield CCG to develop a children in care specification for the service required from MYHT to ensure that the Trust can fulfil the requirements of the contract
Board Members are asked to acknowledge and endorse the contents of the report
References
Department of Education (2015) Children Act 1989: care planning, placement and case review Volume 2 Department for Education: London 22
House of Commons Education Committee (2015/16) Mental health and well-being of looked-after children House of Commons: London (http://www.publications.parliament.uk/pa/cm201516/cmselect/cmeduc/481/481.pdf)
Royal College of Paediatrics and Child Health et al (2015) Looked after Children: Knowledge, skills and competences of healthcare staff RCPCH: London http://www.rcpch.ac.uk/system/files/protected/page/Looked%20After%20Children%2 02015_0.pdf
Department of Health (2015) Statutory Guidance on Promoting the Health and Well Being of Looked after Children Department of Health: London https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/41336 8/Promoting_the_health_and_well-being_of_looked-after_children.pdf
Department of Education (2016) Adoption- A Vision for Change Department for Education: London https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/51282 6/Adoption_Policy_Paper_30_March_2016.pdf
Royal College for Paediatrics and Child Health. 2017. Refugee and unaccompanied asylum seeking children and young people: paediatric health assessment. Available at: https://www.rcpch.ac.uk/improving-child-health/child-protection/refugee-and- unaccompanied-asylum-seeking-cyp/paediatric-heal
Children looked after in England (including adoption), year ending 31 March 2018- https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attach ment_data/file/757922/Children_looked_after_in_England_2018_Text_revised.pdf
Appendix 1
Policies and Legislation Relevant to Children in Care
Children Act (1989)
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The Children Act 1989 provides a comprehensive framework for the care and protection of all children and young people in need, including those living away from home. The Act defines a child as being “looked after” by a local authority if he or she is in their care or is provided with accommodation for a continuous period of more than 24 hours by the authority. These children fall into four main groups:
• Children who are accommodated under a voluntary agreement with their parents (Children Act 1989 – section 20) • Children who are subject to a care order (section 31) or interim care order (section 38) • Children who are the subject of emergency orders (sections 44 and 46) • Children who are compulsorily accommodated. This includes children remanded to the local authority or subject to a criminal justice supervision order with a residence requirement (section 21)
The Legal Aid, Sentencing and Punishment of Offenders Act (2012)
This Act confers ‘looked after’ status to children and young people who are remanded to local authority or youth detention accommodation, where the local authority is held responsible for the care plan of the children.
Children (Leaving Care) Act (2000)
This Act amends the Children Act 1989 and places responsibility on local authority to assess and meet the needs of children leaving care. Young people from the age of 16 years are care leavers and remain the responsibility of the CIC Health Team until they reach 18 years of age.
Children Act (2004)
The Act provides the legislative framework for the government's strategy for improving children's lives through the Every Child Matters agenda. Key provisions included the creation of the post of Children's Commissioner for England, closer joint working and information sharing between agencies involved with children, the introduction of Local Safeguarding Children Boards and a duty on local authorities to promote the educational achievement of children in care.
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Statutory Guidance on Promoting the Health and Well-being of Looked after Children (2015)
This document provides statutory guidance to all agencies involved in meeting the health needs of Children in care and Young People. It defines the roles, responsibilities and processes within and between organisations with the purpose of promoting co-operation between agencies and improving and promoting the health, well-being, safety and welfare of children that are taken into care. This document details ‘best practice’ guidelines to all agencies working with children and young people in care. This document sets out the requirements for children in care to receive holistic health assessments as follows:
• Every Initial Health Assessment should result in an individual health plan being formulated. There is a statutory requirement for the Initial Health Assessment to take place within 28 days of the child/young person being received into care. • The Initial Health Assessment should be undertaken by a medical practitioner in accordance with the Care Planning, Placement and Case Review (England) Regulations 2010. • Review health assessments should be completed every 6 months for children less than 5 years of age and annually for children over 5 years of age. • The health plan should be reviewed at the child’s Statutory Review as part of the child’s overall care plan. • The health assessment is not an isolated event, but part of a continuous process, with emphasis being put on ensuring actions and interventions in the health plan are being taken forward. • There are clearly identified responsibilities regarding the NHS’s contribution to the health of children in care; these can be divided into three main categories: − Commissioning effective services; − Delivery of services through provider organisations; − Individual practitioners providing co-ordinated care for each child or young person and their carer.
Local authorities are responsible for making sure a health assessment of physical, emotional and mental health needs is carried out for every child they look after, regardless of where that child lives. Regulation 7 of the Care Planning, Placement and Case Review (England) Regulations, 2010 requires the local authority that looks after them to arrange for a registered medical practitioner to carry out an initial assessment of the child’s state of health and provide a written report of the assessment 25
Statutory Guidance on Promoting the Health and Wellbeing of Looked after Children (2015)
NICE guidance on Promoting the Quality of Life of Looked after children and Young People – PH28 (2010)
This document is a joint guidance from NICE and SCIE for all professionals who have a role in promoting the quality of life (physical health, social, educational and emotional well-being) of children and young people in care. The focus of the document is on professionals, carers and children working together to promote the quality of life of the children and young people.
Care Standards Act (2000)
The main purpose of the Act is to reform the regulatory system for care services in England and Wales. Care services range from residential care homes and nursing homes, children's homes, domiciliary care agencies, fostering agencies and voluntary adoption agencies through to private and voluntary healthcare services (including private hospitals and clinics and private primary care premises). Local authorities are required to meet the same standards as independent sector providers.
Children and Young Persons Act (2008)
The Act is intended to reform the statutory framework for the care system in England and Wales, and to make provisions in relation to well–being of children and young people, private fostering, child death notification to Local Safeguarding Children Boards and appropriate national authorities.
Children and Families Act 2014
This guidance replaces previous guidance regarding adoption and details a new quicker, faster process for adoption to tackle unacceptable delays in adoption.
The act includes a number of new measures to protect the welfare of children, including: • Changes to the law to give children in care the choice to stay with their foster families until they turn 21.
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• A new legal duty on schools to support children at school with medical conditions better. • Making young carers’ and parent carers’ rights to support from councils much clearer. • Reforms to children’s residential care to make sure homes are safe and secure and to improve the quality of care vulnerable children receive. • A requirement on all state-funded schools, including academies, to provide free school lunches on request for all pupils in reception, year 1 and year 2. • Amendments to the law to protect children in cars from dangers of second-hand smoke Appendix 2
Local Partnerships and Forums to Support Health of CiC
Children in Care Council
Although CiC nurses do not usually attend the Children in Care Council (CiC) meetings, there is close liaison between the Participation worker from the CiC and CIC nursing team. Advice is provided to the Participation worker when needed. The CIC nurse can attend the meetings if requested. CiC team have worked with the participation worker who worked with CiC to update the 18 year leaving care health summaries.
Corporate Parenting Boards
The corporate parenting responsibilities of a Local Authority are defined within Statutory Guidance for Promoting Health (Departments of Education and Health: 2015)
The corporate parenting responsibilities of local authorities include having a duty under section 22(3)(a) of the Children Act 1989 to safeguard and promote the welfare of the children they look after, including eligible children and those placed for adoption, regardless of whether they are placed in or out of authority or the type of placement. This includes the promotion of the child’s physical, emotional and mental health and acting on any early signs of health issues.
The Lead Nurse for Children in Care is a member of the Corporate Parenting Panel. Quantitative and qualitative health data is presented at the panel, as is 27
direct consultation and feedback from children in care, foster carers, partners and elected councillors. This is a quarterly meeting.
Child Sexual Exploitation (CSE) Strategy Meetings
The CiC Lead nurse attends CSE strategy meetings and the Multi-Agency Child Sexual Exploitation (MAACSE) Panel. It is well recognised that children in care especially children placed in residential care (children’s homes) are at greater risk of going missing and being vulnerable to sexual and other exploitation.
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Title of Governing Body Agenda 16 meeting: Item:
Date of 9 March 2021 Public/Private Section: Meeting: Public Private Paper Title: NHS Wakefield Clinical Commissioning N/A Group Risk Register
Purpose (this paper is for): Decision Discussion Assurance Information
Report Authors and Pam Vaines, Governance Officer Job Titles: Responsible Clinical Not Applicable Lead: Responsible Ruth Unwin, Director of Corporate Affairs Governing Board Executive Lead: Recommendation:
It is recommended that Governing Body: i Note the Risk Register as of 21 January 2021.
Executive Summary:
As at 21 January 2021there were 53 risks on the Risk Register following a full review cycle. This included 26 risks with identified links to Covid-19. The risk register was approved by the Quality, Performance and Governance Committee on 28 January 2021.
A review cycle consists of a review by the Risk Owner, Senior Manager and Director. Each risk is scored, allocated a risk appetite score (target score) and, where necessary, cross referenced to any entry on the Governing Body Assurance Framework (GBAF). The controls and assurances in place are reviewed and updated.
The Risk Register was accepted as an accurate representation of the risks faced by Wakefield CCG at the Quality, Performance & Governance Committee on 28 January 2021.
The Risk Register was then archived in preparation for the first cycle for 2021/22 which commenced on the 29 March 2021 with a two-week review period for Risk Owners.
The Risk Register is brought to Governing Body twice a year for oversight and will be presented again in June 2021.
At the end of the risk cycle in January 2021, three risks were approved for closure and five new risks were identified.
The risks approved for closure by Quality, Performance & Governance Committee are: • Quality of care provision in care homes and domiciliary care sector • Delivery of the flu vaccination • GP branch closures due to the impact of Covid-19 on staff
The new risks approved by Quality, Performance & Governance Committee: • Covid vaccination programme • Repatriation of children and young people from out of area placement • Provision of care for patients with ‘long Covid’ • Confidential data breaches due to email errors • Community and crisis mental health services.
The 53 risks on the risk register in January 2021 scored as follows: • Critical Risks (scoring 25-20) – 3 risks • Serious Risks (scoring 16-15) – 9 risks • High Risks (scoring 12-8) – 26 risks • Other risks (scoring 6 or below) – 15 risks
Details of the Critical and Serious Risks are detailed at Appendix 1. Risks linked to Covid-19 are highlighted with a red risk number. The full Risk Dashboard is attached at Appendix 2.
A new risk cycle commenced on 29 March 2021.
An audit of Covid-19 Risk Management Governance was carried out by Internal Audit. The report issued in January 2021 provided a finding of Significant Assurance.
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated The relevant equality impact assessment was carried out in line Impact Assessment with the Integrated Risk Management Framework. completed (IIA) Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts None identified of Interest:
Assurance departments/ All relevant directorates of NHS Wakefield CCG have been organisations who will consulted regarding the Risk Register. be affected have been consulted: Previously presented at The Risk Register was approved at Quality, Performance & committee / governing Governance Committee on 28 January 2021. body:
Reference document(s) / Appendix 1 – High level Risks enclosures: Appendix 2 – Risk Dashboard
Risk Assessment: This is the risk assessment mechanism for NHS Wakefield CCG
Finance/ resource None identified implications:
Appendix 1 - All risks Risk ID Date Created Risk Rating Risk Score Target Target Score Risk Owner Senior Manager Final Reviewer Principal Risk Key Controls Key Control Gaps Assurance Controls Positive Assurance Assurance Gaps GBAF Ref GBAF Entry Description(s) Risk Status Components Risk Components No(s) Rating 621 01/05/2015 20 (I4xL5) 6 (I3xL2) Simon Rowe Simon Rowe Jonathan Webb There is a risk that the CCG will fail to meet the 1) Trust wide Cancer Waiting Time Recovery Action The current challenges 1. Monthly reporting to the CCG quality and ● WY&H cancer alliance are working with all The system needs to established the new 8.1 This risk is entitled, 'There is a risk that our direct Static - 1 Archive(s) required cancer standards including 2ww, 31 day Plan receiving weekly review and updates by the ● Absence of a dedicated CCG cancer lead to performance committee and to Governing Body providers to plan for the new normal governance and meeting structure to review activity response to Covid19 compromises other services'. and 62 day cancer waiting time targets due to Trust Lead Cancer Management Team. oversee this work 2. Weekly elective care monitoring report ● The Independent Sector is being utilised for and performance in advance of the IAF assurance operational performance at Mid Yorkshire Hospitals 2) Dedicated approaches to Urology, Gynaecology ●Diagnostic capacity in endoscopy and Radiology 3. Quality issues escalated to the Trust Quality elective cancer work meetings with NHE/I. IAF reporting has been on NHS Trust (MYHT) and other cancer providers, and Lower GI, which impact on the 62 day standard, ●Pathology capacity both in MYHT and LTHT delays Committee with CCG presence ● Urgent cancer elective care has continued during hold during COVID resulting in an adverse impact on the quality of care with short term and long term action plans to impacting on some pathways 5. NK & W Cancer Locality Group COVID-19 albeit at a reduced rate. Pontefract has and patient experience, and a failure to meet key address these. ●Access to diagnostic tests provided at LTHT (PET) 6. Cancer Alliance - ICS monitoring become a cancer hub site for cancer elective national targets potentially resulting in reputational 3) Overall performance tracked through routine delaying pathways 7. Healthy Futures commissioning collaborative in surgery. damage to the system and having a negative governance, including monthly exception reports to ●Oncology capacity constraints,in particular the West Yorkshire, specially relating to cancer services ● Clinical pathways are being reviewed to facilitate a reputational impact on the CCG. There is an QPG. Lower GI pathway and improving access to diagnostics. digital response - eConsultation, telephone increased risk more recently due to COVID phase1 4) Cancer is identified as a priority in the West ●Access to radiotherapy in Leeds consultation and video consultation. and wave 2, which has resulted in delayed treatment Yorkshire and Wakefield system Plans. ●Reduced capacity due to COVID-19 ● Division of Medicine reviewing Oncology capacity for patients and a delay in patients presenting with 5) Risk also monitored via the Governing Board and demand an initial problem. Assurance Framework. Endoscopy backlog is significant following COVID - ● Urgent cancer elective care has continued during capacity is being sourced from Methley Park COVID-19, albeit at a reduced rate ● Pontefract has become a cancer hub site for cancer elective surgery, albeit at a reduced capacity rate of 70% ● WY&H cancer alliance is leading on and are working with all providers to plan for the new normal ● The Independent Sector is being utilised for elective cancer work ● Clinical pathways are being reviewed to facilitate a digital response - eConsultation, telephone consultation and video consultation. ●FIT testing and results now completed / go the GP.
685 29/07/2015 20 (I4xL5) 12 (I4xL3) Natalie Tolson Karen Parkin Jonathan Webb There is a risk that Mid Yorkshire Hospitals NHS The Quality, Performance & Governance (QPG) No internal gaps within the CCGs reporting and 1. Monthly RTT Tracker Performance data is under constant review. The future meeting structure of MYHT Contract Static - 3 Archive(s) Trust (MYHT) will continue to fail to meet the Committee receive a monthly Performance Report assurance process have been identified. However, 2. Performance report to QPG MYHT have processes in place to monitor the Steering Group has been confirmed. The new required standard for Incomplete 18 week Referral which details the CCGs performance against the with the new functions of the Planned Care 3. Quality Intelligence Group incomplete waiting list and to monitor patient safety oversight board has been established with a primary to Treatment (RTT) which will result in the CCG NHS constitutional standards and relevant exception Improvement Group (PCIG) now in place and the 4. Quality surveillance; serious incidents; patient and risk. purpose of re-design and transformation. failing to deliver the NHS Constitutional standard. reports. Terms of Reference for the Joint Acute System experience; and CCG complaints data. There is a weekly activity and performance report Performance monitoring via JASOG is currently This may also impact on the quality of care of Oversight Group (JASOG) still being defined, there 5. MYHT Reset Programme Scorecard is shared provided on elective care. being reviewed and developed. Until this process is patients, including increased waits and the potential The joint system Integrated Assessment Framework is a gap in the key control to monitoring performance weekly with the CCG. RTT performance at specialty level is reviewed in place, there is a gap in assurance via this Group. for delayed treatment and diagnosis. This increased will also provide a system oversight going forward. and escalating performance issues between the 6. RTT phased performance trajectory has been put weekly at the MYHT Access and Performance risk is due to COVID-19 and the reduction of CCG and Trust. in place at the Trust to support the incomplete Group. planned elective/outpatient activity during COVID Joint oversight board established - first meeting held waiting list. waves 1, 2 and 3. 20 Aug 2020 and governance structure agreed at The arrangements for a system oversight group in ICP 25 Aug. response to the IAF assurance process were also underway prior to COVID. A plan will be required ENT is the specialty driving the RTT position at going forward. MYHT. Joint work between the Trust and CCG is in place to review ENT contracting arrangements, with Oversight Board met 20 Aug 2020, however there the view to seeking support from the AQP sector. are still gaps in defining the projects, workstreams, This has now been put into place via an insourcing performance and measurement. and outsourcing option which will help to clear the backlog waiting list position.
879 19/09/2016 20 (I4xL5) 9 (I3xL3) Natalie Tolson Karen Parkin Jonathan Webb There is a risk of 52 week breaches being reported The Quality, Performance & Governance (QPG) No internal gaps within the CCGs reporting and Performance dashboard and related exception Performance data is under constant review. The future meeting structure of MYHT Contract Static - 3 Archive(s) at Mid Yorkshire Hospitals NHS Trust (MYHT) and Committee receive a monthly Performance Report assurance process have been identified. reports are sent to QPG on a regular basis. MYHT have processes in place to monitor the Steering Group has been confirmed. The new at other neighbouring Acute Trusts Due to COVID- which details the CCGs performance against the Performance is monitored utilising the tools available incomplete waiting list and to monitor patient safety oversight board has been established with a primary 19. During COVID phase 1, activity was reduced NHS constitutional standards and relevant exception Terms of Reference for the Joint Acute System in the NHS Standard Contract. and risk. purpose of re-design and transformation. resulting in excessive patient waits, poor patient reports. Oversight Group (JASOG) now agreed and The weekly Trust Reset Scorecard is shared with Performance monitoring via JASOG is currently outcome and failure of the 52 week referral to programmes of work underway. the CCG. being reviewed and developed. Until this process is treatment (RTT) NHS Constitutional Standard. The Trusts Reset Programme is also scrutinising All providers are now submitting the national in place, there is a gap in assurance via this Group. Planned elective work has further been impacted by the waiting list standards at specialty level. Weekly Integrated Assurance Process - joint oversight performance returns which allows the CCG to the second wave of COVID. performance data is being shared across the Trust group required prior to the IAF with the NHSE/I. monitor performance across all providers. and CCG. More regular, monthly monitoring should be MYHT aims to reduce 52 week breaches and a considered at a future point in time once the urgency trajectory is in place to support performance Due to the phased return of elective work a realistic of the pandemic is over. improvement. There is a specific focus on ENT, short-term target has been established. which is the specialty driving the over 52 week Delay in the outsourcing solution for ENT which is position at MYHT. The reset programme includes weekly reporting on impacting on the 52 week position. MYHT is elective activity in comparison to last year. revising the 52 week ENT performance trajectory as The activity Plan submissions to NHSE was a a result. compliant plan
1696 09/12/2020 16 (I4xL4) 8 (I4xL2) Miranda Berry Jo Fitzpatrick Jo Webster There is a risk that the CCG is unable to deliver the - Programme Management facilitated by CCG - Regional and System Vaccination Operation - Weekly highlight report to Wakefield CCG Senior - Weekly highlight report to Wakefield CCG Senior - Wakefield interface with System Vaccines New - Open rate of vaccine provision / achieve uptake as per the Programme Manager & KPMG Centres yet to be established Leadership Team & Integrated Care Partnership Leadership Team & Integrated Care Partnership Operations Centre still to be developed national Covid-19 Vaccination Programme - SRO, programme managers and work stream - Wakefield Place interface with Vaccination Board Board - Trajectories and KPIs still to be confirmed requirements. leads with clear lines of responsibility & Operations Centres yet to be established - Twice weekly High Level Plan updates to KPMG & - Twice weekly High Level Plan updates to KPMG & accountability - Foundry (data capture) not yet in use nationally WY&HP WYHP This is due to the availability of; trained workforce, - Twice weekly Wakefield Covid-19 Vaccination - Trajectories and KPIs still to be confirmed - Twice weekly workforce updates to KPMG & - Twice weekly workforce updates to KPMG & vaccine supply, national IM&T systems, and public Steering Group WY&HP WYHP appetite for immunisation. - West Yorkshire & Harrogate Partnership - Site readiness assessments for all sites / Go No - Wakefield HLP & readiness discussed at SRO programme management with regional line of Go checklist meeting Resulting in our population not being protected from accountability - MYHT site readiness meeting held with WYHP / the virus, higher morbidity and mortality, continued - WY&H Programme Lead / KPMG Programme WYAAT Lead high demand for health and care services, inability to Manager - Spectrum site readiness meeting to be held with restart the local economy, media interest and - WY&H Workstream leads eg HRD Group, WYHP / WYAAT Lead (Go No Go checklist) reputational damage. IM&T Group - Daily readiness assessments for PCN sites (wave - Twice weekly WY&H Programme Manager 1) meeting - Clinical assurance site visit / readiness for PCN - Daily SRO meetings sites (wave 1) Friday 11th Dec - PCN project plan - Inequalities project plan - Social Care / Local Authority project plan 1600 10/06/2020 16 (I4xL4) 12 (I3xL4) Simon Rowe Simon Rowe Jonathan Webb There is a risk of patients not receiving Secondary - There is an agreed plan for the restarting of routine - There is an need to agreed how the new national The Change of Clinical Pathways Meeting has Oncology, Stroke, Elderly Medicine, Neuro Rehab There is a need to revisit the current plan with 8.1 The GBAF entry is entitled, 'There is a risk that our Static - 1 Archive(s) Care services, due to routine referrals to MYHT elective care at MYHT, by speciality contracting approach for IS hospitals will impact on invested clinician time from MYHT, NK CCG and W and Orthogeriatric will be added to eConsultation MYHT, given that a second wave of the pandemic direct response to Covid-19 compromises other being paused as part of the COVID-19 response, - There are agreed principles between primary and what is available to MYHT from the Spire Methley CCG to work collaboratively as a system to work soon. has commenced. services'. resulting in potential risk and patient harm. This risk secondary care clinicians on the use of e- Park hospital. through this programme of work. may be heightened due to wave 2 of COVID-19. consultation to inform when a referral to MYHT is Requests received from specialities to provide an e- required The agreed plan with MYHT is currently on-track. Consultation service are: - E-consultation is available in 20 specialities •Upper GI Surgery - There is a rolling programme of reviewing e- Two shared routine referral pathways have been •Lower GI surgery consultation between the CCG and MYHT implemented - one in cardiology and the other in •General Surgery - The capacity of the Spire Methley Park hospital is paediatrics. For each e-consultation is used being these specialities are the next group to be added to e- being utilised to support MYHT in the delivery of primary and secondary care clinicians to jointly Consultation. routine elective care decide then a routine referral is needed, with the - There is an agreed process for how patient care MYHT then undertaking the appointment bookings. should be transferred between MYHT and IS service providers -There is a new national contract for how Spire Methley Park hospital can be utilised by the NHS up to the 2010/21 financial year end - There is the 'pooling' of MYHT and independent sector (IS) service capacities in ENT and Gastroenterology, to support reductions in patient waiting times
1506 03/04/2020 16 (I4xL4) 1 (I1xL1) Philip Taubman Judith Wild Suzannah Cookson There is a risk that care providers (domiciliary care, Provision of support from partners to providers, Increasing concerns regarding care provider staff Frequent report via Silver and Gold command All providers are continuing to support Not yet identified Static - 14 care homes and hospices) will be unable to maintain additional capacity being sought, block purchasing resilience patients/clients Archive(s) an acceptable and safe provision of care due to of beds Uncertainty regarding future volume of patients Covid 19 resulting in a reduction in placement Fire-fighting responses, liaison with CQC and IPC discharged from hospital under discharge guidance options and care capacity/care homes being closed colleagues as issues arise Additional capacity (reopening of closed care homes to admissions due to infection Practical support regarding the provision of PPE, and mothballed units) will require resource Due to the extra burden placed on local care education & FAQs (staffing/equipment/it) providers during the pandemic, there may be Regular telephone/skype contact. reduced staffing capacity due to staff sickness and Capacity tracker in place isolation, resulting in families needing to pick up Covid tracker in place to maps infection spread and carer duties which may impact on their overall well- temporary closures due to infection being given respite care will not be available / Additional 20 step down beds commissioned. Virtual reduction in system capacity. care home support team aligned with PCN and IPC leads. Care home manager call every week with Dom care manager calls every fortnight to help support the care sector Liaising with family members/carers to look at alternative and inventive ways to support their family
1507 03/04/2020 16 (I4xL4) 1 (I1xL1) Judith Wild Judith Wild Suzannah Cookson There is a risk to the resilience of CHC staff Staff working well from home. Business continuity Staff working long and unsustainable hours Frequent Silver and Gold command meetings Service currently continuing to support service Not yet identified Static - 14 Due to Covid 19 plan in place. Staff working from home. Face to Three staff currently not working due to Covid requirements for both core and D2A patients Archive(s) Resulting in the inability to complete new face visits suspended. Reviews taking place symptoms assessments of vulnerable patients post discharge virtually. Core CHC functions continuing to take Two staff currently working notice period under Covid arrangements (Discharge guidance), place. Staff supporting early discharge process at Uncertainty regarding future demand provide funding to care providers and those patients MYHT. CHC staff are being supported by line in receipt of a Personal Health Budget case;provide managers via HR processes. the usual level of core CHC support to patients; and address patient/carer queries as they arise including Fast Track/EOL care.
1471 14/02/2020 16 (I4xL4) 4 (I4xL1) Jeremy Wainman Michele Ezro Melanie Brown There is a risk of increased demand for mental Mental health investment prioritised by the MH None at present however the second surge of Covid Covid-19 monthly SWYPFT and CKW CCGs Provider organisations are working together to Detailed performance information has been Static - 3 Archive(s) heath services due to significant external factors Alliance to address key areas of increased demand. and a further period of Lockdown in November may interface MS Teams meeting. ensure the safety of the people who use/access their suspended by SWYPFT in line with national resulting in increased pressure on services, Regular monitoring impact of existing and new impact on mental health service demand, as we Covid-19 monthly Wakefield Mental Health Alliance services. guidance due to the Covid-19 pandemic, although increased waiting times and a failure to achieve investment.. know it had started to pick up from the previous MS Teams meeting. Some organisations from the third sector accessed regular SITRep reports are provided which highlight mandated standards. Additional capacity via a 24x7 mental health helpline Lockdown. SWYPFT are reporting increased Covid-19 monthly WY&HHCP collaborative meeting. grant funding to upgrade their IT kit in order for them issues and potential solutions. The impact of Covid-19 has raised the likelihood of provided by central NHS funds, allocated via referrals to Single Point of Access and inpatient Covid-19 monthly WY (NHSE and CCG) to provide a virtual access to services. Unknown effects on the economy and future impact until such time that an effective vaccine is WYHHCP. levels remain high. They are noticing increased commissioners meeting. NHSE/I letter 31st July confirmed that The Mental uncertainty regarding unemployment as a result of developed and a mass vaccination programme is Additional bereavement, grief and loss support acuity of presentation at the current time. (Monthly reporting to IGC via the Integrated Health Investment Standard is required to be met Covid-19 may compound the impact on community undertaken. helpline provided via WYHHCP. During November 2020 there was a 300% increase Performance Report.) - limited and Phase 3 submissions provide an update on the levels of anxiety and depression. Children and young people returning to school has Regular meeting of Covid-19 Gold Command and in referrals to CAMHS compared to the summer (Monthly contract monitoring meetings with delivery of Long Term Plan ambitions. These need also impacted on demand for services. cascade of command and control activities to closely when referrals were low. providers including Turning Point and SWYPFT.) - to be monitored closely in the context of anticipated monitor the position. limited increased demand. NHS England Assurance and Oversight Framework A new interactive dashboard is being constructed monthly monitoring. and will be rolled-out but awaiting a date to be Positive briefing to Chief Officer. confirmed. Monitor through Health and Social Care Tactical CAMHS data for Sept is positive. IAPT expected to Group and within the Mental Health Alliance. be back on track for Q4. Frequent communication with health, social and We intend to fully utilise any non-recurrent funding charitable sector partners to ensure continuous made available from NHS England to address feedback for how organisations are responding to demand issues. Covid-19 and acting in accordance with the national guidance. Open survey from Healthwatch Wakefield providing regular service user feedback on common themes and trends for action and response by Health and Care partners.
1597 10/06/2020 16 (I4xL4) 9 (I3xL3) Philip Taubman Judith Wild Suzannah Cookson There is a risk care homes may be expected to Wakefield CCG in conjunction with Wakefield Local Further alternative ways at looking at resources for Care home liaison meetings Feedback from care home liaison Assurance is required to ensure that EOL care is Static - 3 Archive(s) manage more complex care needs (COVID and non- Authority now have a "Hub" to support care homes increased supervision. being offered appropriately via Mainstream COVID related) due to increased demands placed and domiciliary care providers with regards the Provider meetings to identify gaps Feedback from care homes community healthcare services on them during the pandemic. For example; taking increased demand on their services. Lack of care homes willing to accept people whom observations (residential care), supporting COVID have been tested +ve for Covid-19 Broadcare records for where clients are being placed conditions respiratory failure, EOL care , PPE Mainstream community services are also supporting and gaps where care homes are not accepting usage, more end of life care, etc. the providers at this time of increased pressures.
The impact is reduced level of the quality of care WCCG have introduced a Virtual Care Home due to increased demands leading potentially to support team since 4 May 2020 whom are linking in poorer outcomes for morbidity and mortality. with all the care homes in the Wakefield area to offer support and guidance.
WCCG are sourcing and procuring PPE for care homes, domiciliary providers and surgeries and are distributing these to areas that need them most.
Increased support for those clients whom may require increased support such as increased funding for 1:1 supervision, these are important now as homes are attempting to reduce the possibility of cross infection which may mean a person requires increased support to avoid "Green" wards/areas 1605 12/06/2020 16 (I4xL4) 12 (I4xL3) Simon Rowe Karen Parkin Jonathan Webb There is a risk - when faced with the Covid-19 - Ability to redirect patients from the A&E to - Further work required to consider the options and - An agreed pathway for the redirection to alternative - Access to Integrated Urgent and Emergency Care - A&E activity levels are increasing Static - 3 Archive(s) pandemic - of being unable to minimise the number alternative services for same-day appointments. opportunities associated with the talk before you services is now in-place, and is monitored regularly; and Enabling Seamless Patient Journeys - NHS 111 is only commissioned to deliver 30% of of patients in the A&E department - Known capacity for the alternative services that walk strategy and how this can be further developed - Agreement from the walk-in service and the Covid - Telephone and video consultation has been the 50% National trajectory. There is therefore a Due to how patients choose to present with their can receive patients redirected from A&E and adhered to by all services and the public primary care assessment centres to receive patients successful in both in and out of hours hospital care concern that here will be more resource required to same-day urgent care need, - Established approach to be able to survey patients - Managing staff absence and its impact on already redirected from the A&E according to evaluations undertaken, and this can be deliver on the talk before you walk strategy Resulting in the potential that this compromises the presenting to the A&E stretched A&E capacity - Established local forum to review the Directory of maintained whilst living with covid and beyond social distancing measures within the A&E. - Established social distancing guidelines within - To formalise an approach to minimise and manage Services to inform NHS 111 call handers when - A new governance structure - with the integrated (20/10/20) A&E Departments long waiters. there is an alternative to the A&E care partnership at the centre - has been agreed, - Known NHSE/I trajectories for the talk before you - In-place reporting mechanism into the new joint which will enable partners to collectively discuss walk strategy acute oversight board. urgent care - Developed communication strategy for public - Monthly West Yorkshire ICS Programme Board to behaviour to encourage talk before you walk gain understanding, assurance and alignment at a - Ongoing practice in-place to manage long waiters West Yorkshire system level. in the A&E
776 18/01/2016 15 (I3xL5) 9 (I3xL3) Natalie Tolson Karen Parkin Jonathan Webb There is a risk that Diagnostics 6 week wait The Quality, Performance & Governance (QPG) No internal gaps within the CCGs reporting and Performance dashboard and related exception Performance data is under constant review. The new Acute Oversight Board and governance Static - 3 Archive(s) performance will fail the required 99% standard due Committee receive a monthly Performance Report assurance process have been identified. Previously reports are sent to QPG on a regular basis. The endoscopy backlog has reduced significantly structure has been agreed (Aug 2020) with the to waits at Mid Yorkshire Hospitals NHS Trust which details the CCGs performance against the PCIG would have been a key control to monitoring Performance is monitored utilising the tools available and the majority of the over 6 week waiters are now primary purpose of re-design, transformation and (MYHT) resulting in the CCG failing to deliver the NHS constitutional standards and relevant exception performance and an escalation route between the in the NHS Standard Contract. in radiology. Improvements in capacity for CT and strategy. The system still therefore needs to develop NHS Constitution standard and may result in poorer reports. Trust and CCG. A new process & forum as part of All providers are now submitting the national MRI are expected to improve this position. The a formal structure for reviewing performance ahead patient experience and lower quality outcomes. This the joint IAF (integrated assessment framework) is performance returns which allows the CCG to Radiology service have suggested reopening to of the IAF meetings with NHSE/I. has been caused predominantly by COVID-19 and The monitoring of referrals has increased from yet to be put into place. monitor performance across all providers. routine direct access referrals from the GPs for CT the reduction/slowing down of routine activity. monthly to weekly. Weekly Trust Reset Programme Scorecard is and MRI, this has been planned for 21st Dec. MYHT's organisational priority is cancer diagnostics shared with the CCG. MYHT continue to review performance via the weekly MYHT Reset Programme are closely monitoring and therefore impacts on routine activity. Access and Review Performance Meeting and weekly referral trends at specialty level and a trigger Endoscopy Task and Finish Group. / escalation process is in place. A significant proportion of the radiology equipment 1 Extra CT scanner has been acquired (Aug 2020). remains beyond end of life which impacts on routine diagnostic capacity.
1169 19/04/2018 15 (I3xL5) 12 (I3xL4) Samiullah Choudhry Samiullah Choudhry Suzannah Cookson There is a risk of overspend of allocated 20/21 Monitoring of monthly price concessions and price Where there are no suitable alternatives to Medicines Optimisation, within current capacity, are Alternative recommendations have been put in place Proactive reporting from BI to identify anomalies in Static - 5 Archive(s) prescribing budget due to central price increases increases to produce alternative advice for prescribing and price concession is high volume low currently monitoring impact of Category M drugs with the NCSO alerting system; Despite the grim prescribing trends (quantities and cost)- working brought about by: prescribing, where appropriate, on those drugs cost/ high cost low volume/high cost high volume. increases in their own therapuetic ares and price forecast of extra costs; Wakefield is one of the currently with BI to include in new suite of reports- 1. National stock shortages of drugs (price affected. It should be noted that for many of these Resource in GP practices that would be required to concessions and offering some advice about lowest for impact of extra NCSO costs in WY this has been delayed due to redeployment as a concessions), even more so due to Covid drugs there is no suitable alternative, therefore the enact the changes recommended was redeployed suitable alternatives. demonstrating that the mitigation is taking effect. result of Covid - but this will be part of reset overordering and/or; price increases need to be monitored through from March to August 2020 to support practices in Full in-depth analysis is performed monthly and 2. Renegotiations of reimbursement of category M impact assessments so as to inform finance reports. implementing electronic ordering and repeat analysis undertaken by the Meds Opt team with Drug Tariff drugs (national increase of £15m per Current forecasted cost impact is extra £3.2 million dispensing to enable the increase access to recommendations for switches for NCSO/Price month from June 2020 and unlikely to decrease for for 20/21. medicines for patients and reducing workload for Concessions. This will form an advice bulletin that the rest of the financial year) QIPP agenda and delivery has been paused until practices. will be issued to GP practices every 2 weeks with 3. Drugs entering back into stock but at a higher further notice due to COVID-19 (technicians unable The primary care medicines optimisation lead has accompanying messages on the point of prescribing reimbursement price in the Drug Tariff*, resulting in to go out into practices). been redeployed into COVID-19 vaccine delivery. software ScriptSwitch. Possibility of reclaiming extra cost pressure; That is a significant reduction in capacity in the costs incurred due to NCSO and overordering leading to risk of CCG possibly not meeting financial meds opt team. during Covid Phase 1 from NHSE as 'Covid costs'. statutory obligations.It is unclear at this point as to The Head of Meds Opt is now the senior Meds Opt team have recently being using whether prescribing costs will be included in NHSEI responsible officer for covid-19. This reduces technology to deliver lunchtime MS Teams learning COVID costs adjustments. capacity massively. She will be reporting to gold and events for prescribers in GP practices; it is planned As of September 2020, the financial impact (ie extra silver command. to use this method for other staff groups e.g. costs) of price concessions, drugs that have been prescription clerks in order to widen the audience for out of stock and returning at a higher price, and any messages about cost-effective prescribing and category M increases for 20/21 full year effect is reducing waste forecast in the region of £3.2 for Wakefield CCG Risk Cycle 4, December 2020 – Appendix 2: CCG Risk Dashboard for January 2021 Governing Body, 9 March 2021
CCG Risks Cycle 4 Movement of Risks in Cycle 4 Risk Score Increasing 2
Total Risks 53 New Risks 5 Risks Score Decreasing 3 Open Risks 50 Marked for 3 Risk Static 40 Closure
Risk Overview
600 558 Total scores531 on open risks524 504504 505 502 478 500 New Risk 415 Score Risk Level 372 400 343 1-3 Low risk 333 Risk Score Increasing 4-6 Moderate risk 300 2018/19 8-12 High risk 200 Risk Score Decreasing 2019/20 15-16 Serious risk 100 2020/21 20-25 Critical risk Risk Score Static 0 1 2 3 4 Closed Risk
Title of Governing Body Agenda 17 meeting: Item:
Date of 9 March 2021 Public/Private Section: Meeting: Public Private Paper Title: Performance, Quality and Assurance N/A Report If private, insert here reason for
inclusion as a private paper Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Natalie Tolson, Head of Business Intelligence Title: Nicola Richardson, Performance, Data and Information Analyst Lucy O’Lone, Quality Co-ordinator Responsible Clinical Dr Adam Sheppard, Chair Lead: Responsible Jonathan Webb, Chief Finance Officer Governing Board Suzannah Cookson, Chief Nurse Executive Lead: Recommendation (s): It is recommended that the Governing Body:- 1. Note the current CCG performance against the Single Performance Framework (NHS Constitutional standards, Oversight Framework and CCG Long Term Plan metrics); 2. Note those indicators where performance is below target and the mitigating assurance/ actions provided; and 3. Acknowledge the actions agreed by the Quality, Performance and Governance Committee.
Executive Summary
Due to the current on-going COVID-19 situation a number of performance measures are not being reported against.
The report includes a summary of the Performance, Quality and Assurance Report presented at Quality, Performance and Governance Committee (QPG) in January 2021. The report includes the following:- - Constitutional measures - December 2020 - Mental Health - December 2020 - Demand and Activity - January 2021 - Mid Yorkshire briefing - Clinical risk and patient experience for those waiting over 52 weeks - Latest CQC ratings - Broxbourne House and Whitwood Grange (Residential Homes) - Community Mental Health Services Survey 2020
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts The outcome of CQC inspections to General Practice may of Interest: present a conflict of interest for Governing Body GP members. Assurance departments/ Performance organisations who will Quality be affected have been Transformation consulted: Integrated Commissioning Primary Care Co-commissioning Previously presented at Quality, Performance and Governance Committee – 28th January committee / governing 2021. body:
Reference document(s) / Not applicable enclosures:
Risk Assessment: Mitigating actions have been included within the report and risks are captured as appropriate in the Governing Body Assurance Framework and Corporate Risk Register. Finance/ resource Mitigating actions required to improve performance or quality are implications: assessed on an individual basis for any finance or resource
implications.
2/23/2021 GB Cover Sheet
Performance, Quality and Assurance Report December 2020
Governing Body March 2021
1/1 2/23/2021 GB - Executive Summary Executive Summary
This report provides a strategic overview of the CCGs Quality Assurance Framework and high level performance against both constitutional and national standards that are used to assess the CCGs overall rating as part of the Oversight Framework, Long Term Plan and Annual Operational Plan.
Due to the ongoing COVID-19 situation, a number of performance measures are not being reported against. The Oversight Framework, which was the prime focus of the performance report has not been updated. As a result, the performance report includes an update against the national constitutional standards.
The Quality, Performance and Governance Committee (QPG) reviews the full performance report and the separate quality reports on a monthly basis.
Constitutional Performance: > A reduction of outpatient and elective surgery capacity to prepare and manage acute hospital services during the COVID-19 outbreak has had a knock on effect to some of the CCGs waiting time measures. Capacity for urgent and suspected cancer continues to be prioritised by Mid Yorkshire Hospitals NHS Trust (MYHT) which also impacts on other responsive performance measures. > Referral to Treatment (RTT) – 18 week performance continues to show an improved position from 73.3% in November to 75.3% in December, however in this month 880 patients breached 52 weeks. > Diagnostics – Performance against the 6 week waiting time standard improved for the seventh consecutive month from 12.6% in November to 4.3% in December, but continues to remain below the 1% national target. > For December, the incomplete waiting list has increased by 227 pathways to 23,496 and reports 14% below the March 19 position. Against the March 20 position, the waiting list reports 10% below. > Cancer Waiting Times - All 3 of the 62 day measures have not achieved standard for December, with 2 of the 28 day measures also not achieving for breast and screening referral. Both the 2 week wait measures continue to meet standard, with breast showing continuous improvement since the performance deterioration in September.
Quality and Assurance: > Broxbourne House (Residential Home) - After an unannounced inspection in September and October 2020, Broxbourne House was rated overall Requires Improvement and achieved Good for the Caring and Responsive domains. Previously in October 2019 the service was rated overall Inadequate and scored Requires Improvement for the Effective domain. > Whitwood Grange (Residential Home) - After an unannounced inspection in August and September 2020, Whitewood Grange was rated overall Inadequate. At the time of inspection the Safe and Well-led domains were only inspected. Previously in August 2019 the service was rated overall Good. > Flu jabs - During Quarter 3 2020/21 the Quality Intelligence Group (QIG) received many examples of positive experiences of care from patients who have had their flu jabs at GP Practices. Overall, patients have felt safe, staff have been professional and the procedures have been organised and efficient. > Community Mental Health Services Survey 2020 - Overall, South West Yorkshire Partnership NHS Foundation Trust (SWYPFT) performed about the same compared to other providers. However, during 2020 the overall patient experience score improved to 7.0 out of 10. Previously in 2019 SWYPFT scored 6.7 out of 10. > 12 hour breaches in Emergency Departments (ED) at MYHT- During Quarter 3 2020/21 MYHT have reported four 12 hour breaches. The YTD figure is 8. The delays have been due to hospital bed availability and waits for transport. There have also been issues with arranging mental health beds for an out of area patient and there have been administrative errors. There was no harm to the patients, and their nutrition and hydration needs were met during their time in ED. 1/1 2/23/2021 CWT Quality of Care and Outcomes - Cancer Waiting Times
Commentary: 2 week wait - The measure for breast has shown a performance improvement since the decline in September, reporting at 96.7% in December, achieving standard. The measure for urgent GP referral continues to maintain standard, achieving 97.8% in December.
62 days wait - All 3 of the measures fail to meet standard for December. The measure for 'urgent GP referral to first definitive treatment' reports a decline at 78.7%. Breaches occurred across a number of tumour types, however a large number were attributed to lower GI, and head and neck, with reasons for delay due to complex diagnostic pathway.
From 1st February 2021, a new rapid diagnostic pathway will be in place at Mid Yorkshire. This will enable patients who have vague symptoms that could indicate Cancer, to be reviewed by a specialist nurse, with diagnostics ordered and undertaken quickly prior to review. This is a positive development that will bring Mid Yorkshire in line with other trusts in West Yorkshire.
1/1 2/23/2021 Planned Care Quality of Care and Outcomes - Planned Care
Commentary: Treatment Function Name % within 18 weeks > 52 weeks Total All Incomplete WL - The Incomplete waiting list has increased in December, but continues to report below the position at Other 76.54% 148 6,546 the end of March 2020 and March 2019. The waiting list is made up of a number of specialties, with Trauma and Trauma & Orthopaedics 62.14% 305 2,715 Orthopaedics, Gastroenterology and Other (largely Pain Management) accounting for nearly half of the incompletes. Gastroenterology 75.03% 8 2,355 18 week and 52 week performance - 18 week performance continues to improve month on month, reporting at 75.3% Gynaecology 77.38% 97 1,852 for December. All specialties except Ophthalmology, report below standard, with Ophthalmology reporting at 92.22%. Ophthalmology 92.22% 4 1,813 Ear, Nose & Throat (ENT) 69.22% 133 1,605 52 week breaches have continued to rise, with Trauma & Orthopaedics showing the highest number of breaches in Urology 78.89% 52 1,284 December at 305. The breaches have occurred across a number of providers with the majority broken down as follows; Dermatology 79.95% 3 1,207
631 at Mid Yorkshire and 115 at Leeds Teaching. General Surgery 65.69% 37 1,023
Plastic Surgery 63.61% 69 882 For Mid Yorkshire, ENT continues to drive the over 52 week position. Specialty level performance trajectories are in place Neurology 80.19% 6 722 to support the Trusts True North standard of zero 52 week breaches against the non-admitted pathway by the end of Cardiology 82.01% 3 467 March 2021. Due to COVID wave 3 and additional pressure on the bed base, the Trust has seen a further increase in the Thoracic Medicine 78.99% 3 414 number of 52 week breaches. The True North standard is not being achieved. Rheumatology 90.68% 4 311 Additional information is provided on the next page further detailing how Mid Yorkshire are managing the clinical risk Neurosurgery 66.99% 8 209 and patient experience for those waiting over 52 weeks. Geriatric Medicine 88.33% 0 60 General Medicine 83.33% 0 24
Diagnostic 6 weeks - Performance continues to report below target but has been steadily improving since June, with Cardiothoracic Surgery 85.71% 0 7
December reporting the lowest at 4.3%. Total 75.25% 880 23,496 1/1 2/23/2021 Planned Care - extra narrative Quality of Care and Outcomes - Planned Care
Briefing - RTT > 52 week waits The purpose of this briefing is to share information provided by MYHT colleagues about how they are managing the potential clinical risks and negative patient experience for patients waiting in excess of 52 weeks, and particularly those waiting over 78 weeks, on an admitted or non-admitted pathway.
Increasing numbers of COVID patients have been in the hospital since the Autumn, meaning MYHT’s ability to treat routine patients has been severely compromised. There are 1,349 patients waiting over 52 weeks, the majority of these waiting for surgery. Nationally, the number of over 52 week breaches has increased. Compared to other West Yorkshire Acute Trusts, Mid Yorkshire reports the second lowest number of 52 week breaches and benchmarks well against all acute trusts across England.
· The over 52 week risk is on the corporate risk register (rated 20) and is regularly reported and discussed at the Trust’s Risk Committee. · Services have completed specialty level recovery trajectories to achieve 0 over 52 week breaches on non-admitted pathway by 31 March 2021 (True North standard) and a reduction in admitted over 52 week breaches. This is a key feature of the Trust’s performance management oversight of specialities, and divisional risks are presented to the Risk Committee. · In line with national guidance, specialties reviewed all patients and categorised them P1-4 nationally specified categories (P tags identify the urgency for treatment), this work was clinically led, and outcomes recorded on PAS. Patients are booked in a strictly clinical, then chronological order. · MYHT have maintained the ability to treat P1 and P2 patients and at times some P3 patients however recent national directives have stated that only P1 and P2 patients can be treated. · The Trust cannot proceed with P3/P4, even if there was capacity to do this, to enable mutual aid to be enacted across the region. The Trust has confirmed that there are no P1/P2 patients waiting over 52 weeks, they are mainly P4 or P5 (where a patient has asked to be delayed until after the pandemic). · During Q1 all patients were made aware in broad terms of the reduction of activity. · In Q3 MYHT wrote to all the patients on the admitted waiting list (who had been added prior to September 2020) to assure them that they were still on the waiting list for surgery but explain the challenges of treating routine patients. All patients were offered an opportunity to have a non-face-to-face appointment with their surgeon if they had any concerns, some patients took this offer up. · MYHT utilised Methley Park Hospital with approx 750 patients treated there between September and November. This capacity has now been reduced by Methley Park, which has impacted on MYHT’s ability to transfer patients there. This is compounded by recent national changed to independent sector contracts so MYHT are actively engaged with Methley Park to ensure full utilisation of whatever capacity they are allowed to use. It is likely the capacity will be used for P2 patients in the first instance, where these patients cannot be treated at MYHT. · MYHT continually discuss plans to increase the amount of planned theatre activity, however this is very much dependent on staffing which at the current time is redeployed to support high acuity areas. · MYHT are now in a mutual aid arrangement for critical care capacity and have been mandated to have ICU beds available and staffed in order to support transfers from out of region. This means that even if ICU is not full staff cannot be sent back to reopen theatres. · There are a cohort of outpatient 52 week waits, particularly in ENT, Oral and Orthodontics. Significant improvement has been made in the ENT backlog since the work that was carried out with the CCG last summer has been implemented and the outsourcing and insourcing is having an impact however it is taking time to get through the more complex patients on those lists. · In addition to the above actions outlined by MYHT, the CCG Quality Team is exploring the feasibility of collating available feedback from those patients affected to understand their experience of the process. Information will be fed back to the next Quality, Performance & Governance Committee meeting. 1/1 2/23/2021 Mental Health Quality of Care and Outcomes - Mental Health
Commentary:
Adult's Mental Health Services: > Access into the Improving Access to Psychological Therapies (IAPT) service, remains consistent at 18.2%, increasing against November. Recovery has also improved reporting at 51.7% in December, after the slight dip of 49.2% in November. > Patient satisfaction for IAPT continues to be high, with November reporting at 94.6%. > Throughout 2020, the number entering treatment within 6 and 18 weeks has remained around 100% across the IAPT service.
Children's Mental Health Services: > Demand for Child and Adolescent Mental Health Service (CAMHS) has started to rise during the months of November and December. In December, the number of children waiting to be assessed was 52 (an increase from 17 in previous months) with 75 waiting to commence treatment. > The longest wait for core CAMHS treatment remains at 15 weeks, with the lowest wait reported in November and July at 13 weeks. > Over recent months the number of children waiting for Cognitive Behavioural Therapy continues to remain low, reporting at 6 for December.
1/1 2/23/2021 Mid Yorkshire - Planned Care Update Mid Yorkshire Hospitals Trust - Planned Care Scorecard
The below table has been captured from the Executive Directors Weekly Snapshot Report produced on the 15th February 2021 by Mid Yorkshire Hospitals Trust, to provide a recent update on their performance measures.
Planned Care Update:
- The over 52 week patient list has seen an upward trend for some weeks now and this is largely driven by the admitted position and lack of elective operating. The Trust's True North Standard of zero breaches against the non-admitted pathway is not being met.
The key risk specialties at the moment are ENT, Oral Surgery and Orthodontics.
Over the last 2 weeks the projected position for the end of March has improved by over 250 patients.
- The diagnostics over 6 week patient list has plateaued.
- For the latest week, outpatient activity reports a delivery rate of 74.7%, elective inpatients reports at 42.5% and daycase reports at 68.5%.
- Routine GP referrals have returned to approximately 1,000 per week, a similar level received during the November lockdown.
- The cancer 62 day backlog has decreased slightly. There is risk to achieving the True North target which is being reviewed through the Cancer Board and Quality Committee.
1/1 2/23/2021 Activity Section Operational Activity (CCG position against last year's activity levels)- December 2020
CCG Activity Delivery Rates (% of last year's activity delivered this year)
EM Description 01 April 2020 01 May 2020 01 June 2020 01 July 2020 01 August 2020 01 September 2020 01 October 2020 01 November 2020 01 December 2020 A&E Attendances - Type 1 & 2 attendances 49.6% 69.3% 76.2% 78.3% 90.1% 86.8% 82.2% 76.1% 73.5% A&E Attendances - Type 3 & 4 attendances 30.5% 51.7% 54.1% 59.8% 75.5% 72.9% 65.8% 58.5% 56.7% Consultant Led First Outpatient Attendances 39.7% 41.9% 65.5% 63.7% 75.9% 90.3% 90.1% 94.5% 93.5% Consultant Led Follow-Up Outpatient Attendances 59.2% 59.5% 80.8% 80.4% 77.9% 92.2% 86.5% 90.7% 97.5% Total Elective Admissions - Day Case 29.4% 32.4% 40.8% 51.0% 68.9% 86.2% 86.3% 80.7% 82.6% Total Elective Admissions - Ordinary 25.1% 23.6% 31.2% 46.2% 58.2% 72.1% 72.5% 49.5% 60.2% Total Non-Elective Admissions - +1 LoS 65.0% 73.5% 82.2% 86.5% 88.4% 98.4% 91.3% 94.2% 93.8% Total Non-Elective Admissions - 0 LoS 40.6% 53.9% 61.2% 60.6% 59.2% 63.6% 49.5% 43.1% 40.2%
Outpatient Activity Trends Elective Activity Trends
Consultant Led First Outpatient Attendances Consultant Led Follow-Up Outpatient Attendances Total Elective Admissions - Day Case Total Elective Admissions - Ordinary 60K 8K
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0K 0K 2017 2018 2019 2020 2017 2018 2019 2020 1/1 Q3 2020/21 Quality Highlights
The Quality highlights presented to the Governing Body are a summary of the key headlines (successes and exceptions) from the Experience of Care report, Quality Exception Report and CQC Inspection Update report that were presented to the Quality, Performance and Governance Committee (QP&GC) on the 28th January 2021. The key headlines are themed against the five principles within the CCG’s Quality Framework. This is a revised style of reporting to reflect the Governing Body’s request for shortened reports whilst not losing the key messages.
Key headlines Place-based reporting Mitigating actions Community Mental Health Services Survey 2020 • The full summary of the survey findings was shared at the Quality • Overall, SWYPFT did not perform better or worse than any other trusts and Intelligence Group (QIG) during December 2020. performed about the same compared to other providers. • The summary has been shared with the relevant mental health • During 2020 the overall patient experience score improved to 7.0 out of 10. commissioners. Previously in 2019 SWYPFT scored 6.7 out of 10. The highest Trust scored • The findings were discussed at SWYPFT Quality Board in December 7.8 out of 10. 2020, and the Trust’s response to the findings will be shared at a future
meeting. The full report is available here. Flu jabs - positive experiences of care During Quarter 3 2020/21 the Quality Intelligence Group (QIG) received many Not applicable examples of positive experiences of care from patients who have had their flu
Successes jabs at GP Practices. Overall, patients have felt safe, staff have been professional and the procedures have been organised and efficient.
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Key Headlines Acute reporting Mitigating actions MYHT’s Patient Experience Sub-Committee Exception Report • All key areas of risks have been discussed at the MYHT Quality Committee on 4th December 2020. • Ongoing increase in support from volunteers. • Positive results from the National Audit of the Care at the End of Life. • National Patient Experience Improvement Framework – the Trust has updated their self-assessment against the framework. • Patient Experience Newsletter based on MYHT’s patient experience priority to improve communication.
Independent Review of Maternity Services at Shrewsbury and Telford Hospitals NHS Trust – the Ockenden Review – local response To meet the requirements of the quality surveillance model the Trust:- The Mid Yorkshire Hospitals Trust submitted their position in relation to the 12 • Has appointed a non-executive director to work alongside the board-level urgent clinical priorities from the Immediate and Essential Actions (IEAs) by the
perinatal safety champion to provide objective, external challenge and required deadline of 14 December 2020. The Trust confirmed compliance with enquiry. all 12 priorities which covered enhanced safety; listening to women and their • Has plans in place to ensure a monthly review of maternity and neonatal families; staff training and working together; managing complex pregnancy; risk safety and quality is undertaken by the trust board. assessment through pregnancy; monitoring fetal wellbeing; and informed
Successes • consent. Will ensured that all maternity Serious Incidents (SIs) are shared with trust boards and the LMS, in addition to reporting as required to HSIB. There are a further two requirements for January/February 2021:- • Will revise the maternity dashboard to include, as a minimum, the required quality measures, drawing on locally collected intelligence to monitor • Complete the NHSEI assurance assessment tool which draws together maternity and neonatal safety at board meetings. elements including: all 7 IEAs; NICE guidance relating to maternity; compliance against the CNST safety actions, and a current workforce gap analysis. Present the completed tool to the Trust Board. An update was provided to MYHT Quality Committee in January 2021, with a Deadline for submission 15 February 2021 with Trust Board proposal for the Maternity Strategy Board to evolve into a Maternity Quality presentation scheduled for 21 January 2021. Surveillance Group. Membership of the group will continue to include the • Confirmation that the Trust has a plan in place to meet the Birthrate Plus CCG, LMS and NHSEI and will provide assurance to the Trust Board against (BR+) standard including confirming timescales for implementation. the requirements within the quality surveillance model. Deadline for submission 31 January 2021 – MYHT has a robust plan in place through the Maternity Transformation work.
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Title of Governing Body Agenda 18 meeting: Item:
Date of 9 March 2021 Public/Private Section: Meeting: Public Private Paper Title: Finance Report Month 10 2020/21 N/A
Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Michelle Whitehead, Head of Finance Title: Responsible Clinical Not applicable Lead: Responsible Jonathan Webb, Chief Finance Officer/Deputy Chief Officer Governing Board Executive Lead: Recommendation:
It is recommended that the Governing Body receives and notes the contents of the report
Executive Summary:
• It was expected that the CCG would break-even by the year end. The latest forecast is a £0.6m surplus.
• NHSE/I‘s reporting requirements prevent the CCG from accounting/forecasting for some future income streams until they are received. Therefore a forecast deficit position is currently being reported which relates specifically to Acute independent sector activity, Hospital Discharge Programme (HDP) funding, and Covid vaccination funding.
• Month 10 financial reporting has been prepared in line with the October 2020 to March 2021 temporary finance regime set out by NHSE/I.
• The CCG is reporting a £1.3m deficit for P10 YTD. This comprises Plan P10 deficit of £1.4m, £2.9m of Acute IS pressure to be funded retrospectively, £1.2m underspend for HDP defunded retrospectively, the benefit of £0.5m reduction in additional roles spending, the benefit of £0.2m Primary Care allocations, the benefit of £0.7m conditional SDF allocation and £0.4m surplus above plan.
• The CCG is reporting a £3.3m deficit for P12 FOT. This comprises Plan deficit of £2.1m, £3.6m Acute IS pressure, £0.2m HDP overspend, less the benefit of £0.7m reduced additional roles spending, £0.3m Primary Care allocation, £1.0m conditional SDF allocation and £0.6m surplus above plan.
• At P10 the CCG is required to report on specific risks and mitigations. Currently, it is assumed that retrospective allocations and reimbursements will be fully received. Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts None identified of Interest:
Assurance departments/ There is a formal monthly reporting requirement to NHS organisations who will England/Improvement be affected have been consulted: Previously presented at Finance Committee committee / governing body:
Reference document(s) / None enclosures:
Risk Assessment: Relevant risks are identified on the CCG risk register
Finance/ resource This report sets out the financial position of the CCG implications:
Finance Report Month 10
2020/21
Date Produced : 11th February2021
Executive Summary – Key Messages • It was expected that the CCG would break-even by the year end. The latest forecast is a £0.6m surplus.
• NHSE/I‘s reporting requirements prevent the CCG from accounting/forecasting for some future income streams until they are received. Therefore a forecast deficit position is currently being reported which relates specifically to Acute independent sector activity, Hospital Discharge Programme (HDP) funding, and covid vaccination funding.
• Month 10 financial reporting has been prepared in line with the October 2020 to March 2021 temporary finance regime set out by NHSE/I.
• The CCG is reporting a £1.3m deficit for P10 YTD. This comprises Plan P10 deficit of £1.4m, £2.9m of Acute IS pressure to be funded retrospectively, £1.2m underspend for HDP defunded retrospectively, the benefit of £0.5m reduction in additional roles spending, the benefit of £0.2m Primary Care allocations, the benefit of £0.7m conditional SDF allocation and £0.4m surplus above plan.
• The CCG is reporting a £3.3m deficit for P12 FOT. This comprises Plan deficit of £2.1m, £3.6m Acute IS pressure, £0.2m HDP overspend, less the benefit of £0.7m reduced additional roles spending, £0.3m Primary Care allocation, £1.0m conditional SDF allocation and £0.6m surplus above plan.
• At P10 the CCG is required to report on specific risks and mitigations. Currently, it is assumed that retrospective allocations and reimbursements will be fully received.
• The CCG has reported nil delivery of the £0.8m efficiency target in the temporary finance regime plan for periods January 2020 and March 2021. This is not considered a risk to the year-end break-even position.
• Further details are provided in the ‘Narrative’ section of this report.
2 2020/21 Financial Summary – 12 Months Budget
YTD FOT Plan Actual Variance Plan Actual Variance £m £m £m £m £m £m Allocation 700.4 700.4 0.0 888.6 888.5 (0.1)
Expenditure (701.8) (701.7) 0.1 (890.7) (891.8) (1.1)
Draft surplus/(deficit) reported to NHSE/I (1.4) (1.3) 0.1 (2.1) (3.3) (1.2)
Month 9 - 10 Covid Out of Envelope 0 (1.2) (1.2) 0 0.2 0.2
Acute IS reimbursement 0 2.9 2.9 0 3.7 3.7
Revised surplus/(deficit) variance (1.4) 0.4 1.8 (2.1) 0.6 2.7
Primary care allocations 0.4 0.0 (0.4)
PCN Additional Role reimbursement 0.7 0.0 (0.7)
Conditional SDF 1.0 0.0 (1.0)
Allocation/income expectations to break-even 0.0 0.6 0.6
The CCG reported against a 6 month temporary finance regime in periods 1 to 6. From period 7 the CCG has reported against 12 months.
The draft deficit forecast outturn includes the Hospital Discharge Programme and Independent Sector overspends that will be covered by retrospective funds .
3 2020/21 Reported Financial Position – 12 Months budget
Annual Budget to Actual to Variance FOT FOT Budget Date Date to date Variance £'000 £'000 £'000 £'000 £'000 £'000 Expenditure Allocation 888,555 700,392 700,392 0 888,555 0
Acute 530,239 408,224 410,871 (2,647) 534,066 (3,827) Mental Health 95,804 73,692 73,991 (299) 96,138 (334) Community 48,300 40,224 40,871 (647) 49,309 (1,009) Continuing Care 34,876 29,871 27,684 2,187 33,539 1,337 Prescribing 66,753 55,872 56,159 (287) 67,181 (428) Co-Commissioning 65,390 54,242 54,264 (22) 65,304 86 Other Primary Care 9,262 7,756 7,462 294 8,637 625 Other Programme Services 32,927 26,038 24,767 1,271 30,831 2,096 Total Programme Services 883,551 695,919 696,069 (150) 885,005 (1,454) Running Costs 7,142 5,898 5,655 243 6,808 334 Total Running Costs services 7,142 5,898 5,655 243 6,808 334 Total CCG Net Expenditure 890,693 701,817 701,724 93 891,813 (1,120)
Surplus/(deficit) (2,138) (1,425) (1,332) 93 (3,258) (1,120)
4 Financial Position at 31 January 2021 - Narrative (1) Under the temporary financial regime the CCG was expected to deliver a break-even position at the year-end. It is now forecast that the CCG will achieve a £0.6m surplus at the year-end.
Due to the period 10 guidance as to when expected allocations can be reported in the financial position, the CCG has reported a £3.3m forecast deficit. £3.9m of the £3.3m deficit is expected to be closed out via allocations/income in the remaining periods. The CCG reported a £3.6m Acute IS spend increase above the baseline allocations received, which is funded retrospectively. The CCG has reported a £0.3m covid overspend to be funded retrospectively for CHC HDP and vaccinations. The CCG has received the full SDF and Primary Care allocations. The £0.7m additional roles is no longer required.
The £0.6m surplus will therefore be achieved as follows: • £(3.3)m deficit reported • £3.6m Acute IS retrospective allocation • £0.3m HDP and covid vaccination retrospective allocations
NHSE/I’s guidance for the latest temporary finance regime to March 2021 requires CCGs to set detailed budgets within centrally advised allocation envelopes. There has been some discretion at a system level and WCCG originally received £2.7m of additional covid funding, on a fair share basis, for periods P7 to P12. At a system level, it was agreed to re-distribute £2m of covid top-up funding to Yorkshire Ambulance Service and Wakefield CCG’s share of this is £0.4m.
As the CCG is the host for the WY&H ICS, it has received £237m system allocations to pass through to NHS trust providers in fixed block value agreements. These system allocations are comprised of NHS Trust top up, covid and growth funding. The CCG included £11.7m of confirmed SDF funding over and above amounts included within baseline allocations at the time of submitting the plan. All expected allocations have been received.
5 Financial Position at 31 January 2021 – Narrative (2) Overspends are noted in red and underspends are noted in green in the narrative below. This is for 31 March 2021 forecast positions.
Total Acute services are £3.8m overspent. NHS Trust and Foundation Trust block payments match the budgets . A review at West Yorkshire system level identified covid system underspends in CCGs and an overspend for Yorkshire Ambulance Service. A West Yorkshire system-wide agreement was reached to re- allocate some of this funding. As noted in the previous slide, Wakefield CCG will re-distribute 0.4m of system covid funding for its share of the £2m. A forecast of Acute independent sector providers indicates a £3.6m increase in costs above the baseline budget but is expected to be recovered through retrospective allocation. A review of the CHC Broadcare system is leading to a £0.1m overspend on the Neuro Rehab budgets. There is a £0.1m increase above plan on other Acute service lines, mainly within non-contracted activity.
Mental Health services are £0.3m overspent. NHS Trust and Foundation Trust block payments match the budgets. Non NHS providers are £0.1m underspent but there is an additional cost pressure within locked rehab and s117.
Community Health service budgets are £1.0m overspent. NHS Trust and Foundation Trust providers block payments match the budgets. There is an overspend due to a deficit identified when setting the Children’s complex care budgets and additional investment in the voluntary sector.
Continuing Healthcare is £1.3m underspent. HDP covid costs are £0.2m overspent but this pressure is expected to be covered through retrospective allocation top up. In period 10, retrospective allocations were received for periods 7 and 8 overspends. Underlying costs are £1.5m underspent and are representative of cost shifting into the HDP model and Acute neuro rehab.
6 Financial Position to 31 January 2021 – Narrative (3) Prescribing is £0.4m overspent, with an emerging cost increase in the second half of the year, indicated by latest BSA forecasting data.
Co-Commissioning is £0.1m underspent to budgets.
Other Primary Care is £0.6m underspent mainly due to underspends in GP access and GP IT due to alternative arrangements and additional funding to respond to the covid pandemic.
Other Programme services are £2.1m underspent. £1.4m SDF allocation benefit resulting from being unable to change the planned £2.1m deficit reported to NHSE/I, which was inclusive of these missing allocations. £0.7m benefit within CCG reserves.
Running Costs are £0.3m underspent. The CCG is forecasting to meet the running cost target.
Deficit – Stands at £3.3m at the year end and comprises the following elements. • £3.6m Acute IS spend increase over baseline allocation expected to be closed out by funds before the year-end. • £0.3m CHC HDP and covid vaccination pressures expected to be closed out by funds before the year-end. • £0.6m expected year-end surplus
Alternatively, the £2.1m plan deficit plus the £1.1m total cost overspend to plan results in a £3.3m forecast deficit.
7 Performance Indicators
Summary of Key Financial Measures FOT RAG Indicator rating Programme spend within plan R Running costs spend within plan G QIPP delivery N/A Mental Health Investment Standard (MHIS) 6.4% G Cash balance at month end is within 1.25% of monthly drawdown A % of Maximum Cash Drawdown Utilised (MCD) A Better Payment Practice Code (Number processed) G Better Payment Practice Code (£) G
• Programme spend – This is due to the retrospective recovery of covid-19 costs and allocations that have not yet been received
• QIPP - NHSE/I is not currently monitoring QIPP under this regime. The CCG reviewed its QIPP plans and identified that some schemes are unlikely to be met due to the current operational requirements.
• Cash - The cash target is still a requirement. The % of Maximum Cash Drawdown Utilised will remain amber due to the prepayments made in April 2020 as per NHS England guidance.
8
Title of Governing Body Agenda 19 meeting: Item:
Date of 9 March 2021 Public/Private Section: Meeting: Public Private Paper Title: NHS Wakefield Clinical Commissioning N/A Group Patient and Community Panel
Purpose (this paper is for): Decision Discussion Assurance Information
Report Authors and Pam Vaines, Governance Officer Job Titles: Responsible Clinical Not Applicable Lead: Responsible Ruth Unwin, Director of Corporate Affairs Governing Board Executive Lead: Recommendation:
It is recommended that Governing Body:
i. Agree to extend the scope and membership of the committee previously entitled PIPEC to take provide advice and assurance to the CCG and its Governing Body on public involvement, equality and diversity and patient experience under the title of Patient and Community Panel. ii. Approve the Terms of Reference for the Patient & Community Panel
Executive Summary: Governing Body was informed on 8 September 2020 that the Public Involvement and Patient Experience Committee (PIPEC), which is a formal committee of the CCG Governing Body had been unable to meet formally during the Covid pandemic due to a number of members being unable to access online meetings.
The Patient and Community Panel had been established as an interim measure to enable NHS Wakefield CCG to continue to obtain patient and public feedback and assurance on patient experience and public involvement at this time. Members of the Equality Group, PPG Network and PIPEC have been invited to take part in the Panel.
This reflected work that was already underway, supported by the Governing Body, to bring together the functions and membership of PIPEC and the Equality Health Panel to strengthen their combined advisory and assurance role.
In view of the success of the Patient & Community Panel, it is proposed that the committee previously entitled PIPEC should extend its scope and membership to incorporate the functions and membership of the Equality Health Panel, and that the committee should report to the Governing Body under the new title of Patient and Community Panel.
The arrangement has provided an ideal solution to enable NHS Wakefield CCG to stay in touch with ‘critical friends’. It is acknowledged that the process is dependent on the use of technology and as such, is not accessible for people who do not have access to a computer. Members who are unable to access meetings online are sent copies of the meeting papers and invited to comment via the engagement team. .
The Patient & Community Panel has considered and agreed the attached Terms of Reference based, which incorporate all of the functions of PIPEC as well as the functions of the Equality Health Panel.
The approved Panel minutes will be shared with Governing Body to provide assurance that the CCG is meeting or exceeding statutory requirements in relation to public involvement, equality duties and patient experience. Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Outline public Members of PIPEC and the Equality Health Panel have been engagement – clinical, engaged in developing these alternative arrangements stakeholder and public/patient: Management of Conflicts None identified – members are requested to declare any of Interest: conflicts of interest at each meeting
Assurance departments/ Not applicable organisations who will be affected have been consulted: Previously presented at Not applicable committee / governing body:
Reference document(s) / Not applicable enclosures:
Risk Assessment: Not applicable
Finance/ resource None identified implications:
TERMS OF REFERENCE FORTHE NHS WAKEFIELD CLINICAL COMMISSIONING GROUP PATIENT AND COMMUNITY PANEL
Accountability The Governing Body for NHS Wakefield Clinical Commissioning arrangements Group (CCG) resolves to establish a committee of the Governing and authority Body to be known as the Patient and Community Panel.
The committee will operate within the legal framework for NHS Wakefield CCG.
The Committee has no executive powers, other than those specifically delegated in these terms of reference.
The CCG Governing Body approved the communications and engagement strategy which included a proposal to develop a committee of the Board with responsibility for advising NHS Wakefield CCG on public involvement, equality and diversity and providing assurance that the CCG appropriately and effectively fulfils the statutory duty stated in Section 242 of the NHS Act 2006 and the duty for public involvement outlined in the Health and Social care Act 2012 Section 26. The Patient and Community Panel will have the authority to request and challenge any information it requires to fulfil its core business.
The Panel will also advise the CCG and provide assurance that it fulfils its duty in respect of Section 149 of the Equality Act 2010, which states that a public authority must have due regard to the need to a) eliminate discrimination, harassment and victimisation, b) advance ‘Equality of Opportunity’, and c) foster good relations. It unifies and extends previous disparate equality legislation. Nine characteristics are protected by the Act, which are age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation.
The Patient and Community Panel will undertake the roles previously carried out by the Public Involvement and Patient Experience Committee, The Patient Reference Group Network and the Wakefield Equality Health Panel.
The Panel is established to provide assurance to the CCG Governing Body and has no authority to make decisions on behalf of the CCG other than that already delegated to its members who are employees of the CCG.
Relationship Patient and Community Panel will report to and submit minutes to and reporting the CCG’s Governing Body. Patient and Community Panel will receive minutes from any group or network established by
NHS Wakefield CCG to support patient involvement.
The meetings will be supported and facilitated by NHS Wakefield CCG’s Senior Engagement Manager.
A member of Patient and Community Panel will be the Committee’s representative on the Integrated Care Partnership and act as a champion for the committee. This role will provide information to and from the Partnership to provide assurance for public involvement across Wakefield District. This role will be enacted by the Chief Executive of Healthwatch Wakefield.
Role and Role function The role of Patient and Community Panel is to oversee the delivery and quality of activity to involve and engage the public and address health inequalities across all aspects of the CCG’s and work, taking into consideration the changing landscape of the local health economy and integration with social care .
The integration of both membership and work across health and social care will ensure that considerations and assurance given around engagement, equality and patient experience reflect a comprehensive picture of the local need to support continuous improvement of local services and population health.
Functions It is expected that the functions of this committee will evolve to meet the developing public involvement, equality and patient experience agenda, however, the core functions will be to:
• provide assurance to the CCG’s Governing Body on public involvement carried out both in quality and meeting statutory requirements • provide assurance to the CCG’s Governing Body on equality duties and reporting • champion public involvement, equality and patient experience throughout the CCG and within the Wakefield Integrated Care Partnership • enable patient feedback to influence CCG planning and commissioning arrangements and subsequent provider arrangements • identify trends and prioritise areas for improvement, instigating further investigation and action from appropriate leads • receive collated patient feedback from a range of sources, including GP and Network patient groups and The Quality Intelligence Group. • ensure action plans are developed as a result of patient feedback and that progress is regularly monitored and impact measured
• approve public involvement, equality and patient experience procedures and policies and make recommendations on related strategies.
Responsibilities Patient and Community Panel will provide a single recognised structure to oversee the delivery of patient involvement, equality and patient experience activity and ensure impact and change is demonstrable both internally and externally.
Patient and Community Panel will provide assurance to the CCG’s Governing Body on involvement planned and carried out as part of the day to day planning, delivery and review of services. The work of the Committee will inform commissioning arrangements, business planning and identify possible improvements.
Membership Members will be drawn from across Wakefield to provide representation of patient views and opinions.
o Chair, NHS Wakefield CCG lay member with responsibility for equality and patient and public involvement o Wakefield Healthwatch Chief Executive o Young Healthwatch (Desirable) o Director of Corporate Affairs, NHS Wakefield CCG, with responsibility for overseeing involvement activity of the CCG o Head of Quality, NHS Wakefield CCG o Senior Engagement Manager, NHS Wakefield CCG o Equality and Diversity Leads from: . Mid Yorkshire Hospitals NHS Trust, . South West Yorkshire Partnership NHS Foundation Trust and . NHS Wakefield CCG o Representatives from Voluntary, Community and Social Enterprise (VCSE ) Sector in Wakefield
Members will be responsible for steering the work of the group and sharing their insight and expertise on health related issues. Members will also be responsible for reporting back to their organisations, communities and groups on the work of the Patient and Community Panel.
Training will be provided to new members joining the group.
Appointments Appointments to Patient and Community Panel will be considered and approved by existing members. New appointments will be made on the receipt of resignations from current members and in the event of the committee identifying gaps in representation.
Chair The Chair of Patient and Community Panel will be a CCG lay
member with responsibility for patient and public involvement.
The meetings will be run by the Chair. In the event of the Chair’s absence meetings will be chaired by the Director for Corporate Affairs, Wakefield CCG. Quoracy Quorum for Patient and Community Panel constitutes a minimum of eight members attending with no less than three members of the public and no less than two CCG representatives.
If minimum attendance is not met, the Patient and Community Panel will be rescheduled. If necessary, CCG representatives may nominate a replacement of equivalent seniority to attend in their absence.
Frequency of Patient and Community Panel will usually meet 6 times a year. meetings The Committee will set up working groups as and when deemed necessary and beneficial to the working of the group. Such groups will be required to report back to the panel on their activities.
Conduct Members of the committee and those in attendance at meetings will abide by the ‘Principles of Public Life’ and the NHS Code of Conduct, and the Standards for members of NHS boards and governing bodies, Citizen’s Charter and Code of Practice on Access to Government Information.
All members will have due regard to and operate within the Standing Orders, Prime Financial Policies and other financial procedures.
Declaration of If any member has an interest, pecuniary or otherwise, in any interests matter and is present at the meeting at which the matter is under discussion, he/she will declare that interest as soon as they become aware of it. The Chair will determine whether the member can continue to participate in the discussions. The Chair will have the power to request that member to withdraw until the committee’s consideration has been completed.
Administration Administrative support for the Committee will be provided by the Business Support Unit or a Governance Officer within the CCG. They will ensure that minutes of the meeting are taken and provide appropriate support to the Chair and Committee members. Duties will include:
• agreement of agenda with Chair and attendees and collation of papers; • ensuring that minutes are taken and keeping a record of matters arising and issues to be carried forward; • timely distribution of papers, no later than five working days before a meeting for agenda and papers; • record of matters arising, issues to be carried forward.
The Senior Engagement Manager will set the agenda, in conjunction with the Patient and Community Panel Chair and based on feedback from the group. The agenda and associated papers will be circulated a minimum of one week prior to the meeting.
Urgent matters The Chair of the Committee, Director of Corporate Affairs, and arising between Senior Engagement Manager, may also act on urgent matters meetings arising between meetings of the Committee after consulting with one of the public representatives of the Panel.
These matters will be reported to the next meeting of the Committee.
Monitoring of The Governing Body will monitor the effectiveness of the compliance Committee through the annual work-plan, receipt of the minutes, annual effectiveness survey and annual report.
Date agreed Approved by Governing Body 9 March 2021.
Review date Annually, or as and when legislation or best practice guidance is and updated. Any amended Terms of Reference will be agreed by the monitoring Committee for recommendation to a subsequent meeting of the Governing Body.
Title of Governing Body Agenda 20 meeting: Item:
Date of 9 March 2021 Public/Private Meeting: Section: Public Paper Title: Recommendation from Remuneration Private Advisory Panel N/A
Purpose (this paper is for): Decision Discussion Assurance Information
Report Author and Job Ruth Unwin, Director of Corporate Affairs Title: Responsible Clinical Not applicable Lead: Responsible Jo Webster, Chief Officer Governing Board Executive Lead: Recommendation:
• To note the Governing Body members approval following the recommendation of the Remuneration Advisory Panel
Executive Summary:
Following a meeting of the Remuneration Advisory Panel held on 17 November 2020 where a Remuneration Review discussed the West Yorkshire & Harrogate CCH Lay Member roles. The Advisory Panel agreed to recommend the following to the Governing Body:
i. Agreed to recommend to the Governing Body to maintain a consistent level of Remuneration for all roles consistent with that applied for NHS Wakefield CCG Lay Members; ii. Agreed to recommend to the Governing Body that in accordance with the above, award an increase in the remuneration of Lay Members/Co-opted Board Member roles by 2% with effect from 1 April 2019 (hourly rate of £36.83 and daily rate of £276.23) and 1% from 1 April 2020 (hourly rate of £37.21 and daily rate of £279.08). This is aligned to the national average and consistent with the remuneration of Lay Members in Yorkshire and Humber. Whilst the Lay Member role remuneration (of which the current remuneration is based) has not increased since 1 April 2013), it is proposed that this would be more than 2% based on affordability and benchmarking information; and iii. Recommend to the Governing Body to link consideration of any future cost of living pay uplift to Agenda for Change pay award rates and any national guidance issued.
A copy of the minutes from the meeting are attached for your information.
The Governing Body members gave their approval to the above recommendations via email confirmation between 5 and 13 January 2021.
Link to overarching principles from the Reduction in hospital admissions where appropriate strategic plan: leading to reinvesting in prevention New Accountable Care Systems to deliver new models of care
Collective prevention resource across the health and social care sector and wider social determinant partners Expanded Health and Wellbeing board membership to represent wider determinants A strong ambitious co-owned strategy for ensuring safe and healthy futures for children A shift towards allocation of resources based upon primary and secondary prevention and social determinants of ill health Transforming to become a sustainable financial economy Organising ourselves to deliver for our patients
Outcome of Integrated Not applicable Impact Assessment completed (IIA) Outline public Not applicable engagement – clinical, stakeholder and public/patient: Management of Conflicts Not applicable of Interest Assurance departments/ organisations who will be affected have been consulted: Previously presented at committee / governing body:
Reference document(s) / enclosures:
Risk Assessment: Not applicable
Finance/ resource Not applicable implications:
2
Agenda item: 21
NHS Wakefield Clinical Governing Committee
Governing Body
Tuesday, 9 March 2021
Committee minutes – items for escalation
Committee Chair Items for escalation (including summary of the issues, risks identified, any mitigations and any actions proposed
Audit Committee Richard No items for escalation Watkinson Clinical Strategy Group Dr Adam No items for escalation Sheppard Connecting Care Executive Andrew No items for escalation Balchin Finance Committee Richard No items for escalation Hindley Patient and Community Stephen No items for escalation Panel Hardy Primary Care Richard No items for escalation Commissioning Committee Hindley Quality, Performance & Richard No items for escalation Governance Committee Hindley
Agenda item : 21a(i) AUDIT COMMITTEE
Thursday 8 October 2020 10:00 to11:00
MINUTES
Present Richard Watkinson Lay Member (Chair) Richard Hindley Lay Member Dr Deborah Hallott Nominated clinical member
In Attendance Jonathan Webb Chief Finance Officer Ruth Unwin Director of Corporate Affairs Karen Parkin Associate Director of Finance & Contracting Amrit Reyat Governance and Governing Body Secretary Jonathan Hodgson Audit Yorkshire Danielle Hodson Audit Yorkshire Jerri Lewis KPMG Shaun Fleming Audit Yorkshire Rebecca Kelly Ledger Accountant Eamonn May Corporate Financial Accountant Adam Robertshaw Strategic Accountant Emma Scholey Governance and Committee Officer (Minute Taker)
20/54 Apologies for Absence
Apologies for absence were received from:
Dr Clive Harries Nominated clinical member
20/55 Declarations of Interest The Chair invited attendees to declare any conflicts of interest.
20/55 Governance Exceptions Report Deborah Hallott declared an interest in this item as the report discusses the tender for the Wakefield GP Organisational Development Fund and her practice is part of the Conexus Healthcare Ltd. She also highlighted the tender for Ardens that is used in General Practice.
The Chair noted this declaration. As these are not a decision making item the Chair determined that Deborah Hallott could provide input into the debate.
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20/56 Minutes of the Last Meeting held on 26 May 2020 The minutes of the meeting held on 26 May 2020 were agreed as an accurate record.
20/57 Action Log Update Amrit Reyat provided an update on the action log. 20/26 Audit Committee Effectiveness and Audit Committee Development The committee effectiveness results have been circulated to members for review during the Audit Committee Development session which was scheduled for 8 October 2020.
20/47 Risk Management Annual Report 2019/20 Following the presentation of the risk management annual report 2019/20, Audit Committee members felt it was beneficial to provide an incident reporting update to all staff during a Staff Briefing. Amrit Reyat informed the committee that this was presented to Staff Briefing on 20 August 2020.
Governance and systems of internal control 20/58 Governance Exceptions Report Amrit Reyat presented this paper and highlighted that during the period from 18 April to 30 September 2020 there has been no declarations made under the CCGs Standards of Business Conduct relating to hospitality/ gift declarations, outside employment/ private practice sponsorship or external remunerated activity. There have been no requests for rebate schemes and the CCG’s seal has not been used to execute any documents. Amrit Reyat reported that there have been two suspensions of Standing Orders during this period. Amrit also reported that during the period there have been nine tender waivers, eight approved and one withdrawn. Seven quotation waivers approved.
It was RESOLVED that: i) Audit Committee noted the paper and the governance control exceptions detailed
20/59 Auditor Panel Terms of Reference Review Amrit Reyat presented the Auditor Panel terms of reference that were approved by the Audit Committee on 26 February 2019. There have been no amendments made to the terms of reference during the annual review therefore the committee are asked to approve the terms of reference for a further year.
It was RESOLVED that: i) Audit Committee approved the terms of reference for the Auditor Panel
20/60 Register of Procurement Decisions Ryan Turnbull joined the meeting to present the six monthly report that provides an update on all of the Procurement Decisions undertaken by the CCG for healthcare services, between the 01 January 2020 and the 30
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June 2020, including the authorisation and governance for each procurement process and a record of the conflicts of interest declared during the procurement.
It was RESOLVED that: i) Audit Committee received the Register of Procurement Decisions ii) Audit Committee approved for publication on the CCG website the content of the Register.
20/61 Accounting hot topics update Eamonn May presented a paper highlighting a number of important items for the Audit Committee to be aware of.
National Fraud Initiative The CCG is taking part in the biennial National Fraud Initiative (NFI), which matches data across organisations and systems to help public bodies identify fraud and overpayments. The CCG will be liaising closely with the Local Counter Fraud Specialist throughout the whole exercise. Data will be submitted, via the NFI 2020/21 web application in October and the distribution of the results is due by the end of January 2021.
Fixed Asset Register, NHS Shared Business Services is developing a fixed asset register, which includes a lease assets register, for all its clients. The CCG has submitted all details from its own, spreadsheet based registers to SBS and they have successfully loaded the data. This will give NHSE/I a consolidated asset register for the first time. We await the results of further testing from SBS before we know a go-live date.
New online system for GP Payments and Pensions administration, Primary Care Support England (PCSE) is developing a new online system for GP Payments and Pensions administration. PCSE have identified some areas for improvement that can be made at this stage before they launch the new service. They were initially working towards having the system ready for the end of September but the decision to extend the testing time means that this date will now move and a new go-live date is yet to be decided. In the meantime, the CCG will continue to submit payments to PCSE and payments will be processed via National Health Application and Infrastructure Service (NHAIS) as usual.
Richard Watkinson sought further assurance by asking if the CCG could be confident that the system is robust against cyber system attacks. Jonathan Webb advised that any issues flagged would be reported through the External Auditors end of year report that looks at risks and assurances.
Kier/Embed Lead Provider Framework VAT update There is a risk of the CCG having to repay VAT being claimed on Keir invoices for the Business Intelligence contract being provided by Keir/Embed. This is due to HMRC not having issued any guidance on whether the services provided are VAT recoverable or not.
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Yorkshire & Humber Chief Finance Officers’ made a joint decision to recover the VAT based on splitting the services over various contracted-out service codes. This was supported by NHSE England who made a joint approach to HMRC on behalf of all CCGs. HMRC have now issued their response to the appeal submitted. The process identified will mean that the assessments will not automatically be reversed but varied. NHSE will be arguing for the assessments to be varied to zero.
It was reported that as further discussions are on-going with HMRC, the CCG has not varied its current provision of £436k in the accounts. This has been recorded as Risk 825 on the CCG’s Risk Register. Audit Committee members felt that this gives them the assurance that this has been approached in the correct way.
It was RESOLVED that: i) Audit Committee noted the current position updates in finance.
20/62 Proposed arrangements for financial governance for the month 7-12 financial plans Eamonn May presented the proposed arrangements for financial governance for the month 7-12 financial plans and the summary of how the reporting will be carried out and how governance will be followed.
The NHS financial framework was recently published setting out how the CCG is required to work within for the period October 2020 to March 2021. It has been considered, through the West Yorkshire and Harrogate ICS Finance Forum that the appropriate financial governance arrangements need to be put in place. This is in the context of the continued move in national finance policy towards system by default.
The CCG now has significant resources at system level which we will collectively allocate/distribute.
Eamonn reported that whilst the Partnership Memorandum of Understanding includes a section on financial management, the pace at which national finance policy has changed has meant that how we make decisions on the allocation of resources at the scale described above is not covered. Jonathan Webb has worked with partners to develop the proposed financial governance arrangements for the NHS financial envelope.
Jonathan Webb explained that the paper was circulated to System Leadership Executives in West Yorkshire, including the Chief Executives with the requirement that all NHS organisations sign up to framework. It was reported that all 10 providers and six CCGs have formally signed up and supported the framework.
It was noted that as there is no formal decision making at the ICS. The paper described how the CCG will seek authority from partners. Ruth Unwin noted that the paper is clear with regard to where the accountability for
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decision making sits.
It was RESOLVED that: i) Audit Committee noted and approved the steps being taken to ensure the correct financial governance is in place for the month 7-12 financial.
Internal Audit
20/63 Proposed Financial Governance arrangements for the NHS financial envelope months 7-12 2020/21 Response from Audit Yorkshire Jonathan Hodgson reported that Audit Yorkshire was asked by Jonathan Webb, as the ICS Lead Director of Finance to provide a formal view on the adequacy and appropriateness of the Proposed Financial Governance arrangements for the NHS financial envelope months 7-12 2020/21 for the WY&H ICS System Assurance & Oversight Group.
Jonathan Hodgson highlighted the clear governance structures in the ICS that are embedded and work within the Partnership Board. The review confirmed the ICS has established a group to focus on system finances, the Finance Forum and concludes that there is no reason to suggest that the group will not follow the key functions of good governance. As such the review confirms the adequacy and appropriateness of these arrangements in supporting sound financial governance.
Jonathan Webb thanked Audit Yorkshire for their quick turnaround for this work and reported that the review has been circulated to all partner organisations.
Jonathan Hodgson highlighted that Helen Kemp-Taylor is working with system leaders across Humber Coast and Vale Health and Care Partnership to develop a clear framework and guidance for ICS
This item will be presented to December Governing Body as a chairs action with the explanation that it has been scrutinised by Audit Committee.
It was RESOLVED that: i) Audit Committee noted the conclusions of the response from the Head of Audit Yorkshire.
20/64 Internal Audit Progress Report Danielle Hodson presented this report which provided an update of the Internal Audit activity since the last Audit Committee meeting. Three reports have received a high assurance opinion. Danielle also noted that the Covid- 19 Cost Revalidation has been finalised and received ‘significant assurance’ with minor recommendations.
The performance against the 2020/21 plan was discussed with changes including the additional review for the Covid-19 Cost Revaluation, the NHS Long Term Plan review has been deferred and the QIPP review has been
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put on hold due to Covid-19. Audit Committee approved the changes to the 2020/21 work plan.
Ruth Unwin referred to the three reports which received ‘high assurance’ and thanked Amrit Reyat and the Governance Team for their work towards these reports.
Jonathan Hodgson reported that Audit Yorkshire is awaiting the finalisation of the national guidance on the Toolkit and noted that there may be an implication of additional days.
Danielle Hodson referred to the follow up recommendations and noted that the Data Security and Protection Toolkit recommendation can now be removed from the tracker. Audit Committee agreed to this.
It was RESOLVED that: i) Audit Committee received this report and noted its contents. ii) Audit Committee agreed to removal of the DSPT recommendations from the tracker.
20/65 Internal Audit Charter Jonathan Hodgson presented the Internal Audit Charter explaining that it sets out how Audit Yorkshire will deliver the Internal Audit service in accordance with the Public Sector Internal Audit Standards (PSIAS). Audit Yorkshire’s in house Quality Assurance Manual is aligned to the standards and provides guidance to our auditors.
Jonathan explained that there have been no changes since it was last presented to the committee.
It was RESOLVED that: i) Audit Committee received this report and approved its contents.
20/66 Audit Yorkshire’s 2020/20 Annual Report Jonathan Hodgson presented the Audit Yorkshire 2020/20 Annual Report which highlights their key achievements throughout the year and their collaborations throughout the year with a range of organisations including 360 Assurance.
Jonathan Webb noted the active Audit Yorkshire Board that Richard Watkinson is a member of and assists with setting the direction. This helps the CCG to feel included as a member. Jonathan Hodgson thanked Richard Watkinson for attending the recent Audit Yorkshire Board meeting.
Jonathan Hodgson referred to the Audit Yorkshire website, which can be accessed here. From here members are able to access the members’ page. Please email Emma Scholey for the password.
It was RESOLVED that: i) Audit Committee received this report and noted its contents
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20/67 Counter Fraud Progress Report Shaun Fleming provided an update on the Counter Fraud progress report. Shaun attended the Staff Briefing on 23 September to introduce himself and provide an introduction to ensure that staff are aware of the Local Counter Fraud Specialist referral contact points.
The quarterly local Counter Fraud Newsletter is forwarded to the Communications Team for distribution to staff. In addition to the quarterly publication, since April seven special Covid-19 newsletters have been published with links in the ‘The Headlines’. The newsletters have covered a number of Covid-19 specific topics
It was reported that there have been eight Fraud Alerts issued to the CCG since the last Audit Committee including the fraudulent use of patient shielding letters and phishing emails.
In September Shaun met with members of the Continuing Healthcare Team to discuss the fraud risks associated with Personal Health Budgets (PHBs). It was agreed that there is a potential risk of fraud and that Shaun would review current procedural and documented processes and recommend any potential system ‘weak’ spots over the coming weeks.
No formal fraud referrals have been received since the last Audit Committee. Shaun referred to Case Reference IMO/18/00046 in which the Audit Yorkshire Fraud Team has continued to actively pursue a local recovery of money. £7000 has been successfully recovered. Jonathan Webb thanked Steve Moss for his work on retrieving this.
Shaun provided an update on the Counter Fraud Functional Standard explaining Audit Yorkshire are working closely with the NHSCFA on the introduction of the standard and members will be kept updated of the developments.
It was RESOLVED that: i) Audit Committee received this report and noted its contents
External Audit 20/68 Technical Update The technical update was presented for committee members to note. The technical update did not include anything for action. Members were asked to note the update
It was RESOLVED that: i) Audit Committee noted the update.
20/69 External Audit Annual Audit Letter 2019/20. Jerri Lewis presented the External Audit Annual Audit Letter for 2019/20, explaining that it does not include any new information for the CCG.
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KPMG issued an unqualified opinion on the CCGs accounts on 24 June 2020 meaning that the accounts gave a true and fair view of the financial affairs of the CCG.
The report confirms that the CCG complied with NHS England requirements in the preparation of the CCG’s Governance Statement. Jerri explained that the value for money is clean and unqualified and that there are no risk recommendations arising from the 2019/20 audit work. KPMG did not issue a report in the public interest or refer any matters to the Secretary of State in 2019/20.
Audit Committee welcomed the new KPMG team and noted thanks to Rob Jones and Rachael Pearson for their time working with the CCG.
It was RESOLVED that: i) Audit Committee considered the contents of the Annual Audit Letter.
20/70 Matters to be referred Matters to be referred to:
(i) Governing Body – Details of any exception reporting (ii) Other Committees - Items to be included on other committee agendas
Item 20/63 Proposed Financial Governance arrangements for the NHS financial envelope months 7-12 2020/21 Response from Audit Yorkshire was referred to the meeting of the Governing Body to be held on 8 December 2020.
20/71 Any Other Business There was no other business raised.
20/72 Date, Time and Venue of Next Meeting Date and time of next meeting: Tuesday 15 December 2020, 10:00 to 12:00
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Agenda item : 21a(ii) AUDIT COMMITTEE
Thursday 15 December 10:00 to 12:00
MINUTES
Present Richard Watkinson Lay Member (Chair) Richard Hindley Lay Member Dr Clive Harries Nominated clinical member
In Attendance Jonathan Webb Chief Finance Officer Ruth Unwin Director of Corporate Affairs Karen Parkin Associate Director of Finance & Contracting Michelle Whitehead Head of Finance Amrit Reyat Governance and Governing Body Secretary Jonathan Hodgson Audit Yorkshire Helen Kemp-Taylor Audit Yorkshire Danielle Hodson Audit Yorkshire Jerri Lewis KPMG Tim Cutler KPMG Shaun Fleming Audit Yorkshire Eamonn May Corporate Financial Accountant Emma Scholey Governance and Committee Officer (Minute Taker)
20/73 Apologies for Absence Apologies for absence were received from: Dr Deborah Hallott Nominated clinical member
20/74 Declarations of Interest The Chair invited attendees to declare any conflicts of interest.
No declarations of interest were received.
20/75 Matters Arising There were no matters arising.
20/76 Minutes of the Last Meeting held on The minutes of the meeting held on 8 October 2020 were agreed as an accurate record.
20/77 Action Log Update
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Amrit Reyat provided an update on the actions.
20/26 Audit Committee Development Audit Committee members attended the development session on 12 November 2020 with Helen Kemp Taylor & Amrit Reyat. Amrit Reyat provided further feedback later in the committee.
20/63 Proposed Financial Governance arrangements for the NHS financial envelope months 7-12 2020/21 Response from Audit Yorkshire This was presented to Governing Body on 8 December 2020
Governance and systems of internal control 20/78 Governance Exceptions Report Amrit Reyat presented this paper and highlighted that during the period from 1 October to 30 November 2020 there has been no declarations made under the CCGs Standards of Business Conduct relating to hospitality/ gift declarations, outside employment/ private practice sponsorship or external remunerated activity. There has been one request for rebate schemes and the CCG’s seal has not been used to execute any documents. Amrit Reyat reported that there have been no suspensions of Standing Orders during this period. Amrit also reported that during the period there have been five tender waivers and two quotation waivers approved. There have been no instances of Losses and Special Payment.
It was RESOLVED that: i) Audit Committee noted the paper and the governance control exceptions. 20/79 Governing Body Assurance Framework Amrit Reyat presented the Governing Body Assurance Framework to the Audit Committee highlighting that this was approved by Governing Body on 8 December 2020.
Amrit explained that Audit Committee has role to oversee the effectiveness of the GBAF and the up to date risks. Since the previous GBAF was approved by the Governing Body on 10 March 2020 and at Audit Committee on 30 April 2020 it has been through a complete revision prior to transfer to the electronic GBAF system which mirrors the Risk Register system.
The transfer has been discussed frequently at SLT which approved the GBAF Objectives. The objectives are now based on the CCG Statutory Duties. Each risk and associated Control, Assurance, score was reviewed by the relevant Owner, Director and Clinical Lead and finally considered at SLT on 16 November 2020 and at Quality, Performance and Governance Committee (QPGC) on 26 November 2020. QPGC recommended that the Governing Body approve the GBAF as a true record, which took place on 8 December 2020.
Ruth Unwin explained that the purpose of the GBAF being presented to Audit Committee is to ensure that members are satisfied that the system of
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internal control adequate. Audit Committee needs to be aware that this is an effective way of reporting and to be clear of the purpose of it coming to the committee.
A discussion followed on the level of detail that needs to be presented to the committee. Karen Parkin suggested that the committee receives trend information on how the scores have changed over a period of time rather than looking at the content to see how the organisation is using it to the best way they can. There was a suggestion to include another column to provide any trends in a snap shot and start to see what assurances are effective.
Ruth Unwin explained that we need to ensure that the assurance framework drives the committee work plans. It is appropriate for the Audit Committee role to consider what the GBAF is saying the assurances are when looking at the work plans and the self-assessment reports to get the overall assurances that the Governing Body is getting the assurances identified through the GBAF.
Jonathan Hodgson has been doing a piece of work looking at the development of the receiving of assurances and will share the outcomes as a revised GBAF template to track assurances.
It was confirmed that QPGC will look at the detail of the control and the assurances but the overview that Audit Committee will take is to assure they are effective and happening.
It was RESOLVED that: i) Audit Committee noted the updated 2020/21 Governing Body Assurance Framework for NHS Wakefield Clinical Commissioning Group which was approved by the Governing Body on 8 December 2020. ii) Audit Committee will take away and bring back to a future committee regarding the level of report required as the GBAF continues to be evolving
20/80 Audit Committee Development Session Feedback Amrit Reyat provided feedback following the Audit Committee development session on 12 November 2020. This was attended by all members and led by Helen Kemp-Taylor, Head of Internal Audit. During the meeting the group discussed the role of the Audit Committee and looked at the terms of reference and the function of the committee supported by the HMFA committee handbook.
The paper includes an action plan which supports the decision making and what members need to challenge or seek further assurance on.
The following updates were noted: • To include an item on the agenda for reflections • The frequency that the Audit Committee receives the assurance framework was discussed. It was agreed that reviewing the report
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regularly will allow Audit Committee to consider any deep dives into risks that are not progressing • Audit Committee members to meet before the meeting to discuss any item then feel they may want to challenge • Audit Committee have a role in making sure the document reporting is fit for purpose and the key risks on the document are being managing appropriately • Agreement to triangulate with other committees and Governing Body
Audit Committee members felt it was beneficial having the conversation and allowing the time was valuable in bringing the members together. It was RESOLVED that: i) Audit Committee noted the actions following the Audit committee development session and consider if there are any further development needs to be explored. 20/81 Audit Committee Self-assessment Amrit Reyat presented the Audit Committee self- assessment report noting that it is good practice to undertake annual reviews of the effectiveness of the Audit Committee and the Internal Audit and Counter Fraud services provided by Audit Yorkshire. This will support committee development and as evidence to support the Annual Governance Statement with respect to the robustness of the CCG’s governance framework.
The Audit Committee self-assessment is split in to two sections:
Checklist one: Committee Processes Checklist one will be completed for all committees between the Chair of the committee and the Governance and Board Secretary. This checklist is designed to elicit a simple yes or no answer to each question. Where there are any ‘no’ answers these will be discussed with the committee.
Two: Committee Effectiveness The questions from checklist two will be share with the committee members and regular attendees for completion. Checklist two is designed to gauge the committee’s effectiveness by taking the views of the committee members across a number of themes.
Jonathan Hodgson reported that the survey for the Internal Audit effectiveness will also be sent to the group at the same time. This is to assess the effectiveness of the Internal Audit and Counter Fraud services provided by Audit Yorkshire.
A report summarising the results of both of the surveys including points for discussion and potential actions will be produced for Audit Committee meeting in February 2021.
It was RESOLVED that: i) Audit Committee noted the process for the completion of the 2020/2021 Audit Committee Self-Assessment questionnaire to consider the effectiveness of the Audit Committee.
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20/82 Current work plan relating to Year-end Assurance Eamonn May presented this paper to give members of Audit Committee an opportunity to review the relevance of the financial and accounting papers that are to be presented at future meetings.
It has been agreed that an Audit Committee will be scheduled for February 2021. At this meeting the Finance Team will be bringing papers to review the timetable for the production of the financial statement. Eamonn noted that NHSE/I have been holding virtual workshops to go through changes and the temporary financial regime. It is expected that NHSE/I and HFMA will hold another set of workshops in February.
Other papers that will be presented to the February Audit Committee will include the Annual Accounts 2020/21 Accounting Estimates and Judgements, the results from Period 9 Mini Year End, the Annual Accounts 2020/21 Going Concern Review.
Eamonn noted that there will be an opportunity for Audit Committee members, should they chose, to receive draft accounts and provide any comments thereon, will be provided on 30th April 2021.
The year-end process timetable is yet to be received but is expected to be similar to previous years.
It was RESOLVED that: i) Audit Committee noted the papers due to future Audit Committees, in relation to the Annual Report and Accounts for 2020/21. Internal Audit 20/83 Internal Audit Progress Report Danielle Hodson presented this report which provided an update of the Internal Audit activity since the last Audit Committee meeting. Two reports have received a significant assurance opinion. Danielle reported that the two audits outstanding will be carried out in quarter four. These have been discussed and the sponsors are aware of the timeframe they will be completed in.
Danielle discussed the changes that have been made to the 2020/21 audit plan. The QIPP audit has previously been put on hold. Due to the revised financial regime for the remainder of the 2020/21 financial year it is recommended that the QIPP review is deferred to 2021/22. The audit days are to be utilised to facilitate the two second stage Control Improvement Audits. Audit Committee approved this recommendation.
The CCGs 2020/21 performance to date is 100% for all KPIs. Danielle noted the high level of engagement that Internal Audit receives from the staff.
Danielle reported that the Covid-19 Cost Revalidation received three minor recommendations. The Children’s Continuing Care (CIA Stage Two) review has one recommendation following the improvements that have been taken
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since stage one.
Jonathan Webb thanked Internal Audit and Debbie Hallot for helping with the Covid work in the Primary Care Networks sites
It was RESOLVED that: i) Audit Committee received the Progress Report and noted its contents. ii) Audit Committee approved the changes made to Audit Plan since the last Audit Committee iii) Audit Committee noted the progress of the previous audit recommendations.
20/84 Counter Fraud Progress Report Shaun Fleming provided an update on the Counter Fraud progress report.
He reported that the Fraud Awareness Presentations will be continuing into 2021. All presentations will be tailored at departmental/team level concentrating on specific local fraud risks.
Since the last Audit Committee Audit Yorkshire has published their eighth special Covid-19 newsletter this year, concentrating on Covid related frauds. They also issued a special ‘Black Friday’ edition to raise awareness among staff of the dangers of online/internet targeted scams.
There have been four Fraud Alerts issued to the CCG since the last Audit Committee. Shaun highlighted the salary diversion alert in which one client received. Shaun also noted the phishing emails have been received by some finance teams. Advice has been given to report these emails as spam and not to click on the link.
The National Fraud Initiative (NFI) exercise has now been completed and work will commence in the new year with updates being provided to the Audit Committee via progress reports throughout 2021.
No formal fraud referrals have been received since the last Audit Committee. There will be more guidance on the Fraud champion role coming out.
The new fraud investigation system CLUE is currently delayed. It is expected that the new system will provide an improved case management system, streamline the process for recording system weaknesses and allow LCFSs to better capture savings and outcomes. Further updates will be provided as this develops. It was RESOLVED that: i) Audit Committee received the report and noted its contents.
External Audit 20/85 Technical Update
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Tim Cutler reported that communication is expected in January informing of the timetable and External Audit deadlines.
Tim noted that there is no immediate action required following the technical update. He confirmed that the implementation of the IFRS 16 has been deferred into the next financial year with an implementation date of 1 April 2022.
Tim Cutler reported that at the National Audit Office meeting last week auditor firms confirmed some of the issues that KMPG have been experiencing when auditing on behalf of the ICS. Tim will produce the audit plan to be presented at the next meeting.
It was also noted that KPMG are progressing with the value for money scope, a management information request has been produces produced for teams in order to produce revised risk assessments.
The Mental Health Investment Standard scope of work has been communicated to the CCG. The terms of reference are in the process of being agreed. The team are working towards the February/ March reporting deadline.
It was RESOLVED that: i) Audit Committee noted the update.
20/86 Reflections and Agenda Items for next meeting There were no reflections or future agenda items discussed.
20/87 Matters to be referred to: (i) Governing Body – Details of any exception reporting (ii) Other Committees - Items to be included on other committee agendas
There were no matters that required referral to other committees or Governing Body.
20/88 Any Other Business There was no other business raised.
20/89 Date, Time and Venue of Next Meeting It was agreed that the next meeting would take place on Thursday, 11 February 2020 at 13:00-15:00
Page 7 of 7 NHS Wakefield Clinical Commissioning Group Agenda item:21b(i) CLINICAL STRATEGY GROUP DRAFT MINUTES Of the meeting held on Thursday 19 November 2020
Dr Adam Sheppard GP, WCCG, Chair Dr Aly Damji GP, WCCG Clinical Director Dr Tim Dean GP, WCCG Clinical Director Dr Greg Connor GP, WCCG Executive Clinical Advisor Dr Debbie Hallott GP, WCCG, Board Member Dr Clive Harries GP, Board Member Dr Pravin Jayakumar GP, Board Member Stephen Hardy Vice Chair, Lay Member Dr Jordache Myerscough GP, WCCG Dr Pauline Riddett GP, WCCG Clinical Director Dr Colin Speers GP, WCCG Clinical Director Jonathan Webb Chief Finance Officer/Deputy Chief Officer
In attendance: Jenny Becket Head of Programme Delivery, MYHT Lucy Beeley Programme Manager, Re-design of Urgent Care Lisa Chandler Public Health Principal Samiullah Choudhry Head of Medicines Optimisation Joanne Fitzpatrick Head of Medicines Optimisation & EPRR Strategic Lead Anne-Marie Henshaw Head of Midwifery, MYHT Jacob Mutsvanemoto WY&H HCP, Diabetes Project Officer Jordache Myerscough GP, WCCG, College Lane Surgery Amrit Reyat Governance and Board Secretary Dr Will Robertson GP Lead Jo Rooney Senior Commissioning Manager, CYP Martin Smith Head of Integrated Commissioning Paula Spooner Practice Nurse Consultant Anna Staples ICP Support Manager, CCG Commissioning Manager Dena Coe (Minutes) Business Support Administrator
1 No. Agenda Item 20-50 Apologies for Absence were received from: Dr Abdul Mustafa, Dr Nadim Nayyar, Suzannah Cookson, Ruth Unwin.
20-51 Declarations of interest
Agenda Item 20/54 – NDPP (WY&H HCP): Post CV-19 Restart - Mail Outs A declaration of interest was noted for all GPs regarding the primary care incentive scheme which was briefly outlined. This was for information only and no decision or further discussion took place regarding this.
20-51 Action log from the meeting held on 15 October 2020 Amrit Reyat presented the updates to the Action Log.
20-52 Matters arising:
There had been a request for a Clinical lead for the system on asymptomatic testing in general practice/primary care, it was noted that this was a national ask, no further details at this stage was available on time requirements etc. Dr Tim Dean and Dr Pravin Jayakumar volunteered, they were asked to contact Michala James for further information and details.
There were no further matters arising.
20-53 COVID-19 Vaccination Programme
Joanne Fitzpatrick attended to give an update and overview of the Covid-19 Vaccination Programme for the place-based model for West Yorkshire and Harrogate. An overview of the mission and immediate priorities was outlined including, cohorts, storage and distribution. Also outlined were; variety of models, roles, Wakefield workforce, assurance and governance and initial engagement.
The rapid collaborative work of Clinical Directors and Business Managers was highlighted.
It was noted that this was still at submission stage only and final details would be agreed and confirmed at a regional and West Yorkshire level.
Key areas of discussion included: • Communication; standardisation of approach • Access and equality; ensuring vaccination points suitability for all • Utilisation of army, ex-care staff etc. • Logistical issues around storage, delivery and “shelf-life” of potential vaccines • Issues around training and management of volunteers/non-clinical staff • How to engage/vaccinate vulnerable and hard-to-reach cohorts
It was RESOLVED that:
(i) Members noted the update and presentation of the Covid-19 Vaccination 2
Programme for WY&H
20-54 NDPP (WY&H HCP): Post CV-19 Restart - Mail Outs
DECLARATION OF INTEREST: A declaration of interest was noted for all GPs regarding the primary care incentive scheme which was briefly outlined. This was for information only and no decision or further discussion took place regarding this.
Jacob Mutsvanemoto attended to outline the re-start of the Wakefield NDPP. The proposal to deliver locally in waves was detailed and the incentives were summarised. It was noted that re-set for NDPP was part of a local Wakefield re-set programme and the proposed three waves of delivery were outlined, there would also be a learning pack developed as well as a 12 month action plan which would include a series of scheduled events.
Dr Colin Speers added background information on previous diabetes work in Wakefield over the prior 3 to 5 years.
It was noted and clarified that the request was that GPs should send letters to patients which would encourage self-referral. The benefits of self-referral were highlighted, e.g. lower drop-out percentages etc.
Discussion took place on : • Timing of communications/most appropriate • It was suggested that a broader link with the ICS would be helpful to understand what was happening at the ICS level and to tie in with relevant governance structures etc. • Issues around loss of organisational memory due to loss of staff
It was RESOLVED that:
(i) Members noted the update and presentation.
20-55 Structure Medication Reviews Samiullah Choudhry attended to give outline the Network Contract Directed Enhanced Service Structured medication reviews and medicines optimisation.
It was highlighted that the work had been a collaborative place-based approach and the tiers and potential break-down of tiers were discussed in detail. It was noted that further expansion of the scheme was envisaged. Due to Covid-19 it was emphasised that the current phase was a “sign-up” to soft targets stage and not a requirement this year.
Other key areas of discussion included: • Planned Care links a priority after Covid-19 • Pain management and long-term conditions to be considered • Support to practices
There was overwhelming support for the programme, providing sufficient resources were available.
It was RESOLVED that: 3
(i) Members noted and discussed the Network Contract Directed Enhanced Service Structured medication reviews and medicines optimisation guidance.
20-56 Future in Mind Update Jo Rooney attended to give an update of the Future in Mind programme. Details were given on the on the additional investment into the programme and how the providers had revised and expanded the model. The challenges and effects of Covid-19 were also outlined.
Discussion took place on communications and sign-posting and clarification of the services on offer and how they are accessed. This included information on self- referral.
Issues around Primary school services were discussed and it was noted that there were 6 pilots on hold due to Covid-19, work had been undertaken with community navigators with particular issues around language being looked at.
The Eating Disorder service highlighted.
It was RESOLVED that:
(i) Members noted and discussed the Future in Mind update.
20-57 Update re Covid-19 Oximetry at home service Anna Staples, Lisa Chandler and Martin Smith attended to give an update regarding Covid-19 Oximetry at home service. The proposed pathway was outlined including the likely national recommendations.
Issues were raised and discussed regarding governance and resilience and clarification was given on who would potentially operate the service, referrals and access. It was also clarified that at this stage it was envisaged that this scheme would be a separate service across the system and one practice in Wakefield was already operating a similar service. It was noted that in the first instance this would be a short-term service operating whilst Covid-19 was prevalent, but would inform any further long-term future service. It was also noted that once a model had been approved an appropriate procurement procedure would take place.
Further key areas of discussion included:
• Referral and potential templates and use of existing systems such as Ardens. • Delivery of equipment; logistics, GPs on call, volunteers, access to equipment • Impact on workloads and capacity • Proactive monitoring • Need to ensure high risk/vulnerable would have prompt access to equipment • Issues around ensuring safe and correct use of equipment • Need for a holistic, linked and aligned approach
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It was RESOLVED that:
(i) Members noted and discussed the Covid-19 Oximetry at home service update (ii) The majority of members supported the Option One recommendation.
20-58 Maternity Update Anne-Marie Henshaw, Jenny Beckett and Tracy Morton attended to give an update on maternity services, this included national policy and drivers, the ambition of the programme, background documentation, current provision, the local maternity strategy and programme (including governance and structure), partnership arrangements, Pontefract FMLU, public engagement and impacts of Covid-19.
Dr Debbie Hallott gave a brief introduction which highlighted the complexities and challenges and gave reassurance that the service would continue to be monitored and thanked staff for their hard work. The Chair also thanked staff for the informative overview which showed the joined up approach undertaken.
Detailed discussion took place on communications and documentation and issues around incompatibility of IT systems and also clinical risks regarding medication and a need for protocols and access to information, in particular for prescribers.
It was agreed that a separate meeting would be arranged to discuss IT systems and digital data to include Dr Colin Speers and Ann-Marie Henshaw.
It was RESOLVED that:
(i) Members noted the development and progress of the Maternity Improvement Programme led by Mid-Yorkshire Hospitals NHSTrust.
20/59 WorkPlan Review and Future Agenda Items
It was suggested that a future agenda item on long-term conditions, i.e. diabetes should be considered in terms of a strategic approach and assurance.
Any further to suggestions to the Chair in the first instance.
It was RESOLVED that:
(i) Members noted and discussed the WorkPlan and future agenda items.
20-60 Matters to be referred to other committees or Governing Board: There were no matters to be referred to other committees or Governing Body.
20-61 Minutes from Sub-Committees to Note: The Medicines Optimisation Group Highlight Report was noted.
20-62 Any other business:
Dr Colin Speers had a governance matter query as he wished to propose a change 5 to how district nurses administer palliative care, specifically around a digital sign-off model. Dr Speers was asked to submit details to Jonathan Webb who would direct the proposal to the appropriate place.
There was no further business to discuss.
Date and Time of Next Meeting:
Thursday 17 December 2020 from 8.30 to 11.30 MS Teams meeting
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NHS Wakefield Clinical Commissioning Group CLINICAL STRATEGY GROUP Agenda item: 21b(ii) DRAFT MINUTES Of the meeting held on Thursday 26 January 2020
Present: Dr Adam Sheppard Chair Dr Greg Connor GP, WCCG Executive Clinical Advisor Suzannah Cookson Chief Nurse Dr Tim Dean GP, WCCG Clinical Director Dr Debbie Hallott GP, Board Member Dr Clive Harries GP, Board Member Stephen Hardy Vice Chair, Lay Member, PPI Dr Abdul Mustafa GP, WCCG Clinical Director Dr Nadim Nayyar GP, WCCG Clinical Director Dr Caoimhin Tobin GP, WCCG Clinical Director Dr Colin Speers GP, WCCG Clinical Director Ruth Unwin Director of Corporate Affairs Jonathan Webb Chief Finance Officer/Deputy Chief Officer In attendance: Dr Serena Alim GP Lead (Agenda Item 21.8) Lucy Beeley MYHT, Programme Manager, Urgent and Emergency Care (Agenda Item 21.9) Lisa Chandler Public Health Respiratory Lead (Agenda Item 21.7) Dr Katherine Hickman Leeds CCG & WYH ICS, GP Respiratory Lead (Agenda Item 21.7) Louise Horsfield Interim Senior Transformation Manager (Planned Care) (Agenda Item 21.6) Dr Jordache Myerscough GP, WCCG, College Lane Surgery Dr Will Robertson GP Lead Jackie Tatterton MYHT, Head of Planned Care & Improvement (Agenda Item 21.6) Jo Webster Chief Officer Dena Coe (Minutes) Business Support Administrator
1 No. Agenda Item 21-1 Apologies for Absence were received from: Dr Aly Damji, Dr Pravin Jayakumar, Joanne, Fitzpatrick, Amrit Reyat
21-2 Declarations of interest There were no declarations of interest.
21-3 Minutes of the meeting held on 19 November 2020 The draft minutes of the meeting held on 19 November 2020 were agreed as a true record.
21-4 Action log from the meeting held on 19 November 2020 There were no open Action Log actions to update.
21-5 Matters arising:
Oximetry at Home referrals were highlighted. It was agreed that further communications were required and it was also agreed that data received should be forwarded directly to Local Care Direct for action. An email would be circulated to all GPs with the information.
There were no further matters arising.
21-6 Shared Referral Pathway Update
Jackie Tatterton and Louise Horsfield attended to give an update on the Shared Referral Pathway. It was noted that the presentation had been updated with the latest validated figures (December 2020). This included new comparison data and also some patient stories.
Detailed discussion took place, key areas noted were: • Joint communications • Re-audit in 3 months • Digital services now classed as Direct Clinical Contract Time • EMIS to be phased out • How to capture/measure benefits to patients, i.e. shorten journey time • Impact of Covid on waiting lists and mitigation • Methodology for re-start of services • Specialities unable to be digitised • Shared Waiting Lists • Essential to go through the right process/pathways in order to achieve effective transformation
It was noted that Dr Debbie Hallott was included in discussions for gynaecology going forward and that there was representatives from both Wakefield and North Kirklees but anyone else would also be welcome.
It was RESOLVED that:
(i) Members noted the update on Shared Referral Pathway.
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21-7 Long Covid Dr Katherine Hickman and Lisa Chandler and Anna Staples attended to present and discuss proposals for a service to support people with Long COVID. Dr Clive Harries also gave an introduction.
An overview of the definitions of Long Covid (Acute, On-going and Post) were given and how the current local pathways had been developed. Health Inequalities and impacts were highlighted. The next steps were outlined. The non- medical, voluntary/community/social aspects were also emphasised.
Dr Katherine Hickman outlined the partnership approach that had been adopted in Leeds and the positive impacts of the MDT Clinic were noted. Sustainability and resilience issues were also outlined.
Key areas of discussion included:
• The existing MY Therapy Pathway • Potential GP Specialist support required • Potential e-consultation pathway for complex patients • Digital MDT (as in Leeds) / single point of contact • Mindful of potential for this to exacerbate the challenges associated with patients presenting with fatigue symptoms • Education and communication
It was RESOLVED that:
(i) Members noted the presentations on Long Covid.
21-8 Ardens / Clinical Prioritisation Dr Serena Alim attended to discuss Ardens. It was noted that there had been 10 responses to the survey last year and feedback was summarised; positive feedback had been that the system was appreciated and negative feedback was that there were “busy screens”
It was highlighted that there would be an Ardens Top Tip Communications system set up in order for practices to be able to use the system more effectively. Lunch and Learn sessions delivered by Conexus had also been arranged.
Discussion took place on individual experience and other key areas and/or suggestions included;
• Possible buddying system • Training relevant for Clinical, Admin/Reception and ACP/Nurses • All relevant new employees to be given half-day training on Ardens and SystmOne
It was RESOLVED that:
(i) Members noted the update on Ardens.
21-9 Strategic Overview and Strategic Direction for Urgent Care
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Lucy Beeley attended to give a presentation on the Strategic Overview and Direction for Urgent Care, this included an overview of the system and details of the services involved and a summary of the system-wide programme approach. The suggestion to create a single version of system data / single dashboard and thereby the potential to change the reporting approach was outlined.
Members were asked for any comments or feedback and Lucy highlighted that she would be happy to discuss individually or engage with groups. It was also noted members could be involved in the process should they wish.
It was RESOLVED that:
(i) Members noted the Strategic Overview and Direction for Urgent Care presentation and update.
21-10 Tele-dermatology Update
Grace Owen attended to give an update on Tele-dermatology. This included an update on supply of equipment.
Members were asked to advise if practices required more than the suggested one item of equipment per practice or if no equipment was needed at a particular site so that supplies could be appropriately distributed.
It was highlighted that it may be useful for practices to consider training a HCA to support with picture taking.
Discussion took place on communications and it was requested that a one-page summary of the process should be developed and circulated and that a clear launch date should be conveyed.
It was noted that initially the option to refer without a dermatoscopic image would still be possible however the strategy should aim to transition to a fully digital service going forward.
It was RESOLVED that:
(i) Members noted the Tele-dermatology Update.
21-11 Diabetes Programme Update
Grace Owen attended to give a brief update on the Diabetes Programme.
It was noted that Dr Tim Dean would attend the Yorkshire and Humber Children and Young People Diabetes Network Quarterly meeting.
It was RESOLVED that:
(i) Members noted the Diabetes Programme Update.
21-12 Cancer Strategy 2020 and Beyond
Dr Abdul Mustafa gave an introduction and background to the draft strategy and 4
Grace Owen attended to give an overview. Members were asked to consider the ambitions and the five focus areas and feedback any comments or further suggestions.
Health inequalities and outcomes and prevention were suggested as further areas to be included in the strategy. It was also suggested that the strategy should be disseminated more widely, i.e. to Public Health, ICP and the Health and Well-being Board.
There was support for the draft strategy and it was agreed that there was a commitment for cancer to be kept as a priority.
It was RESOLVED that:
(i) Members noted the Cancer Strategy 2020 and Beyond.
21-13 Work Plan Review and Future Agenda Items
It was noted that it was often the case that there were no items on the Work Plan for the forthcoming month and the potential to hold a bi-monthly meeting was put forward.
Estate strategy was a suggested future item.
Suggestions to ensure connectivity were discussed, including alignment with the ICS and ICP and in particular with the ICS Clinical Forum and mechanisms to bring together.
Mutual accountability driving priorities and influence were agreed as key focus areas for the group.
The Chair requested any suggestions for future agenda items to be emailed.
21-14 Minutes from Sub-Committees to Note: The Medicines Optimisation Group Highlight Report was noted.
21-15 Any other business:
Dr Debbie Hallott asked that consideration be given on how to contact unpaid/voluntary/informal carers in order for them to be included in the Group 6 COVID-19 Vaccination Cohort. Ruth Unwin suggested that once criteria for identifying informal carers had been agreed, this could be supported by communications activity to encourage people to register.
There was no further business to discuss.
21-16 Date and Time of Next Meeting:
Thursday 18 February 2021 from 8.30 to 11.30 MS Teams meeting
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Connecting Care Executive Meeting Agenda item 21c(i)
Thursday 10 September 2020 11.00 to 1.00pm Via Microsoft Teams
Present: Melanie Brown (MB) Chair Director of Commissioning and Integrated Care, WCCG Angela Nixon (AN) Group Finance Manager, Adults Health & Communities, WMDC Caroline Carter (CC) Group Finance Manager, Children & Young People, WMDC Dr Ann Carroll (DrC) GP and Clinical Lead for Connecting Care, WCCG Gary Jevon (GJ) Chief Executive Officer, Healthwatch Dr Adam Sheppard (DrS) Chair of Wakefield CCG Jonathan Webb (JW) Chief Finance Officer, WCCG
In attendance: Andrew Lancashire (AL) Service Director Education and Inclusion, WMDC David Hamilton (DH) Service Director Adults, WMDC Nichola Esmond (NE) Service Manager, Joint Commissioning, WMDC Stephen Crofts (SC) Service Director Children’s Services Strategy & Innovation, WMDC Judith Wild (JWi) Deputy Chief Nurse and Head of Service for CHC, WCCG Elizabeth Goodson (EG) Senior Finance Manager Partnerships, WCCG Martin Smith (MS) Head of Connecting Care, WCCG Michelle Domoney Minute Taker
Action 1. Welcome and apologies:
Andrew Balchin (AB), Anna Hartley, Beate Wagner (BW), Jo Webster (JoW) and Suzannah Cookson (SC) submitted their apologies.
2. Declarations of Interest:
No declarations were made.
3. Minutes from 9 July 2020:
The minutes were approved as an accurate record.
4. Action Log:
Reviewing the action log, the CCE members noted the updates as detailed on the action log with the following additions: 20191114-021: Better Care Fund is ongoing with MS leading; 20200312-001: Tracy Morton is progressing pooled arrangements for Short Breaks; 1
20200611-005: JWi advised Virtual Care Home support work has been raised with community colleagues and will be progressed with MS and NE.
5. FOR DECISION: Reablement Review:
Advising it is a working document and the latest version will be circulated to colleagues after a meeting which is to be held on Friday, DH talked members through the PID advising: • Work is taking place on the workstreams which have reduced from 6 to 4; • Some wider services including equipment, intermediate care, some urgent response services are to be looked at as part of the review; • There is a need to join up services as much as possible and build on the good work which is already taking place; • Services will be evaluated for continued improvement with possible different models to be explored; • Recommendations regarding how to improve existing services, rationale and suggestions in terms of new models and approach going forwards will be presented at a future meeting; • Risks include ensuring interdependencies with other groups are clearly understood and informing people on what is trying to be achieved including why and what their part may be; • National requirements are being considered to ensure connections with the NHS Long Term Plan and Care Act etc.; • Noting the work involved, it is anticipated that it will be March 2021 before a further detailed update will be available.
Referencing the recommendations DH asked CCE members to agree to support the undertaking of this piece of work and agree a timeframe for updates; suggesting December/January as the next update.
MB advised this will be a significant joint commissioning review for CCE to be aware off noting an investment of approximately £1.8m into intermediate care facilities and over £2m of reablement spend. Noting the level of investment, MB asked if finance colleagues were part of the review. AN confirmed reablement investment is £2.8m and finance colleagues will be supporting DH.
In discussion, GJ supported the programme of work and asked to be kept informed regarding communications and engagement when that comes to fruition.
DH acknowledged the level of spend, advising one of the tasks will be to review budgets so there is clarity with the new service created within existing finance levels; adding changes and efficiencies are likely though is not the main intention of the programme. DH will keep CCE informed of benefits realisation and what they may look like.
Noting the scale of the work to be undertaken, DrC asked how the programme will link with the ICP to ensure oversight, adding there is lots of work taking 2
place in lots of areas. DH confirmed steps are being taken to map existing activity to ensure connectivity where required whilst also avoiding confusion and duplication.
The CCE approved the review proceeds with an update to be given in January: noting it will be March 2021 before a new model can be shared for CCE approval.
6. FOR DECISION: Domiciliary Care Winter 2019/20 Initiative Evaluation Report:
NE advised the supporting report has been written by Alison Critchell and provides details of domiciliary care and winter funding from last year, adding domiciliary care differs between WCCG and WMDC though funding was to support of both. Talking through the report, NE highlighted; • Admissions from hospital for domiciliary care packages are at least as high as they are from care homes and would require further investigation; • There are significant workforce issues in the independent care sector which can have an impact on consistency, quality, service user experience and provider stability; • The winter funding provided an opportunity to invest in domiciliary care and understand which initiatives made the most impact on hospital discharge, reducing avoidable admissions, maintain quality etc. • Providers had advised one of the biggest issues was hospital retainers. Upon investigation it highlighted a concern regarding stability between the WMDC and CCG markets therefore a broader approach (a model from Sheffield) was used. The model allowed providers to submit bids for funding with ideas on what they could do to reduce avoidable hospital admissions, reduce delayed discharge and improve quality and consistency of care; • Of the 35 providers within Wakefield only 13 submitted bids. Approximately £200k was allocated between these 13; • An interim evaluation was undertaken in January 2020; however the final evaluation has been delayed until now due to the Covid-19 pandemic. Broadly, there was positive feedback from providers, staff and service users, with positive impact seen particularly during holiday periods and an increase in the number of care hours provided; • A comparison is included in the report which shows the impact of the additional £200k over winter for certain initiatives versus the impact of Covid-19 when WMDC started to pay un-commissioned hours rather than actual. Although expensive, it had a huge impact on providers being able to pick up packages and deliver care; resulting in the waiting list disappearing; • Un-commissioned hours have now declined and WMDC have reverted back to paying actual with a small hospital retainer in place after recognising during Covid-19 and from a CCG perspective there were no challenges. That market is very stable and suggested WMDC looks at how WCCG manages its payments to providers to see if there is anything which can be learnt; • Providers reported the most effective measures were regarding enhanced pay, enhanced rates, bonuses for picking up additional work which result in better staff satisfaction and retention. 3
NE noted the recommendations as being: • Although it was a good short term exercise in terms of provider engagement and understanding what works in domiciliary care to improve quality and hospital avoidance tactics, it would not be beneficial to repeat this process for either WMDC or CCG; • WMDC needs to take note of the differences when moved to un- commissioned care; • To explore a different approach for domiciliary care this winter. It remains an important area, however perhaps support should be more targeted with solutions around fast response teams either commissioned or in house; • A joint domiciliary care strategy is needed (similar to the care home strategy) between commissioners, providers, service users etc. to ensure a quality, timely, consistent and responsive domiciliary care can be delivered.
In discussion DrS asked if there was any intelligence regarding why so few providers submitted a bid for funding. NE suggested lack of capacity and understanding in terms of what it meant could have been factors; adding it was not possible to advise how much funding would be available.
Acknowledging commercial issues, DrS also asked if there were future plans for more collaborative working between providers. NE advised collaborative working did take place during the pandemic and has tried to promote it, though following a survey there was little appetite for providers to sign up to some sort of MOU or sharing agreement, with most expressing concern about losing their staff. However, suggesting this should be progressed; NE advised it would be helpful to speak to providers to understand their concerns and try to address them.
DrC asked if the cost of night sitting or a turning service had been looked into, noting one private provider does provide this option. JWi confirmed a night sitting/turning service which both health and social care can access has been highlighted as a commissioning gap and steps are being taken to see how this can be addressed. MB asked that an update on this work is given to CCE at a future meeting when in a position to do so.
DH added one future piece of work which may need considering in the medium to longer term is commissioning for outcomes and how domiciliary providers may contribute to the reablement approach in the future to continue the reablement ethos and ideology in the future. DH added, he has tried to do something similar with care homes in the past, however following Covid-19 there could be an appetite and opportunity for this work to take place; noting there has been a change in thinking and the stabilisation and research review has also picked up on the need to rethink relationships and partnership arrangements with providers.
JW added there is the potential to learn lessons from other places across West Yorkshire in terms of what has worked last winter, through Covid-19 and what is 4
planned for this winter, noting all areas are dealing with similar issues. NE acknowledged the need for joint working, advising there is some taking place however more could be done.
NE advised a financial sustainability survey has been done for care homes and suggested the data is sent to JW. JW advised that would be helpful, adding there is a need for sustainability across West Yorkshire noting future financial arrangements from the NHS are likely to be ICS wide.
CCE supported both recommendations as detailed in the supporting paper.
7. FOR DECISION: Work Plan 2020/21
Advising a draft version was presented at a previous CCE meeting, MB provided an update advising: • The children’s section has been strengthened to acknowledge the work which is taking place in children’s commissioning; o A work programme for children and young people’s (C&YP) commissioning is being progressed; o Monthly Joint Commissioning Panel meetings take place and minutes from these meeting are shared with CCE for information; o Approximately 20 areas of work are taking place in C&YP commissioning across the system. MB and SC have oversight; o A virtual OD session will take place later this year to bring the C&YP team together. • Wording has been added regarding CCE endorsing the work which is taking place and is being commissioned at ICP; reflecting ICP is not currently a decision making body.
MB asked CCE to adopt the workplan, noting some recommendations on health and reform may be announced in October.
DrS welcomed the alignment between ICP and CCE noting CCE is the only venue to formally agree BCF spending. MB added as opportunities arise through new legislation (expected in 2021) steps can be taken to look at different ways of delivery across the system, in the meantime the aim is to remain safe.
All CCE supported to adopt the workplan.
8. FOR DISCUSSION: One System Vision – Wakefield Families Together:
Advising an update is to be given to ICP on 22 September 2020 SC gave a verbal update on the Wakefield Families Together (WFT) programme, advising: • The vision of WFT is to work across CCG, children’s services and Public Health, with BW chairing a project team which is focused on taking WFT in to the next step of delivering more joined up planning and commissioning; • Work is progressing with teams at the point of understanding outcomes and KPIs across the system and what a joint commissioning approach may look 5
like; • The next project team meeting is taking place on 24 September 2020 with fortnightly meetings planned until the end of the year; • A further update will be available for the next CCE meeting.
MB added it is exciting to see the way joint commissioning is starting to galvanise within children’s, with relationships developing over recent months as a result of the bottom up approach which has been taken. 9. FOR DISCUSSION: Wakefield Joint Commissioning Framework:
Advising the CCE has signed off previous Joint Commissioning Frameworks (JCF) MB gave a presentation providing an update on the development of the latest version; advising on its requirement, the work programme for 2020 to 2023, the development of a toolkit, next steps and areas for discussion. MB added: • The development of the JCF has been delayed by Covid-19 however colleagues have progressed the document over the last 5 months with updates given on its progress and development at other forums; • It is hoped the final document will be available by the end of October 2020.
MB asked CCE members for any comments and suggestions for inclusion or improvement; adding the document is evolving and is likely to change after it is reviewed by DMT later in September.
JW noted the document talks about the Better Care Fund (BCF) and the arrangements which are in place, however asked if the finance teams should be tasked with providing more detail where there is shared financial risk arrangements in place. MB welcomed this suggestion and suggested Liz Goodson works with WMDC finance colleagues on this. JW agreed, advising such a step will provide a sense on if we are doing all that we want to do, adding conversations take place about the large BCF pot across Wakefield however when looking at the services were resources are truly jointly pooled, the funding may not be as big as expected and such a step would allow for a baseline discussion to take place. ACTION: WCCG and WMDC Finance colleagues to LG/AN jointly provide more detail on where there are shared financial risk /MS arrangements in place.
NE also suggested including some detail regarding where the money goes and the impact it has had. MB advised this could be possible for adult services noting MS does this for the BCF, however to do the same for children’s would require some work. MS confirmed this could be done for adults and would be happy to take the work forward including speaking to Liz Goodson regarding the elements previously suggested by JW.
DH advised some authorities are now working on outcome based budgeting and suggested this could be something to be considered in the future though acknowledged other elements need to be in place beforehand. ACTION: MS to MS investigate this further with Finance colleagues.
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After discussion CCE members supported the development of a toolkit to support the JCF. CCE also agreed delegated sign off to MB and AB in the event of a regulatory request before the next CCE meeting. ACTION: Final version of MS JCF to be shared with members when available.
10. FOR DISCUSSION: Continuing Health Care Report:
JWi talked members through the supporting paper, adding/highlighting: • The annual report for Continuing Health Care (CHC) Report would normally run through a financial year, however due to Covid-19 the report provides information from April 2019 to February 2020; • From 2017 to February there has been a marked improvement in the number of assessments completed within 28days: improving from 2% to 86%; • The profile of CHC spending is currently different due to Covid-19 for the period 19 March to 31 August. Work is taking place with WMDC colleagues to agree a set of principles to how uplifts can be done going forwards; • Patients who are terminal and at the end of life, fast track funding is allocated to allow patients to be fully funded whilst also ensuring patients are where they wish to be when they pass away; • Work has been taking place with WMDC colleagues to see how CHC contracts can be aligned and bring WMDC and WCCG CHC contracting teams together; • From 19 March 2020 all existing CHC assessment processes were suspended. Instead, the team put into place Covid-19 discharge service requirement arrangements. The purpose was to expedite safe discharge of patients to free up beds for Covid-19 patients being admitted into hospital and also reduce the burden of in/out hospital setting assessments. During this process 134 patients were safely discharged within the first two weeks; o The CHC team was split into two: one half looked at the existing 890 core patients, the other look at Covid-19 patients coming through from hospital discharges. Noting each patient was required to have a review 24/48 hours post discharge to ensure their health and social care needs had been identified and the care commissioned was appropriate; • Covid-19 funding concluded at midnight on 31 August 2020; • The number of patients seen has changed from those detailed in the report: CHC looked at 804 individuals during March to August: o 432 were social care of which 202 patients are open cases; o 372 were nursing of which 145 are still open; • 347 CHC cases remain open and now require assessment. It is recognised nationally there is a backlog of assessments (approximately 10,000 across North East and Yorkshire) and weekly meetings are taking place with WMDC colleagues to see how many assessments can be undertaken; • Covid-19 spend over the last 6 months has been £6.7m; hospital discharge has been £335k on red bed sites, £622k on block beds, £310k was set aside for step down dementia beds; • Working with WMDC colleagues, principles are being developed for stepping
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patients off funding; • From 1 September 2020, new discharge guidance was introduced; CHC assessment processes have begun to be restored and WMDC colleagues are starting to undertake their Care Act processes again; • NHSE are looking to release some FAQs in coming few weeks to support and underpin the guidance and how the funding should work; • The new guidance also describes a new D2A process which allows patients up to 6 weeks free funding and care whist assessments are undertaken therefore working with WMDC colleagues, steps are being taken to track patients being discharged from hospital in addition to putting measures in to avoid hospital admissions and funding those through a D2A process; • The frequency of Sitrep submissions has now been confirmed as fortnightly with the first to be submitted next Tuesday.
JWi asked CCE to note the contents of the report and the improvement which have been made to date with the help of the CHC team.
DrC asked how funding would be applied in terms of hospital avoidance; asking would these patients be eligible for the 6 weeks free funding. JWi advised NHSE have issued further guidance today, advising for hospital avoidance, free funding could be received for up to 72 hours whilst an assessment is being undertaken. JWi added funding is to support moving patients out of hospital, improve patient flow and for hospital avoidance; for any other service changes, existing resources and different ways of working with regards to contracts and resources should be looked at, noting this is non-recurrent monies.
CCE accepted the recommendations as detailed in the supporting paper. On behalf of CCE, MB congratulated JWi and the team on the impressive work which has taken place.
11. FOR DISCUSSION: Update on ASC Commissioning and Next Steps:
Noting a comprehensive update was given at the last CCE meeting, NE provided a brief verbal update, advising: • There are currently 7 care homes with patients with Covid-19. All cases have been picked up via home testing, all are asymptomatic and no onward spread has been seen; • More positive cases are expected moving into winter • As part of keeping care homes safe, steps are being taken to review step down Covid-19 and winter/general resilience bed requirements. A proposal will be presented at SLT and DMT in the coming weeks; • There has been an increase in safeguarding alerts for care homes, with 9 homes being looked at currently. During Covid-19 it has not been possible to visit care homes for quality checks therefore the increase in quality and safeguarding cases is being closely monitored. Noting some care homes are small with limited support a peer support approach is being considered; • Since WMDC returned to paying on actuals (with a small hospital retainer for short notice cancellations) for domiciliary care, one provider has returned all 8
packages, advising they are unable to sustain delivery on the way they are paid. These packages have been redistributed elsewhere within the system, however it is a concern this has happened and will need to be monitored.
12. FOR ASSURANCE: BCF 2019/20 Quarterly Progress Report Q4 and Year End report:
MS talked CCE members through the latest BCF submission, highlighting: • The Q4 report from last year’s BCF has been delayed due to Covid-19; • All national conditions have been achieved; • 3 of the 4 metrics have been achieved. The nationally set Delayed Transfers of Care (DToC) target was not achieved however significant improvement has been made on last year’s performance. It is hoped this will reduce further this year as a result of the work being undertaken across the High Impact Change model (HICM) • The HICM is one requirement of the BCF which includes early discharge planning, systems to monitor patient flow, multi-agency discharge teams, home first discharge to assess, 7 day services, trusted assessors, focus on choice, enhanced health in care homes and the red bag scheme. All these elements are coming together with one group looking to have oversight on them; • The report includes a summary of the year including elements of good practice, how the winter pressures grant was allocated, income and expenditure; • The final BCF Q4 submissions shows Wakefield BCF spend is slightly lower than expected due to some schemes underspending on staff and vacancies, though there was some overspend with some mental health schemes; • Successes this year included strong system wide governance and leadership from CCE and ICP and personalised care, primary care networks and live well; • 2 areas of challenge are highlighted regarding electronic sharing of notes with residents and sustainability of the care sector; • Details on how the iBCF was spent are also included.
MS added there is no indication from NHSE as yet on the requirements for this year’s BCF, however as advised at previous CCE meetings, the intention is to work on the basis of what the plan was last year, with HICM embedded within the workstreams and continue to deliver against the 4 national metrics. The BCF will also continue to include the disabled facilities grant, iBCF and winter pressures monies.
DH enquired about Connecting Care 2.5 monies from 2020 which will be utilised for 2021/22; asking if any plans are being consider/have been made. MS advised some work has taken place to work through what was allocated and applying some uplifts so there was a budget, however how the money is to be used is still an area for discussion. AN confirmed this, adding due to Covid-19 discussions have not yet taken place. JW advised he would need to have a conversation at a later date with Neil Warren given the materiality.
9
On behalf of CCE, MB thanked MS and all finance colleagues for their hard work in managing the BCF in order for Wakefield to meet its requirements.
13. FOR ASSURANCE: Joint Legacy Reserves:
The CCE noted the paper for information after AN advised the report is as detailed, though advised if all planned spending is undertaken, there could be some funds left on Connecting Care.
14. 2019/20 Learning Disabilities Mortality Review (LeDeR) Annual Report:
The CCE noted the paper for information.
15. FOR ASSURANCE: Joint Commissioning Panel Children and Young People Update and/or Minutes from June and July 2020 meetings.
The CCE noted the minutes from Joint Commissioning Panel for information.
16 Matters to be referred to Governing Body, Health and Wellbeing Board or other Committee:
No items were raised.
17. Any Other Business:
MB thanked members for the quality of the today’s reports and for members contributions.
18. Date and Time of Next Meeting:
Thursday 12 November 2020, 11.00 to 1.00pm via Microsoft Teams.
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Agenda item: 21d FINANCE COMMITTEE
Thursday, 26 November 2020 Microsoft Teams
MINUTES
Present Richard Hindley Lay Member (Chair) Dr Clive Harries Governing Body member – GP Jo Webster Chief Officer Jonathan Webb Chief Finance Officer and Deputy Chief Officer Ruth Unwin Director of Corporate Affairs Mel Brown Director of Commissioning Integrated Health and Care
In Attendance Richard Watkinson Lay Member Karen Parkin Associate Director - Finance and Contracting Emma Scholey Governance and Committee Officer (Minute Taker) Natalie Tolson Head of Business Intelligence Michelle Whitehead Head of Finance
20/109 Apologies for Absence Apologies for absence were received from: Suzannah Cookson Chief Nurse Dr Adam Sheppard Chair & Clinical Leader
20/110 Declarations of Interest The Chair invited attendees to declare any conflicts of interest.
No declarations of interest were received.
20/111 Minutes of the Last Meeting held on 22 October 2020 The minutes of the meeting held on 22 October 2020 were agreed as an accurate record.
20/112 Action Log Update 20/104 Activity Monitoring Report The Shared Routine Referral Pathway will be presented at Governing Body on 8 December 2020
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20/113 Matters Arising There were no matters arising.
20/114 Month 7 Financial Reporting Michelle Whitehead provided an update on this item. She explained that it is expected that the CCG will break-even by the year end. NHSE/I ‘s reporting requirements prevent the CCG from accounting/forecasting for some future income streams until they are received, a deficit position is therefore currently being reported.
Michelle reported that month seven financial reporting has been prepared in line with the October 2020 to March 2021 temporary finance regime set out by NHSE/I. This requires the CCG to report positions inclusive of the P6 YTD deficit of £2.10m which has not yet been closed off by a retrospective allocation. The CCG is reporting a £3.51m deficit for P7 YTD. This comprises Plan P7 deficit of £0.45m, £2.10m P6 YTD b/f, £1.05m overspend for the Hospital Discharge Programme funded retrospectively and the benefit of £0.09m conditional SDF allocation.
Michelle noted that the Continuing Healthcare overspend is not currently a concern as it is being funded by the Hospital Discharge Programme and we will be able to claim this back next month.
Michelle discussed the performance indicators showing as red, noting that the programme spend is due to the retrospective recovery of covid-19 costs and allocations that have not yet been received.
Michelle noted that the key thing for Finance Committee members to note is that our year to date position is balanced and our forecast out turn is also balanced for the year.
Jo Webster and Finance Committee members thanked the Finance Team for their work on the complex situation.
It was RESOLVED that: i) Finance Committee noted the current financial position to month seven under the temporary finance regime.
20/115 WCCG Risk Register: Assessment of Financial Risks Michelle Whitehead provided an update on the current status of the financial risks on the risk register. The CCG has completed the quarterly risk cycle and the risks are relevant as at 10 November 2020.
There is one risk with a high risk score of 12 relating to the CCG entering 2021/22 financial year not in a position to deliver its recovery plan due to the impact of the Covid-19 pandemic and the changes to the financial regime. Michelle explained that this is a risk due to the uncertainty about allocations for 2021/22. The CCG is well placed to receive and respond to updates from NHSE/I in respect of the finance regime, and is currently working with organisations within West Yorkshire & Harrogate Health and
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Care Partnership to achieve the required financial position across the system. By way of assurance, the CCG will continue to provide reports to Finance Committee, Audit Committee and Governing Body in this respect.
There is a risk that the CCG will not achieve its running cost target due to the inability and lack of opportunity to achieve a 20% reduction. In the previous report to Finance Committee, the risk score was eight due to the risk of non-delivery of the financial plan. The forecast level of expenditure in 2020/21 has meant that this risk score has been reduced to six as it is forecast that we will achieve the running cost target in 2020/21.
One risk has been closed since the last update relating to a VAT risk with West Wakefield Health and Wellbeing Ltd due to HMRC’s outcome that there is no VAT liability due. There have been subsequent discussions with West Wakefield Health and Wellbeing Limited about the financial implications of the confirmation of VAT applicability which we expect to conclude shortly.
It was RESOLVED that: i) Finance Committee noted the financial risks currently on the risk register and note the rationale for the scores.
20/116 P7 Covid-19 costs The Covid-19 cost tracker continues to be reported to the Senior Leadership Team (SLT) meeting where there are changes to report and where decisions are formally logged. Total expenditure forecast to date is £14.1m.
All forecasts are to the end of the financial year and take into account any changes in guidance. For the period April 2020 to September 2020 Covid- 19 costs were funded retrospectively by NHSE/I. From October 2020 the Covid-19 funding is a fixed amount included in the CCG’s allocation; this excludes the Hospital Discharge Programme which will be recharged retrospectively to NHSE.
As the pandemic has entered the second wave additional costs maybe incurred. This will be managed within the overall CCG budget envelope. All costs will be authorised in line with the CCG Covid-19 governance process and national guidance on reimbursement.
It was RESOLVED that: i) Finance Committee received and noted the Covid-19 financial governance arrangements and the tracking of associated spends.
20/117 Contract assurance report – 2020/21 financial year Simon Rowe presented a paper that provided an update on the completion of contract actions for 2020/21. The contracts team is responsible for the contracting of healthcare services (with the exception of Continuing Healthcare) and non-healthcare services.
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Simon reported the progress against the total 320 contracts; there were 57 still to action as at the reporting position on 16 November 2020. He reported to the committee that there are now three contracts that are outstanding to be actioned and eight contracts with a pending date for action, these are signed off and going through the governance before being provided. Simon also reported that all outstanding contractual actions will be actioned by the end of the week.
Jonathan Webb and Richard Hindley thanked to Simon and the Contracting Team for their work on this. Richard felt that the committee can take assurance from this report.
It was RESOLVED that: i) Finance Committee noted the contents of the report; ii) Finance Committee agreed to receive a further update, before March 2021, to update on 2020/21 actions and to advise on what is required for 2021/22.
20/118 System Oversight and Assurance Group - Finance Report Jonathan Webb presented the copy of the finance report that goes to the West Yorkshire and Harrogate System Oversight and Assurance Group. Jonathan explained that he attends in his ICS role and Jo Webster in her sector lead role.
The report comments on the finical performance of the NHS Organisations in the Partnership. Jonathan explained that the ICS submitted a balanced plan. A realistic plan was formed following an assessment across the ICS on the value from provider incomes,
The forecast full-year position is that the system will be £1m better than plan. Jonathan noted the issues of annual leave provision for provider accounts for leave not taken and there is an expectation across providers that the value will increase as staff are unable to take all of their allotted leave. Jonathan also reported the range of CCG allocation issues, including adverse technical variances in CCGs of £23m all relating to prior month top ups not yet received.
The positons exclude the potential adverse impact of the Elective Incentive Scheme. At the end of month seven, there was a favourable year-to-date variance of £2.7m. Scenario planning across each organisation suggests a best case scenario of £13m better than plan for the full-year. The worst case scenario is £122m worse than plan (of which £43m is viewed as “local” issues, and £79m relate to issues which are of a “national” nature).
It was noted that the plan was submitted knowing that some organisations were taking more risk than others. The ICS is continuing to have the conversation via the West Yorkshire and Harrogate Finance Forum about putting in place risk share arrangements for 2020/21.
It was RESOLVED that:
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i) Finance Committee noted the West Yorkshire & Harrogate Integrated Care System consolidated financial position.
20/119 Activity Monitoring Report Natalie Tolson attended the meeting to present this report which is centred on the current activity trends and demand on service provision as a result of the COVID-19 pandemic and to support the monitoring of activity re-set. The report provides a September overview of the 2020/21 activity trends, current activity delivery rates compared to 2019/20 and the volume of referrals being made. The activity reports current delivery rates at POD and specialty level. The report also includes an overview of the phase 3 activity plan for Mid Yorkshire Hospitals NHS Trust as of the end of October.
Natalie noted the following areas from the report: • GP appointments increased throughout October and report above trend from last year • GP routine referrals into Mid Yorkshire have a delivery rate of 72%. Mid Yorkshire have put in an escalation process to monitor referrals and trigger where routine referrals are above 70% • E-Consultations are also increasing on a weekly basis, with current activity levels above that reported last year. The increase is across all specialities. • Delivery rates are increasing each month. A&E has a delivery rate of 86%. At site level this was a delivery rate of 91% for Pinderfields and Dewsbury and 74% for Pontefract • Ambulance handover remains a challenge for the Trust along with poor patient outflow from ED to inpatient wards. • Outpatients appointment delivery rates are doing well due to transformation of non-face to face • The Trust is looking at activity delivery rates on a weekly basis at consultant level and the data is reviewed at the weekly Access and Performance Meeting. Additional activity is being sourced from the Independent Sector to support the delivery of activity. • The number of 52 week breaches being reported continues to rise both regionally and nationally. At the end of September, 2.2% of patients waiting for treatment were waiting over 52 weeks. Nationally, 3.2% of patients have been waiting over 52 weeks for treatment
It was RESOLVED that: i) Finance Committee noted the CCGs current activity performance against last year’s position and the actions that are under-way to support the delivery of restarting planned activity within Mid Yorkshire Hospitals NHS Trust. ii) Finance Committee acknowledged that reset and the delivery of elective activity has been impacted by the recent increase in COVID positive patients in beds
20/120 Matters to be referred to: (i) Governing Body – Details of any exception reporting
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(ii) Other Committees - Items to be included on other committee agendas
20/121 Any Other Business There was no other business raised.
20/122 Date, Time and Venue of Next Meeting Thursday, 28 January 2021, 11.30 am to 13.30 pm
Page 6 of 6 NHS Wakefield Clinical Commissioning Group Agenda item: 21e(i) Patient & Community Panel
Notes of the Meeting held virtually via Microsoft Teams on 28 August 2020 Present : Christine Allmark Patient Representative Sandra Cheseldine Citizens Advice Bureau Stephen Hardy Lay Representative, Wakefield CCG (Chair) Paulette Huntington Patient Representative David Hutchinson Patient Representative, PPG Network Sandy Gillan Patient Representative Simon Green Patient Representative Anna Milnes Patient Representative Safeen Rehman Healthwatch Wakefield Hilary Rowbottom Patient Representative Janet Witty Patient Representative NHS Wakefield CCG Staff Laura Elliott Head of Quality Dáša Farmer Wakefield CCG, Engagement Sarah Mackenzie- Equality and Diversity Manager Cooper Lucy O’Lone Quality Coordinator Ruth Unwin Director of Corporate Affairs Pam Vaines Minute Taker Mike Potts Project Lead (item 20/16 only) Gill Galdins Project Lead (item 20/16 only) Gordon Smith Head of Diversity and Inclusion, MYHT (item 20/17 only) 20/10 Apologies for Absence Apologies were received from: Hilary Cooper Health Visitor, 0-19 service, Bradford District Care NHS Foundation Trust Mavis Harrison Patient Representative David Hutchinson Patient Representative Jill Long Engagement & Communications Officer, Yorkshire Cancer Community, Healthwatch Wakefield Zahida Mallard E&D Lead, SWYPFT Beverly Poppleton Wakefield District Sight Aid Val Pratt Wakefield Deaf Society Mohammed Rawat E&D Lead, Mid Yorkshire Hospitals NHS Trust Carol Smith Patient Representative Peter Wilson Patient Representative
20/11 Declarations of Interest
The Chair invited attendees to declare any conflicts of interest.
There were no declarations of interest noted.
20/12 Minutes of the meeting held on 2 July 2020
Comment was made that support for the proposed new build Health Centre within the planned shopping complex at City Fields had not been recorded in the minutes of 2 July 2020. The Chair confirmed that the support was recorded in the minutes at 20/06 and the subject was on today’s agenda.
It was agreed that the roles of the representatives would be recorded as ‘Patient Representative’ to ensure consistency.
The minutes of the meeting held on 2 July 2020 were agreed as a correct record.
Post Meeting Note – Laura Elliott, Head of Quality at NHS Wakefield CCG, asked for her attendance at the meeting of 2 July 2020 to be noted.
20/13 CCG Update - Verbal
Ruth Unwin provided a verbal update of the work currently underway within NHS Wakefield CCG.
Ruth explained that the CCG is preparing a response to the recent letter issued from Simon Stevens (Chief Executive of NHS). This will be the first integrated response as part of the Integrated Care System (ICS) and will provide comment and information from the whole area, including Public Health.
Public Health have been heavily involved in supporting organisations and individuals in Covid-19 outbreak areas, looking into causes and providing direct support to communities with increased need (eg bed and food factories and their employees/communities). Public Health continues to run Keep Safe campaigns.
Healthwatch Wakefield has commissioned a survey to understand people’s experience of using services during the pandemic. The survey was shared with members of the Panel who were encouraged to promote it within their networks. The results will be used to ensure that unintentional barriers are not created when services are reinstated or newly commissioned.
Ruth Unwin commented that a number of changes have occurred within Primary Care in relation to how patients access a GP. All practices now have a telephone triage system in place. Ruth confirmed that throughout the pandemic, GPs have seen patients for face-to-face appointments when necessary and that these are continuing. Face-to-face appointments for
non-urgent issues are now increasing.
Other work to improve the patient experience continued to take place, including GPs issuing prescriptions to the patient’s pharmacy of choice rather than the patient having to collect a prescription from Practice and take it to the pharmacy, thereby limiting potential exposure to risk of infection.
A Home Visiting service has been put in place to support GPs with visits to patients who are unable to attend face-to-face appointments at the Practice.
The Community Nursing team continue to visit patients in their homes where necessary and is liaising with patients via telephone etc when appropriate. The aim is to keep exposure to a minimum for both the patient and staff member.
Ruth Unwin commented that attendance at A&E is slowly increasing and social distancing is becoming an issue. Members were asked to help to share the assurance that GP appointments are available and should be the first contact wherever possible.
Ruth Unwin confirmed that the dedicated cancer centre situated at Pontefract hospital is now fully operational and has proven to be very successful.
Hospital services which had been suspended as part of the response to Covid-19 are being reinstated. There is a national target for planned care to return to a capacity similar to three quarters of the 2019 activity by the end of September and full provision by the end of October 2020. Work is underway to reduce the backlog of cases which has developed over recent months. All patients referred to Mid Yorkshire Hospitals NHS Trust prior to April 2020 have been contacted. Patients will be managed by the Trust throughout their care pathway although they may be seen by other providers in the independent sector who are supporting the Trust.
Ruth Unwin provided assurance that patient safety has remained the primary criteria for decisions. A number of patients have waited over 52 weeks for procedures and each case has been clinically prioritised to minimise risk.
Ruth Unwin explained that South West Yorkshire Partnership NHS Foundation Trust and other mental health providers, such as Creative Minds, are working to ensure safe delivery of services and to restore suspended services and support. Clinically vulnerable people are being prioritised, especially anyone suffering with Post Traumatic Stress Disorder (PTSD) resulting from the impact of Covid-19.
Janet Witty commented that the report from Public Health was easy to read but felt that it did not give sufficient statistical evidence for official committees to understand and monitor the impact on the larger population.
She asked for future reports to contain data in addition to patient experience stories.
Ruth Unwin responded that data had been shared with the Integrated Care Partnership and Health and Wellbeing Board and would enquire whether that information could be shared with Panel members.
Paulette Huntington commented that PPG members were becoming concerned that Practices are heavily reliant on telephone contacts which is increasing difficulties for patients with hearing loss. She acknowledged that some practices are now offering appointments for routine issues; however, these may be offered only at specific times which may not be acceptable to all patients.
Ruth Unwin explained that NHS Wakefield CCG and Healthwatch Wakefield are working to understand the impact of the increased use of technology on specific cohorts of patients (eg hard of hearing patients). She reminded members that GPs are offering face-to-face appointments and will ensure feedback is provided to Practices regarding timings of appointments. Ruth asked members to refer concerns to their specific Practices.
20/14 Patient Experience & Engagement Update - Presentation
Laura Elliott and Lucy O’Lone presented the Experience of Care report which covered the period from April to August 2020. The report reflected a thematic review of available data, including information obtained from the Healthwatch Wakefield survey and via the Quality Intelligence Group (QIG).
Maternity Services.
42 items of feedback were received, of which 22 items (52%) provided positive feedback or good practice and 14 items (34%) highlighted areas for improvement.
As expected, the restrictions implemented due to Covid-19 caused distress to some women who were unable to experience the birth they had planned and some patients commented that staff appeared busy and stressed.
The majority of people were positive regarding the care they received during birth but concerns were raised regarding lack of post-natal support.
Dáša Farmer informed the Panel members that work is being carried out to fully understand the experience of maternity services and specifically the impact of Covid-19. A survey is currently underway and so far 221responces have been received.
Ruth Unwin confirmed that the maternity service will be fully staffed from September following a period of recruitment. The latest Care Quality Commission report had identified staff shortages within the Pinderfields maternity unit and an excess of staff at the Pontefract site. The temporary
closure of the Pontefract midwife led unit had helped to alleviate this and would remain in place for the foreseeable future.
Cancer Services
31 items of feedback were received with 12 items (39%) providing positive feedback and 15 items (48%) highlighting areas for improvement.
Patients described staff as caring and gentle and facilities as clean, safe and inviting. The restrictions imposed by the Covid-19 response had a negative impact on patient experience and patients felt that they were not provided with a clear explanation of their care pathway.
Primary Care
184 items of feedback were received with positive feedback from 66 items (36%) and 102 items (56%) identifying areas for improvement.
Patients acknowledged the difficult circumstances that staff were experiencing and many felt that telephone consultations were useful and worked well. However, concerns were highlighted regarding unclear guidance due to rapid changes to processes and procedures.
The feedback included support for the availability of face-to-face appointments and acknowledged the difficulties faced by certain cohorts of patients when using on-line or telephone appointments.
A number of patients recorded that they had been mindful of not putting additional pressure onto the system and had delayed seeing GP. A number of people who were shielding have reported feeling isolated as a result.
Concern was raised regarding the possible repercussions of the cancellation of a number of standard procedures such as smear tests and vitamin injections.
Dáša Farmer confirmed that the feedback has been closely reviewed and work is underway to identify how the new ways of working are impacting on patients and staff. A Primary Care survey is underway and almost 4000 responses have been received. NHS Wakefield CCG continues to work with Practices and Primary Care Networks to ensure that the move to digital responses does not result in a disenfranchised cohort of patients.
Dáša Farmer acknowledged the concerns of the deaf community and explained that a new BSL Interpreter service would be implemented from 1 September 2020 with specific KPIs to improve the patient experience for this cohort of individuals.
Stephen Hardy acknowledged the work involved in continuing to obtain patient feedback during the pandemic and asked that the outcomes be shared at a future meeting.
20/15 Equality and Diversity Update - Presentation
Sarah Mackenzie-Cooper presented the Equality report to the Patient and Community Panel. The report highlighted the work undertaken to improve access, care experience and outcomes for patients, carers, the public and staff and to reduce health inequalities. Sarah reminded members of the statutory responsibilities of the CCG.
Sarah Mackenzie-Cooper commented that as part of the work to establish a dedicated cancer service at Pontefract Hospital, an impact assessment had been carried out and shared with Mid Yorkshire Hospitals NHS Trust to identify what could be improved, such as clear and appropriate signage for the newly established service.
The Panel was reminded that the National NHS Accessible Information Standard (AIS) includes a requirement to provide clear communication for patients with a disability or communication need. Such patients should not experience a delay in their care as a result of their disability (eg delay whilst waiting for a BSL interpreter). A report and action plan will be submitted by 31 August 2020.
Panel members were informed that a review of workforce disability equality standards is underway and will be available by the end of the year. South West Yorkshire Partnership NHS Foundation Trust has confirmed that a report on gender pay gap which will reflect staff disabilities will be submitted shortly. NHS Wakefield CCG is not required to provide a similar report.
Sarah Mackenzie-Cooper explained that the surveys undertaken by NHS Wakefield CCG are reviewed to ensure that all cohorts of patients are reflected in the responses and where necessary, recommendations are made and monitored to ensure learning takes place thereby improving the situation for patients and staff.
Reporting on health inequalities is not a statutory responsibility for the CCG; however, where an individual is born, lives and works can have an influence on opportunities for good health. Sarah shared a map of the local area, which, whilst not being scientifically accurate, gave an indication of life expectancy along bus routes from the centre of Wakefield, showing clear link between areas of deprivation and reduced longevity.
Sarah Mackenzie-Cooper explained that the impact of Covid-19 has been disproportionate on a number of groups: • Those living in disadvantaged areas • Those from Black, Asian and Minority Ethnic communities • Older people • Men • Those with mental health concerns • Those with learning disabilities
Sarah gave the example that between 10 April and 15 May, 386 people with learning disabilities died nationally, compared with 165 people in the same period in 2019.
It was acknowledged that healthcare decisions had to be taken at speed during the height of the pandemic and that they may have had unintentional Impacts on specific cohorts of individuals.
A number of work streams have been implemented by NHS Wakefield CCG. Equality impact assessments have been carried out and are being monitored to reduce any negative impacts. Decision tools have been made available for use by commissioners to ensure that there are no unintended outcomes as a result of work to re-set the health economy.
Sarah Mackenzie-Cooper confirmed that risk assessments had been carried out for approximately 500 BAME staff within the local health economy, to ensure the safety of at risk staff. This work was supported by the BAME Network at South West Yorkshire Partnership NHS Foundation Trust.
Gordon Smith, Head of Diversity and Inclusion at Mid Yorkshire Hospitals NHS Trust, provided an update on the work undertaken by the Trust. This included details of Project Search, an American programme to support young people (aged 19-24) with learning disabilities to enter the workforce and obtain employment. He shared stories of several young people from Highfield School who had benefited from the scheme. Project Search is to be rolled out into the Dewsbury area in September 2020 in conjunction with Kirklees Council.
Gordon explained that the principles of Project Search had been deployed to support older patients with life changing injuries or conditions to obtain work experience within the Trust.
The scheme has been instrumental in encouraging staff involved in the recruitment process to consider applicants outside the usual range.
Gordon Smith went on to explain the Rainbow Badge scheme, which aims to encourage engagement with the LGBT workforce. A tool kit was launched in May 2020 within the Trust. This has proven to be a catalyst for an open dialogue to support staff.
Gordon Smith commented that providing accessible information for patients with disabilities remains a challenge. This is not patients with English as a second language, where translation and interpreting services are available. One of the barriers to clear information is that clinical systems do not allow information regarding communication needs to be easily transferred between providers. This can cause delays for patients and provide a negative patient experience. Sarah Mackenzie-Cooper explained that work is underway to link primary and secondary care so that information can be
shared within the Patient Portal in order to improve the situation.
Sarah Mackenzie-Cooper explained that West Yorkshire and Harrogate Health and Care Partnership has established an independent review into the impact of Covid-19 on health inequalities and support needed for Black, Asian and Minority Ethnic (BAME) communities and staff. The review sessions will be chaired by Professor Dame Donna Kinnair, Chief Executive and General Secretary of the Royal College of Nursing.
Stephen Hardy acknowledged the discriminatory impact of Covid-19 and the work that is currently underway to reduce the effects and prevent future reoccurrence for both patients and staff.
20/16 Maternity Update – Verbal
Ruth Unwin provided a verbal update regarding maternity services. Ruth confirmed that the midwife-led unit at Pontefract hospital continues to provide antenatal and post-natal care whilst remaining closed for births.
NHS Wakefield CCG continues to work with Mid Yorkshire Hospitals NHS Trust to identify safe and sustainable options for the future. It was noted that it would be unlikely meaningful consultation could take place in the current environment and therefore there would be no plans to make any changes to the current arrangements until the pandemic had subsided.
The Overview and Scrutiny Committee are aware of the situation.
It was noted that the number of home births had increased during recent months as a direct consequence of Covid-19.
20/17 City Fields Update – Verbal
Mike Potts provided a verbal update on the progress being made regarding the provision of GP services to the new housing development at City Fields.
Consultations and interviews had continued over the last few weeks, although restricted due to Covid-19. All the practices in the Brigantes and Trinity networks have been contacted and engagement has taken place with some Patient Participation Groups virtually. Conversations have also taken place with the builders, developer and other key stakeholders. Practices are considering options to enable them to increase their capacity and patient lists.
Mike Potts acknowledged that other areas of Wakefield are experiencing increases in population which will impact on other GP Practices and explained that he and Gill Galdins have been commissioned solely to consider the impact of the City Fields development. NHS Wakefield CCG is working with the Local Authority regarding other development areas.
The City Fields development will continue until 2031 at which time it is
expected to have a population of between five and seven thousand residents.
Using a figure of between 2.2 and 2.7 persons per home, the 2017/20 development of 820 houses would increase the Wakefield population by between 1800 and 2216 people.
Mike Potts explained that 845 people from the development are currently registered with a local GP. This would suggest that a significant number of people are not registered but it is not known how many may be registered with out of area GPs or have private medical arrangements/insurance.
Future development plans are as follows and will allow time to plan services: 2021-25 - plans are in place for another 1300 homes which will bring an increase in population of between 3k and 3.5k 2026-31 - plans are for a final 400 houses with an associated population increase of between 900-1200.
Mike Potts confirmed that plans will take into account the success of on-line appointments and other changes to primary care, which were instigated during the current pandemic. The requirement for future provision remains unclear.
Mike Potts commented that historical evidence shows that patients are reluctant to register with newly established practices and it is probable that the appropriate way forward will be to develop existing practices rather than establish a new one.
The option to collocate provision for City Fields with the practice at Eastmoor was not considered viable due to the difference in demographics and the lack of frequent public transport between the two locations.
Mike Potts confirmed that further engagement with Young Healthwatch and the Youth Parliament are planned in early October.Initial findings were due to be presented to the CCG Senior Leadership Team in September.
Simon Green commented that New Southgate Practice have experienced a constant flow of requests from potential new patients and are having difficulties in meeting the demand. Mike Potts recommended that practices should raise any concerns directly with the CCG and reminded members that Practices receive increased funding when patient numbers increase which allows for an increase in staff numbers to meet the extra patient demands. Ruth Unwin commented that the Primary Care would support practices that were experiencing demand growth if required.
Members of the Panel commented that the issue of population growth due to new housing has been evident for a considerable period without any practical solutions being offered.
Ruth Unwin commented that the Senior Leadership Team are aware of the situation and acknowledged that historically the CCG’s links with the Local Authority had not been effective in relation to new housing developments; however it had improved recently.
Ruth assured members that the CCG was working with elected members via the Overview and Scrutiny Committee on this matter.
20/18 Mental Health Engagement – young people update - Verbal
Dáša Farmer provided a verbal update on engagement with young people regarding the provision of mental health services.
Dáša explained that at the end of 2019, the primary care networks started to look at pooling their understanding of mental health support for 16-25 year old. Working with Healthwatch Wakefield, engagement took place during lockdown to establish what young people wanted from services. A report has been prepared and will be presented to the next Integrated Care Partnership meeting.
The key concerns highlighted in the report relate to consistent and reliable support and an easy-flow pathway from children to adult services.
Dáša Farmer provided assurance that work in this area will continue and that a model of services for the east of the district will be developed in conjunction with the Regeneration Trust in September 2020. The Save Space project which provided support for 18 year olds transitioning to adult services has been adopted.
Members were assured that patient experience has remained at the heart of decision making for NHS Wakefield CCG during the pandemic.
20/19 Any Other Business
Janet Witty acknowledged that NHS Wakefield CCG does not have responsibility for dental provision but requested that the CCG raise the lack of dental provision during Covid-19 with NHS England. Stephen Hardy supported the request, commenting that NHS patients were unable to obtain treatment when private patients and those receiving orthodontic treatments were able to access care.
Ruth Unwin added that dental patients were being directed to GPs and A&E where pain relief could be provided, although full treatment was not available. This gap in care had already been raised with NHS England and local MPs have been encouraged to raise concerns with the Health Minister.
Simon Green commented on local speculation that Wakefield might go into lockdown and asked whether the CCG was aware. Ruth Unwin responded that the CCG continued to work closely with Public Health to monitor the
situation and that a national announcement was expected shortly.
Paulette Huntington commented that use of the term ‘Lockdown’ for local measures caused confusion as it does not have the same implications as the national ‘Lockdown’. Ruth Unwin acknowledged the confusion caused.
Dáša Farmer confirmed that the Healthwatch survey would be shared with members and asked that they share it further. The slides presented at the meeting would also be shared.
Dáša Farmer asked for volunteers to review draft versions of leaflets currently being produced.
Dáša Farmer confirmed that the PIPEC meeting scheduled for 15 September 2020 had been cancelled and that the PPG network meeting on 23 September 2020 would go ahead as planned.
Members were reminded that NHS Wakefield CCG Annual General Meeting will take place virtually on 8 September 2020 and were encouraged to attend if possible.
ACTION: Pam Vaines to share survey and slides with members.
20/20 Date and Time of next meeting TBC
PIPEC meeting scheduled for Tuesday 15 September 2020 has been stood down
NHS Wakefield Clinical Commissioning Group Agenda item: 21e(ii) Patient & Community Panel
Notes of the Meeting held virtually via Microsoft Teams on 5 November 2020
Present : Christine Allmark Patient Representative Sandra Cheseldine Citizens Advice Bureau Rebecca Ellis Principal Psychologist at MYHT Simon Green Patient Representative Stephen Hardy Lay Representative, Wakefield CCG (Chair) Glynis Harrap Patient Representative Mavis Harrison Patient Representative Paulette Huntington Patient Representative David Mitchell Patient Representative, PPG Network Zahida Mallard E&D Lead, SWYPFT Craig Milburn Patient Representative Val Pratt Wakefield Deaf Society Hilary Rowbottom Patient Representative Ali Usman Patient Representative Peter Wilson Patient Representative Janet Witty Patient Representative
NHS Wakefield CCG Staff Louisa Bradley Clinical Quality Manager Laura Elliott Head of Quality Dáša Farmer Wakefield CCG, Engagement Lucy O’Lone Quality Coordinator Ruth Unwin Director of Corporate Affairs Pam Vaines Minute Taker
20/21 Apologies for Absence Apologies were received from: Gary Jevon Healthwatch Wakefield Jill Long Engagement & Communications Officer, Yorkshire Cancer Community, Healthwatch Wakefield John Nye Patient Representative Safeen Rehman Healthwatch Wakefield
20/22 Declarations of Interest
Dáša Farmer invited attendees to declare any conflicts of interest.
There were no declarations of interest noted.
20/23 Minutes of the meeting held on 28 August 2020
The minutes of the meeting held on 28 August 2020 were agreed as a correct record subject to two amendments –
• Attendance: David Mitchell asked for his apologies to be recorded as he had attended only part of the meeting on 28 August 2020.
• Item 20/13 - public health report – Janet Witty asked for a statistical report in future. Ruth Unwin assured Janet that the latest Public Health data would be included in the next report.
The amendments will be made and the approved minutes of the meeting held on 28 August 2020 will be shared with members. . 20/24 Matters Arising The meeting was informally Chaired by Dáša Farmer in the presence of Stephen Hardy, due to technical IT difficulties.
Ruth Unwin commented that there has been no change to the provision of intrapartum care at the Midwife Led Unit at Pontefract Hospital. The antenatal and post-natal services continue.
NHS Wakefield CCG continues to work with Mid Yorkshire Hospitals NHS Trust regarding the future of the service.
It is expected that the public engagement carried out last year will be repeated when the pandemic allows, as a new cohort of women and families have accessed the service and their experiences need to be considered as part of future planning.
20/25 CCG Update - Verbal
Ruth Unwin provided a verbal update of the work currently underway within NHS Wakefield CCG.
An Emergency Level 4 has been declared nationally which demonstrates the significance of challenge faced by NHS. There are eleven thousand Covid patients nationally, which equates to 22 hospitals full of patients. This figure is an increase equivalent to the capacity of two hospitals since Saturday.
Members were reminded that current infection rates will impact on the NHS in two to three weeks and that the impact of the current Lockdown will not be immediately apparent.
There are currently more patients in ICU care than during the first Lockdown period. The average age of ICU patient is 60 but evidence suggests that the pandemic can affect everyone in population and it is therefore vitally important that everyone follows advice and guidance
provided both nationally and locally.
Ruth Unwin confirmed that the NHS is maintaining safe services and there is a commitment to try to continue as much routine activity as possible.
The Nightingale hospitals are ready for use if required and the Manchester site has already been implemented.
There is a possibility that a Covid vaccination will be available by Christmas although it is likely that the roll-out will begin in early 2021 and will take some time to complete. Plans are being developed to roll-out a vaccination programme and members were advised that the national advice at the time was that people would need to allow at least 28 days between a flu vaccine and a Covid vaccine (note this advice has subsequently changed to seven days) Patients requiring both are therefore encouraged to obtain a flu vaccination as soon as possible.
Ruth explained that the local health system is under a great deal of pressure, as are neighbouring Trusts. Calderdale and Huddersfield NHS Foundation Trust are to close their Birth Centre to allow the space to be used for cancer activity.
Mid Yorkshire Hospitals NHS Trust is preparing for a forecasted number of 300 positive patients requiring care by the end of November. The Trust is increasing the number of Covid wards to meet demand and moving non- Covid patients to Dewsbury which is currently designated as a non-Covid site. .
Mid Yorkshire Hospitals NHS Trust has worked hard to reduce the back log of patients whose procedures had been delayed in phase 1. National guidance has now been received and plans are now in place to close four theatres to free staff to provide support elsewhere. This leaves 15 theatres available for emergency and planned care procedures.
The Emergency Department at Pinderfields is under significant pressure, due in part to difficulties in allocating beds to patients needing admission and also due to the continued attendance by patients who could/should seek assistance elsewhere.
Ruth Unwin asked members to do all that they can to encourage people not to attend A&E unless they have a life threatening condition. She reminded members that x-rays could be obtained at Pontefract Urgent Treatment Centre – either by appointment or as a walk-in service with shorter waiting times than could be expected at A&E.GP practices can support patients by booking patients into appointment with appropriate hospital departments or could have discussions with clinicians at the hospital to reduce A&E attendance. Primary care services are available 24/7 and can be accessed by people calling their usual practice number. .
There are dedicated primary care sites where people with Covid symptoms
can be seen face to face if necessary.
Ruth Unwin attended a seminar on Brexit preparations yesterday. National contingency plans are in place to ensure that there will not be a shortage of medication or clinical supplies so it is not necessary for patients to stock pile items. Reassurances were also received that there will be little impact on the NHS as a result of restrictions relating to EU clinical staff.
Members were reminded that from January 2021 the EU travel card will no longer be relevant and anyone planning to travel to Europe will need to obtain medical cover via insurance.
Paulette Huntington commented that PPGs are not operating at the moment and asked whether there was an alternative way to share information with patient groups. Ruth Unwin confirmed that the CCG was working with the Trust to identify routes for clear communication; including social media, paid and editorial content in local papers, GP websites and texts etc.
Janet Witty suggested that the current message not to attend A&E ‘unless necessary’ was too vague as it allowed personal interpretation of what was necessary. She suggested specific direction be included in future communication.
Simon Green asked where local ‘test, track and trace’ centres were located and Ruth Unwin responded that pop-up centres were based at Featherstone Rovers and Wakefield Trinity. NHS Wakefield CCG is not directly involved in establishing or running the centres. The centres can be accessed by symptomatic people and booking is via the national website.
Mavis Harrison asked what assurances clinicians can give members of the public regarding the safety and side effects of the new Covid vaccine. Ruth Unwin confirmed that the vaccine had been accelerated but had been tested rigorously. Information will be provided to enable individuals to make informed choices regarding the vaccine.
20/26 Experience of Care Report and Patient Safety Partners - Presentation
Lucy O’Lone provided an update from the Experience of Care report for Quarter One, 2020-21.
Lucy reminded members that the CCG holds a monthly Quality Intelligence Group which focuses on the feedback the CCG has received regarding patient experiences and triangulates soft data in order to identify themes and agree actions.
Lucy explained that the GP patient surveys had a return rate of 35% which is higher than the national average. Patient satisfaction has reduced slightly (from 83% to 80%) although patients have confidence in their GP and the services they receive.
The move to telephone appointments was reported to have worked well.
Laura Elliott explained that the CCG is supporting GP practices which did not show an improved result and will work with them to improve the experience for their patients.
Lucy O’Lone explained that the adult inpatient survey carried out by MYHT for 2019 showed comparative scores to neighbouring Trusts and showed an improvement on the score from the previous survey.
Cancer patient experience report was published in June 2020 and showed an overall rating for cancer care of 8.8 out of 10 which is a slight improvement on the previous score of 8.7.
Louisa Bradley explained to role of Safety Partners within the NHS England Patient Safety Strategy 2019.
The role of Patient Safety Partners (PSP) will be in place within all Trusts from April 2022 and will be independent advocates to represent patients ‘from ward to Board’ within the Trust. They will ensure that the voice of patients is heard and will support the empowering of patients to be involved in their own care and safety. The PSPs will be involved with strategy and policy change. The roll will be subject to a National, formal role description which is still in development and the roll will be unpaid and remuneration will be via expenses.
Louisa asked members for ideas or comments as to how the role could work within NHS Wakefield CCG.
Mavis Harrison supported the concept of the role and commented on the importance of work to prevent patient falls, highlighting the Carelink call line and green wrist bands to highlight potential falls risks when in hospital.
20/27 Future of Patient and Community Panel
Ruth Unwin reminded members of the Panel that prior to the Pandemic, the CCG was in the early stages of integrating the PIPEC and Equality Health Panel. The Patient & Community Panel was established in light of the continuing pandemic as a temporary means of ensuring that NHS Wakefield CCG could obtain patient and public opinion during the Pandemic, when formal public meetings were stepped down.
Ruth commented on the success of the Patient and Community Panel and proposed that it could be formally established as the engagement & equalities committee of the Board. Stephen Hardy would continue to act as a formal link to NHS Wakefield CCG Board which he attends as a Lay Member. Gary Jevon would link the Panel to the Integrated Care Partnership.
Janet Witty commented that the attendees of the Patient and Community
Panel are predominantly members of PIPEC and expressed concern that work would need to take place to ensure representation from community groups. Ruth Unwin acknowledged this concern and hoped that formal Terms of Reference for the Patient and Community Panel would ensure wider attendance to support an agenda of equality and tackling health inequalities.
Paulette Huntington suggested that it would be necessary to avoid duplication of role with PPG Network. Simon Green confirmed that the current system does result in unnecessary duplication.
Stephen Hardy supported the formalisation of the Patient & Community Panel and commented that in order to support equality and diversity issues it will be necessary for the CCG to work closely with the Local Authority to widen the cohort of contributors and include representation from young people.
Sandra Cheseldine supported the concept and commented that tackling health inequalities should be a major focus of the group. Sandra represents Citizens Advice Bureau and will be able to share information between the two organisations. She commented that Citizens Advice is launching 12 new sites to support people dealing with the impact of Covid-19. Val Pratt agreed that health inequalities should be a priority and believes that a formal Panel will be in a position to progress this agenda.
Christine Allmark commented that the Panel would be able to ensure patient engagement, particularly during the pandemic period when PPGs are dormant.
Dáša Farmer acknowledged the comments made by members and Ruth Unwin asked members to highlight any items/subjects that they would like to see on future agendas.
Action: Dáša Farmer and Ruth Unwin to draft Terms of Reference for formalising the Patient & Community Panel as the route by which NHS Wakefield CCG would receive advice and assurance on engagement and equality issues.
20/28 Engagement Results
Dáša Farmer provided a detailed report on a six week engagement launched in July 2020 to investigate patient opinion and experience in using GP practice during the pandemic. Almost 4000 surveys were returned. Overall, patients were content with the service they had received from their GP and were supportive of the use of the new technology employed during this time.
Dáša went on to provide the findings of a short engagement regarding Emergency Departments which ran from 28 September to 11 October 2020 at all three sites of Mid Yorkshire Hospitals NHS Trust. 154 questionnaires
were completed.
The engagement established that one in five attendees at ED were there to investigate bone injuries. Members were reminded that x-rays can be provided at the Urgent Treatment Centre, at Pontefract Hospital, and appointment can be booked prior to attendance.
40% of attendees indicated that they were directed to ED by other healthcare professionals. NHS Wakefield CCG will work with other providers to identify whether this is appropriate or necessary advice.
Dáša Farmer provided feedback from maternity services, which covered both Mid Yorkshire Hospital NHS Trust and Calderdale and Huddersfield Hospitals NHS Foundation Trust. The survey established that between 67 and 87% of women were satisfied with each element of care.
Responders preferred face-to-face rather than virtual appointments and concerns were raised regarding the restrictions imposed during the Covid pandemic which had prevented women from being supported by partners or other family members when attending appointments. Concern was also raised regarding the increased need for mental health support to be provided during this period. Women from BAME communities were less satisfied with the care they received than other women.
Dáša Farmer confirmed that the presentation would be shared with members in due course. A slide pack from Healthwatch Wakefield will also be shared, capturing findings from their second survey relating to the pandemic.
20/29 Mental Health Engagement – Young People Update
Dáša Farmer introduced Rebecca Ellis, Principal Psychologist at Mid Yorkshire Hospitals NHS Trust, who provided an update on the pilot scheme of providing Mental Health Navigators within the Trust.
The scheme is funded by NHS Wakefield CCG and began in August 2020, following a delay due to the pandemic. Early indications are that the programme has proven to be a success.
The scheme aims to integrate mental health into each stage of care within the Trust, so that staff are comfortable dealing with mental health issues and are able to identify situations and correct referral pathways where necessary.
Provision is currently via the liaison team and anyone attending A&E In Crisis is assessed. Mental Health Navigators will work with individuals to signpost them to support mechanisms in the community, if appropriate. There are excellent support organisations and schemes available. However, individual often do not know of their existence or how to access them.
Rebecca asked members to consider attending virtual focus groups to extend the pilot and ensure that it is appropriately advertised and accessible to the correct groups of patients.
Christine Allmark sought clarity regarding the extent of the pilot and Rebecca explained that feedback was being sought from all areas. However, the main users of the system have been people attending A&E.
Sandra Cheseldine suggested that Citizens Advice Bureau may be well placed to support this service. Sandra commented that the mental health services provided excellent support for patients.
Mavis Harrison confirmed this and in particular, expressed support for the Talking Therapies Service.
Rebecca clarified that her aim was to organise a patient focus group for anyone who wants to be involved. She will provide additional information for members of the group.
Post meeting Action. Information regarding the Mental Health Navigator Pilot Project, including meeting to be held on 3 & 8 December 2020, was shared with members on 12 November 2020.
20/30 Any Other Business
Mavis Harrison highlighted a concern that GP practices are increasingly providing a wide appointment time for virtual appointments, often offering a call at some point within a three hour window. Mavis feels that this is inconvenient for patients and would prefer a precise appointment time.
Stephen Hardy asked for a future agenda item to consider how Primary Care Networks obtain and respond to patient feedback and engagement.
Dáša Farmer informed Panel members that Wakefield Council is undertaking consultation on the next phase of preparing the Wakefield District Local Plan 2036. The Plan sets out the Council’s planning policies for securing growth, investment and sustainable development across the district. It also focuses on safeguarding and improving the environment and biodiversity, whilst also improving the quality of development and places for people to live, work and visit, through new and amended policies. The draft plan includes the provision of 1,400 new homes each year until 2036 and the allocation of an additional 290 hectares of employment land. It will ensure developments are well located to public transport networks, improve transport infrastructure, including the highway network and walking and cycling routes, and importantly, support the Council’s commitment to tackling climate change. A Key Changes leaflet will be available to highlight how the draft plan has changed since the consultation in 2019. For more details visit: http://www.wakefield.gov.uk/planning/policy/emerging-local- plan-2036/local-plan-2036
Janet Witty made a plea for NHS Wakefield CCG to be involved with housing planning at an early stage.
Dáša Farmer explained that MYHT will be asked to provide an update on the Shared Referral Pathway for the next meeting and an update of the Cancer Strategy will also be provided. Laura Elliott suggested that an update on the Safe Space Service is given at the next meeting.
20/31 Date and Time of next meeting 10am on Thursday 7 January 2021
Agenda item: 21f
NHS Wakefield Clinical Commissioning Group
PRIMARY CARE COMMISSIONING COMMITTEE
Minutes of the Meeting held on 29 September 2020
Present: Mel Brown Director of Commissioning Integrated Health and Care Dr Greg Connor Executive Clinical Advisor Diane Hampshire Registered Nurse Stephen Hardy Lay Member (Deputy Chair) Richard Hindley Lay Member (Chair) Richard Watkinson Lay Member (Audit)
In Attendance: Samantha Cavanagh NHS England Representative on behalf of Anna Ladd Amrit Reyat Governance and Board Secretary Chris Skelton Head of Primary Care Co- Commissioning Ruth Unwin Director of Corporate Affairs Pam Vaines Minute Taker Emily Waters Graduate Trainee – Primary Care
20/57 Apologies
Apologies were received from Suzannah Cookson, Mr Hany Lotfallah, Jonathan Webb, Anna Hartley, Cllr Faith Heptinstall, Karen Parkin and Richard Sloan.
20/57 Declarations of Interest
There were no declarations of interest made.
20/58 (a) Minutes of the Primary Care Commissioning Committee meeting held on 30 June 2020
The minutes from the meeting held on 30 June 2020 were agreed as an accurate record.
(b) Action sheet from the Primary Care Commissioning Committee meeting held on 30 June 2020
The action sheet was noted.
20/59 Matters Arising
There were no matters arising discussed.
1
20/60 Interim Provider Policy
Chris Skelton explained that the Interim Provider Policy is enacted whenever NHS Wakefield CCG needs to secure an immediate alternative provider to take over a GP contract.
The policy proved to be fit for purpose when it was last used to support Eastmoor GP Practice. Therefore, no changes have been made to the policy and it is now recommended that the period of review for the policy is extended from two to a three year period.
Chris Skelton confirmed that the role of the Primary Care Networks (PCNs) did not need to be included in the terms of the policy, as this would not be a fair determining factor for a new provider.
Diane Hampshire was assured that the Primary Care Commissioning Committee would be informed of any future changes and if necessary that the policy would be updated sooner if there were any significant changes before the review period.
Samantha Cavanagh reminded members that NHS E/I had produced a new purchasing system for GPs, providing a platform of pre-approved providers, including caretaker providers. The system could be considered should the policy be enacted.
It was RESOLVED that: i. Primary Care Commissioning Committee approved the Interim Provider Policy for a period of three years
20/61 Additional Roles Reimbursement Scheme – PCN Workforce Plans
Emily Waters presented the NHS Wakefield CCG Additional Roles Reimbursement Scheme.
The scheme supports PCNs to recruit additional roles under the PCN DES (Direct Enhanced Service) to expand and diversify the workforce.
PCNs have submitted plans which are currently being discussed. Plans may be extended to include two new roles – Nursing Associates and Trainee Nursing Associates.
45 members of staff are already in place as part of the scheme with a second wave planned for the coming months. The Covid-19 pandemic has impacted delivery of the scheme during the first two quarters of the year and this has been reflected in £0.5 million underspend. It is expected that the full financial allocation will be required in 2021/22.
The clinical pharmacy and pharmacy technician roles are embedded in the PCN workforce with a current focus on recruiting to personalised care roles.
2
The terms of the scheme allow PCNs to bid for the un-allocated funding. PCNs have raised concerns that this would lead to inequalities and create further complexities. Emily Waters explained that PCNs would prefer to use short term contracts to employ staff until the end of the financial year rather than undertake a formal bidding process. The PCNs have requested support from NHS Wakefield CCG for the introductions of paramedics and mental health practitioners as reimbursed roles.
Emily Waters clarified the aims for the Additional Roles Reimbursement Scheme for the coming months as - • Accelerate recruitment of the intended roles for the remainder of this financial year • Workforce plans may be reviewed by PCNs in light of additional roles including Nurse Associates • Early recruitment starting January to ensure 100% spending of 2021-22 budget
Diane Hampshire enquired whether national or local requirements were in place to evaluate the effectiveness of the new roles and was assured that local guidance was currently being developed. Mel Brown confirmed that the evaluation process would be undertaken and that this had already taken place with Social Prescribers.
Dr Connor commented that staff recruited to the additional roles will work within practices to develop both the practice and the PCN to meet the requirements of the enhanced service. The scheme is enabling PCNs to develop multi-disciplinary workforces (eg blends of staff to support Care Homes).
Mel Brown indicated that social prescribers will be able to support the mental health practitioners once the roles have been recruited. Emily Waters confirmed that practices have found the social prescribers to be a valuable and effective addition to the workforce.
It was RESOLVED that: i. The Primary Care Commissioning Committee considered the position in regards to the Additional Roles Reimbursement Scheme PCN workforce plans. ii. The Primary Care Commissioning Committed supported the intentions to maximise the funding available as described in the presentation
20/62 For Information - Urgent Decisions by CO at Governing Body 28 August 2020
Amrit Reyat explained that the paper presented to Governing Body on 28 August 2020 had been shared for information only to ensure that Primary Care Commissioning Committee members were aware of the current situation regarding the temporary closure of GP branch surgeries.
It was RESOLVED that: 3
i. The Primary Care Commissioning Committee noted the contents of the Urgent Decisions by CO at Governing Body on 28 August 2020
20/63 Matters to be referred to other committees or Governing Body
The following papers are to be referred to other Committees: i. The minutes of this meeting to be shared with the Governing Body.
20/64 Any Other Business
No other business was discussed.
20/65 Date and Time of Next Meeting
Tuesday, 19 January 2021, 2pm, The Boardroom, White Rose House/ Virtually via Microsoft Teams
4
Agenda item: 21g
NHS Wakefield Clinical Commissioning Group
QUALITY, PERFORMANCE & GOVERNANCE COMMITTEE
Minutes of the Meeting held on 26 November 2020
Present: Dr Deborah Hallott Nominated Clinical Member Stephen Hardy Lay Member Richard Hindley (Chair) Lay Member Ruth Unwin Director Corporate Affairs Jonathan Webb Chief Finance Officer/Deputy Chief Officer
In Attendance: Karen Charlton Designated Professional Safeguarding Adults (20/191) Laura Elliott Head of Quality (deputising for Suzannah Cookson) Dasa Farmer Senior Engagement Manager (20/180) Stella Johnson Research Manager, WY R&D (20/190) Lucy O’Lone Quality Co-ordinator (item 20/183, 20/184) Tracy Morton Service Delivery and Transformation Manager, Maternity & Children’s Services) 20/181 Angela Peatfield Minute taker Amrit Reyat Governance & Board Secretary Jo Rooney Senior Commissioning Manager CYP (item 20/179) Caroline Squires Information Governance Manager (20/188) Suzie Tilburn Associate Director HR &OD (20/189) Natalie Tolson Head of Business Intelligence (item 20/182) Pam Vaines Governance Officer (item 20/186, 20/187) Richard Watkinson Lay Member
20/174 Apologies for Absence
Apologies were received from Jo Webster, Dr Adam Sheppard, Suzannah Cookson 1
20/175 Declarations of interest
Dr Deborah Hallott declared an interest regarding reference to GP practices in the papers presented to the Committee as Dr Hallott is a GP in the area. The Chair noted the declaration and as the reports referred to were not decision making items, Dr Hallott could take part in the debate when these reports were presented.
Dr Hallott also declared an interest regarding the Care Quality Commission Update and in particular reference to Glynn Care Home advising that this care home is within Dr Hallott’s GP Practice locality. The Chair noted the declaration and as the report referred to is not a decision making items. Dr Hallott could take part in the debate when this report was presented.
20/176 Minutes of the meeting held on 24 September 2020
The minutes of the meeting held on 24 September 2020 were agreed as an accurate record.
20/177 Action Sheet from the meeting held on 24 September 2020
All actions were noted.
20/178 Matters Arising
There were no matters arising.
20/179 Update on progress from the SEND inspection (2017) and revisit (2019)
Jo Rooney joined the meeting to provide an update on the current position in relation to the SEND Inspection and Revisit.
In 2019 Wakefield had an announced Revisit by OFSTED and the CQC to monitor performance against the Written Statement of Action (WSOA). The finding of the Revisit was that Wakefield had made Sufficient Improvement (this was the highest rating that could be achieved). There were 3 areas noted which still required improvement:
1. Pathway 2. Engagement 3. Assessment
The main concern of the initial Inspection and the Revisit was the ASD diagnosis pathway and in particular the 14+ element of the pathway. The development of the assessment process to be NICE compliant had active engagement from both service providers and the new pathway was developed with both providers to ensure there was joint working and access to additional support from Child and Adolescent Mental Health 2
Services when needed.
The new pathway has been designed with robust engagement of parents and carers and this continues through both the ASD professional and clinical development group and Parent Carer Forum representation on the ASD Strategy Group.
An engagement event with young people with ASD was held in October 2019 through a locally run group which supports young people with ASD. The concerns of this group were not around the assessment process but rather people understanding them, the consistent message was around school being their biggest problem. Further engagement was planned for 2020 but has been altered due to the pandemic. KIDS have been commissioned to undertake some engagement work to look at the effects on families and young people of the pandemic.
The new 0-18 Pathway went live in September 2020 and all assessments in the new pathway are undertaken by Mid Yorkshire Hospital NHS Trust (MYHT). The progress of the new 0-18 years pathway and the recovery restoration plan were shared in October at the Target event and Dr Hallott commented that this was well received.
Jo Rooney referred to the third area of concern relating to assessment noting this is regarding what happens after assessment. This area will be expanded to encompass how the information is used by professionals and schools. The ASD Strategy Group will agree actions on how this work can be evaluated.
Stephen Hardy queried the length of time before an assessment is requested and whether schools were undertaking their part as this was a concern addressed across West Yorkshire and Harrogate.
Jo Rooney responded to advise that the Local Authority School Improvement Team continue to work on this issue and they are developing training awareness of ASD events. Support for parents as part of the assessment process is also being developed. It was noted that if parents opt out of the assessment process the report is sent to the school.
Jonathan Webb queried following the 2017 first inspection and re- inspection in 2019 what the next steps would be to review the actions taken.
Jo Rooney advised that OFSTED are not planning on reviewing the recommendations from 2019 as all OFSTED SEND inspections are on hold. It is anticipated that there will be no further inspection over the next 2/3 years. However, termly meetings with NHSE, OFSTED and the Education Authority continue to take place.
Dr Hallott recognised the enormous work that had been completed so far to ensure NICE compliant with a diagnostic assessments. Jo Rooney 3
advised that this target continues to be met. Creative ways to meet compliance is being sought including virtual parental interviews as an alternative to running clinics.
It was RESOLVED that:
i) members noted the update on the current position in relation to the SEND Inspection and Revisit for assurance to the CCG Governing Body of progress made
20/180 Engagement Annual Report 2019/20
Dasa Farmer joined the meeting to present this report which includes information on consultations and engagement activities that have been undertaken and completed during 2019/20 and includes any that started before that period.
The report outlines the key areas of work including details on the recent developments and engagement supporting the CCG’s response to the COVID-19 pandemic:
• Primary care – engagement to understand patient use and possible impacts of changes introduced within practices. Digital exclusion, access and demographic variations were considered. • Emergency Department – raid engagement to understand what and how services are used prior to patients presenting themselves at A&E, again supporting plans within primary and secondary care. • Maternity services – gathering patient experience during all points of care to understand experience, impact and support actions to be taken including public messaging. • Patient experience across the ICS and joint work with Healthwatch Wakefield on impacts (phase 1) and reset (phase 2) • Engagement mapping and input into priorities and enablers of the Integrated Care Partnership.
Ruth Unwin commented that this report re-enforces the outstanding assessment achieved in public engagement demonstrating that engagement has made a difference to services.
Ruth acknowledged the work of the Engagement Team who consistently work to a high standard to improve the outcome of commissioning decisions. Stephen Hardy extended his thanks and commended the hard work of the team acknowledging that the highest score possible was achieved in the assessment.
It was RESOLVED that:
i) members noted the content of the report for information: and ii) agreed that public engagement is considered and undertaken for all commissioning intentions
4
20/181 Maternity Service Transformation Update
Tracy Morton joined the meeting to present this report. The paper outlines the detail of the Mid Yorkshire Hospital Trust (MYHT) maternity improvement programme within the context of national maternity strategy and aims to give the Committee assurance on quality, safety and monitoring.
The national maternity strategy “Better Births” and the NHS Long Term Plan set out a maternity transformation programme with a vision for more person centred, safe and high quality maternity services.
Locally this is overseen and supported by the West Yorkshire and Harrogate Local Maternity System (LMS). The MYHT maternity strategy is aligned to this national policy and local LMS strategy and is being implemented through the MYHT maternity improvement programme.
At the same time of this work, births at the Pontefract Free Standing Midwifery Led Unit (FMLU) needed to be suspended due to staffing pressures. A full outline business case with potential solutions for the future of the Unit has been shared with Yorkshire and Humber Clinical Senate. Engagement continues with families whilst births at FMLU are paused due to COVID-19 and quality and safety continues to be monitored.
During the pandemic national guidelines were followed and MYHT maternity service used a Quality Impact Assessment assurance process to implement any changes to pathways that were necessary. Tracy advised that there has been a re-introduction of partners able to attend for scans in line with national guidelines. MYHT had also re-introduced visiting on and this was welcomed by parents.
Dr Deborah Hallott wanted to acknowledge the incredible amount of work that has been undertaken to develop the strategy and Tracy’s involvement developing the Maternity Voices Partnership and supporting primary care service provision.
Jonathan Webb commented on the breast feeding targets for Wakefield being below the target shown in the maternity dashboard and queried how MYHT were progressing to meet these targets. Tracy advised that she would gather more information on breast feeding targets including how they were set. Tracy also updated that the Trust was working towards the UNICEF Breast Feeding Initiative accreditation. Tracy would follow up on how this was progressing and seek further information from the LMS on breast feeding data and targets.
It was RESOLVED that:
i) members noted the content of this report as an update on developments of the MYHT Maternity Improvement Programme 5
within the wider context of the national maternity strategy
20/182 Performance Report
Natalie Tolson joined the meeting to present this report advising that currently the report is against the national constitutional standards only and at the end of September 2020, 12 of the 20 measures reported achieved the national standard.
Cancer Waiting Times performance Cancer two week Breast Symptoms, Cancer 28 day faster diagnosis, Cancer 31 days (for all cancer) and Cancer 62 days (GP referral) did not meeting the national standard in September. Cancer two week breast symptoms saw a significant drop in performance to 64.2%, this was mainly due to problems with radiology capacity at Mid Yorkshire Hospitals NHS Trust which have now been resolved. It was noted that performance in October is looking like it is back on track.
Planned Care 18 week and 52 week performance continues to show signs of improvement. All but one speciality (cardiothoracic surgery) reports below the national standard. ENT reports the lowest 18 week performance at 32.2% and also reports the highest number of 52 week breaches. The number of 52 week breaches being reported continues to rise both regionally and nationally. Speciality level performance trajectories are in place to support the Trusts True North standard of zero 52 week breaches against the non-admitted pathway by the end of March 2021.
As elective work is cancelled to support the increased number of COVID patient being treated it is acknowledged that this has an impact on the referral to treatment position.
Mental Health Patient satisfaction for IAPT remains consistent throughout the year. CAMHS continue to maintain a waiting list reduction, reporting 174 patients on the waiting list at the end of October 2020 compared to 606 at the end of October 2019. The improvement in the CAMHS waiting list reduction was acknowledged.
Jonathan Webb thanked Natalie Tolson for the comprehensive report and advised members that the Senior Leadership Team receive information on a daily basis to assure the Committee that senior leadership are informed daily of any operational activity.
Richard Hindley commented that he was assured that if there was any significant change this would be reported to the Committee in a timely way.
It was RESOLVED that:
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i) members noted the current CCG performance against the constitutional standards; and ii) noted those indicators where performance is below target and the associated exception reports where provides.
20/183 Patient Safety and Outcomes Report – Quarter 2 2020/21
Lucy O’Lone joined the meeting to present this report.
The key headlines from the report included:
• Quarter 3 2020/21 Quality Exception Report noting that there were two MYHT 12 hour breaches at the Dewsbury Hospital Emergency Department in October 2020 • Statistical Process Control (SPC) Charts • Medicines Safety Reporting – Quarter 2 2020/21 • Update on Learning Disability (LD) work from the Primary Care Team • Perfect Ward® care home visits – Quarter 2 2020/21 • National Reporting and Learning Management System (NRLS) for South West Yorkshire Partnership Foundation Trust, Yorkshire Ambulance Service and Mid Yorkshire Hospitals Trust • Healthcare Associated Infections
Lucy advised that Springfield Grange and Broxbourne House are currently under enhanced surveillance following Care Quality Commission inspections. Attlee care home has been removed from enhanced surveillance.
Dr Deborah Hallott referred to the temporary medication information documentation as part of the discharge process commenting that there are issues with this. Laura Elliott agreed to seek an update from the Medicines Optimisation team and circulate to members.
It was RESOLVED that:
i) members noted the current trends and themes relating to patient safety
20/184 Experience of Care Report – Quarter 2 2020/21
Lucy O’Lone presented this report which provides details of emerging themes and trends from local data, patient experience measures, soft intelligence and summaries of local and national publication that are related to experience of care.
Lucy advised that the top three themes from the Quality Intelligence Group from Quarter 2 meetings were: 1. Cancer Services (mixed feedback) 2. Poor access to dental services (negative feedback) 7
3. Triage and telephone appointments at GP Practices (positive feedback)
The report included details of the future or Health and Care Services – Wakefield District Coronavirus Reset Survey and Perfect Ward® visits.
It was noted that Healthwatch Wakefield along with other WY&H Healthwatch organisations have submitted evidence to the NHSE Dental Commissioning Executive to highlight the current situation of poor access to dental services.
A discussion followed acknowledging that this was a real problem and had been discussed at the Patient and Public Panel. Stephen Hardy questioned whether there was anything that could be done from a commissioning perspective to address the health inequalities. Jonathan Webb suggested that this should be highlighted to NHS England and we will await the response.
It was RESOLVED that:
i) members noted the current trends against indicators in the experience of care dashboard and themes relating to patient experience
20/185 Care Quality Commission (CQC) Inspection Update Report
Laura Elliott presented this report advising that the CQC has moved to transitional monitoring arrangements based on risk assessment and a number of inspections of providers have taken place.
The CCG and our main providers continue to regularly engage with the CQC and the CQC continue to be an integral part of our enhanced surveillance process for care homes.
Laura gave an update on the inspection of both the Glynn Residential Home and Springfield Grange, confirming that the CQC report for Springfield Grange has now been published.
The Winter Discharge Designation scheme is intended for people who have tested positive for COVID-19 and who are being admitted to a care home. Anyone with a COVID-19 positive test result being discharged into or back into a registered care home setting must be discharged into an appropriate designated setting and cared for there for the remainder of the required isolation period. Laura advised that currently there are three homes in our area as appropriate designated settings and there are currently two more going through the process to become an appropriate designated setting.
Richard Hindley referred to the care homes with enhanced surveillance and queried whether under the current circumstances this is providing challenges. Laura Elliott responded that enhanced surveillance 8
continues with wrap around support from the Local Authority and the Infection Prevention team.
It was RESOLVED that:
i) members noted the contents of the report for information
20/186 Governing Body Assurance Framework (GBAF)
Pam Vaines joined the meeting to present this paper advising that the GBAF has undergone a full refresh, prior to the setting up of the electronic GBAF which has been developed by the Health Informatics Service. The transfer has been discussed in detail by the Senior Leadership Team who approved the GBAF objectives. The objectives are based on the CCG Statutory Duties. Each risk and associated Control Assurance score was reviewed by the relevant Owner, Director and Clinical Lead and transferred to the electronic GBAF.
The electronic GBAF will reflect matrix working and allows for entries to be linked to the Risk Register. This process will be completed within the next few months.
Pam advised that the system provides four automatically generated reports and these were shared for information. Following discussion it was agreed that the GBAF Risks Combined and GBAF Risks Summary reports will be used to present information to Committees in the future.
Stephen Hardy made a comment regarding the system wide approach and whether system wide assurance is appropriate. Ruth Unwin responded that the GBAF provides a line of sight of where the control is within the system to enable the Governing Body to monitor the progress and this will reflect what is happening across the system.
It was RESOLVED that:
i) members recommend the closure of the previous GBAF entries to the Governing Body; ii) agreed the GBAF was a true and fair reflection of strategic risks/threats and as evidence that satisfactory progress is being maintained to manage risk; iii) recommended the GBAF to the Governing Body for approval; and iv) agreed the level of report required at future Committees.
20/187 Risk Register Update
Pam Vaines presented this report reflecting the current position including a full list of the risks on the Risk Register. As at 14 September 2020 there were 55 risks on the register, 48 open risks with 30 risks reflecting the impact of COVID-19.
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There are three critical risks relating to waiting times at MYHT and four newly identified risks have been added. Eight risks were marked for closure.
The new risk cycle will commence Monday, 30 November 2020.
It was RESOLVED that:
i) members approved the public Risk Register for NHS Wakefield Clinical Commissioning Group as a correct reflection of the current position
20/188 Information Governance Update
Caroline Squires joined the meeting to present this update on current work being undertaken by the Information Governance Team providing assurance that the CCG is completing its obligations in respect of Information Governance.
Caroline advised that as at 13 November 2020 the Data Security and Protection Toolkit (DSPT) for 2020/21 has not been launched. In the meantime the IG team have been pressing ahead with DSPT related work packages and the CCGs Head of Digital is engaging with THIS in relation to provision of IT related evidence for 2020/21.
Conversations are ongoing with Audit Yorkshire into the format and timing of the annual internal audit of the CCGs DSPT submission. This year the evidence lines for audit have been centrally selected and have increased in number for CCGs from 27 to 40. This has been generally felt locally to be a disproportionate sample size in relation to the risk profile of a CCG.
It is understood that NHS Digital will for the first time deliver centrally commissioned DSPT audits/independent assessments to a sample of 20 to 30 Trusts and CCGs and NHS Digital will be in touch with organisations directly, during November, with further details once the selection is confirmed.
Caroline advised that a DSPT related risk has recently been added to the corporate risk register.
As an optional required of the DSPT and for the CCG’s own assurance, a survey was carried out during September and October to understand the effectiveness of awareness raising and the working knowledge of staff in relation to information governance with a focus on working from home and following the results an action plan has been developed.
Following an incident that took place at the end of July 2020 where confidential patient information was emailed to a member of the public in error. The Information Commissioners Office (ICO) wrote to the CCG on 28 August and advised that they had considered the information the 10
CCG had provided and had decided that no further action by them was necessary. The SIRO, DPO and IG Manager have reviewed the ICO recommendations and it is expected that a full root cause analysis will highlight if there are any further actions required.
The CCG has received notice from the Data Services for Commissioners at NHS Digital that they would like to meet with representatives from the CCG to review the NHS Digital Data Sharing Agreement. The visit is arranged for 20 November and an update will be included in the report presented at the January meeting.
Caroline referred to the EU Data Protection Board who cover data control in the UK and EU data processors. This is not a high risk area but an evolving one. It is expected that the results of a consultation will be published before the end of the year and organisations will have on year gave period to get systems in place.
It was RESOLVED that:
i) members noted the contents of the Information Governance Update; and ii) approved the IG Staff Survey 2020/21 findings action plan
20/189 Workforce Report – Quarter 2 (2020/21)
Suzie Tilburn joined the meeting to present this report providing the Committee with a range of workforce information and key workforce actions.
Suzie highlighted the following:
• A reduction in Sickness Absence within the CCG during Quarter 2 • The organisational workforce updates in relation to Equality and Diversity information • The implementation of key HR, OD and LD actions based on organisational priorities during Quarter 2 • The Staff Engagement Group (formerly known as Staff Forum) has undertaken a rebrand and re-focus. The group will focus on six key work streams and take forward initiatives lined to these areas; employee wellbeing; living the values and behaviours; recognition and celebration; employee journey; sustainability and listening to employees
The following actions have been identified based on the findings within this report.
• Embed the Staff Engagement Work Streams within the organisation and take action on these • Progress actions identified within the NHS People Plan • Following publication of the WYH ICS BAME Review report, work to 11
embed the recommendations identified within the organisation • Further work to be undertaken to attract talent, retain talent and succession planning to support the organisation’s workforce demographics to ensure it aligns t the population within Wakefield District
A discussion followed regarding the reduction in sickness absence and Laura Elliott queried whether there is under reporting as staff are now working from home? Suzie Tilburn responded to say this requires further exploration to consider whether staff are less likely to pick up illness or whether staff feel better able to work without the journey to and from work. Line Managers are encouraged to ensure that sickness is reported through ESR.
Dr Deborah Hallott commented that her GP practice is seeing a number of patients presenting with postural problems. Suzie Tilburn responded to say this was a valid point and the CCG are aware that people have different working stations at home. Individual risk assessments and display screen assessments have been completed to identify where action is required. Awareness sessions for staff have been made available by Posturite and through staff briefings including sharing information and staff will continue to be reminded to make sure they take regular breaks.
It was RESOLVED that:
i) members noted the content of the workforce update provided within this report and the actions proposed
20/190 NHS Wakefield CCG – Research Quarter 1 and 2 update 2020/21
Stella Johnson joined the meeting to present this detailed report providing a description of the work that the WY R&D team has undertaken in delivering a comprehensive research service on behalf of and in collaboration with the CCG to ensure that the CCG has met their statutory obligations with regard to research and can demonstrate their willingness to participate and use research evidence in their commissioning activities.
A key focus of the NHS Long Term Plan is research and innovation to drive future outcomes and improvement and Stella highlighted some of the research that the CCG has taken part in during Quarter 1 and 2 of 2020/21.
It was RESOLVED that:
i) members noted this report as a summary of research activities for Quarters 1 and 2 of 2020/21; and ii) agree to sign post any future opportunities for the WY R&D team to engage with the CCGs commissioning teams and member practices in order to facilitate further promotion of research and the use of 12
research evidence in the CCGs commissioning activities.
20/191 Managing Safeguarding Allegations Against Staff Policy
Karen Charlton joined the meeting to present this report and confirmed that there have been no legislative changes since the first version of the policy was developed in 2018.
The policy contains a procedure to follow in the event that allegations against CCG staff which have safeguarding concerns are dealt with appropriately and consistently in line with local safeguarding agreements.
It was noted that the main changes to the revised policy are in the Equality Impact assessment which was completed with input from the CCG Equality and Diversity Lead.
It was RESOLVED that:
i) members approved the policy for two years subject to any statutory changes at which point the policy will be revised and reviewed if required
20/192 Minutes of meetings
The minutes of the following meetings were shared for information
i) 999/111 Joint Quality Board – minutes of meetings held on 17 August and 2 October 2020 ii) Quality Intelligence Group – minutes of meetings held on 15 September and 13 October 2020 iii) Mid Yorkshire A&E Improvement Group – minutes of meetings held on 15 September and 20 October 2020
20/193 Matters to be referred to other committees or Governing Body
20/186 – GBAF Recommend closure of previous GBAF entries to Governing Body and recommend approval of GBAF to Governing Body.
20/194 Any other business
None
20/195 Date and time of next meeting:
Thursday, 28 January 2021, 9.00 to 11.00 am.
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Agenda item: 21h
West Yorkshire & Harrogate (WY&H) Joint Committee of Clinical Commissioning Groups Summary of key decisions - Meeting in public, Tuesday 12th January 2021
Urgent and emergency care (UEC) - provider collaboration review The Committee received a presentation on the Care Quality Commission (CQC) provider collaboration review (PCR) which had reviewed how health and social care providers were working together in response to Covid. Deep dive reviews were conducted in Kirklees and Harrogate, but the pathway had been reviewed across all places in WY&H. CQC had concluded that the system had worked well together, well established partnerships had allowed effective collaboration and that the response to Covid broke down barriers to achieving shared objectives. The Committee: Welcomed the report and the best practice identified. It noted that the UEC Programme Board would be co-ordinating work across place, providers and ICS programmes to embed any findings that required substantial change. Commissioning out of hours primary medical care services across West Yorkshire 2021 to 2024 The Committee considered a report on primary medical care services in West Yorkshire, which were provided by Local Care Direct (LCD). The current contract expired at the end of March 2021 and work to understand what would be required from April 2021 had been put on hold by the pandemic. LCD was a key partner in the system’s integrated urgent and emergency care approach. The response to the pandemic, changes driven by national policy and potential changes to the commissioner landscape meant that there was uncertainty about what should be commissioned. To ensure continuity of service, prevent uncertainty and support system planning it was proposed that the service be extended for a further 3 year period. The Committee noted the long lead times for complex procurements and that in the current circumstances a pragmatic approach should be taken, This would give commissioners time to develop their requirements and inform a further decision about procurement during 2022. The Committee: The Committee agreed to extend the current service from LCD for three years from 1st April 2021.
Amendment to Flash Glucose Monitoring Commissioning Policy The Committee had previously approved a policy for commissioning flash glucose monitors - small sensors worn on the skin for monitoring the glucose levels of people with diabetes. The policy applied to patients with Type 1 Diabetes and the report proposed to amend the policy to include type 2 diabetes patients with learning disabilities who need to use insulin. Self-management of diabetes by patients with learning disabilities would promote independence and reduce health inequalities. The proposed amendment was in line with advice from NHS England. The Committee: The Committee agreed the amendments to the WY&H Flash Glucose Monitoring policy with immediate effect. Joint Committee work plan – implementation update and risks to delivery The Committee considered a high level summary of progress in implementing its work plan. This included improvements in urgent and emergency care and acute stroke services and the detection and treatment of atrial fibrillation. West Yorkshire Healthy Hearts had improved the treatment of people with high blood pressure and policies on evidence based interventions had reduced unnecessary procedures. A more detailed summary would feed into the Joint Committee’s annual report The Committee: Noted the report, alongside an update on the risks to delivery of its workplan.
The Joint Committee has delegated powers from the WY CCGs to make collective decisions on specific, agreed WY&H work programmes. It can also make recommendations. The Committee supports the Partnership, but does not represent all partners. Further information is available here: https://www.wyhpartnership.co.uk/meetings/west- yorkshire-harrogate-joint-committee-ccgs or from Stephen Gregg, [email protected]. Agenda item 21i
Decisions of the Chief Officer Verbal Update