Sandwell and West Clinical Commissioning Group Governing Body Meeting held in PUBLIC

Date: Wednesday 4th March 2020 Time: 13:45 – 1530 hrs

Venue: Board Room 2F, Kingston House, , B70 9LD AGENDA

Non-Confidential – Please ensure your phone is on silent throughout the meeting.

This meeting will be held in public and will be recorded purely as an aide memoir for the minute taker to ensure an accurate transcript of the meeting, decisions and actions. Once the minutes have been approved the recording will be destroyed. All care is taken to maintain your privacy; however, as a visitor in the public gallery, your presence may be recorded. Should you contribute to the meeting during questions from the public, you agree to being recorded.

No Subject Lead Time

INTRODUCTION

1. Mental Health showcase item Verbal Mrs Phillips/Mr Cole 13:45

2. Apologies for Absence: Therese McMahon Verbal Dr Sykes 14:00

3. Declarations of Interest Verbal Dr Sykes 14:02 To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item.

4. Draft Minutes of the Previous Meeting held on Enc 1 Dr Sykes 14:05 Wednesday 8th January 2020 for approval 5. Action Register Enc 2 Dr Sykes 14:10 6. Questions from the Public Verbal Dr Sykes 14:15 7. Chair’s Report Enc 3 Dr Sykes 14:20

8. Performance 8.1 Quality and Safety Report Enc 4 Dr Marok/Ms Carolan 14:25 8.2 Finance and Performance Committee Report Enc 5 Dr Hallan /Mr Green 14:35 8.3 Primary Care Co Commissioning Report Enc 6 Mr Sondhi 14:45 8.4 Audit and Governance Committee Report Enc 7 Mrs Jasper 14:50 8.5 Strategic Commissioning Redesign Report Enc 8 Dr Aslam 14:55

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8.6 Integrated Urgent and Emergency Care update Enc 9 Mrs Ellis 15:00 8.7 Organisational Development Committee update Enc 10 Mrs McGee 15:10

9. Governance and Business 9.1 Board Assurance Framework Enc 11 Miss Woodhouse 15:15

10. Ratified Minutes of Committees for Information (All minutes available on CCG Website) 15:20 All 10.1 Audit and Governance Committee Minutes dated Enc 12 21st November 2019 10.2 Quality and Safety Committee Minutes dated 16th Enc 13 December 2019 10.3 Strategic Commissioning and Redesign Committee Enc 14 Minutes dated 12th December 2019 10.4 Primary Care Co Commissioning Minutes dated 5th Enc 15 December 2019 10.5 Organisational and Development Committee Enc 16 Minutes dated 7th November 2019 10.6 and West Birmingham Joint Enc 17 Commissioning Committee Minutes dated 10th October 2019 10.7 Black Country and West Birmingham Transition Enc 18 Board dated 10th October 2019

11. ANY OTHER BUSINESS 11.1 Items to share with staff Verbal Dr Sykes 15:30

12. DATE AND TIME OF GB IN COMMON MEETING Tuesday 31st March 2020 1300 to 1630 hours Council Chambers

CLOSE OF MEETING

Guidance on Declarations of Interest Definition of Interests Sandwell & West Birmingham CCG Governing Body Meeting held in Public Page 2 Agenda Wednesday 4th March 2020

A Governing Body/Committee member has a personal interest if the issue being discussed at a meeting affects the well-being or finances of the member, the member’s family, or a close associate more than most other people who live in the area affected by the issue. Personal interest are also things related to an interest the member must register such as outside bodies to which the member has been appointed by the CCG or membership of certain public bodies.

A personal interest is also a prejudicial interest if it affects the finances of the member, the member’s family or a close associate and which a reasonable member of the public with knowledge of the facts would believe it likely to harm or impair the member’s ability to judge the public interest.

Declaring interest If a member has an interest, they must normally declare it at the start of the meeting or as soon as they realise they have the interest. If a member has a personal and a prejudicial interest, they must not debate or vote on the matter and must leave the room.

Questions from the Public Questions for the Governing Body should be submitted by email or post five working days before the meeting. For details on how to submit a question please visit our website.

Quoracy No business shall be transacted at the meeting unless there is at least one-third of the whole number of the chair and members (including at least one member who is also an Officer Member of the CCG and one member who is not) is present.

Legend Accountable Officer – AO Chief Finance Officer –CFO Chief Officer, Transformation – COT Chief Officer, Quality – COQ Chief Officer, Strategic Commissioning and Redesign - COS

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Minutes of the Governing Body Meeting held in Public on Wednesday 8th January 2020

1345 to 1608 hours The Pavilion, Moor Lane, Birmingham, B6 7AA

Dr Ian Sykes Chair, Sandwell & West Birmingham CCG Mr Ranjit Sondhi Vice Chair, Sandwell & West Birmingham CCG Mr Paul Maubach Accountable Officer Dr Priyanand Hallan GP Director - Sandwell Dr Parmjit Marok GP Director – West Birmingham Dr Ayaz Ahmed GP Director - Sandwell Mr James Green Chief Finance Officer Mrs Therese McMahon Non-Executive Board Nurse Mrs Janette Rawlinson Lay Member Dr Karl Grindulis Secondary Care Consultant

In Attendance: Mrs Sharon Liggins Interim Chief Operating Officer Ms Michelle Carolan Chief Officer, Quality Mr Rhod Mitchell Co-opted Lay Member Dr Jonathon Bown Co-opted Birmingham and CCG GP representative Mr Jason Evans (on behalf of Deputy Chief Officer for Integrated Urgent & Emergency Mrs Ellis) Care, West Region (SWB CCG) Mr Chris Green* (agenda item Development Lead for Integrated Urgent and 8.7) Emergency Care, Region (SWB CCG) Mr Terence Read* (agenda item Partnerships Development Manager (SWB CCG) 1 only) Dr Elizabeth Bates* (agenda Doctors of the World item 1 only) Miss Jodi Woodhouse Acting Head of Corporate Governance Mrs Jayne Salter-Scott (for Head of Engagement and Communications career development purposes) Ms Helen Attwood Executive Assistant to Accountable Officer (SWB CCG)

Apologies: Mrs Rachael Ellis Chief Officer for Transformation Mrs Alice McGee Director of Human Resources and Organisational Development Mrs Julie Jasper Lay Member Dr Manir Aslam GP Director – West Birmingham

Absent: Ms Lucie Carrington Arden & GEM CSU

*Denotes part attendance

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Members of the Public There was 1 member of the public present

184/19 Declarations of Interest

Members noted that prior to the meeting taking place; a review of the conflicts of Interest checklist in compliance with the Conflicts of Interest guidance took place.

Dr Sykes confirmed the meeting was quorate.

Dr Sykes informed Governing Body members there was a conflict of interest in relation to agenda item 8.4, Primary Care Co Commissioning Report regarding the extension of the caretaking arrangements for Five Ways Health Centre. Dr Aslam is directly conflicted. However, Dr Aslam was not present at today’s meeting and the item is not for decision, therefore no mitigation was required.

Dr Sykes informed Governing Body members there was a conflict of interest in relation to agenda item 8.6, SCR report regarding Programme for Respiratory Integration of Services in the Midland Metropolitan area (PRISMM) which GP Directors held a financial interest in. However, the item is not for decision and no mitigation was required.

Dr Sykes informed Governing Body members that Lay Members had a financial interest in relation to agenda item 9.2, Clinical Leads and Lay Member Terms of Office and agreed they could remain in the meeting due to the meeting being held in public but would not be allowed to participate in the discussion and decision-making process. It was noted that papers had not been restricted from Lay Members to allow comments to be sent to the author on the clinical lead posts.

185/19 Migrant Health and Safe Surgeries showcase item

Mr Read, Partnerships Development Manager and Dr Bates were in attendance for this agenda item and provided an overview as follows:-

• Doctors of the World is an international charity with its UK chapter based in East London. • Dr Bates is the GP Champion for Birmingham and the West Midlands which has been active for eighteen months, is making significant progress and has secured continuation funding from Sandwell and West Birmingham CCG. • The clinic is used by people who have problems accessing the NHS and its objective is to sort out the immediate clinical need and get people registered with NHS GPs. • People hit barriers with registering with primary care due to a number of reasons i.e. through homelessness, no identification documents or may not have adequate proof of address. • In order to help overcome these issues, the Safe Surgeries Initiative was designed to make it easy for GP practices to help people to register and for that to be recognised within their patient population and also to demonstrate good practice for their peers.

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• The organisation also advocates for universal access to healthcare and NHS charging and acknowledged that a piece of work was underway. • The population concerned are essentially undocumented and include those that have been through the Asylum System and refused and those affected by the Windrush crisis. There are many other reasons why people fall into this category none of which are their fault. • It was noted that the clinic in London has seen over 2000 patients per year over the last 3-4 years. • Lack of proof of address, lack of identification and lack of immigration status are not reasonable grounds to refuse someone GP registration. • There are strong public health reasons for this initiative which also saves money due to a reduction in accident and emergency admissions. • We ask GP surgeries to sign a pledge that they will not insist on patients’ providing identification. • We have also asked GP surgeries to display some signage indicating they have an ‘open’ policy for registration and translated versions are also available. • There are several tools and other materials that GP surgeries can use to improve their care for this group of patients. • We are designed to be a supportive national network and will be visible about what it is doing. • The initiative is very welcomed by The Care Quality Commission and demonstrates that GP practices are caring responsibly. • In May 2018, there were 36 Safe Surgeries across 3 cities which has now increased to 300 Safe Surgeries and 17 GP surgeries within Sandwell and West Birmingham who have signed up to the initiative. • It was acknowledged that large GP practices and super partnerships have also signed up within the West Midlands. • The first PCN in the country which includes 2 Sandwell and West Birmingham GP practices. • There are also 43 GP practices in Birmingham and Solihull (BSoL) CCG. • A number of educational events are available for clinical and non-clinical staff that are free to attend. • There is significant support from local public health teams and the organisation is also working closely with third sector organisations.

The following comments were noted:-

• Mr Sondhi referred to the issue of financial hostility in society and acknowledged that some GPs, in the past, had put up signs advising that undocumented patients were not allowed. Dr Bates confirmed that a lot of advocacy work was undertaken within the NHS in terms of challenging the charging policy. • Dr Grindulis asked if there were any ‘blockers’ in terms of secondary care referrals. Dr Bates confirmed that Doctors of the World UK were working nationally with NHS Improvement and locally with SWBH on its policy and helping people who are hitting the barriers with healthcare. For an urgent or immediately necessary problem the policy is to seek treatment first and worry about the charging aspect later. In terms of a patient’s ability to pay for treatment, Safer Surgeries would then support the patient with advocacy on that.

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• Mrs Rawlinson acknowledged there was the Expulsion of Asians from Uganda in 1972 which did not hit the media in the same way as the Windrush scandal. • Mrs Rawlinson referred to the impact on mental health and asked how this is also factored in. Dr Bates confirmed there was access to good local primary care services, which sit outside the charging regulations. Dr Bates confirmed that she was not aware of anyone with a bill for mental health services and did not feel they were particularly engaging with it. The British Medical Association had also advised that it was not the job of GPs to flag up to hospitals the potential charging status. It was noted that it was the responsibility of individual NHS Hospital Trusts to chase payment and this was entirely outside the Safer Surgeries remit.

Action: Circulate presentation slides to Governing Body members after the meeting and include highlights of the slides in members news.

186/19 The Minutes of the previous meeting held on the 6th November 2019 were agreed as an accurate record, subject to the following amendments:-

• Page 1, there is a misalignment in the text with Mrs Salter-Scott and her job title. • Page 3, 3rd bullet point, change to ‘in three years we have seen a cohort of nurses move into their 60s’. • Page 4 of the pdf, 3rd bullet point, change ‘oversees’ to ‘overseas’.

Mrs Rawlinson referred to page 6 and expressed her concern at the closure of action point 90/19 around the NHS cancer position statement. Mrs Rawlinson felt that moving the item into the quality and safety report was inadequate from a governance perspective and did not think the issues would be resolved in the correct arena given that discussions had taken place at Public Governing Body during the last two years.

Ms Carolan confirmed that the issue had been discussed via the Clinical Quality Review meetings and the Quality Oversight Group. Mrs Liggins provided assurance that the issue would continue to be progressed with NHS England and updates would be provided in due course. However, there was no information to share with Governing Body members at the current time.

Action: Ms Carolan/Mrs Rawlinson to discuss further outside this meeting and also agreed to pick up at the next System Review Meeting with NHS England and NHS Improvement.

Mrs Salter-Scott updated Governing Body members on her recent discussion with NHS Specialised Commissioning. There was significant interest to move the gynaecology oncology service back into Sandwell on a non-acute site and University Hospitals Birmingham NHS Foundation Trust (UHB) have identified a site in Rabone Lane, . This item is due to be discussed at the Health Overview and Scrutiny Committee in February 2020. It was noted that Sandwell and West Birmingham NHS Trust (SWBH) had also put forward a proposal for Gyaen Oncology services.

Mr Maubach referred to the CCG’s relationship with NHS England and its quality and assurance responsibilities and recognised there was an intention to engage at system level far more in its decision-making processes around specialised services. Mr Maubach

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referred to the NHS England and NHS Improvement Collaborative Commissioning meetings that STP leads are invited to and suggested this issue is picked up with the Regional Director of Commissioning from NHS England in these forums.

It was noted that in statute there is no mechanism to hold NHS England to account.

Action: Mrs Liggins to liaise with the Director of Commissioning from CCG and ask him to raise the issue at the NHS England and NHS Improvement Collaborative Commissioning meetings.

187/19 Action Register

Action point 112/19 Finance and Performance Report Cancer 31 day waits and new 28-day Faster Diagnosis Standard

Mr Green confirmed that the issue would be covered in the STP five-year plan which would be presented to Governing Body once finalised by NHS England. Action completed/closed.

188/19 Action point 173/19 Audit and Governance Committee Report Miss Woodhouse confirmed that details of QS1901 had been circulated to Governing Body members. Action completed/closed.

189/19 Action point 175/19(c) Integrated Urgent and Emergency Care update – post ‘go live’ Showcase service transfer at Annual Awards Ceremony

Mr Evans confirmed a number of nominations had been made and a response was awaited from the organisations.

190/19 Action point 179/19(a) Communications and Engagement update – outcome of Acute Respiratory Listening Exercise

Ms Carolan confirmed that the Equality Impact Assessment had been circulated to Governing Body members. It was acknowledged there was currently no Quality Impact Assessment. However, SWBH have assured the CCG an assessment had been undertaken and is awaited. This action was carried forward to the next meeting.

Mrs Rawlinson referred to the consultation process and the subtleties at the chest clinic i.e. different types of conditions are covered on different days and asked for assurance in terms of adequate sampling of all conditions. Mrs Rawlinson informed Governing Body members that a lot of the outpatients in respiratory are high intensity users ‘in and out’ of acute services with long-standing conditions like chronic obstructive pulmonary disease and are relevant to the acute services. Ms Carolan confirmed this had been fed-back after the last Governing Body meeting.

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191/19 Action point 88/19 Nursing Homes update

This action was carried forward in the absence of Mrs Ellis.

Mrs Rawlinson acknowledged that this action had been on the action register since July 2019 and felt March was too late to discuss winter pressures. Ms Carolan confirmed that the action related specifically to the Star 6 function following the integration of the 111 and the 999 Service and did not relate to winter pressures confirming that these plans were already in place.

192/19 Matters arising

The Governing Body had been asked to address the incorrect use of terminology that had been highlighted retrospectively. Within the papers for last month’s Governing Body meeting held in public, the Strategic Commissioning Redesign (SCR) Report made reference to a ‘consultation’ around the same day access service. However, the term ‘consultation’ was incorrectly used and in fact it was not a consultation but an engagement listening exercise. For the purpose of formal minuting we are highlighting it under matters arising and SCR Committee will also be doing the same.

193/19 Questions from the Public

There were no questions from the public.

However, at the last meeting Mr John Taylor, the Chair of Sandwell Healthwatch made a request to submit a question. Although the CCG were unable to provide a response during the meeting, SWB CCG has responded directly. For transparency and to ensure the question is recorded formally in the minutes, the question and response were read out as follows:-

Urgent Care – has it gone to Health Overview and Scrutiny Committee (HOSC)? If not, when might it go? This is the work around the Same Day Access and Walk-in centres. SWB CCG is moving into the final phase of this work. This phase together with subsequent phases have been to both Sandwell and Birmingham Overview and Scrutiny Committees. The final phase went to HOSC in October 2019 where it was agreed to seek the views, inform patients, members of the public and staff of the potential changes.

The SCR Report refers to Urgent Care – what is happening to this piece of work? Once Purdah was announced, the NHS directive was to cease all conversations that could distract from the election campaign or be argued to give one participant in it an advantage. The final phase of this work launches on the 6th January 2020 for a period of six weeks and will go back to Overview and Scrutiny Committee following the outcome in March 2020.

There was an action on the action log regarding a response from the Alliances – what is the latest update? Mr Taylor has been issued with a set of presentation slides regarding the work with the Sandwell and West Birmingham Care Alliances (now known as the Integrated Care

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Partnerships). Mr Taylor has been offered a meeting with the Programme Director and the Head of Engagement and Communications to discuss this piece of work. Social Prescribing – if all prescribers are not in place by the end of the financial year what happens to the funds? If primary care networks do not utilise the funding for Social Prescribers by the 31st March 2020, then they lose the funding. The allocation for Social Prescribers was something that SWB CCG had to find ‘in year’. The money that goes unspent on Social Prescribers will remain within the primary care budget.

194/19 Chairs Report

The Chairs report was tabled at the meeting. Dr Sykes shared key highlights as follows:-

• The Midland Metropolitan Hospital completion work was due to start this month and is back on track to be completed in 2022. • It was noted that Sir Graham Meldrum will step down as chair of West Midlands Ambulance Service NHS Foundation Trust on the 31st March 2020. Professor Ian Cummings will take over the role later in the year and the Governing Body wished him well in this role.

The Governing Body had a discussion around the potential removal of the chair’s report from the Governing Body agenda given that the same information was contained in ‘Members News’.

Mr Sondhi asked if members of the public had access to ‘Members News’. Mrs Salter-Scott confirmed that ‘Members News’ was an internal method of communication and not generally accessible by members of the public. Ms Carolan suggested that a highlight summary of Members News would need to be available to members of the public in the event the chairs report is removed.

The Governing Body agreed that the chair’s report would continue.

The Governing Body received the report for information.

195/19 Quality and Safety Committee Report

The Quality and Safety Committee Report was circulated prior to the meeting. Dr Marok shared key highlights.

The following comments were noted:-

• Mr Maubach referred to the new Liberty Protection Standards responsibilities and asked for clarity around current responsibility and any potential issues. Ms Carolan confirmed that current responsibility sits with the local authority although some of that falls to CCGs via continuing healthcare. The change in legislation would result in all CCGs holding full responsibility and accountability for Liberty Protection Standards and would have significant implications for providers. Mr Maubach asked if it was likely the CCG would uncover existing cases that may not have been dealt with correctly? Ms Carolan confirmed that the continuing healthcare team at SWB

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CCG had undertaken that piece of work and gave its assurance but potentially there could be cases across all areas. It was acknowledged that the code of practice had not yet been finalised and recognised that Training would also be required. The four CCGs would need to have a collective conversation to agree approach and way forward. • Mr Sondhi asked if the CCG was vicariously liable for Deprivation of Liberty cases for Care Homes. Ms Carolan confirmed that current responsibility sits with the local authority. However, under the new Liberty Protection Standards, the CCG would be responsible and would be working with care homes via continuing healthcare. • Ms Carolan noted that the new legislation would include 16-year olds upwards and acknowledged that parental responsibility would no longer apply for some 16-year olds. This would pose challenges particularly around the Transforming Care Partnership (TCP) and Special Educational Needs Disability (SEND) individuals. It was acknowledged that the safeguarding leads were working together on this issue. However, a collaborative discussion across the system was deemed essential in order to put some local agency in place. • Dr Sykes asked if there had been any never events and Ms Carolan confirmed there had been no never events. • Dr Sykes referred to the primary care kiosks and asked how the governance framework would be monitored moving forwards. Ms Carolan confirmed a report was awaited which would provide assurance that the safety issues have been addressed and robust mechanisms put in place to ensure the validation reaches the appropriate governance standards. • Mrs Rawlinson referred to cancer targets and acknowledged there was no connect with the information in the Performance Report and the Quality and Safety Committee Report. Ms Carolan confirmed there were no issues raised from a quality and safety perspective. It was noted that SWB CCG reviews any breaches in terms of root causes and harm. • Mr Sondhi asked if it was possible to have an integrated Performance and Quality Report and it was acknowledged that this had been discussed previously. • Mr Maubach informed Governing Body members that the issue of integrated assurance would be discussed at the Governing Body in Common meeting as part of the new governance arrangements. • Dr Marok noted there was a typo in the Quality and Safety Report under the ‘primary care kiosks’ which should read ‘a verbal update was given regarding patient safety updates by ‘Manoj Behal’. Action: Feedback amends to report author.

The Governing Body received the report for information and assurance.

196/19 Finance and Performance Committee Report

The Finance and Performance Committee Report was circulated prior to the meeting. Dr Hallan shared key highlights of the report.

The following comments were noted:-

• Mr Maubach informed Governing Body members that the Transforming Care Partnership (TCP) was one of the top priorities for NHS England and NHS Improvement.

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• Mr Maubach acknowledged the TCP position had worsened and noted there had been six admissions across the Black Country over the Christmas and new year period which places the CCGs in a position collectively of being furthest away from the national target. • It was acknowledged that the CCGs have a significant shared challenge across the Black Country and West Birmingham to try and improve its TCP performance. • It was noted that the CCGs will be holding a risk summit with the emerging mental health provider i.e. Black Country Partnership NHS Foundation Trust and Dudley and Walsall Mental Health NHS Trust in order to collectively improve TCP arrangements. • Dr Hallan felt the TCP target was slightly unrealistic and based on population and patient numbers. Dr Hallan suggested there was evidence to show that SWB CCG has more patients in its group and felt this was an issue. Mr Maubach acknowledged there were complicating factors but did not feel six admissions during the last few weeks was acceptable and recognised it was a collective, clinical leadership and managerial challenge. Mr Maubach stressed the importance as an individual CCG to recognise its performance by our regulator as the 2nd worst performer in the country. • Dr Hallan referred to the Finance and Performance discussion around the Health Exchange Service and expressed concern that the majority of patients were not from Sandwell and West Birmingham and the CCG is effectively subsidising the asylum seekers service. A discussion had also taken place around potentially moving the service to a more central location and asked if Governing Body would consider this. Mrs Liggins agreed to discuss this issue under the Strategic Commissioning and Redesign Report on today’s agenda. • Mrs Rawlinson referred to page 53 of the pdf and the additional allocations in month 8 for several posts under winter funding and nurse staffing etc. Mrs Rawlinson asked if these were permanent employees and required additional resource. Mr Green confirmed that the specific allocations had been received from the central winter funding resource from NHS England and would need to seek clarity. • Mrs Liggins confirmed that the additional allocations for these posts would be discussed, agreed and managed by the Accident and Emergency Delivery Board. Mr Green confirmed this was in addition to the normal winter funding. • Mrs Rawlinson asked if there were any guidelines in terms of the additional staff. Mrs Liggins confirmed this was managed through providers and their own arrangements. • Dr Grindulis referred to page 60 of the pdf and the Quality Innovation Productivity and Prevention (QIPP) savings from clinical coding in acute services which has seen little impact and asked how SWB CCG were incentivising acute services to change their coding practices in order to make savings for the CCG. • Mr Green confirmed that the CCG had identified issues with their coding patterns last year and had resolved via contract challenges rather than incentivising them to code differently. Mr Green did not know the specifics around the non-delivery of this particular QIPP scheme. • Dr Grindulis asked if the QIPP scheme would disappear in the next financial year and Mr Green confirmed there would be a different QIPP plan for 2020/21. • Ms Carolan acknowledged that SWBH had undertaken an in-depth piece of work around its coding processes which have improved significantly.

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• Mr Sondhi referred to SWBH accident and emergency performance which was 75% and asked if the activity was one of the lowest the CCG had seen. Mr Green confirmed that this issue was monitored and discussed at the quality and assurance meetings with the Trust. It was noted that the number of people attending accident and emergency was lower than the previous month for last year. Mr Green confirmed that 8,500 patients arrived at the accident and emergency department in November 2018 compared to 17,700 patients in November 2019. • Ms Carolan acknowledged that the acuity levels were much higher for all providers which was having a cumulative affect and confirmed a piece of work around this was being undertaken. • Dr Sykes referred to the significant pressure on local hospitals with ambulances being diverted to SWBH because they were managing their flow so effectively. • Dr Sykes asked if the policies of lesser clinical value would be included in the new QIPP plan which should contribute around £500k. Mr Green confirmed this would be included in the QIPP plan. • Mrs Rawlinson referred to page 76 of the pdf and the CT scan delays at SWBH and asked if the acute respiratory move to Birmingham City Hospital would add to this problem. • Mrs Rawlinson referred to page 84 of the pdf and highlighted that there were no percentage of patients with their first psychotic episode within two weeks of referral. In addition, all the narrative talks about low numbers and made a plea for figures to be included on future reports as percentages get skewed. • Mrs Rawlinson referred to page 84 of the pdf and children’s and young people mental health which indicates there are issues with data capture to be fully realised in 2019. However, the figures were poor and asked if a further update was available as the mitigated response does not answer the question. • Mrs Rawlinson highlighted that the arrow for indicator EH9 was in the wrong direction.

Action: The above issues/queries to be resolved via the Finance and Performance Committee.

The Governing Body received the report for information and assurance.

197/19 Financial Plan 2020-21 onwards

The Financial Plan 2020-21 onwards was circulated prior to the meeting.

Dr Sykes acknowledged the surplus SWB CCG were being asked to achieve over the next four years by NHS England and NHS Improvement and noted its frustration to deliver constant increasing surpluses to provide healthcare for its significantly deprived community.

The Governing Body received the report for information and assurance.

198/19 Primary Care Co Commissioning Report

Dr Sykes informed Governing Body members there was a perceived conflict of interest identified in relation to this agenda item regarding the extension of the caretaking arrangements for Five Ways Health Centre. Dr Aslam is directly conflicted, however Dr Sandwell & West Birmingham CCG Governing Body held in Public Minutes of the Governing Body Meeting held in Public Page 10 Wednesday 8th January 2020 Wednesday 8th January 2020

Aslam was not present and had received a separate redacted pack of papers. This item is not for decision and no mitigation was required. The Primary Care Co Commissioning Report was circulated prior to the meeting. Mr Sondhi shared key highlights.

The following comments were noted:-

• Dr Hallan noted a typo in the Primary Care Co Commissioning Report in item number 2.5.5, the Estates Update regarding the Group Practice that is being developed. However, this is a separate GP practice to the one that is actually being developed and should be amended to read ‘the group of Great Barr Practices’. Action: Mr Sondhi to feedback amends to report author.

The Governing Body received the report for information and assurance.

199/19 Audit and Governance Committee Report

The Audit and Governance Committee Report was circulated prior to the meeting.

The following comments were noted:-

• Mr Maubach asked where TCP sits on the CCGs risk registers. Miss Woodhouse confirmed there were two risks on the SWB CCG Quality and Safety Committee risk register.

Action: Miss Woodhouse to undertake a comparative risk review of the TCP risks for the four CCGs across the Black Country.

The Governing Body received the report for information and assurance.

200/19 Strategic Commissioning Redesign Report

Dr Sykes informed Governing Body members there was a conflict of interest in relation to this agenda item regarding the Programme for Respiratory Integration of Services in the Midland Metropolitan area (PRISMM) which GP Directors held a financial interest in. However, the item is not for decision and no mitigation was required.

The Strategic Commission Redesign Report was circulated prior to the meeting. Mrs Liggins shared key highlights in the absence of Dr Aslam.

The following comments were noted:-

• Mr Maubach referred to the Harmonisation policies and informed Governing Body members that discussions had taken place with the joint executive teams across the four CCGs and recognised there was an opportunity to consider a Black Country approach and also to talk to Birmingham and Solihull (BSoL) CCG colleagues with a view to aligning. • Mrs Rawlinson referred to page 144 of the pdf and the termination of patient transport and asked for clarity around the handover period and if there were any vulnerable patients left without transport. Also, a general point for consideration when undertaking future procurement exercise is to ensure an incumbent provider continues to provide cover until the new provider is in place. • Mrs Rawlinson referred to page 116 of the pdf and a request for retrospective approval by Governing Body and asked what other governance instruments could Sandwell & West Birmingham CCG Governing Body held in Public Minutes of the Governing Body Meeting held in Public Page 11 Wednesday 8th January 2020 Wednesday 8th January 2020

have been used to prevent retrospective approval. Mrs Liggins informed Governing Body members that the contract had already been awarded but the value was outside the scope of the Strategic Commissioning and Redesign (SCR) Committee and was the reason for retrospective approval being required by Governing Body. • Mrs Liggins confirmed that termination of patient transport related to ‘out of hours’ and was not ‘in hours’ and only became apparent during the procurement process. • Mrs Rawlinson referred to page 116 of the pdf regarding Improving Access to Psychological Therapies (IAPT) and reconfiguration and asked where cancer services feature in this i.e. are they included or excluded? Action: Mrs Liggins to obtain clarity and feedback to Mrs Rawlinson. • Mrs Rawlinson noted a typo in the Strategic Commissioning Redesign Report (SCR) on page 10, item number 4.9.4 regarding gaps in provision in ‘Wednesday’ which should read ‘’. Action: Feedback amends to report author. • Dr Sykes referred to the Primary Care Homeless Exchange Service Contract and acknowledged that the Strategic Commissioning and Redesign Committee had agreed that NHS England be approached to increase the funding allocation for these patients. • Dr Sykes referred to the significant homelessness issue and the suggestion of moving the existing site or having a second site to ensure Sandwell and West Birmingham patients receive this service. • Mrs Liggins informed Governing Body members that SWB CCG does not commission the Homelessness service which is delegated from NHS England to BSoL CCG who are the Lead Commissioner. As part of the model, patients are registered at a primary care service which has its own practice code that is assigned to SWB CCG who receive the annual allocation of commissioning money for those patients. Those patients carry an additional cost which SWB CCG feels is disproportionate and there is a piece of work being undertaken to resolve this financial challenge. There is a commitment from BSoL colleagues to hold a discussion around the gap and agreed risk share. • Dr Sykes asked if there was a service for homeless patients within SWB CCG. Mrs Liggins confirmed the service was provided Birmingham-wide and acknowledged there were different arrangements in place for Sandwell although they are not commissioned in the same way as Birmingham. Action: Mrs Liggins and Dr Hallan to discuss arrangements for Sandwell outside this meeting. • Mr Green referred to the discussion at the recent Finance and Performance Committee which related to the resistance from BSoL CCG in terms of their financial contribution, particularly the secondary care costs and acknowledged that the majority of costs are picked up by SWB CCG. Mr Green informed Governing Body members that the costs were spiralling out of control at £3m for secondary care costs and were unacceptable to maintain. Mr Green recognised the validity of moving to a more central service in Sandwell and West Birmingham - the resources could be split and BSoL CCG would have their own allowance. • The Governing Body noted the complexities and a further update would be provided in due course.

The Governing Body received the report for information and assurance.

201/19 Post-Christmas Brief/Integrated Urgent and Emergency Care Performance

The Post-Christmas Brief/Integrated Urgent and Emergency Care Performance paper was circulated with the agenda prior to the meeting. Mr Green was in attendance for this agenda item in the absence of Mrs Ellis and shared key highlights.

The following comments were noted:-

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• Dr Sykes commended West Midlands Ambulance Service NHS Foundation Trust (WMAS) on the successful delivery of the service in very challenging circumstances. • Mr Mitchell asked for clarity around the 111 performance and the reduction in the volume of activity. Mr Green confirmed this equated to a reduction of 220 ambulances per month. • Mrs Rawlinson referred to the ‘calls forecast’ and ‘calls answered’ and the ‘spike’ on the 28th December 2019. Mr Green advised Governing Body members that historically the 27th December is the busiest day of the year but due to the Christmas period in 2019, the 28th and 29th December were the busiest periods for the 111 service. • Mr Maubach compared the performance to that of the previous supplier and acknowledged that WMAS had over-achieved. Mr Green acknowledged that WMAS had also helped other providers across the country during this busy period. • Mr Sondhi acknowledged WMAS’s success and asked how this could be improved. Mr Green acknowledged the difficulty was staffing and the ability to cope with demand, particularly during peak periods i.e. Christmas and Easter. The way the pathway cycles work you need to be trained, proficient and continually using that system and it is very difficult for any provider to carry that amount of staff during quieter periods. Mr Green confirmed the integrated urgent and emergency care team would be looking to improve on the performance and would be looking at opportunities via direct booking for GP appointments and how the 111 service can be used for other services together with a robust staffing solution.

The Governing Body received the report for information and assurance.

202/19 Organisational Development (OD) Committee update

The OD Committee update and updated Terms of Reference were circulated prior to the meeting for approval.

Mrs McMahon shared key highlights of the report.

• It was noted that the CCG’s Annual Staff Awards Ceremony was scheduled to take place on Friday 31st January 2020.

The following comments were noted:-

• Mrs Rawlinson highlighted that the date and version control details were missing from the OD Committee Terms of Reference. • Miss Woodhouse referred to the Terms of Reference membership for ‘Board Nurse Lay Member’ (who will be the chair of the committee) and felt it would be useful to change this to ‘Lay Member’.

The Governing Body received the report for information and assurance and approved the Terms of Reference subject to the above amendments.

203/19 Future Form Black Country and West Birmingham – Next Steps following Engagement Listening Exercise (phase one)

The Future Form Black Country and West Birmingham – Next Steps following Engagement Listening Exercise (phase one) was circulated prior to the meeting. Mrs Salter-Scott shared key highlights as follows:-

• The Future Form Engagement Listening Exercise was held in October 2019.

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• The target audience for this piece of work were members of staff, GP members, stakeholders and patients. • A standard approach was adopted across the four CCGs. • The CCGs held four staff development events across the patch, five external stakeholder events and seven GP events. • A paper is due to be presented at the Governing Body in Common Meeting on the 21st January 2020 around moving to the second phase of engagement on the establishment of a single commissioning voice via shared governance arrangements.

The following comments were noted as follows:-

• Mrs Rawlinson asked for clarity around the breakdown of attendees for the other three CCGs. Mrs Salter-Scott was unable to confirm percentages in terms of the numbers. However, Mrs Salter-Scott acknowledged that the stakeholder events were well attended by Birmingham partners and patients and positive feedback received. • Mrs Rawlinson expressed her concern, that as a membership association, GP attendance was poor compared to other CCGs. Dr Sykes confirmed that every primary care network within West Birmingham was represented. It was also worth noting there was an element of engagement fatigue after the recent SWB CCG boundary consultation. Mrs Rawlinson felt it was worth adding a note to the report indicating representation by primary care network. • Mr Sondhi referred to the final decision on a CCG merger which lay with NHS England and asked what would happen if the CCGs were not in favour of a merger. • It was noted that the Accountable Officer and the Chief Officer - Transition Governance had met with NHS England and NHS Improvement in December 2019 to obtain an understanding around the application process and acknowledged there was a significant amount of work to be undertaken prior to completing this process. The CCGs immediate focus needed to be on the new governance arrangements and establishing the single management team. • Mr Maubach informed Governing Body members that as part of the new single management team there would be a dedicated post to support the transition arrangements for the foreseeable future.

The Governing Body received the update for assurance.

204/19 Clinical Leads and Lay Member Terms of Office

Dr Sykes informed Governing Body members that Lay Members had a financial interest in relation to this agenda item and agreed they could remain in the meeting due to the meeting being held in public but would not be allowed to participate in the discussion and decision- making process. It was noted that papers had not been restricted from Lay Members to allow comments to be sent to the author on the clinical lead posts.

The Clinical Leads and Lay Member Terms of Office were circulated prior to the meeting. Dr Sykes shared key highlights in the absence of Mrs McGee.

It was noted that the current Terms of Office for the CCG’s Clinical Leads were due to expire on the 31st March 2020.

The following comments were noted:-

Clinical Leads

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• Ms Carolan recognised there were ‘pros’ and ‘cons’ for both extension dates. However, Governing Body members agreed that the ambition would be an extension date to the 30th June with a caveat that should greater flexibility be required, the terms of office could be extended up to the 30th September 2020 if clinically required or in the event the consultation process was delayed. It was noted that this decision could be made outside this meeting by chairs action. • Mr Maubach referred to the timetable for a single management team and acknowledged the CCG were aiming to formally consult on the proposed changes during June 2020. It was important that the consultation process is equitable across all staff groups and should apply equally to the clinical leads who are supporting and working alongside those staff and should be included in the consultation process. This did not include the Governing Body membership which would be dealt with separately. • Dr Sykes informed Governing Body members that Dr Liz England would be stepping down on the 31st March 2020 and confirmed her Terms of Office would not be renewed.

Lay Members

It was noted that the current Terms of Office for the CCG’s Lay Members were due to expire on the 31st March 2020.

It was noted that the current Terms of Office for the CCG’s Secondary Care Consultant were due to expire on the 30th June 2020.

The Governing Body were asked to extend the Terms of Office until the 30th September 2020.

The Governing Body were asked to change the post of ‘Board Nurse’ to ‘Lay Member’ which would take effect from the 1st April 2020.

There were no further comments noted.

The Governing Body approved the recommendations to extend the Terms of Office for Clinical Leads, Lay Members and the Secondary Care Consultant.

205/19 Black Country Safeguarding update and Memorandum of Understanding (MOU)

The Black Country Safeguarding update and MOU was circulated prior to the meeting. Ms Carolan shared key highlights.

The Governing Body were asked to note the contents of the report and approve the MOU to facilitate a single Head of Service for Safeguarding across the Black Country ensuring operational oversight of the safeguarding statutory functions until the 31st March 2021.

The following comments were noted:-

• It was noted that SWB CCG would be hosting the Head of Service for Safeguarding for the Black Country CCGs. • Dr Sykes asked if a person had been identified. Ms Carolan confirmed that a recruitment process was underway. • Mrs Rawlinson expressed concern around the complexity of this service and was not certain that one post would be sufficient, were there to be more than one safeguarding issue at any one time. Ms Carolan confirmed that local resource would remain unchanged and highlighted that the new post was an additional post that would oversee the safeguarding service and involved a huge portfolio. Mrs Carolan

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noted that there was no-one currently on an operational level who had oversight on a black country level. • Mr Maubach added that one of the reasons for facilitating a single Head of Service was due to the complexity of the service which collectively was an area of high-risk and necessary for the CCGs to make immediate progress.

The Governing Body received the report for information and assurance and approved the MOU.

206/19 Minutes of the Constitutional Committees for information

The Governing Body accepted the minutes for information and assurance.

207/19 Items to share with staff

• WMAS Christmas performance. • The CCG’s flu vaccine uptake had greatly improved. Well done to everyone that has had their flub jab and a gentle reminder to those who have not can obtain the vaccine from pharmacies etc. • Safer Surgeries Showcase agenda item and highlights from the presentation slides. • Future Form Engagement Listening Exercise outcomes and common themes. • Continuity of the Terms of Office for the CCG’s Clinical Leads and Lay Members.

208/19 Any Other Business

There were no items of any other business.

209/19 Close of Meeting

The Public Governing Body meeting closed at 1608 hours.

210/19 Date and Time of the Next Meeting:

Wednesday 4th March 2020 1345 to 1600 hours Board Room 2F, Kingston House

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Public GB Open Action Register: Wednesday 4th March 2020

Discussion Ref Action By Whom Deadline/ Comment/Response Date Date update Completed

6th 175/19 Integrated Urgent and Emergency Care Chief Officers 8th January Mr Evans confirmed that a number of entries had been November (c) update – post ‘go live’ 2020 made and a response was awaited. th 2019 4 March 2020 Showcase service transfer at either the

Health Service Journal (HSJ) Awards or The Commissioning Show for consideration.

6th 156/19 Patient Participation and Advisory Group Mrs Salter-Scott 4th March It was noted the GB working group on Public November (PPAG) 2020 Engagement Mechanisms and Consultation will 2019 supersede this work. That working group will be reviewing the approach across all 5 places. So, with Quarterly or six monthly PPAG update respect we are asking for this agenda item to taken off suggested for further consideration. the agenda for next month with a view to being presented as part of the wider piece of work in the PPAG update report to be presented to Summer. future Governing Body meeting.

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8th January 185/19 Migrant Health and Safe Surgeries Dr Sykes 4th March The slides were circulated to Governing Body members 2020 showcase item 2020 and highlights captured in members news.

Circulate presentation slides to Governing Body members after the meeting and include highlights in members news.

8th January 186/19 NHS England Cancer Position Statement Ms Carolan 4th March Following the last meeting, an update has been received 4th March 2020 (a) Ms Carolan to raise with NHSE and NHSI 2020 from the West Midlands Cancer Alliance Board which 2020 at the next System Review Meeting and will be circulated separately.

feedback.

(b) Mrs Liggins to liaise with the Director of Mrs Liggins Commissioning from Walsall CCG and ask him to raise the issue at the NHS England and NHS Improvement Collaborative Commissioning meetings.

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8th January 195/19 Quality and Safety Report Meeting 4th March 2020 Administrator 2020 Feedback amends regarding primary care kiosks to report author.

8th January 196/19 Finance and Performance Committee Mrs Rawlinson/ 4th March 2020 Report Mr Green 2020

Feedback points raised by Mrs Rawlinson via the Finance and Performance Committee.

8th January 199/19 Audit and Governance Committee Report Miss 4th March 2020 Woodhouse 2020 Undertake a comparative risk review of the TCP risks for the four CCGs across the Black Country.

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8th January 200/19 SCR Report Mrs Liggins 4th March 2020 (a) 2020 Mrs Liggins to obtain clarity regarding IAPT and reconfiguration and where cancer services feature.

8th January 200/19 SCR Report Mrs Liggins/ 4th March 2020 (c) Dr Hallan 2020 Mrs Liggins/Dr Hallan to discuss arrangements for a Sandwell homelessness service outside this meeting.

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Discussion Ref Action By Whom Deadline/ Comment/Response Date Date update Completed

4th 147/19 Sustainability and Transformation Plans 6th September (STP) 5 Year plan – Health and Wellbeing November 2019 Boards 2019 TBC

a) Governing Body members to feedback All additional comments to Mrs Liggins/Mrs Salter-Scott who will feedback to the central communications team.

Final draft being presented to Strategic Mrs Liggins b) Commissioning Redesign Committee and approval by the CCG Governing Bodies in November 2019.

7th August 110/19 Local delivery plan for the interim long- Mrs McGee 4th This information has not yet been published. 2019 term people plan to be added to September September’s Public Governing Body 2019 TBC agenda.

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Discussion Ref Action By Whom Deadline/ Comment/Response Date Date update Completed

1st May 34/19 Transformation Report, Integrated Urgent Mrs Ellis 5th June Details of the WMAS radio interview was emailed to 2nd May 2019 (a) and Emergency Care 2019 Governing Body Members. Action completed/closed. 2019

Share details of the WMAS radio interview with Governing Body members. 3rd April 17/19 Sandwell and West Birmingham CCG Mr Evans 1st May On agenda 1st May 2019 Stakeholder Consultation Plan update 2019 2019

Produce a written process around the voting for submission to the next Governing Body meeting. 1st May 28/19 Quality and Safety Report Ms Carolan via 5th June Ms Carolan confirmed the request had been fed-back to 5th June 2019 (a) Cancelled operations CQRM process 2019 Sandwell and West Birmingham Hospital NHS Trust 2019 (SWBHT). Action completed and closed. SWBHT to review paperwork sent to patients making sure ‘fasting’ requirement is clear and setting out the consequences if patients forget.

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Discussion Ref Action By Whom Deadline/ Comment/Response Date Date update Completed

1st May 28/19 Quality and Safety Report Ms Carolan 5th June Ms Carolan confirmed SWBHT were fully aware of the 5th June 2019 (b) Mortality data 2019 SHIMI guidance and could share this with Governing 2019 Body members if helpful and comments fed-back to Review national requirements in terms of SWBHT. Action completed and closed. SHIMI data and check position in terms of measuring and day counted i.e. patient admission date or the date patient dies.

1st May 28/19 Quality and Safety Report Ms Carolan 5th June Ms Carolan confirmed the procedures undertaken at 5th June 2019 (c) 2019 tertiary centres and local readmissions potentially 2019 The procedures undertaken at Tertiary having an impact on the 30 day financial penalty had centres and local re-admissions may have been fed-back to SWBHT. Action completed/closed. an impact on the 30 day financial penalty and MC agreed to feedback to SWBHT.

1st May 31/19 SCR Report Dr Sykes 5th June Ms Carolan confirmed Dr Sykes had made contact with 5th June 2019 (a) 2019 the PMO Manager and confirmed the PM3 is equitable 2019 Liaise with the PMO manager and confirm in terms of BSoL reporting. Action completed/closed. the PM3 system is equitable e.g. BSol reporting.

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1st May 31/19 SCR Report Mr Mitchell 5th June Mr Williams confirmed that Birmingham and Solihull 5th June 2019 (b) Homeless Primary Care Service Contract Mr Green 2019 (BSoL) CCG have re-procured the Alternative Provider 2019 Medical Services (APMS) Contract for the Homeless Check and clarify how best we Primary Care Service Contract. SWB CCG had agreed, in communicate and formalise how the costs are distributed between SWB CCG and principle, as part of that process there would be a re- BSoL CCG. distribution of the secondary care costs. Mr Green agreed to liaise with BSoL CCG. The Governing Body members agreed to close this action on this basis. 1st May 34/19 Transformation Report, Integrated Urgent Mrs Ellis 5th June Mrs Ellis confirmed that WMAS had reviewed the 5th June 2019 (b) and Emergency Care 2019 indicators in terms of the percentages for the response 2019 type and this was included in the report. Action Ask WMAS if possible to review the completed/closed. indicators in terms of the percentages (rounding up/down) for the response type.

1st May 42/19 Any other business Ms Carrington 5th June Ms Carrington confirmed that Mr Jack Linstead, Senior 5th June 2019 Two week waits for chest x-rays 2019 Account Lead, would be contacting Mrs Rawlinson to 2019 resolve. The Governing Body members agreed to close Liaise with Mrs Rawlinson to agree an this action on this basis. alternative method of communication (previously circulated via video).

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3rd July 88/19 Include data for the regional strategic Mrs Ellis 7th August This information has been included in the 7th August 2019 (b) capacity cell in the Transformation Report 2019 Transformation report for August and moving forward. 2019 update for August 2019 and moving forwards.

26th June 2/19 Confirm outcome of members vote to Mr Williams 7th August Mr Williams confirmed both actions had been discussed 7th August 2019 (a) NHS England and provide update to 2019 and completed. Actions completed/closed. 2019 Governing Body.

26th June 2/19 Further discussion to take place with chief Chief Officers 7th August Mr Williams confirmed both actions had been discussed 7th August 2019 (b) officers in terms of a clear communication 2019 and completed. Actions completed/closed. 2019 plan for SWB CCG staff and what it means for the transition process and the Transition Board.

26th June 2/19 Obtain a position update from the two Mr Williams 7th August Mr Williams confirmed that the STPs had agreed a 7th August 2019 (d) Sustainability Transformation 2019 process of collaborative working and have made an on- 2019 Partnerships (STP’s) going commitment to work together. Action completed/closed.

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26th June 2/19 Further reflection and discussion on how All 7th August Mr Williams informed Governing Body members that 7th August 2019 (e) the CCG approach the issue of talking to 2019 SWB CCG had not planned a specific follow-up as, a 2019 members about the detail and the way consequence of the boundary vote but acknowledged forward and whether it needs to think there were split opinions from its members and would about having a conversation with colleagues in Sandwell, where the voter manage this via its ongoing relationship with primary was closer. care networks and members. SWB CCG had agreed to proceed with its communications strategy on this basis. Action completed/closed.

3rd July 83/19 Email link to Vanguard Governing Body Ms Carolan 7th August Mrs Carolan confirmed she had emailed the link to the 7th August 2019 paper (Care Connected Partnership) re: 2019 paper and the evaluation audit findings to Mr Highton. 2019 end of funding and lessons learnt (March Action completed/closed. 2018) and the evaluation audit findings minutes to Mr Highton.

3rd July 92/19 Proposed future commissioning approach Mrs Liggins 7th August On agenda. 7th August 2019 The balanced scorecard will be presented 2019 2019 to the next Governing Body meeting.

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3rd July 91/19 Governance Handbook Miss 7th August Miss Woodhouse confirmed that she had suggested 4th 2019 Separate discussion to take place outside Woodhouse/ 2019 some amendments to the scheme of delegation and September Governing Body meeting regarding SCR Mrs Liggins 4th once these had been agreed with Mrs Liggins, the 2019 September scheme of delegation would need to be re-presented to and the SORD. 2019 Governing Body for approval. Action

completed/closed. Seek clarity regarding the delegated amount for the SCR Committee and feedback to Dr Sykes.

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7th August 99/19 Arrange for the Time2Talk Team to Miss 4th Miss Woodhouse informed Governing Body members 2019 contact SWBHT. Once a response has Woodhouse September that a response had already been sent to the public been received this will be shared with Mrs 2019 member regarding their query and confirmed that Sandwell and West Birmingham NHS Hospitals Trust Geddes and included in the Public (SWBHT) had responded as follows:- Governing Body Minutes. ‘A new appointment-based system has been introduced In response to the question, it would be by the phlebotomy service at SWBHT. Patients may helpful to include all the current request a timeslot for a blood test at The Lyng Centre, phlebotomy arrangements indicating West Bromwich or Oldbury Health Centre. The ‘walk-in’ those that are ‘appointment free’ for the service, however, will also continue to operate’. The public member was not aware that you could still benefit of all patients, members of the receive the walk-in appointments. public and Governing Body members. ‘It is anticipated that the new system will lead to shorter waiting times for patients attending blood test clinics. Appointments can be made by patients calling a dedicated telephone number providing their name, date of birth, home address and name of their GP. The new system will be ‘rolled-out’ by December 2019 at Soho Road Health Centre in Handsworth, Aston Pride Community Health Centre, Neptune Health Centre in , Victoria Health Centre in Smethwick and Hospital. The reason for the implementation of the new system was for the benefit of patients and members of the public following requests for appointment slots for blood tests’.

Based on her own experience, Mrs McMahon was not confident that you could walk into The Lyng Centre and

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Discussion Ref Action By Whom Deadline/ Comment/Response Date Date update Completed

have a blood test and asked for further clarity to be obtained from the Trust. Action: Miss Woodhouse to contact SWBHT and clarify.

Mrs McMahon asked if the decision had been made based on the patients’ or hospital’s best interests. Miss Woodhouse confirmed that patient feedback had identified that some patients prefer to have an appointment for their blood test rather than queue. Patients with an appointment are finding that there is no delay and they are seen on time, whereas walk-in patients have to wait their turn depending on the number of patients in front of them.

Dr Marok asked if a communications message could be included in members news so that GP practices could be informed. Action: Miss Woodhouse to liaise with the Head of Engagement and Communications once a final response has been obtained. Action completed/closed on this basis.

4th 128/19 Circulate DToC presentation slides to Meeting ASAP Action completed. 5th September Governing Body members after the Administrator September 2019 meeting. 2019

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4th 146/19 Circulate Place Based Budgets Meeting ASAP Action completed. 5th September presentation slides to Governing Body Administrator September 2019 members after the meeting. 2019

5th June 62/19 Obtain cancer position statement from Mr Williams 3rd July Mr Williams confirmed that the position with gynae 6th 2019 NHS England for the next meeting. 2019 oncology remains unchanged pending capital November 3rd July 90/19 TBC developments at University Hospitals Birmingham NHS 2019 2019 6th Foundation Trust (UHB) and is likely to be the position November for the foreseeable future. 2019 It was noted that discussions were underway in relation to the repatriation of solid tumour oncology. A briefing was scheduled for discussion at the Joint Health Overview and Scrutiny Committee but was likely to be stood down during the pre-election period.

This action will be handed over to the Chief Officer for Quality and will be picked up via the quality and assurance process between SWB CCG and SWBH and further updates to Governing Body will be provided via the Quality and Safety report. Action completed/closed on this basis.

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7th August 118/19 Transformation Report, Integrated Urgent Mrs Ellis 4th Mrs Ellis confirmed a split of 70/30 with the old provider 6th 2019 and Emergency Care September and acknowledged the position had ‘moved’ on November 2018/19 outcomes (grouped together) 2019 following the new joint service. Action 2019 6th completed/closed on this basis.

November Mrs Ellis agreed to try and find out the 2019 split for ‘Face to Face’ and provide feedback.

4th 144/19 Black Country and West Birmingham Mrs Liggins 6th An update has been included in the chair’s report on the 6th September Clinical Commissioning Groups Merger or November agenda. Action completed/closed on this basis. November 2019 Continued Collaboration – 2019 2019 Communications and Engagement Plan

The feedback received during the listening period will be presented to the CCGs Governing Bodies in November.

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4th 145/19 Response from Alliances Mr Williams 6th This item will be discussed at the next Governing Body 6th September Mrs Liggins November Development Session. Action completed/closed on November 2019 Response from Alliances paper to be 2019 this basis. 2019

presented to Governing Body in November.

4th 131/19 Miss Woodhouse to contact SWBHT again Miss 6th Miss Woodhouse informed Governing Body members 18th September to obtain further clarity in terms of the Woodhouse November that she had spoken to SWBH again following the last December 2019 walk-in service still being available at The 2019 meeting and confirmed there was still a walk-in service 2019 at The Lyng in West Bromwich. It was noted that Lyng Centre. patients had raised a number of concerns with the Trust and as a result it had produced a lessons learned Miss Woodhouse to liaise with the Head document prior to ‘rolling’ out to its other sites. A of Engagement and Communications patient survey regarding the phlebotomy service had once a final response has been obtained been undertaken and feedback results and an action from SWBHT and include in members plan had been shared with SWB CCG. Action: Circulate news. phlebotomy survey feedback/action plan to Governing Body members via email. Action completed/closed on this basis.

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6th 170/19 Finance and Performance Committee Mr Green 8th Finance and Performance update report circulated via 7th November Report January email. Action completed/closed. November 2019 2020 2019 Circulate the Finance and Performance update report to GB members.

6th 175/19 Integrated Urgent and Emergency Care Dr Sykes 8th Dr Sykes confirmed he had written to the chair of West 12th November (b) update – post ‘go live’ January Midlands Ambulance Service NHS Foundation Trust. November 2019 2020 Action completed/closed. 2019 SWB CCG to write to formally to the chair of West Midlands Ambulance Service NHS Foundation Trust recognising the contribution and success of the transfer of the service.

6th 175/19 Integrated Urgent and Emergency Care Mrs Ellis 8th 111 video circulated to Governing Body members via 11th November (a) update – post ‘go live’ January email. Action completed/closed. November 2019 2020 2019 Circulate 111 video to Governing Body members.

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6th 179/19 Communications and Engagement Ms Attwood 8th January AGM video circulated to Governing Body members via 11th November (b) update – Annual General Meeting Video 2020 email. Action completed/closed. November 2019 (AGM) 2019

Circulate AGM video to Governing Body members. 7th August 112/19 Finance and Performance Report Mr Green TBC Mr Green confirmed that the issue would be covered in 8th January 2019 Cancer 31 day waits and new 28 day 6th the STP 5-year plan which will be presented to 2020 Faster Diagnosis Standard November Governing Body once finalised with NHS England. 2019 Action completed/closed on this basis.

8th STP Five Year Planning Process to be January presented to a future Governing Body 2020 meeting.

6th 173/19 Audit and Governance Committee Report Miss 8th Miss Woodhouse confirmed that details of QS1901 had 8th January November Woodhouse January been circulated to Governing Body members. Action 2020 2019 Circulate risk details QS1901c to GB 2020 completed/closed.

members.

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Discussion Ref Action By Whom Deadline/ Comment/Response Date Date update Completed

6th 179/19 Communications and Engagement update Ms Carolan 8th The Equality Impact Assessment and the Quality Impact 24th November (a) – outcome of Acute Respiratory Listening January Assessment had been emailed to Governing Body February 2019 Exercise 2020 members. Action completed/closed. 2020

Ms Carolan to feedback the concerns raised via the SWB CCG/SWBH assurance and planning meetings and felt it would be useful to share the equality impact assessment and the quality impact assessment virtually with Governing Body members.

6th 169/19 Quality and Safety Report Ms Attwood 4th March On agenda. Action completed/closed. 4th March November 2020 2020 2019 Schedule mental health showcase agenda item for future GB meeting.

Sandwell & West Birmingham CCG Page 19 Public Governing Body Enc 2 – Open Action Register Wednesday 8th January 2020

Enc 2

Discussion Ref Action By Whom Deadline/ Comment/Response Date Date update Completed

3rd July 88/19 Nursing Homes update to be presented to Mrs Ellis TBC On agenda. Action completed/closed 4th March 2019 (a) future Governing Body meeting following 6th 2020 service transfer to WMAS. November 8th

January 4th March 2020 8th January 201/19 SCR Report Meeting 4th March The amends had been fed-back to the report author. 4th March 2020 (b) Administrator 2020 Action completed/closed. 2020 Feedback amends to report author.

8th January 198/19 Primary Care Co Commissioning Report Meeting 4th March This information has been fed-back to the Head of 4th March 2020 Administrator 2020 Primary Care and Estates Lead. Action 2020 Feedback amends regarding the Estates completed/closed. update which should read ‘the group of Great Barr Practices’ to report author.

Sandwell & West Birmingham CCG Page 20 Public Governing Body Enc 2 – Open Action Register Wednesday 8th January 2020

Sandwell and West Birmingham CCG – Governing Body, Wednesday 4 March 2020 CHAIR’S REPORT

COVID 19 (Coronavirus)

Covid 19 (Coronavirus) continues to be at the top of most news bulletins. Public Health England is updating its advice to the public and health professionals daily, via the NHS website at https://www.nhs.uk/conditions/coronavirus-covid-19/. The UK Chief Medical Officers have raised the risk to the public from low to moderate. But the risk to individuals remains low. The symptoms for Coronavirus are a cough, high temperature and shortness of breath but these symptoms do not necessarily mean you have the illness as they are like other illnesses that are much more common such as cold and flu. If you have these symptoms and have been to the following countries below, contact 111:

• Hubei province in China in the last 14 days • Iran, areas of northern Italy in lockdown or "special care zone" areas in South Korea since 19 February • other parts of mainland China or South Korea, Thailand, Japan, Hong Kong, Taiwan, Singapore, Malaysia or Macau in the last 14 days and have a cough, high temperature or shortness of breath • other parts of northern Italy (anywhere north of Pisa, Florence and Rimini), Vietnam, Cambodia, Laos or Myanmar since 19 February and have a cough, high temperature or shortness of breath • Or in close contact with someone with confirmed Coronavirus

Midland Met Hospitals new name announced

Earlier this month, Sandwell and West Birmingham NHS Trust revealed a change of name for the super hospital that will serve the people of Sandwell and West Birmingham from 2022. It will now be called The Midland Metropolitan University Hospital to acknowledge the Trust’s partnership with education providers across the West Midlands and deepening engagement with research. The new name was confirmed at a special event held at the new build, which marked the restarting of work by Balfour Beatty on the multi-million-pound site, alongside academic and industry partners, as well as local politicians and patient groups.

High intensity users service The Sandwell and West Birmingham High Intensity User Service, provided by the British Red Cross, is now up and running. The team are working in partnership with West Midlands Ambulance Service and Sandwell and West Birmingham Hospitals NHS Trust to identify those individuals who are the most frequent callers of 999 and the most frequent attenders at A&E.

In SWBCCG, we are lucky to have 5 staff members dedicated to the service who work with these individuals to identify why they are calling 999 or attending A&E and provide practical and emotional support, which enables people to reduce their reliance on unscheduled care.

The team encourages resilience, not reliance, to support people to navigate their way through the complex health and social care environment, and to remove the barriers that hinder self-management and teach coping strategies. The team are making really good progress with the individuals they are currently working with and are demonstrating quantifiable reductions in A&E and 999 usage in this cohort.

Commissioning at place and our two Integrated Care Partnerships I attended a conference called Commissioning at Place on Wednesday 19 February . There were three comments that came out of the general discussion that struck home for me. The first was about smoking and stopping smoking which is still the most cost-effective health intervention we can make. It remains vital to the wider health service that we use our position as the NHS ‘gatekeepers’ to encourage our patients to quit or, better still, never start smoking.

My second comment is around the wider determinant of health underlying social care issues, are the root cause of many of the medical problems we see in surgeries. This suggests that the current push to bring health and social care together more formally through integrated care partnerships (ICPs) in Sandwell and West Birmingham is an opportunity we cannot miss. The final comment was around the meaning of place-based care. It’s rapidly become NHS jargon but what we as a health system recognise as ‘place’, is not necessarily how our patients perceive it. This has implications for the integration of health and care in Sandwell and West Birmingham and how we develop our ICPs. On that point, our two ICPs are now established, and we can name them as the Sandwell ICP and Ladywood and Perry Barr ICP.

Primary Care Network Contract agreed between the British Medical Association and Department of Health Extra funding for primary care workforce confirmed The BMA and NHS England have agreed funding to support the employment of new primary care clinicians and staff including physician associates, physiotherapists, social prescribers and pharmacists. This is an important step forward in the development of primary care networks and place-based healthcare in both Sandwell and West Birmingham (Ladywood and Perry Barr).

GOVERNING BODY Report Title: Report Author and Title: Quality and Safety Committee Report Alison Hughes Deputy Chief Officer - Quality

Date of Governing Body: 4th March 2020 Contact Details: Agenda No: 8.1 07724 700 997 Enclosure No: 4 [email protected]

Sign off from Chief Officers:

Chief Finance Officer:

Chief Officer for Quality:Y

Chief Officer for SCR:

Chief Officer for Transformation:

Supporting Documents/further Reading:

Previous Decision

Summary of purpose and scope of the report:

The report provides assurance of the issues discussed at the Quality and Safety Committee held in February 2020 as well as detailed information collated by the Quality Directorate pertaining to provider services.

Recommendations:

• Note the report from the Quality and Safety Committee for assurance

The Governing Body/Committee are requested to: Action Approve Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified X Conflict noted, conflicted party can participate in clinical discussion but not decision

Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only)

Please state rationale for above decision:

Strategic Priorities related to the report: (Identify what priorities the report is linked to)

S1 - Partnerships with other commissioners S2 – Support the establishment of integrated provider partnerships S3 – Agree contracts to deliver including risk/gain share S4 – Review/Performance monitor, take corrective actions/discharge public accountabilities S5 – Integrated urgent and emergency care S6 – JCC and STP S7 – Deliver against clinical priorities to improve health outcomes Implications: (Mark the box to identify any implications to the associated area) Financial Assurance Framework Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated Consultation: (Mark the box to identify who has been consulted) Patients Staff Committees Public Partners Sponsored by: Chief Officer for Quality Date report received for Governing Body: 27th February 2020

SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP

Report to the Governing Body

Subject: Quality and Safety Committee Date: 24th February 2020 Author: Alison Hughes, Deputy Chief Officer - Quality

Remit of Committee The Quality and Safety Committee is a committee of the SWBCCG Governing Body. The Committee will inform the Governing Body of its deliberations by means of a formal report after the Committee has met, and informally by other means of communication.

The purpose of this committee is to provide assurance that commissioned services provides patients with safe, effective care and a positive experience of services, in accordance with their contractual terms and conditions.

The December Q&S Committee was quorate, and the following discussions/ decisions were made.

Progress Last Month: The committee discussed:

Regular Reports: • Quality Report Risk Register • Review and Update of the Quality and Safety Risk Register Assurance Reports • Safeguarding Assurance Group Report • Care Provider Quality Assurance • Information Governance • CHC Performance Report – Q2, 2019/20 Additional Items • GP Practice Waiting Room Self-Service Kiosks Policies for Review • 2 Week Wait Revised Forms • FREED Document

Regular Reports: Quality Report (see appendix) The committee discussed the report in detail.

• Primary Care Information regarding Primary Care was provided, which included recognition of the recent CQC rating of Outstanding for Broadway Health Centre.

A brief summary of a whistleblower case involving two GP Practices was also provided. CQC have since visited five additional practices who are under the same contract holder, which identified similar concerns. There were a large number and variety of issues identified. In response, the CCG have commissioned the Royal College of General Practice ( RCGP) to offer

support to all of the practices identified, to ensure that quality and safety issues are addressed as a priority and ensure that the relevant support and improvements occur.

The committee discussed whether any of the issues raised could have been identified had it not been for the whistleblower. The Primary Care Quality Lead noted that the CCG had previously requested evidence from the practice regarding assurance relating to certain areas and this had been submitted by the contract holder. It was also noted that the CQC had previously rated some of these practices as ‘good’ prior to the involvement of the whistleblower and the issues were validated following unannounced visits to all of the practices at the same time. The CCG continues to offer support to the practices involved and the required submissions of improvement plans are continuing to the CQC, in response to a number of urgent notices that had been served by CQC to the practice. The CCG has also issued several breach notices to the Practice and met with the contract holder to discuss the concerns and expected improvements.

• Sandwell and West Birmingham Hospitals In regard to Sandwell and West Birmingham Hospitals, it was noted that: A&E performance rose to 72.2%; A Data Quality Review is being carried out in regard to Neutropenic Sepsis performance, which dropped following the introduction of the new IT system, Unity. An improvement Plan will be shared with the CCG in regard to Cancelled Operations, which has continued to rise and a detailed Action Plan in regard to admissions to the hyper- acute stroke wards within 4hrs and thrombolysis achievement, has been requested by the CCG. Delays in the submission of root cause analysis report submissions, following serious incidents were also discussed and are being addressed by the Director of Governance at the trust, who provided reassurance that the issue will be resolved within the next month.

• Black Country Partnerships Bed Occupancy remains high in Adult Mental Health, and Black Country Partnerships continued to work with the CCG to support patient flow with a joint approach to new Bed Management. The Improving Access to Psychological Therapies ( IAPT) service backlog stands at 1300 patients and has been escalated to commissioners and added to the corporate risk register. A formal agreement has been put in place with financial support to ensure improvement, which will continue to be monitored.

• Urgent Care The 999 service continues to perform well against all KPIs and national standards. There has been increased demand over winter but this has not led an increase in reported serious Incidents. The 111 service has seen significant improvements to quality since transferring to West Midlands Ambulance Service. Calls answering time within 60 seconds now stands at 89% and recruitment of Clinicians into the CAS (Clinical Advisory Service) has doubled since changing provider.

• Nursing Homes One nursing home still remains suspended following a visit where safeguarding concerns were identified. A safeguarding referral was also received for another nursing home and the Continuing Healthcare team are providing support to this investigation. Weekly observational visits by the Funded Nursing Care Team, are still in place at a further nursing home following some Safeguarding concerns that were identified in November.

Risk Register The committee reviewed all risks on the Risk Register, with the following updates noted:

• An update was agreed for Risk QS17 relating to Staffing issues at SWBH. CCG have requested staffing reports at SWBH Board Assurance meeting. • An update was agreed for Risk SG11_16a. Issues receiving data pertaining to Safeguarding, despite there being an MOU in place. The Safeguarding team continue to progress conversation with Birmingham to collate and send the data. • Risks QS06_18a, QS19_01b – were reviewed and remain unchanged. • An update was agreed for Risk QS05_19a – Risk closed, as appointment for Adult Safeguarding Lead for Birmingham has now been appointed. • An update was agreed for Risk QS19_11 – Confirmation that two additional workers are supporting Dementia screening. Progress is being monitored via the Primary Care Commissioning Framework ( PCCF).

Newly identified risks were discussed, relating to:

• Liberty Protection Safeguards ( LPS)-From Autumn 2020, the CCG will be responsible for undertaking the assessments and monitoring regarding LPS, for patients in their own homes. This includes a significant increase in cases, which is currently being scoped to better understand the activity and will pose a risk to the CCG in terms of its capacity to deliver this. • Discussion around CCG’s response to risk of Coronavirus. Assurance was given that the CCG was working with NHSE ,Public Health and partners, to manage assessment and testing of people who may potentially have the virus and significant time and resource was being utilised

Assurance Reports:

Safeguarding Assurance Group Report • Regarding the Sandwell Children Safeguarding Partnership Update, there was a discussion around the role of the scrutineer. The Safeguarding Team confirmed that the CCG will be appointing to the role, which has recently become vacant.

Care Provider Quality Assurance • In order to Quality Assurance Providers of Continuing Health Care ( CHC) services, the CCG has previously planned to award NHS contracts, with a view to procure services. However, this was delayed in view of adopting a Black Country STP-wide approach. This left a gap in the Quality Assurance process for providers currently on spot-purchase contracts. The Quality and Safety Committee approved the current Quality Assurance Process in place for spot-purchase contracts.

Information Governance • The Information Governance report was presented, which highlighted the following key details: Toolkit compliance for IG Training. There were no Information Governance Incidents or new risks. The CCG has received no formal queries or notices from the Data Protection Office.

Continuing Health Care ( CHC) Performance Report – Q2, 2019/20 • The Quality and Safety Committee acknowledged the effective partnership working with Birmingham and Solihull CCG as outlined within the report and the effective teamwork with providers that is currently underway to address accurate assessment for patients identified with challenging behavior.

Additional Items Learning from Experience • Recognition was given for the Learning from Experience Newsletter, which outlined the key themes and trends. The committee asked for a detailed analysis of the incident theme pertaining to ‘Records, Information and Communication’, which will be provided to the next committee.

Policies for Review • The Revised Urgent (Two Week Wait) Suspected Cancer Referral Forms for Breast and Urology were presented to the committee for information. The new forms have been agreed by the relevant specialties and will be accepted by all receiving Trusts across the West Midlands.

• The FREED Document (Frailty-Recognising End of Life and Escalating Deterioration) was presented to the committee, which outlined several tools to be used across all nursing homes within Black Country and West Birmingham STP, to promote early recognition of patient deterioration alongside pre-emptive care plans. The committee approved the document.

• The Partnership Working - Commercial Sponsorship Policy was presented to the committee, which requires NHS bodies to have formal arrangements, with clear policy statements, codes of practice in working with sponsors and CCG Boards, Clinical Commissioning Group (CCG) members and staff. These arrangements need to be in line with the Standing Orders, Reservation and Delegation of Powers and Standing Financial Instructions.

• The updated Serious Incident ( SI) Policy was reviewed and approved by the committee. The policy was modified to reflect the recent changes in the local assurance process.

• The updated Assurance Visit Policy was reviewed and approved by the committee.

GOVERNING BODY Report Title: Report Author and Title: Dr P Hallan Finance and Performance Committee Report Chair - Finance and Performance Committee James Green Chief Finance Officer

Date of Governing Body: Contact Details:

Wednesday 4th March 2020 [email protected] Agenda No: 8.2 Enclosure No: 5

Sign off from Chief Officers:

Chief Finance Officer: Yes

Chief Officer for Quality:

Chief Officer for SCR:

Chief Officer for Transformation:

Supporting Documents/further Reading:

Previous Decision:

Summary of purpose and scope of the report:

The purpose of this report is to provide the Governing Body with an overview of the content of the Finance and Performance Committee meetings held on 27th January 2020 and 24th February 2020. The key reports considered at the Finance and Performance Committee (on 27th January 2020) are attached.

Recommendations:

• To note the content of the update.

The Governing Body/Committee are requested to: Action Approve Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified X Conflict noted, conflicted party can participate in clinical discussion but not decision

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Finance and Performance

Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:

Strategic Priorities related to the report: Quality & Safety X Finance & Performance X Strategic Commissioning and Redesign X Organisational Development X Primary Care Co-Commissioning X Collaborative Commissioning X Implications: Financial State any financial implications for the CCG Assurance Framework

Risks and Legal Obligations The Finance and Performance Committee Review the corporate risk register on behalf of the Governing Body.

Equality and Diversity

Statutory and External Influences

Further implications not stated Detail any further implications including resources and

training

Consultation: X Patients Staff Committees Public Partners Sponsored By: (Chief Officer or Committee James Green, CFO Chair) Date report received for Governing Body Wednesday 26th February 2020

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SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP

Report to the Governing Body

Subject: Finance and Performance Committee

Date: Monday 24th February 2020

Author: Dr P Hallan (Chair – F&P Committee)/James Green (Chief Finance Officer)

Remit of Committee

Finance and Performance Committee of the SWBCCG Governing Body

The Finance and Performance Committee will inform the Governing Body of its deliberations formally by means of a report to the Governing Body meeting after the Committee has met and informally by other means of communication.

The Committee shall review the financial and performance management. The Committee will provide assurance to the Governing Body that the financial and performance issues of the CCG are being properly addressed. The Committee shall provide assurance that significant finance and performance risks are being adequately managed and agree remedial action where necessary.

Progress Last Month/Key Issues Discussed

A full set of papers have been produced and circulated to the Committee’s membership. The content of the February agenda included the following:-

• Minutes from the previous • Action log • Chairman’s Report • Performance Report • Urgent Care Report • RTT Waiting List Report • Financial Planning 2020/21 Update • Finance Report Month 10 • Review of Risks

Performance Report

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Finance and Performance

Referral to Treatment (RTT)

Both the CCG and SWBHT failed to achieve the headline measure again in December with failures across most specialties. Apart from DGFT, all other local providers failed to meet the headline measure, as did the national average. Remedial Action Plans (RAPs) are being monitored by commissioners.

Diagnostics

The CCG failed the target in December due to increased numbers of breaches at DGFT (85), the vast majority of these were recorded under colonoscopy, flexi-sigmoidoscopy and gastroscopy. A remedial action plan that includes additional capacity and extended hours has been agreed with Dudley CCG with recovery forecast for March 2020.

Accident & Emergency (A&E)

The Trust position against the 4 hour access target for January 2020 was 72.86%, a slight increase in performance from December (72.18%) with performance particularly improving at City ED in the latter part of the month. ED attendances in January 2020 were 18,447, a decrease from the levels seen in December (19,330). There were no 12 hour trolley waits in January. The Emergency Departments are continuing to focus on their internal KPI’s of triage within 30 mins, patient seen by a doctor within 1 hour, plan to admit or discharge within 2 hours, and timely discharge or transfer within 4 hours. The directorate has been working on roles and responsibilities for shop floor leadership. The implementation of this should see reduction in 4-5 hour breaches for non-clinical reasons, and improvement in performance out of hours. The Trust are reviewing the AMAA model and early SEAU pathways and are working to schedule OOH arrivals into next day ambulatory care and hot clinics.

Cancer 62 day waits

The CCG has failed to meet the headline measure in any month so far this year. Breaches are in the main at UHB, with a few others across the patch. UHB have developed a new recovery trajectory and shared with BSoL CCG for review and comment.

CYPMH

It is increasingly likely that the CCG will not achieve its year-end target for access. There are still some data capture issues. These are being addressed with providers. Commissioners are reviewing practice, which in turn will improve access and provision for CYP.

Finance Update

The key financial headlines for 2019/20 are:-

• Overall annual Revenue Resource Limit - £861.4m • Planned cumulative surplus - £23.9m • Annual QIPP target - £30.4m • Running cost allowance 2019/20 - £11.9m (budget £11.7m post QIPP)

The key financial metrics are summarised below:-

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Finance and Performance

The table above represents an anticipated achievement of our financial targets for this financial year.

Financial Planning 2020/21 Update

David Hughes provided an update in respect of the planning issues for next year. The update included:-

. Operational Planning Guidance . Financial Plan . Wider BCWB Impact . SWBH . Continuing Healthcare . QIPP . Budget Setting

Risks

The group reviewed the Committee’s risks and recommended two risks for closure.

Sandwell & West Birmingham CCG Page 5 of 5

Finance and Performance Finance & Performance Committee 24th February 2020

Finance & Activity Report Month 10 Contact Officers

James Green, Chief Finance Officer, [email protected] 0121 612 1568 David Hughes, Deputy Chief Finance Officer, [email protected], 07872055022 Finance & Performance Committee

Report Topic: Finance & Activity Report as at 31st January 2020 (Month 10 – 2019/20) Report From: James Green – Chief Finance Officer Date: Monday 24th February 2020 Purpose of Report: To provide information to the committee on the financial performance of the CCG for the period 2019/20. Key Issues: The CCG is currently operating within:

Overall Revenue Resource Limit - £861.4m Planned cumulative surplus - £23.9m QIPP target - £30.4m Running cost allowance - £11.9m (Budget £11.7 post QIPP) This represents an achievement of our financial targets for this year. Recommendations: Discuss the content of the report and approve.

Page 1 Executive Summary The table below is formed from a range of key metrics used by NHS England to assess the financial performance of CCGs. The overall performance for the CCG is rated as green.

Financial Performance The CCG has a planned cumulative surplus for the year of Self £23.9m. This is the cumulative surplus of £20.7m achieved in No. Indicator Assessment the financial year 2018/19, plus the additional £3.2m mandated 1 Underlying Recurrent Surplus 1.1% for 2019/20. However, there has been a slight deterioration in the CCG’s underlying surplus during the year. 2 Surplus - Year to Date Performance - Variance 0.4%

3 Surplus - Full Year Forecast - Variance 0.4% The year-to-date actual position is currently £20k ahead of the year to date planned surplus. The CCG will likely achieve the 4 QIPP - Year to Date Delivery 100% planned cumulative surplus in 2019/20. 5 QIPP - Full Year Forecast 100%

6 Running Costs Achievement 100% QIPP achievement is expected at this stage. Clear Identification of Risks Against Financial Indicator Met 7 Delivery & Mitigations In Full The CCG is currently forecasting to achieve the mental health 8 Mental Health Investment Standard Yes investment standard. Budget is in place and spending is expected during the year. 9 Cash Efficiency - Target Below 1.25% 0.04%

Better Payment Practice Code -YTD Volume 98.11% The CCG continues to meet its cash related performance targets. 10 Better Payment Practice Code - YTD Value 98.99%

Overall: Primary Indicators Are Green Green The CCG has performed above its target of paying 95% invoices within 30 days.

Page 2 Financial Position Forecast Outturn Annual Budget YTD Budget YTD Actual YTD Under / (Over) Forecast Outturn Under / (Over) £000 £000 £000 £000 £000 £000 Allocation 861,379 710,437 710,437 0 861,379 0 Expenditure Acute 403,230 335,856 336,640 (785) 405,995 (2,765) Community 108,575 89,612 90,079 (467) 109,108 (533) Mental Health & Learning Disabilities 110,563 89,966 88,840 1,126 108,448 2,115 Winter Pressures 1,757 1,020 1,003 17 1,715 42 Primary Care 93,431 77,114 78,863 (1,749) 94,552 (1,122) Prescribing 83,893 70,624 69,085 1,539 83,094 799 Better Care Fund 19,858 16,552 16,525 27 19,826 32 Reserves 4,474 0 0 0 3,317 1,157 Running Costs 11,701 9,780 9,468 312 11,428 273 Total Expenditure 837,482 690,523 690,503 20 837,482 0 Surplus 23,897 19,914 19,934 20 23,897 0 The CCG’s Revenue Resource Limit for 2019/20 is £861.4m.

The year to date position shows £20k ahead of the planned surplus.

The CCG has a planned cumulative surplus for the year of £23.9m. This is the cumulative surplus of £20.7m achieved in the financial year 2018/19, plus the additional £3.2m planned for 2019/20.

A detailed breakdown of the financial position can be found in Appendix 1 of this document together with details of budget movements in appendix 2.

Page 3 Revenue Resource Limit

The CCG’s revenue resource limit (funding/income) for 2019/20 is £861.4m. This includes the initial £853.9m baseline allocation (which includes a £20.7m cumulative surplus brought forward) with further in-year net adjustments of £7.5m. The CCG has been mandated (by NHSE) to achieve an in-year surplus of £3.2m. This will increase the planned cumulative surplus (at March 2020) to £23.9m.

The CCG has received £396k non cash running costs allocation during month 10. This allocation accounts for the 6.3% increase in pension uplift which has been funded centrally.

£000 £000 £000 Description Recurrent Non Recurrent Total

Revenue Resource Limit December2019 (Month 09) 833,222 26,358 859,580

Additional Allocations (Month 10)

£75k Moorhouse Consultancy (75) (75) GPFV 2019-20 Training Hub Upskilling 65 65 GPFV 2019-20 Training Package 51 51 GPFV - Practise CPD Backfill 7 7 Mental Health Liaison Core 24 Transformation Funding 174 174 FTA payments 19/20 In-Year Q1&2 701 701 HSCN CCG Corporate Connections costs 10 10 Primary Care HSCN transitional relief for move to fair share allocations in 2019/20 28 28 LD Accelerated Discharge Support 25 25 GDE funding to West Midlands Ambulance Service NHS Foundation Trust for milestone 4 340 340 Winter Pressure Volunteering Programme - SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST 25 25 HSCN migration support funding 52 52 6.3% pension uplift 1920 396 396

Total in month allocations 0 1,799 1,799

Revenue Resource Limit January 2020 (Month 10) 833,222 28,157 861,379

Page 4 Healthcare Contracts The table below details the NHS contracts within the CCG of significant value:

Forecast Forecast Outturn Annual Plan YTD Budget YTD Actual YTD Under /(Over) Outturn Under /(Over) £000 £000 £000 £000 £000 £000 Acute Sandwell & West Birmingham Hospitals NHS Trust 257,159 214,341 214,085 255 257,173 (14) University Hospitals Birmingham NHS Foundation Trust 40,272 33,573 33,115 458 39,909 363 Dudley Group NHS Foundation Trust 38,907 32,444 33,014 (570) 39,603 (696) Walsall Healthcare NHS Trust 9,077 7,596 7,847 (251) 9,374 (298) Birmingham Women's & Children's Hospital NHS Foundation Trust 15,038 12,566 12,439 127 14,923 114 Royal Orthopaedic Hospital NHS Foundation Trust 5,623 4,692 4,777 (85) 5,726 (104) The Royal Hospital NHS Trust 2,664 2,226 2,482 (255) 2,962 (298) West Midlands Ambulance Services NHS Foundation Trust 21,841 18,293 18,491 (197) 22,072 (231) Acute Hospitals NHS Trust 399 334 379 (45) 465 (66) University Hospitals of North Midlands NHS Foundation Trust 713 597 321 276 413 300 Shrewsbury & Telford Hospital NHS Trust 160 133 167 (34) 197 (37) Total 391,852 326,796 327,118 (322) 392,819 (967)

Community Sandwell & West Birmingham Hospitals NHS Trust 31,879 26,753 26,835 (82) 32,017 (138) Birmingham Community Healthcare NHS Trust 18,394 15,328 15,787 (458) 18,946 (551) Walsall Healthcare NHS Trust 339 283 283 0 339 0 The Royal Wolverhampton Hospital NHS Trust 139 116 161 (45) 192 (53) Dudley Group NHS Foundation Trust 476 396 398 (2) 478 (2) NHS Other 605 504 572 (67) 674 (69) Total 51,832 43,381 44,034 (654) 52,645 (813)

Mental Health Black Country Partnership NHS Foundation Trust 32,464 27,054 27,375 (321) 32,868 (403) Dudley & Walsall Mental Health Partnership NHS Trust 2,351 1,958 2,033 (74) 2,445 (94) Birmingham & Solihull Mental Health Trust 1,202 1,002 941 61 1,141 61 Forward Thinking Birmingham 7,154 5,962 5,744 218 6,916 238 Total 43,172 35,976 36,092 (116) 43,371 (198)

Page 5 Sandwell & West Birmingham Hospitals

Activity Annual Plan YTD Plan YTD Actual YTD Under/(Over)

Activity Activity Activity Activity A&E 154,655 117,124 115,443 1,681 Elective 29,670 21,639 20,499 1,140 Emergency 47,599 35,495 35,647 (152) Outpatients (New) 142,262 104,061 106,059 (1,998) Outpatients (Review) 246,698 185,322 174,823 10,499 Outpatient Procedure 70,000 52,172 54,343 (2,171) Total 690,885 515,813 506,814 8,999

Cost (£) Annual Plan YTD Plan YTD Actual YTD Under/(Over)

£000 £000 £000 £000 A&E 20,384 15,437 15,437 0 Elective 35,228 25,797 26,380 (583) Emergency 84,188 62,678 61,995 683 Outpatients (New) 25,283 18,682 19,671 (988) Outpatients (Review) 17,468 13,220 12,159 1,062 Outpatient Procedure 13,202 9,843 10,098 (255) Community 31,838 23,900 23,917 (17) Other 61,402 46,121 46,107 14 Total 288,993 215,678 215,764 (85)

The above table provides a summary of the month nine monitoring information received from SWBH. The SWBH reported position for month is a £85k year-to-date overspend against the minimum income guarantee (MIG) and RTT plan. However, the CCG is over performing by £2.8m against the MIG plan.

The CCG is forecasting an overspend of £141k based on actuals if the trend continues. However, we should be mindful that SWBH are behind on their waiting list trajectory and plan to catch up in the later months of the financial year. Furthermore, the profile of the contract takes into account the trust carrying out more work in Q4.

Page 6 Dudley Group of Hospitals The table below shows the performance for the period April to December 2019, as reported by the Trust before any adjustments.

Activity Annual Plan YTD Plan YTD Actual YTD Under/(Over) Activity Activity Activity Activity A&E 19,263 14,468 15,382 (914) Elective 15,149 11,282 11,680 (398) Emergency 8,701 6,534 6,587 (53) Outpatients (New) 22,784 16,981 18,401 (1,420) Outpatients (Review) 40,338 30,036 29,289 747 TOTAL 106,235 79,300 81,339 (2,039)

Cost (£) Annual Plan YTD Plan YTD Actual YTD Under/(Over)

£000 £000 £000 £000 A&E 3,003 2,256 2,344 (88) Elective 6,853 5,138 5,325 (187) Emergency 16,957 12,750 12,717 33 Outpatients (New) 4,195 3,129 3,320 (192) Outpatients (Review) 2,565 1,910 1,875 35 Community 470 350 351 (1) Emergency Blended Payment 0 0 (31) 31 Other 5,340 4,001 4,252 (251) TOTAL 39,383 29,534 30,154 (620) Overall activity is above plan by 2.6% with the largest overperformance in first outpatients (8.4%). The overall financial value of this activity results in a year-to-date overperformance of £620k (2.1%).

CCG View: After adjustments have been applied to the above report we will see an overall reduction of £10k. The emergency blended payment adjustment will be a credit of £29k upon reconciliation. The largest overperformance is in elective, rehabilitation post discharge, and outpatient procedures (review).

Page 7 Page 7 West Midlands Ambulance Service

The West Midlands Ambulance Service contract is over performing year-to-date by 1.04% (cost). Based on activity levels to-date, the contract is expected to overperform by £200k at year-end.

YTD Activity Annual Plan YTD Plan YTD Actual Under/(Over) Activity Activity Activity Activity Incidents 114,845 85,560 86,395 (835) 45-60 min Handover Delays 208 156 161 (5) >60 min Handover Delays 42 31 69 (38)

YTD Cost Annual Plan YTD Plan YTD Actual Under/(Over) £'000 £'000 £'000 £'000 Incidents 19,598 14,600 14,743 (142) 45-60 min Handover Delays 18 13 13 0 >60 min Handover Delays 11 8 17 (9) Sub-Total 19,626 14,622 14,773 (151) M10 CCG Estimate 0 1,764 1,781 (17) Block Element 2,182 1,818 1,818 0 Practice Moves Recharges (673) (561) (561) 0 Total 21,135 17,642 17,811 (169)

Page 8 Prescribing Performance

The prescribing budget for 2019/20 is £83.9m, with annual expenditure forecast to be £83.1m. This forecast is in line with the forecast issued by Prescribing Prescription Authority (PPA). The year-end forecast position for prescribing is currently £0.8k below plan. This forecast is based upon historic trends, month eight year to date actual prescribing data and known changes in future prescribing costs. The graph below shows a comparison of prescribing expenditure over the financial years 2016/17 to 2019/20.

* Above graph is based on information from PPA. Practice moves are only reflected in the year 2017/18 onwards.

Page 9 Primary Care The CCG’s primary care budget for the year is £87.5m, with forecast outturn of £87.6m. This equates to an overspend of £73k. The management plan has been monitored at the CCG’s Primary Care Co-commissioning Committee to ensure that the primary care portfolio operates within its annual budget.

Delegated Resource

Forecast Under/ Annual Plan YTD Plan YTD Actual YTD Under/ (Over) Forecast Outturn (Over) £000 £000 £000 £000 £000 £000 General Practice Contracts 55,032 45,835 46,515 (680) 55,739 (707) Premises Cost Reimbursement 5,981 4,985 4,644 341 5,711 270 Primary Care NHS Property Services Costs - GP 3,679 3,066 2,980 86 3,560 118 Primary Care Commissioning Framework 7,927 6,607 7,547 (940) 7,938 (12) Enhanced Services 833 694 667 28 805 29 QOF 7,305 6,089 5,766 323 6,919 386 Primary Care Network 2,624 2,106 1,823 283 2,373 251 Other GP Services (1,419) (1,184) (1,118) (66) (988) (431) Total Delegated 81,961 68,198 68,824 (626) 82,057 (96) The CCG also has the following plans in relation to the GP resilience programme, primary care transformation and collaborative fees: GP Resilience Programme Forecast Under/ Annual Plan YTD Plan YTD Actual YTD Under/ (Over) Forecast Outturn (Over) £000 £000 £000 £000 £000 £000 Improving Access 3,746 3,073 3,097 (24) 3,746 0 GP Consultation Software 157 0 0 0 157 0 GP Resilience Programme 79 79 79 0 79 0 Primary Care Networks 334 116 116 0 334 0 Total GP Resilience Programme 4,316 3,269 3,292 - 24 4,316 0

Non-Delegated Resource

Forecast Under/ Annual Plan YTD Plan YTD Actual YTD Under/ (Over) Forecast Outturn (Over) £000 £000 £000 £000 £000 £000 Primary Care Transformation 863 719 719 0 863 0 Collaborative Fees 375 312 269 44 352 23 Total Non Delegated 1,238 1,031 988 44 1,215 23 Total Primary Care Investment 87,515 72,499 73,105 (606) 87,588 (73)

Page 10 QIPP Transactional

The CCG has an overall QIPP target of £30.35m, of which £27.2m is recurrent and £3.15m in non recurrent. We are currently reviewing some on the transactional schemes, this may include a re-categorisation between transformational and transactional. Transactional schemes account for £15.05m of the total QIPP programme. The table below details the transactional QIPP schemes:

Annual Year to Date Forecast Outturn Plan Plan Actual Variance Plan Actual Variance £000 £000 000 £000 £000 £000 £000 Transactional Acute services - Coding 286 240 9 (231) 286 11 (275) Acute services - Contract Challenges 1,711 1,430 1,430 0 1,711 1,711 0 Acute services - Non Recurrent Funding Reversal 500 420 0 (420) 500 0 (500) Acute services - Tariff Reclassifications / Realignments 1,877 1,560 1,560 0 1,877 1,877 0 Prescribing - OptimiseRx/other software etc 500 420 662 242 500 794 294 Prescribing - Patent Expiry 2,000 1,670 0 (1,670) 2,000 0 (2,000) Prescribing - Category M adjustments 500 420 0 (420) 500 0 (500) Prescribing - Practice changes - Five Ways/Broadway etc 500 420 0 (420) 500 0 (500) Prescribing - Diabetes - switch to Gliptins 500 420 456 36 500 547 47 Running Costs Reduction 200 170 482 312 200 473 273 Procedures of Limited Clinical Value 167 140 140 0 167 167 0 Biosimilar Savings - Adalimumab 1,495 1,250 1,457 207 1,495 1,748 253 Over the Counter 270 230 226 (4) 270 271 1 Drugs of low clinical value 298 250 202 (48) 298 243 (55) Biosimilar Pipeline Savings 400 330 0 (330) 400 0 (400) Prescribing 850 710 710 0 850 850 0 PHB & CHC Realignment 500 420 445 25 500 534 34 Prescribing OTC QIPP Stretch Target 1,700 1,420 1,420 0 1,700 1,700 0 Waiting List QIPP Stretch Target 800 667 667 0 800 800 0 Total Transactional Schemes 15,054 12,587 9,866 (2,721) 15,054 11,726 (3,328)

Page 11 QIPP Transactional

Prescribing: Prescribing has a QIPP plan of £500k against Prescribing software, this is forecasted to over achieve by £294k. £500k against Diabetes prescribing switch to gliptins this is forecast to over achieve by £47k. The £1.5m against biosimilar savings for Adalimumab has also had a favourable movement and is forecast to over achieve by £253k.

However patent expiry, category M adjustment, practice changes and the biosimilar pipeline savings are all schemes that will not be taking place this financial year. Creating a shortfall of £3.4m, these shortfalls will be mitigated against the anticipated QIPP savings within other transactional prescribing. The reported FOT against Prescribing other is £2.9m, the movement is due to over achievement in the some of prescribing schemes (as above.)

Over the Counter is forecast to breakeven and drugs of low clinical value under perform by £55k.

Running cost reduction: The CCG has a 2019/20 running cost QIPP of £200k. Currently this is forecasted to be overachieved by £273k.

Funding Reversal: The £500k non recurrent funding that was included in SWBH contract in 18/19 was again included in 19/20. Therefore resulting in no achievement of QIPP.

Other gains and benefits: Shortfall from under achieving QIPP schemes are offset against gains/non recurrent benefits in the wider CCG portfolio.

Page 12 QIPP Transformational Transformational schemes account for £14.6m of the total QIPP programme. The table below details the Transformational QIPP schemes:

Annual Year to Date Forecast Outturn Plan Plan Actual Variance Plan Actual Variance £000 £000 000 £000 £000 £000 £000

Transformational

Acute services - Case Mix PIDS 1-7 300 250 250 0 300 300 0 Acute services - Flexi-beds winter pressures funding 1,500 1,250 0 (1,250) 1,500 0 (1,500) Acute services - SEAU Impact - Reduced Emergency Admissions 3,009 2,510 2,510 0 3,009 3,009 0 Demand Management Schemes - Acute 3,925 3,270 2,571 (699) 3,925 3,085 (840) Demand Management Schemes Community 620 520 0 (520) 620 0 (620) Demand Management Schemes - Continuing care 351 290 290 (0) 351 351 0 Demand Management Schemes Mental Health 974 810 1,414 604 974 1,487 513 Demand Management Schemes Other programme 300 250 0 (250) 300 0 (300) Respiratory (COPD & Asthma) - phase 3 (19/20) 200 170 0 (170) 200 0 (200) Diabetes 150 130 130 0 150 150 0 Endocrine (within Diabetes) 49 40 40 0 49 49 0 High Intensity Users (unplanned team A&E) 848 710 0 (710) 848 0 (848) Dermatology 195 160 30 (130) 195 36 (159) Ophthalmology - pathway 150 120 120 0 150 150 0 Ophthalmology - prescribing 46 40 0 (40) 46 0 (46) Circulation - CVD 366 300 300 0 366 366 0 Demand Management - Primary Care: PMS Savings 1,164 970 906 (64) 1,164 1,088 (76) Prescribing - POD 500 420 420 0 500 500 0

Total Transformational Schemes 14,646 12,210 8,981 (3,229) 14,646 10,571 (4,075)

Other QIPP Stretch Target - Non recurrent 650 542 542 0 650 650 0 Other QIPP Stretch Target - Recurrent 0 0 3,562 3,562 0 4,543 4,543 Other Gains and Benefits - prescribing 0 0 2,408 2,408 0 2,860 2,860

Total Other Schemes 650 542 6,512 5,970 650 8,053 7,403

Total QIPP Schemes 30,350 25,338 25,358 20 30,350 30,350 0

Page 13 QIPP Transformational

Respiratory (COPD & Asthma): Due to the delay in the start date of the respiratory scheme there will be no QIPP achievement for this scheme in 2019-20.

High Intensity Users (unplanned team A&E): The HIU programme was anticipated to deliver £848k of QIPP savings. However, due to delays in the start date, there is no QIPP achievement anticipated in 19/20

Acute Services (Flexi Beds Winter Pressure): As the service has not been decommissioned this financial year, the QIPP saving of £1.5m will not be achieved

Demand Management: A 1% demand management deduction has been made across a portfolio of budgets for 2019/20. In order to achieve the planned QIPP, budgets are then required to perform within the financial envelope set.

Dermatology: The £159k forecasted underperformance has resulted from the tele dermatology pilot outcomes as well as the skin cancer follow ups initiative not taking place this year. The £36k set for DMARD monitoring is forecasted to fully achieve its QIPP plan for 19/20.

Page 14 Statement of Financial Position 31 January 2020 £'000 The CCG’s Statement of Financial Position (SOFP) also Non-Current Assets 0 known as the Balance Sheet, provides a snapshot of the Total Non-Current Assets 0 CCG’s financial position on the 31st January 2020. Current Assets Inventory 0 Trade and Other Receivables 1,779 Accrued Income and Prepayments 3,995 The SOFP is made up of two parts which must always VAT 102 Bad Debt Provision (179) balance each other. The top section (total assets) shows Cash and Cash Equivalents 0 the CCG’s assets (what the CCG owns) and liabilities Total Current Assets 5,697

(amounts the CCG owes). The bottom part of the SOFP is Total Assets 5,697 reflecting how the CCG has been financed. Current Liabilities Trade and Other Payables (15,153) Accrued Expenditure and Deferred Income (20,837) Prescribing (14,085) The cash book balance recorded on the SOFP at the end Provisions (10,275) of January 2020 was £49. This represents a £25k Tax and Social Security (248) timing difference to the bank balance shown on the cash Total Current Liabilities (60,598) efficiency report. Non-Current Assets plus/less Net Current Assets/Liabilities (60,598) Non-Current Liabilities Trade and Other Payables 0 Provisions 0 Total Non-Current Liabilities 0

Assets Less liabilities (60,598)

Financed by Taxpayers' Equity General Fund (60,598) Revaluation Reserve 0 Charitable Reserves 0 Total Taxpayers' Equity (60,598)

Page 15 Cash Efficiency Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's Actual Bank Balance 13 15 29 37 45 111 17 13 5 17 Funding from DH 61,204 61,204 60,092 62,500 61,400 61,500 62,500 62,500 61,500 64,000 0 0 Adjustments to main funding 0 0 800 0 2,800 0 0 1,000 0 2,000 0 0 Total cash available 61,217 61,219 60,921 62,537 64,245 61,611 62,517 63,513 61,505 66,017 0 0

Less net payments via Government Banking Service 61,203 61,190 60,884 62,492 64,133 61,594 62,505 63,508 61,488 65,992 0 0 0 0 0 0 0 Total net payments 61,203 61,190 60,884 62,492 64,133 61,594 62,505 63,508 61,488 65,992 0 0

Closing BANK BALANCE 15 29 37 45 111 17 13 5 17 25 0 0 Actual % of closing balance (compared to opening balance plus 0.02% 0.05% 0.06% 0.07% 0.18% 0.03% 0.02% 0.01% 0.03% 0.04% drawdown)

The CCG had a bank balance of £25k at the end of January 2020. This balance has continued to be managed well within the 1.25% threshold of the in month funding ceiling as set by NHS England.

Page 16 Better Payment Practice Code The CCG is required to pay 95% of all valid invoices within 2019-20 (April 2019 to March 2018-19 (April 2018 to March 30 days. 2020) 2019) 31-Jan-20 31-Jan-20 31-Mar-19 31-Mar-19 January 2020: Number £000 Number £000 There were 2,754 invoices were registered with a value Non-NHS Payables: CCG of £67.5m during January 2020. In total, 2,647 invoices Total Non-NHS trade invoices paid in the year 17,167 173,192 19,535 186,626 Total Non-NHS trade invoices paid within target 16,810 168,127 19,191 182,999 (96.1%) were processed within the required 30 days (99% Percentage of CCG Non-NHS Trade Invoices Paid Within Target 97.92% 97.08% 98.24% 98.06% in financial terms). NHS Payables: CCG Total NHS trade invoices paid in the year 3,583 467,158 4,112 516,939 Total NHS trade invoices paid within target 3,547 466,264 3,987 514,212 Percentage of CCG NHS Trade Invoices Paid Within Target 99.00% 99.81% 96.96% 99.47%

In Year Performance: Better payment practice code performance for the period ended January 2020 showed 98% of non NHS invoices were paid within 30 days (97% in terms of financial value paid on time). Performance for NHS invoices for the period ended January 2020 showed that 99% of NHS invoices were paid within 30 days (99.8% in financial value terms).

Overall Performance: The year to date performance is above the required target of 95%.

Page 17 Conclusion & Recommendations

The key points to note from this report are:

- Sandwell & West Birmingham CCG’s overall revenue resource limit is £861.4m.

- The CCG has a planned surplus for the year of £23.9m

- The CCG is currently expecting full achievement of its QIPP target of £30.4m

- The CCG has operated within its running cost allowance of £11.9m.

Recommendation

Members of the Finance & Performance Committee are asked to:

1. Discuss the content of the report

2. Approve the report

Page 18 Appendix One Forecast Outturn Under Annual Budget YTD Budget YTD Actual YTD Under / (Over) Forecast Outturn / (Over) £000 £000 £000 £000 £000 £000 SOURCES OF FUNDING Confirmed Allocations - Commissioning (746,797) (614,926) (614,926) 0 (746,797) 0 Confirmed Allocations - Primary Care Co-Commissioning (81,959) (68,268) (68,268) 0 (81,959) 0 Anticipated Allocations (20,747) (17,289) (17,289) 0 (20,747) 0 Allocations - Running Costs (11,876) (9,954) (9,954) 0 (11,876) 0 Total Revenue Resource Limit (861,379) (710,437) (710,437) 0 (861,379) 0

APPLICATIONS - PROGRAMME Acute Services NHS Acute Services Sandwell & West Birmingham Hospitals NHS Trust 257,159 214,341 214,085 255 257,173 (14) University Hospitals Birmingham NHS Foundation Trust 40,272 33,573 33,115 458 39,909 363 Dudley Group NHS Foundation Trust 38,907 32,444 33,014 (570) 39,603 (696) Walsall Healthcare NHS Trust 9,077 7,596 7,847 (251) 9,374 (298) Heart of England NHS Foundation Trust 0 0 0 0 0 0 Birmingham Women's & Children's Hospital NHS Foundation Trust 15,038 12,566 12,439 127 14,923 114 Royal Orthopaedic Hospital NHS Foundation Trust 5,623 4,692 4,777 (85) 5,726 (104) The Royal Wolverhampton Hospital NHS Trust 2,664 2,226 2,482 (255) 2,962 (298) West Midlands Ambulance Services NHS Foundation Trust 21,841 18,293 18,491 (197) 22,072 (231) Worcestershire Acute Hospitals NHS Trust 399 334 379 (45) 465 (66) University Hospitals of North Midlands NHS Foundation Trust 713 597 321 276 413 300 Shrewsbury & Telford Hospital NHS Trust 160 133 167 (34) 197 (37) Total NHS Acute Services 391,852 326,796 327,118 (322) 392,819 (967) Acute Services Other Non Contracted Activity & Out of Area 5,678 4,309 4,297 12 5,137 541 Individual Funding Requests 18 15 11 4 14 3 Extended Choice Contracts 4,496 3,746 3,933 (186) 4,729 (233) Other Acute Services 1,187 989 1,282 (292) 3,296 (2,108) Total Acute Services Other 11,378 9,060 9,522 (463) 13,176 (1,798) Total Acute Services 403,230 335,856 336,640 (785) 405,995 (2,765) Commissioned Community Services NHS Community Services Sandwell & West Birmingham Hospitals NHS Trust 31,879 26,753 26,835 (82) 32,017 (138) Birmingham Community Healthcare NHS Trust 18,394 15,328 15,787 (458) 18,946 (551) Walsall Healthcare NHS Trust 339 283 283 (0) 339 0 The Royal Wolverhampton Hospital NHS Trust 139 116 161 (45) 192 (53) Dudley Group NHS Foundation Trust 476 396 398 (2) 478 (2) NHS Other 605 504 572 (67) 674 (69) Total NHS Community Services 51,832 43,381 44,034 (654) 52,645 (813) Community Assessment NHS 111 2,143 1,789 2,197 (409) 2,697 (555) Clinical Assessment & Urgent Care Centres 2,186 1,821 1,784 38 2,177 9 Total Community Assessment 4,328 3,610 3,981 (371) 4,874 (546) Continuing Healthcare Continuing Healthcare - Physical Disabilities 13,534 11,214 10,528 686 12,718 815 Continuing Healthcare - Children 270 225 617 (392) 765 (495) Continuing Heathcare - Children's PHB 292 243 137 106 173 119 Continuing Healthcare - Staffing 2,376 1,972 1,761 211 2,153 223 Continuing Healthcare - Joint Funded 4,261 3,596 2,294 1,301 2,746 1,515 Personal Health Budgets 4,853 4,045 3,765 280 4,506 347 Joint Funded Personal Health Budget 2,398 1,973 1,771 203 2,219 179 Funded Nursing Care 7,722 6,435 6,413 22 7,640 82 Looked After Children 428 353 253 100 304 123 Palliative Care 234 0 70 (70) 234 0

Total Continuing Healthcare 36,367 30,055 27,608 2,447 33,459 2,908 Other Community Services Interpreting Services 896 747 733 14 879 16 Safeguarding (Programme) 1,156 985 928 57 1,074 82 Carers 487 406 405 0 486 1 Hospices 198 165 200 (35) 233 (35) Intermediate Care 1,619 1,349 1,320 29 1,580 39 Commissioning Schemes 717 292 343 (51) 884 (166) Patient Transport 1,883 1,569 1,675 (106) 2,040 (157) Non NHS Community Contracts 7,645 6,196 7,045 (849) 8,397 (752) Total Other Community Services 14,601 11,709 12,650 (941) 15,574 (973) Property Costs NHS Property Costs 1,446 857 1,805 (948) 2,555 (1,109) Total Property Costs 1,446 857 1,805 (948) 2,555 (1,109)

Total Community Services 108,575 89,612 90,079 (467) 109,108 (533) Mental Health & Learning Disabilities NHS Trust Contracts Black Country Partnership NHS Foundation Trust 32,464 27,054 27,375 (321) 32,868 (403) Dudley & Walsall Mental Health Partnership NHS Trust 2,351 1,958 2,033 (74) 2,445 (94) Birmingham & Solihull Mental Health Trust 1,202 1,002 941 61 1,141 61 Forward Thinking Birmingham 7,154 5,962 5,744 218 6,916 238 Total NHS Trust Contracts 43,172 35,976 36,092 (116) 43,371 (198) Mental Health Birmingham Joint Commissioning arrangements 23,654 19,712 19,498 214 23,447 207 Assessments 8 6 1 5 2 6 CAMHS 777 420 385 35 736 41 IAPT 2,252 1,732 1,633 99 2,141 110 Mental Health NCA 301 251 289 (38) 405 (103) Mental Health Non NHS 1,541 1,286 1,230 56 1,485 56 Mental Health Placements 11,452 9,339 9,073 267 11,089 363 Mental Health Section 117 5,431 4,526 4,181 345 5,024 407 Total Mental Health 45,417 37,273 36,290 983 44,329 1,088 Learning Disabilities Learning Disability Placements 4,672 3,893 4,021 (128) 4,842 (170) Learning Disability Joint Commissioning 12,068 8,507 8,182 325 10,741 1,327 Learning Disability Section 117 5,234 4,316 4,255 61 5,164 69 Total Learning Disabilities 21,974 16,716 16,458 259 20,748 1,226 Total Mental Health & Learning Disabilities 110,563 89,966 88,840 1,125.53 108,447.99 2,115.11 Winter Pressures Winter Pressure Schemes 1,757 1,020 1,003 17 1,715 42 Total Winter Pressures 1,757 1,020 1,003 17 1,715 42 Primary Care GP Commissioning (Delegated) 81,961 68,198 68,824 (626) 82,057 (96) Local Incentive Schemes 1,515 1,237 1,297 (59) 1,590 (75) Out of Hours 3,065 2,554 3,314 (760) 3,885 (820) GP IT 2,076 1,542 1,866 (324) 2,229 (154) Collaborative Commissioning 375 312 269 44 352 23 Primary Care Non Recurrent 4,439 3,269 3,292 (24) 4,439 (0) Total Primary Care 93,431 77,114 78,863 (1,749) 94,552 (1,122) Prescribing Prescribing Practice Budgets 79,545 67,004 65,824 1,179 79,158 387 Prescribing Other 1,928 1,607 1,579 28 1,890 38 Home Oxygen 1,083 899 905 (6) 1,085 (2) Medicines Management Clinical 1,337 1,114 776 338 961 376 Total Prescribing 83,893 70,624 69,085 1,539 83,094 799 Better Care Fund Better Care Fund 19,858 16,552 16,525 27 19,826 32 Total Better Care Fund 19,858 16,552 16,525 27 19,826 32 Reserves, Contingency & QIPP Reserves, Contingency & QIPP 3,485 0 0 0 3,317 168 Quality Premium 989 0 0 0 0 989 Total Reserves 4,474 0 0 0 3,317 1,157

TOTAL PROGRAMME EXPENDITURE 825,782 680,743 681,035 (292) 826,054 (273)

APPLICATIONS - RUNNING COSTS CCG Running Costs 10,837 9,060 8,769 291 10,588 248 CCG Running Costs - CSU 762 635 626 9 748 14 CCG Running Costs - NHS 111 102 85 73 12 92 11 TOTAL RUNNING COSTS 11,701 9,780 9,468 312 11,428 273

TOTAL EXPENDITURE 837,482 690,523 690,503 20 837,482 (0)

Required Surplus Planned Surplus 23,897 19,914 0 19,914 0 23,897 . Planned Required Surplus 23,897 19,914 0 19,914 0 23,897

Total 861,379 710,437 690,503 19,934 837,482 23,897 Appendix Two December 2019 January 2020 Budgets Movements Comments Budgets £ £ £

Acute 407,199,781 407,529,781 330,000 * Co-Commissioning 81,961,000 81,961,000 0

Community Health Services 62,014,829 62,014,829 0

Continuing Care Services 35,705,384 35,705,384 0 Corporate 11,324,688 11,700,688 376,000 ** Mental Health 109,455,099 110,563,099 1,108,000 *** Other 32,584,966 32,301,966 (283,000) **** Primary Care Services 95,437,451 95,705,451 268,000 ***** Surplus 23,897,000 23,897,000 0 Grand Total 859,580,198 861,379,198 1,799,000

Notes for movements over £250k * WMAS - Global Digitial Exemplar allocation

** 6.3% Pension Uplift £396k, net £20k recoding

*** TCP allocations £726k, Core 24 MH £174k allocation, £208k MH Investments from reserves

**** (£208k) MH Investment, (£75k) TCP allocation transfer, (£41k) Safeguarding budget recoding

***** £123k GPFV allocations, £80k GP IT allocations, £65k budget recoding

Report Topic: Key Indicators Performance Report – data up to January 2020

Report From: James Green – Chief Finance Officer Date 24th February 2020

To provide information to the Board on the performance of the CCG against key indicators for the financial years 2017/18 Aim of Report to 2019/20.

- Referral to Treatment (RTT) - Diagnostics - Accident & Emergency (A&E) Discussion Points - Cancer 62 day waits - CYPMH

Members of the Committee are asked to: RECOMMENDATIONS 1. Discuss the contents of the report 2. Approve the contents of the report Contents

Section Page

Key Messages 3 NHS Constitution Measures 4 Other Measures 12 Legend 14

1 Key Messages

Summary: Our lead roles and responsibilities:

Referral to Treatment (RTT) Sandwell and West Birmingham Clinical Commissioning Group (SWB CCG) is the lead commissioner on; Both the CCG and SWBHT failed the headline measure again in December with failures across most specialties. Except for DGFT, locally all other providers failed to meet the headline measure, as did the national average. Remedial Action Plans (RAPs) are being monitored by NHS 111 across the West Midlands. commissioners. WMAS across the West Midlands Home Oxygen across the West Midlands. Urgent care for the Black Country Diagnostics The CCG failed the target in December due to increased numbers of breaches at DGFT (85), the vast majority were recorded under Colonoscopy, Flexi-sigmoidoscopy and Gastroscopy. A remedial action plan that includes additional capacity and extended hours has been agreed with Dudley CCG with recovery forecast for March 2020. Our significant CCG redesign projects are;

Musculoskeletal services Accident & Emergency (A&E) Eye Care The Trust position against the 4 hour access target for January 2020 was 72.86%, a slight increase in performance from December (72.18%) Cancer with performance particularly improving at City ED in the latter part of the month. ED attendances in January 2020 were 18,447 a decrease Diabetes from the levels seen in December (19,330). There were no 12 hour trolley waits in January. The Emergency Departments are continuing to Neurology focus on their internal KPI’s of triage within 30 mins, patient seen by a doctor within 1 hour, plan to admit or discharge within 2 hours, and Circulation timely discharge or transfer within 4 hours. The directorate has been working on roles and responsibilities for shop floor leadership. The implementation of this should see reduction in 4-5 hour breaches for non-clinical reasons, and improvement in performance out of hours. The Trust are reviewing the AMAA model and early SEAU pathways and are working to schedule OOH arrivals into next day ambulatory care and hot clinics.

Cancer 62 day waits The CCG has failed to meet the headline measure in any month so far this year. Breaches in the main at UHB, with a few others across the patch. UHB have developed a new recovery trajectory and shared with BSoL CCG for review and comment.

CYPMH It is increasingly likely that the CCG will not achieve it's year end target for access. There are still some data capture issues. These are being addressed with providers. Commissioners are reviewing practice, which in turn will improve access and provision for CYP.

2 NHS Constitution Measures

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Incomplete Referral to Treatment pathways 92.04% 92.19% 91.92% 91.75% 91.63% 91.51% 91.55% 91.66% 91.44% 91.35% 91.71% 91.90% 92.27% 92.02% 91.64% 91.41% 91.33% 91.09% 90.44% 89.75% 89.89% CCG Dec-19 89.89% 91.08% A                     

92.50% 92.79% 92.47% 92.20% 92.07% 92.00% 92.02% 92.26% 92.17% 92.60% 92.92% 93.02% 93.17% 92.63% 92.07% 92.03% 92.04% 92.01% 91.58% 90.94% 91.06% SWBHT Dec-19 91.06% 91.93% G                     

93.51% 94.70% 94.45% 94.08% 93.61% 93.14% 93.29% 93.32% 93.22% 93.20% 93.65% 93.54% 93.95% 94.80% 94.67% 94.15% 94.24% 93.63% 93.10% 92.48% 92.03% DGFT Dec-19 92.03% 93.67% G                      E.B.3/ % of incomplete pathways within 18 92% < 92% % 129a weeks 85.91% 88.34% 89.01% 90.01% 89.51% 89.02% 90.01% 90.04% 90.01% 89.60% 90.01% 91.04% 90.72% 91.04% 89.37% 88.83% 87.11% 86.86% 87.43% 86.33% 86.05% WHT Dec-19 86.05% 88.11% R                     

90.60% 90.62% 90.94% 90.94% 90.98% 90.84% 90.89% 90.80% 90.76% 90.05% 89.82% 88.65% 88.08% 87.05% 85.90% 85.07% 84.51% 83.01% 83.34% 83.18% 82.88% RWH Dec-19 82.88% 84.74% R                     

92.22% 92.53% 89.85% 89.45% 88.59% 87.63% 87.78% 87.99% 86.92% 86.76% 86.31% 86.50% 86.42% 86.54% 85.61% 85.21% 84.13% 83.64% 83.18% 82.58% 81.00% UHB Dec-19 81.00% 84.22% R                     

783 835 751 720 710 756 736 639 755 816 765 735 821 920 860 869 943 1025 1058 1060 1238 CCG Dec-19 1238 8794 n/a                      Local Number of >26 weeks Referral to Local Measure to Number measure Treatment Pathways - Incomplete reduce 655 648 608 625 566 619 608 522 623 644 561 528 590 708 723 752 737 797 777 785 930 SWBHT Dec-19 930 6799 n/a                     

89 80 65 59 63 50 35 39 49 47 45 48 48 61 55 67 71 69 75 81 110 CCG Dec-19 110 637 n/a                      Local Number of >40 weeks Referral to Local Measure to Number measure Treatment Pathways - Incomplete reduce 91 92 39 44 38 45 38 30 39 24 30 31 32 34 43 42 70 64 53 57 76 SWBHT Dec-19 76 471 n/a                     

12 10 12 9 5 5 1 0 0 3 0 0 0 5 4 1 1 0 0 0 0 CCG Dec-19 0 11 R                      Number of 52 week Referral to E.B.S.4 0 > 0 Number Treatment Pathways - Incomplete 2 2 2 2 1 3 2 0 1 1 1 0 0 5 6 0 1 0 0 0 0 SWBHT Dec-19 0 12 R                     

Updated RTT - Incomplete - CCG RTT - Incomplete > 52 wks - CCG Incompletes 95% 14 Both the CCG and SWBHT failed to meet the headline measure again in December. The CCG had failures at all local providers and across a number of specialties. 12 90% 10 8 RWT have agreed a RAP. WHT have also submitted a recovery trajectory and as part of the CCG review the Trust has been asked to provide planned activity levels by specialty. DGFT continue 6 85% to achieve the headline measure 4 2 80% 0 SWBHT have shared exception reports for the failing specialties, together with revised improvement trajectories. January is also expected to fail. A third party provider has been contracted to clear their Ophthalmology waiting list but this is still not expected to recovery until July. A business case to put vanguard theatres behind the Birmingham Midland Eye Centre (BMEC) is being considered to address the inpatient backlog. Also the mobilisation of the glaucoma service in April should support this. The Trust ceased to provide dermatology to new adult non-cancer % < 18 wks National Target Number > 52 wks National Target referrals from end of 19 and are using the surplus capacity to reduce the existing waiting list.

We are awaiting sight of a new overall waiting list plan from the Trust, which is currently in discussion at the Executive meeting, and this will confirm that the forecasted waiting list plan will not RTT - Incomplete - SWBH RTT- Incomplete >52 wks - SWBH be achieved.

95% 7 A separate waiting list report is attached. 6

90% 5 4 52 week waits 3 85% 2 There were no over 52 week breaches for the CCG or SWBHT in December. 1 80% 0 The CCG has started a weekly process to track all out of area/independent sector patients waiting above 40 weeks to ensure they do not breach 52 weeks.

>26 week waiters % < 18 wks National Target Number > 52 wks National Target A Standard Operating Plan has been drawn up to outline the principles and operational elements in offering patients' choice of an alternative provider if their current one does not have the capacity to provide their treatment within 26 weeks.

The first phase of the pilot is underway and will focus on one specialty area which has been mutually agreed by all partners as General Surgery (Excluding Vascular & Paediatric). The pilot will run until the end of March when it will be evaluated and any lessons learned can be addressed. It will then be rolled out to other specialties. As an example, in a one week period DGFT offered choice to transfer to SWBHT to 5 patients, two didn't wan to move, two were not clinically appropriate to transfer and one patient transferred.

3 NHS Constitution Measures Cont.….

Diagnostic test waiting times 2.18% 2.06% 1.05% 1.01% 1.18% 1.47% 2.02% 2.46% 2.76% 1.13% 0.48% 0.81% 1.45% 1.98% 0.87% 0.81% 1.87% 1.46% 1.07% 0.88% 1.61% CCG Dec-19 1.61% 1.33% A                      % waiting 6 weeks or more for a E.B.4 1.00% > 1.00% % diagnostic test 2.85% 2.42% 1.04% 1.22% 1.45% 1.73% 3.21% 3.81% 3.87% 1.00% 0.44% 0.72% 1.76% 2.58% 0.95% 0.77% 2.34% 1.46% 1.15% 0.16% 0.73% SWBHT Dec-19 0.73% 1.34% G                     

Updated Diagnostic Test Waiting Times - CCG Diagnostic Test Waiting Times - SWBH 3.0% 4.5% The CCG failed the target in December due to increased numbers of breaches at DGFT (85) which accounted for 55.2% of all the CCG breaches. The vast majority of breaches at DGFT were 4.0% 2.5% 3.5% recorded under Colonoscopy, Flexi-sigmoidoscopy and Gastroscopy which all had performance in the 60% range. A remedial action plan that includes additional capacity and extended hours has 2.0% 3.0% been agreed with Dudley CCG with recovery forecast for March 2020. 2.5% 1.5% 2.0% 1.0% 1.5% The Trust achieved the headline measure in December and this is expected to be sustained. 1.0% 0.5% 0.5% 0.0% 0.0%

Monthly Actual National Target Monthly Actual National Target

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

A & E Waiting Times < 4 hours % of patients who spend 4 hours or less 83.91% 80.10% 81.28% 84.14% 82.70% 83.02% 81.10% 80.69% 75.01% 78.03% 82.25% 85.85% 78.26% 82.67% 81.80% 81.40% 81.57% 73.59% 71.71% 70.85% 72.18% 72.86% E.B.5 95% < 95% % SWBHT Jan-20 72.86% 76.69% R in A & E                      

Total number of patients who have 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 2 2 1 1 0 E.B.S.5 waited over 12 hours in A&E from 0 > 0 Number SWBHT Jan-20 0 6 R                       decision to admit to admission

Updated % < 4hrs in A&E - SWBH The Trust position against the 4 hour access target for January 2020 was 72.86%, a slight increase of 0.68% in performance from December (72.18%) with performance particularly 100% improving at City ED in the latter part of the month. ED attendances in January 2020 were 18,447 a decrease from the levels seen in December (19,330). There were no 12 hour trolley waits in January. The Emergency Departments are continuing to focus on their internal KPI’s of triage within 30 mins, patient seen by a doctor within 1 hour, plan to admit or 95% discharge within 2 hours, and timely discharge or transfer within 4 hours. The directorate has been working on roles and responsibilities for shop floor leadership. The implementation 90% of this should see reduction in 4-5 hour breaches for non-clinical reasons, and improvement in performance out of hours. The Trust are reviewing the AMAA model and early SEAU pathways and are working to schedule OOH arrivals into next day ambulatory care and hot clinics. 85% In January there were 601 days delayed resulting at SWBHT from delayed transfers of care, an increase from the previous 2 months figures. As previously, numbers continue to be 80% predominantly accounted for by Birmingham responsible delays. As per previous months delay reasons continue to be due to housing issues, family choice once a discharge 75% destination is identified or waiting for care homes to assess patients (both residential and nursing). A DTOC peer review is being held covering the Birmingham geography over the next 2 weeks and SWBH NHS Trust and SWB CCG are involved. 70%

Monthly Actual National Target

Mixed Sex Accommodation Breaches 1 0 2 11 0 1 0 1 0 847 177 33 15 8 7 41 11 14 4 3 3 CCG Dec-19 3 106 R                      Number of mixed sex accommodation E.B.S.1 0 > 0 Number (MSA) Breaches 0 0 0 15 0 0 0 0 0 1123 229 40 22 11 9 44 7 16 - - - SWBHT Dec-19 - 109 R                     

Updated MSA Breaches - CCG MSA Breaches - SWBH 900 1200 There were a total of 3 breaches in December, however SWBHT did not submit data again due to data quality issues. The 3 breaches recorded were at DGFT two (out of 11 they had in total), 800 1000 and 1 out of area (Imperial College Healthcare NHS Trust - London). All were due to capacity constraints. At the SWBHT Assurance and Planning meeting (successor CQRM and CRM 700 600 800 arrangement) the trust described the challenge they have in delivering zero breaches as per the guidance in their current configuration, especially within step down from critical care on the 500 Sandwell site. The CCG Chief Officer for Quality commented that the process for clinical sign off via the matrons feels much more robust than previous mechanisms. 600 400 300 400 The anticipated new guidance on MSA breaches has been published which should help to improve the position at the trust particularly in ITU as the guidance expects that critical care patients 200 200 100 are not moved overnight even if they have gone beyond the usual timeframe expectation in ITU. The trust may still be hamstrung by the current estate in ITU which limits the amount of physical 0 0 changes that can be made in advance of MMH.

Monthly Actual National Target Monthly Actual National Target

4 NHS Constitution Measures Cont.….

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Cancer - 2 week wait 93.08% 95.80% 95.56% 97.56% 96.43% 95.67% 96.20% 97.20% 97.24% 95.28% 96.77% 94.81% 94.89% 94.95% 94.80% 94.41% 94.71% 94.63% 91.00% 90.63% 93.84% CCG Dec-19 93.84% 93.68% G                      E.B.6 All cancer two week wait 93% < 93% % 95.48% 96.48% 96.90% 98.07% 97.33% 96.40% 96.98% 97.41% 97.91% 97.21% 97.35% 96.08% 96.85% 96.40% 95.70% 96.13% 96.20% 97.49% 95.84% 96.68% 98.96% SWBHT Dec-19 98.96% 96.66% G                     

95.77% 94.52% 95.56% 95.40% 97.62% 96.77% 97.77% 96.15% 95.41% 93.71% 95.80% 85.86% 91.98% 91.94% 88.76% 93.91% 90.36% 93.75% 93.01% 86.90% 85.71% CCG Dec-19 85.71% 90.53% A                      E.B.7 Two week wait for breast symptoms 93% < 93% % 98.55% 94.56% 96.92% 96.67% 97.58% 97.62% 98.34% 97.71% 98.00% 97.95% 95.74% 89.55% 97.44% 95.28% 95.12% 98.06% 95.83% 98.03% 100.00% 95.72% 98.15% SWBHT Dec-19 98.15% 97.09% G                     

Updated All cancer 2 week waits - CCG

100% 2WW 95% The CCG and Trust both achieved the headline 2WW measure. 90% Monthly Actual 85% National Target The CCG failed the 2WW for Breast in December with 20 patients out of 140 waiting over 2 weeks. 75% were waiting because of capacity issues (15 breaches in total). 8 patients were at DGFT who again failed this target as a total trust in December with performance at 4.69%. Dudley CCG are awaiting a response from the Trust before issuing any contractual action. All local providers 80% failed the target with the exception of SWBHT

75% Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 The CCG and SWBHT (with input from Black Country and West Birmingham STP Cancer colleagues) have revised the breast pain pathway developed in 2016 in conjunction with a Black Country and West Birmingham wide 2 week wait referral form, which gives explicit guidelines for referral. The two week wait form and urology form have now been agreed with their perspective Expert Advisory Groups (Trust lead consultants across the region) in addition to the breast pain pathway. These are now being shared with SCR and Quality and Safety Committee in January then we All Cancer 2 week waits - SWBH will look to roll them out as soon as possible afterwards. 100%

95%

90% Monthly Actual 85% National Target

80%

75% Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

5 NHS Constitution Measures Cont.….

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Cancer - 31 day waits 97.13% 97.50% 96.59% 98.99% 97.08% 98.54% 95.51% 96.63% 95.91% 97.13% 96.99% 96.57% 94.58% 93.33% 96.27% 93.02% 94.25% 98.82% 95.39% 93.51% 95.35% CCG Dec-19 95.35% 94.92% A                      % receiving first definitive treatment E.B.8 96% < 96% % within one month 99.33% 98.46% 97.33% 98.20% 98.54% 97.46% 98.50% 98.61% 96.40% 96.08% 96.64% 98.71% 97.46% 96.24% 96.77% 96.53% 96.95% 95.80% 96.55% 95.12% 99.15% SWBHT Dec-19 99.15% 96.70% G                     

94.44% 100.00% 100.00% 94.12% 88.46% 87.50% 100.00% 96.30% 100.00% 95.83% 100.00% 100.00% 100.00% 90.00% 88.24% 95.24% 90.91% 90.48% 96.15% 87.50% 100.00% CCG Dec-19 100.00% 93.55% A                      31-day standard for subsequent cancer E.B.9 94% < 94% % treatments-surgery 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 95.45% 100.00% 100.00% 95.00% 95.24% 100.00% 94.74% 95.00% 96.15% 95.24% 100.00% 93.55% 100.00% 93.10% SWBHT Dec-19 93.10% 95.96% G                     

100.00% 100.00% 96.43% 100.00% 100.00% 100.00% 100.00% 100.00% 95.00% 100.00% 97.37% 100.00% 100.00% 97.78% 100.00% 97.22% 100.00% 100.00% 100.00% 100.00% 100.00% CCG Dec-19 100.00% 99.20% G                      31-day standard for subsequent cancer E.B.10 98% < 98% % treatments-anti cancer drug 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% SWBHT Dec-19 100.00% 100.00% G                     

100.00% 100.00% 94.64% 90.63% 94.20% 92.19% 98.21% 96.36% 98.25% 98.28% 100.00% 98.04% 100.00% 90.48% 98.15% 98.31% 91.07% 98.33% 94.44% 95.16% 100.00% CCG Dec-19 100.00% 96.17% G 31-day standard for subsequent cancer                      E.B.11 94% < 94% % treatments-radiotherapy SWBHT This service is not provided at SWBHT

Updated Cancer 31 day waits - CCG 100% 31 day waits

95% CCG 90% Monthly Actual The CCG again failed to meet the headline 31DW in December with 95.35%. 6 patients out of 129 waited over 31 days. 5 at UHB and 1 at SWBHT. 4 of the 6 patients were all delayed due to 85% National Target capacity issues with Urological tumours continuing to be a particular issue across all providers.

80% All other 31 day measures were achieved for December. 75% Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 SWBHT Cancer 31 Day Waits - SWBH The Trust achieved the 31 day headline measure in December with only 1 breach recorded. However, the Trust did fail the surgery treatment standard with 2 breaches recorded, the Quarter 100% position was still achieved with 94.59%.

95%

90% Monthly Actual 85% National Target

80%

75% Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

6 NHS Constitution Measures Cont.….

Target Previous Year Current Monitoring Year Data Actual FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Cancer - 62 day waits 83.53% 77.46% 90.22% 82.65% 86.25% 85.45% 84.06% 78.67% 77.91% 81.58% 84.31% 85.87% 75.95% 84.78% 80.00% 78.87% 71.05% 76.25% 71.62% 78.05% 68.12% CCG Dec-19 68.12% 76.31% R                      All cancer two month urgent referral to E.B.12 85% < 85% % first treatment wait 91.55% 79.02% 92.17% 88.10% 86.54% 84.54% 89.05% 85.31% 85.62% 84.35% 84.68% 87.15% 85.82% 90.65% 87.29% 85.61% 84.33% 86.33% 82.68% 90.98% 81.40% SWBHT Dec-19 81.40% 86.16% G                     

50.00% 100.00% 87.50% 93.33% 90.91% 91.67% 94.12% 93.75% 100.00% 88.89% 100.00% 66.67% 100.00% 100.00% 94.44% 94.74% 100.00% 100.00% 80.00% 100.00% 88.89% CCG Dec-19 88.89% 95.83% G 62-day wait for first treatment following                      E.B.13 referral from an NHS cancer screening 90% < 90% % service 94.12% 100.00% 90.00% 91.30% 90.63% 92.86% 97.67% 96.08% 100.00% 91.53% 91.43% 90.00% 100.00% 98.18% 91.67% 94.44% 100.00% 96.88% 93.18% 94.59% 89.74% SWBHT Dec-19 89.74% 95.57% G                     

91.67% 100.00% 100.00% 79.17% 80.36% 83.67% 84.44% 79.37% 86.79% 85.71% 86.54% 89.09% 85.96% 78.18% 85.96% 80.00% 79.63% 76.79% 74.51% 73.81% 81.08% CCG Dec-19 81.08% 79.74% n/a 62-day wait for first treatment for cancer No                      E.B.14 following a consultants decision to Operational % upgrade the patient's priority Standard 90.00% 93.33% 100.00% 87.01% 85.14% 85.14% 85.00% 80.82% 87.10% 87.95% 89.47% 89.01% 89.39% 83.10% 92.86% 84.34% 80.00% 86.36% 76.47% 81.82% 82.26% SWBHT Dec-19 82.26% 83.89% n/a                     

Updated Cancer 62 day waits - CCG 100% 100% 62 day waits

95% 95% CCG 90% 90% The CCG failed to meet the headline measure again in December (22 patients out of 69 waiting over 62 days) and has failed to achieve this target so far this year. Breaches in Monthly Actual Monthly Actual the main at UHB (15), with a few others across the patch. UHB are reporting that they have developed a new recovery trajectory and shared with the CCG for review and 85% National Target 85% National Target comment. Late tertiary referrals into the Trust continue to heavily impact the overall position as well as internal challenges along pathways, especially in Urology. 80% 80% The CCG also failed the other 62 day measure with 1 breach recorded at SWBHT due to the patient not attending. 75% 75% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 SWBHT The Trust failed the headline measure in December with 81.40% having had 12 breaches recorded however they did achieve for the quarter (85.09%). All other local providers Cancer 62 day waits - SWBH 100% also failed to meet the headline measure. Nationally the target was also missed and has been all year.

95% 104 day waits at SWBHT 90% Monthly Actual 85% National Target This data is a month behind the national and refers to October 18. There were 6 patients involved, 3 breaches were apportioned to the Trust. Two were head & neck and four were lung. 80% Head and neck – this was due to a lack of consultant capacity and the knock on effect this had to representation on multi-disciplinary team meetings. 75% Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Lung – for lung patients there has been developments in the lung pathway, taking into account lessons learned previously, but further work is still required.

7 NHS Constitution Measures Cont.….

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Response Times 05:54 06:06 06:17 05:38 05:41 05:54 05:50 05:39 05:27 05:30 05:26 05:33 05:23 05:27 05:30 05:39 05:41 05:49 05:45 05:43 05:33 05:43 <7 mins >7 mins Mean 05:43 05:37 G                       CCG Jan-20 Category 1 09:17 09:40 10:01 09:24 08:43 09:13 09:20 08:38 08:37 08:55 08:19 09:04 08:18 08:36 08:44 09:02 09:09 09:33 09:35 09:17 09:02 08:56 <15 mins >15 mins 90th 08:56 09:05 G                       Life-threatening

Respond to calls in 7 minutes on average, and 06:50 06:51 06:59 06:47 06:40 06:46 06:51 06:53 06:48 06:44 06:46 06:46 06:43 06:44 06:47 06:52 06:44 07:00 07:02 07:06 07:02 06:59 <7 mins >7 mins Mean 06:59 06:55 G respond to 90% of Category 1 calls in 15 minutes.                       WMAS Jan-20 12:04 11:50 12:03 11:42 11:23 11:41 11:48 11:50 11:49 11:34 11:42 11:50 11:38 11:51 11:55 12:00 11:39 12:10 12:13 12:15 12:15 12:03 <15 mins >15 mins 90th 12:03 12:00 G                      

10:34 10:51 11:19 11:34 10:09 10:14 10:22 10:39 10:34 10:25 10:52 10:24 10:50 10:05 10:54 10:51 10:36 11:21 11:59 12:10 12:13 10:36 <18 mins >18 mins Mean 10:36 11:11 G                       CCG Jan-20 Category 2 17:22 18:22 19:19 19:15 17:21 17:29 17:25 17:56 17:53 17:22 17:58 17:18 18:35 16:49 18:56 18:34 17:53 19:22 20:01 21:39 21:24 17:36 <40 mins >40 mins 90th 17:36 19:09 G                       Emergency

Respond to calls in 18 minutes on average, and 11:24 12:00 12:28 12:47 11:43 11:59 12:04 12:47 12:30 12:11 12:32 11:59 12:14 11:50 12:59 12:59 12:36 13:11 13:49 14:31 14:56 12:29 <18 mins >18 mins Mean 12:29 13:13 G respond to 90% of Category 2 calls in 40 minutes                       WMAS Jan-20 20:24 21:30 22:22 23:19 21:17 21:49 21:55 23:29 22:57 22:09 22:49 21:46 22:22 21:31 23:57 23:44 23:06 24:10 25:21 27:06 28:09 22:45 <40 mins >40 mins 90th 22:45 24:20 G                      

Category 3 29:38 38:09 41:50 46:45 32:51 36:03 35:12 42:59 39:57 38:44 43:39 34:59 40:09 37:48 52:38 56:18 45:57 54:36 65:03 72:12 63:14 34:34 <120 mins >120 mins Mean CCG 34:34 51:18 G                       Urgent Jan-20 Respond to 90% of Category 3 calls in 120 minutes 25:37 30:57 34:58 39:21 29:32 32:53 32:56 39:16 36:12 35:15 38:20 32:41 35:07 32:03 44:41 47:26 39:38 47:41 54:03 54:03 61:08 32:47 <120 mins >120 mins Mean WMAS 32:47 45:11 G                      

50:05 53:16 73:49 70:03 55:33 57:26 64:22 58:09 59:07 62:13 78:15 58:52 52:27 53:44 73:58 72:36 69:08 94:23 80:49 72:12 85:30 69:40 Category 4 <180 mins >180 mins Mean CCG 69:40 70:13 G                       Less Urgent Jan-20 39:26 49:07 55:04 57:37 45:47 49:54 51:44 57:46 51:27 51:34 51:06 45:37 48:21 43:58 62:15 72:11 53:03 70:38 75:47 79:40 76:39 48:36 Respond to 90% of Category 4 calls in 180 minutes. <180 mins >180 mins Mean WMAS 48:36 61:37 G                      

Updated

The report shows performance against the new Ambulance Response Programme (ARP). Although the tables above show both CCG and WMAS level data, the Ambulance ARP standards at the moment apply to the Contract (as a whole) not to individual CCGs.

Activity

At CCG level, WMAS responded to 9,655 assigned incidents, 6.59% below planned activity. Contract wide WMAS responded to 98,424 assigned incidents, 4.91% below planned activity.

Finance

At CCG level YTD the contract is 151 assigned incidents over plan which equates to £25.7k. At Contract wide level, YTD the contract is 19,000 assigned incidents over plan which equates to £3.2m approx.

Performance

It is worth noting, across the contract footprint we regularly see natural variation in performance due to surge and system pressures. WMAS will also prioritise Category 1 or 2 cases in real time, for example, an Ambulance responding a Category 4 case may be diverted to a subsequent higher acuity case, where it is clinically appropriate do to so. Due to the low the volume of activity in Category 4 , a small number of the instance described above can have a significant impact on the monthly reported aggregates at a by CCG level.

8 NHS Constitution Measures Cont.….

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Handover Times 281 340 298 260 216 200 221 259 344 295 295 177 232 193 203 208 227 344 356 295 362 289 SWBHT Jan-20 289 2709 R                       E.B.S.7a Handovers of over 30 minutes 0 > 0 Number 5446 6083 5264 6237 5578 6301 6705 6661 8236 9828 7958 5905 6560 5439 6264 6694 5780 6787 7612 9184 12724 9519 WMAS Jan-20 9519 76563 R                      

8 11 11 4 11 6 2 12 14 8 17 8 7 5 5 7 10 37 9 10 13 11 SWBHT Jan-20 11 114 R                       E.B.S.7b Handovers of over 1 hour 0 > 0 Number 606 631 456 689 709 869 949 811 1344 1945 1374 710 1130 680 827 806 578 744 792 1454 2744 1596 WMAS Jan-20 1596 11351 R                      

Ambulance Handover Delays - SWBH Ambulance Handover Delays - WMAS 400 14000 12000 300 10000 8000 200 6000 100 4000 2000 0 0 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

Monthly Actual > 30 mins Monthly Actual > 1 hour National Target Monthly Actual > 30 mins Monthly Actual > 1 hour National Target

Crew Clear Times - Local measure 69 65 105 85 128 98 101 95 104 154 103 97 32 17 10 10 3 9 12 11 7 17 SWBHT Jan-20 17 128 R                       E.B.S.8a Crew clear delays of over 30 minutes 0 > 0 Number 596 467 716 712 970 845 805 776 885 1152 828 808 354 200 151 146 83 111 98 159 136 181 WMAS Jan-20 181 1619 R                      

0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 9 0 0 1 SWBHT Jan-20 1 10 G                       E.B.S.8b Crew clear delays of over 1 hour 0 > 0 Number 4 3 1 5 31 8 45 3 5 13 7 23 8 3 9 2 3 3 40 5 6 3 WMAS Jan-20 3 82 R                      

Ambulance Crew Clear Delays - SWBH Ambulance Crew Clear Delays - WMAS

200 1400 1200 150 1000 800 100 600 400 50 200 0 0 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

Monthly Actual > 30 mins Monthly Actual > 1 hour National Target Monthly Actual > 30 mins Monthly Actual > 1 hour National Target

Updated

Hospital Handovers

SWB CCG saw 5090 (A&E Type 1&2) handovers with 5037 taking place between 0-45 minutes, 38 taking place between 45-60minutes and 15 taking over 60 minutes. Contract wide saw 49,355 (A&E Type 1&2) handovers with 46,883 taking place between 0-45 minutes, 1,146 taking place between 45-60minutes and 1,326 taking over 60 minutes.

Crew Clear

SWB CCG – 3,571 within 15 minutes, 1,135 within 15-30 minutes, 17 within 30-60 minutes and 1 over 60 minutes. Contract wide –36,293 within 15 minutes, 12,142 within 15-30 minutes, 181 within 30-60 minutes and 3 over 60 minutes.

Response Performance

Contract wide, response standards achieved.

9 NHS Constitution Measures Cont.….

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual Cancelled Operations % of cancelled operations not treated Reduce from previous 1.85% 0.00% 0.00% 0.93% 0.00% 0.00% 0.00% E.B.S.2 % SWBHT Q3 19-20 0.00% 0.00% n/a within 28 days year       

Updated Cancelled Operations not treated within 28 days - SWBH 2.00% SWBHT

1.50% All patients cancelled during Q3 were treated within 28 days. 1.00%

0.50%

0.00% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 18/19 18/19 18/19 18/19 19/20 19/20 19/20 19/20

Urgent operations cancelled for a second time Reduce from previous E.B.S.6 operations cancelled for a second time Number SWBHT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Dec-19 0 0 G year

Updated Urgent operations cancelled for second time 2 SWBHT had zero urgent operations cancelled for the second time in December.

1

0 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

Care Programme Approach (CPA) 96.32% 96.98% 97.83% 95.19% 96.00% 95.54% 96.83% CCG Q3 19-20 96.83% 96.11% G        E.B.S.3 Follow-up within 7 days 95% < 95% % 94.47% 98.43% 98.53% 98.03% 98.21% 97.74% 97.96% BCPFT Q3 19-20 97.96% 97.97% G       

Updated Care Programme Approach (CPA) - CCG 100.00% CCG

95.00% The CCG achieved the target in Q3 with 96.83%.

90.00% Monthly Actual BCPFT National Target 85.00% The Trust achieved the target in Q3 with 97.96%.

80.00% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 18-19 18-19 18-19 18-19 19-20 19-20 19-20 19-20

10 Other Measures - Mental Health

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Improving recovery from mental health conditions 3.97% 4.13% 5.24% 6.10% 5.42% 4.98% E.A.3 IAPT - People entering treatment 4.75% < 4.75% % CCG Q2 19-20 4.98% 13.28% G      

60.42% 59.20% 59.35% 59.91% 57.25% 51.82% E.A.S.2 IAPT - Moving to recovery 50% < 50% % CCG Q2 19-20 51.82% 54.04% G      

67.95% 64.44% 65.06% 67.12% 61.80% 56.15% E.A.S.2 IAPT - Moving to recovery 50% < 50% % BCPFT Q2 19-20 56.15% 57.10% G      

Waiting times

The proportion of people that wait 6 95.12% 90.98% 89.64% 87.84% 90.22% 92.58% weeks or less from referral to entering a E.H.1_A1 course of IAPT treatment against the 75% < 75% % CCG Q2 19-20 92.58% 91.47% G number of people who finish a course of       treatment in the reporting period.

The proportion of people that wait 18 99.19% 98.82% 98.41% 98.20% 98.91% 99.68% weeks or less from referral to entering a E.H.2_A2 course of IAPT treatment against the 95% < 95% % CCG Q2 19-20 99.68% 99.32% G number of people who finish a course of       treatment in the reporting period

No new data

Entering Treatment Q2 national data shows achievement of the required monthly target.

There has been an update to the prevalence levels, derived from the recently published 2014 Adult Morbidity Survey. This, coupled with a change in the technical guidance, has resulted in the prevalence for all CCGs to increase, in Sandwell this is by a large margin 54,408 to 84,326.

This impacts the % achievement of the national measures. There has been sufficient push back from NHSE/I on the Long Term Plan submission that it has had to be updated to reflect the new levels. The financial resource is being re-calculated and work is underway with providers to establish the workforce requirement.

Moving to Recovery & Waiting Times Both the recovery and waiting times were achieved in Q2.

As mentioned above, the new CCG targets from the 2014 survey will have a knock on effect to all the IAPT measures.

Dementia Estimated diagnosis rate of people with 62.81% 62.77% 61.94% 61.65% 61.68% 61.80% 61.64% 62.35% 62.34% 62.22% 62.46% 63.52% 63.05% 63.54% 63.69% 63.02% 62.88% 62.49% 62.54% 62.63% 62.47% 62.32% 126a 66.71% <66.71% % CCG Jan-20 62.32% R dementia                      

Updated

A revised trajectory and implementation plan (published in July 2019) includes the following actions : GP clinical systems data cleansing, awareness and education for GPs and their primary care teams, improving access to specialist assessment and diagnosis, increasing opportunities for frontline identification and initial screening across the local health and care system. GPs will be upskilled to diagnose dementia in primary care and the first 2 training sessions have already occurred. Through the Primary Care Commissioning Framework (PCCF) for 2019/20, GPs will be incentivised for good dementia care. Further initiatives are also now being planned including a review of the local MAS pathways, conducting some targeted work with practices who have the lowest coding rates, exploring care home diagnosis and the development of a multi-agency strategy and a review of post-diagnosis support. Also, a joint dementia post with Sandwell MBC has been appointed to and a key element of the role is to implement the CCG dementia strategy and resulting action plan.

Recovery is now expected to be March 2020.

11 Other Measures - Mental Health Cont…..

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Early Intervention in Psychosis (EIP) People with first episode of psychosis 69.23% 50.00% 0.00% 11.11% 57.14% 100.00% 71.43% 100.00% 75.00% null 20.00% 33.33% 28.57% 20.00% 50.00% 50.00% 40.00% 0.00% * * E.H.4/ starting treatment with a NICE- 56% <56% % CCG Sep-19 0.00% R 123b recommended package of care treated                   within 2 weeks of referral

No new data but update to narrative

With effect from October there is no longer a separate provider return for EIP. The Data Collection Board (DCB) has now approved the decommissioning of the collection of Early Intervention in Psychosis waiting times information. Waiting times for EIP are now monitored using data from the Mental Health Services Data Set (MHSD). However, NHS Digital round all their data to the nearest 5 or 10, therefore, because of the small numbers of referrals, so far SWBCCG has had their numbers supressed and this is likely to continue. It is not clear yet whether NHSE/I will monitor the CCG on a 'rolling' 12 month basis, which is what they have done historically for similar measures.

Physical health checks for people with a serious mental illness E.H.13/ Number of people on the GP SMI register 28.70% 31.22% 32.60% 36.24% 33.77% 34.67% 60% <60% % CCG Q3 19-20 34.67% A 123g receiving all six physical health checks      

No new data

This is a fairly new indicator and data is pulled direct from GP systems and submitted to NHS Digital. A measure was included in the PCCF for 18/19 that was similar to this but did not specifying the 'six' physical health checks to be completed and therefore didn't provide the incentive required to meet this target. The 19/20 PCCF has been amended to reflect the national requirement and improvement is expected going forward. Work is also now being undertaken to target underperforming GP practices.

Out of Area Placements Number of inappropriate Out of area E.H.12/ placement (OAP) bed days for adults Quarterly plan to Number STP 1040 1295 1600 1585 2145 2355 Q2 19-20 2355 R 123f requiring non-specialist acute mental reduce health inpatient care

No new data

This measure is based on the Black Country and West Birmingham STP footprint and counts the number of bed days, so can fluctuate significantly from one month to the other.

As part of the Long Term Plan there will be a single Black Country & West Birmingham approach to contracting of beds, with the development of a single 24/7 bed management function across the Black Country. Enhancing the BCPFT Bed Management Team to include embedding a Discharge Co-Ordinator role. There will also be an effective 24/7 community Based Crisis Response.

Other Measures - Children & Young Peoples Mental Health

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Improve access rate to Children and Young People's Mental Health Services (CYPMH)

Percentage of children and young people 17.07% 12.62% 12.62% 15.88% 25.23% 17.66% aged under 18 with a diagnosable mental E.H.9/ health condition who are receiving 34% <34% % CCG Q2 19-20 17.66% A 123d treatment from NHS funded community       services

No new data

Q3 local data is of a similar level and therefore the end of year target is now looking unlikely to be achieved. There are still some data capture issues. These are being addressed with providers. Commissioners are reviewing practice, which in turn will improve access and provision for CYP. Providers are becoming more aware of how the need to meet the target affects how services are commissioned in the future.

CYP Eating Disorders (Routine) The proportion of CYP with ED (routine 91.67% 90.00% 88.89% 100.00% 83.33% 90.00% 100.00% cases) that wait 4 weeks or less from E.H.10 95% <95% % CCG Q3 19-20 100.00% A referral to start of NICE-approved        treatment (rolling 12 months)

CYP Eating Disorders (Urgent)

The proportion of CYP with ED (urgent 100.00% 100.00% 100.00% 100.00% 100.00% 0.00% 0.00% cases) that wait one week or less from E.H.11 95% <95% % CCG Q3 19-20 0.00% G referral to start of NICE-approved        treatment (rolling 12 months)

Updated

In Q3 all 11 routine patients were treated within 4 weeks. There was one urgent patient who was not treated within one week at BCPFT, an exception report has been received and the reason was because the appointment was cancelled at the patients parents request due to childcare/work commitments.

12 Legend

NHSE Six Clinical Priority Areas Basis

CCG Sandwell & West Birmingham CCG SWBHT Sandwell & West Birmingham Hospitals Trust BCPFT Black Country Partnership Foundation Trust WMAS West Midlands Ambulance Service DGFT The Dudley Group NHS Foundation Trust UHB University Hospitals Birmingham NHS Foundation Trust HEFT Heart of England Foundation Trust RWH The Royal Wolverhampton NHS Trust WHT Walsall Healthcare NHS Trust BWC Birmingham Women's & Children's NHS Trust

Statistic DSR Direct Standardised Rate ISR Indirect Standardised Rate

FOT RAG G Green - forecast to achieve target A Amber - some uncertainty but may achieve target R Red - unlikely to achieve target

Directional Arrows  Improvement in data since last data point  Decline in data since last data point  No change in data since last data point or first publication of data

13

GOVERNING BODY Report Title: Primary Care Commissioning Report author and Title: Carla Evans, Head of Committee PUBLIC Session Update – February Primary Care 2020

Date of Governing Body: Contact Details: [email protected] Wednesday 4th March 2020

Agenda No: 8.3 Enclosure no: 6 Sign off from Chief Officers:

Chief Finance Officer: N/A

Chief Officer for Quality: N/A

Chief Officer for Strategic Commissioning: N/A

Chief Officer for Transformation: N/A

Supporting Documents/further Reading: N/A

Previous Decision: N/A

Summary of purpose and scope of the report: To provide an update to the Governing Body of the actions and outcomes from the previous meeting of the Primary Care Commissioning Committee Public session which took place on 6th February 2020. Recommendations: To note the contents of the report and decisions taken by the Primary Care Commissioning Committee.

The Governing Body are requested to: Action Approve Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified X Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only)

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Please state rationale for above decision: Strategic Priorities related to the report: Quality & Safety Finance & Performance Strategic Commissioning and Redesign Organisational Development Primary Care Commissioning X Collaborative Commissioning Implications: Financial Assurance Framework Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated Consultation: Patients Staff Committees Public Partners Sponsored By: (Chief Officer) Sharon Liggins Date Report received for Governing Body 25/02/20

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Public Primary Care Commissioning Update to Governing Body

1.0 INTRODUCTION

1.1 This paper is to update the Governing Body of the actions and outcomes from the previous meeting of the Primary Care Commissioning Committee Public session which took place on 6th February 2020.

1.2 The items presented at the Committee for information included: • Finance Report • Risk and Issues Register Report • Contracting Update • Estates Update • Digital Update • Engagement Update • PCN Contract Network DES Draft Service Specifications • Financial Plan 2020/21 – Early View

1.3 The items presented at the Committee for decision included: • GPFV Update • Development of the PCCF 20/21 • Sub-Contracting of GMS Services at Your Health Partnership (YHP) • Friar Park Surgery Business Case

2.0 DETAIL OF THE REPORT

2.1 Finance Report

2.1.1 As at 31st December 2019 (month 9), the forecast outturn for 2019/20 before the implementation of the management plan is a £96k overspend, with a YTD underspend of £420k.

2.1.2 This was noted to be a considerable movement in position since the last reported update for month 7. The largest movements noted in month 9 were confirmed to relate to further benefits carried forward from 2018/19 and a reduction in forecast of £270k funding against the additional role reimbursements due to delays in recruitment (although further movements were expected to be made against this in the future).

2.1.3 The primary care management plan introduced following the identification of the £1.4m cost pressure against the primary care delegated budget for 2019/20 was noted at month 9 to have been successful in identifying savings to mitigate the overspend. It was confirmed that a number of small risks and flexibilities existed which would be managed during the final three months, should no further unexpected cost pressures arise a breakeven position was forecast to be achieved by the end of the financial year. It was noted that £1,408k cost pressure was caused by a recurrent allocation adjustment to fund GP indemnity fee’s, given a large proportion of the savings for the current financial year were of a non-recurrent nature it was

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confirmed that a recurrent solution would need to be identified to ensure balanced positions in future years.

2.1.4 It was noted that final payments for all standards within the 2018/19 PCCF had now been approved and appeals processes finalised. It was noted that the final outturn for 2018/19 was an actual spend of £6,934k against a planned £7,451k resulting in a variance of £517k. It was noted that for 2019/20, 70% of the £14.50 per head would be paid to practices in quarterly instalments and reconciled at the end of the financial year based on actual performance and payments made accordingly.

2.1.5 It was noted that an overperformance of £91k had been recorded against the £622k Asylum Seekers funding allocation due to a number of invoices relating to premises that had not previously been sent to the CCG.

2.1.6 Committee noted the update.

2.2 Risk and Issues Register Report

2.2.1 The risk register was reviewed by Primary Care Operations Group on 23rd January 2020 and updates against each risk provided to committee.

2.2.2 Committee approved the closure of the following risks:

2.2.3 PC08_19b – If the closedown of Bloomsbury Health Centre by the current partner fails to adequately address all aspects of the business, there is a risk the CCG will be financially liable for costs incurred. This risk has now been fully mitigated given financial accounts to cover any potential outstanding debt in connection with the Bloomsbury Heath Centre closure are in place.

2.2.4 PC10_18c – There will be a growing financial risk to the CCG as long as the caretaking arrangements for Five Ways Health Centre are required to continue. Recommended for closure following the PCCC approval of the dispersal of Five Way Health Centre’s patient list and extension of the caretaking arrangements for the practice until 31st March 2020 to ensure patients have sufficient time to re-register with a practice of their own choice.

2.2.5 PC19_11a – If Primary Care Networks choose to not recruit Social Prescriber Link Workers through the Network DES, then there is a risk we will not achieve the trajectories set out to NHSE and the Personalised Care Demonstrator site. PCN assurance visits have been held and further assurance offered around the network recruitment of Social Prescriber Link Workers, whilst it was noted that at the time of reporting 6 whole time equivalent link workers had been recruited which was ahead of predictions.

2.2.6 It was also noted that the Primary Care Risk Register and process was discussed at the most recent CCG Audit and Governance Committee meeting, where it was agreed that the current process was delivering a good level of information and assurance.

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2.2.7 A query was raised on the impact of the patient registration cap being lifted for the Babylon GP at Hand site as part of risk PC08_19a. It was noted that the current patient registration was 1876 and had remained stable without any concerns having arisen so far. Regular conference calls with relevant partners are in place as a part of monitoring and updates will be shared as and when appropriate.

2.2.8 A suggestion was made in relation to Latent TB screening uptake in primary care and the possible use of different incentives (e.g. vouchers) with some suggested good examples from London.

2.2.9 It was also suggested that there could be some learning from other areas such as in relation to social prescribing (PC12_18c) with an example of an offer for lung cancer patients in the area.

2.2.10 Committee noted and accepted the updates and recommendations for closure of PC08_19b, PC10_18c and PC19_11a.

2.3 GPFV Update

2.3.1 Committee were asked to consider two recommendations around use of GPFV funding to offer an additional two clinical update events (one for GPs and ANPs and another separate event for Practice Nurses outside of the ANPs) and next steps following resubmission of PCN workforce strategies.

2.3.2 It was noted that an evaluation of the previous clinical updates had been included within the report evidencing the positive feedback from clinicians regarding the events that held been held through Red Whale. Following discussion at the GPFV Monitoring Group, they had agreed the recommendation for two additional sessions (possibly in September 2020) using remaining available funds.

2.3.3 A query was raised around whether the topics covered would be in alignment with the CCG’s own local priorities. It was confirmed that the importance of a focus on local priorities had been discussed and would be considered as part of discussions with whichever facilitator is commissioned by the CCG.

2.3.4 The participation of key local partners such as secondary care providers at PLT events was also queried and it was suggested it would be important to maintain this means of engagement as an example between hospital teams, their consultants and primary care. It was confirmed that practice place-based forums for a for both Sandwell and West Birmingham had been set up on a bi-monthly basis with a view to maintaining this important kind of engagement highlighted.

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2.3.5 Decision: Committee approved the recommendation for funds to be utilised to hold the two additional clinical update events.

2.3.6 In relation to the PCN Workforce Strategies it was noted that following committee’s review of the initially submitted workforce strategies in July 2019, it was agreed that 13 of the 14 submissions would be given an extended period for some further detail to be added based upon constructive feedback with a return date of 31st December 2019. It was noted that the panel who reviewed the original submissions was reconvened on 24th January (with the exclusion of the training hub coordination who was now in a seconded position outside of the CCG) utilising the same evaluation system and providing an overall score between 0 (major reservations) and 5 (excellent).

2.3.7 A recommendation for committee’s consideration was outlined:

• Those resubmissions scoring 3.0 (5 of the 13 strategies) or more to be approved.

• Those scoring between 2.5 and 2.9 (7 if the 13 strategies) to go back to relevant PCNs requesting changes / improvements identified by the panel are implemented and resubmitted within 2 weeks for final review and scoring.

• Those scoring less than 2.5 (1 of the 13 strategies) to be returned to relevant PCNs requesting that changes / improvements be implemented and resubmitted within 2 weeks for a final review and scoring by the panel.

2.3.8 Following further resubmissions and further review, where strategies failed to reach a score of 3.0 it was proposed that the original funding would be clawed back by a suggested formula – funding x (overall score/3), this was noted to represent the equivalent of a 20% clawback of funding from the currently lowest scoring submission.

2.3.9 The nature of the reservations which had been identified for those 8 strategies which it was proposed to return to PCNs for further adjustment was queried. It was confirmed that improvements had been noted in their submissions and many of the issues flagged were suggested to be relatively minor rather than representing a lack of understanding of the requirements. It was also noted that no other significant concerns had been identified for the PCN who scored lowest.

2.3.10 Decision: Committee approved the recommendations in relation to the workforce strategy resubmissions.

2.3.11 A query was raised around the future of the training hubs given the tight timeframe prior to the current SLA ending on 31st March 2020. It was confirmed that the Black Country and West Birmingham STP team were continuing to liaise with appropriate colleagues at Health Education England around the proposed model, whilst further updates were expected soon it Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Meeting Enc - Page 6

was suggested there was a possibility that the current SLA would be extended to allow sufficient time to introduce the new model.

2.3.12 Following further discussion it was agreed that a paper detailing the work and projects undertaken by the training hub since its inception would be shared with committee at March’s meeting.

2.4 Contracting Update

2.4.1 The sad passing of Dr Jhanjee was noted by committee. Dr Jhanjee had been a long serving GP in Sandwell at Lodge Road Surgery.

2.4.2 It was acknowledged that following the conclusion of the original informal PCCF Appeals process in August 2019 that one practice had remained dissatisfied and exercised their right to progress their appeal onto stage 1 of the appropriate Primary Medical Services Disputes Policy. The panel convened on 12th December and following review of all of the available correspondence the panel agreed on balance that the requirements of the particular standards of the PCCF were not explicitly clear and therefore upheld the appeal for a payment totalling the sum of £589 to be made to the practice.

2.4.3 PCCF annual validation visits for 2019/20 had been scheduled between 28th January 2020 and 17th February 2020, these visits would be held with 25% of the practices signed up to the framework and would be selected as per the previously agreed process and criteria.

2.4.4 It was confirmed that he current providers of the Birmingham and Solihull Special Allocation Scheme (Zero Tolerance) had given notice to end the contract. It was noted that the notice period was 3 months meaning originally the contract would have expired from the end on 30th March 2020 but the practice had agreed to extend this notice period until 30th June 2020 allowing additional time to find a suitable replacement. Discussions were currently underway with Birmingham & Solihull CCG along with other potential providers to ensure the safe continuity of the service, a further update would be provided at the next meeting in March.

2.4.5 Committee noted the update.

2.5 Estates Update

2.5.1 Carters Green - Construction progresses well on site. The Trust are awaiting final approval of their ETTF business case submitted in January that will enable the allocated £2.2m transfer to be completed before end of financial year. The project is on target for occupation February 2021.

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2.5.2 St Pauls - The Practice continues to work through a complex land purchase with SMBC. One outstanding issue around the site development agreement has caused further delay but both parties are hopeful of resolution during February. If this is achieved the completed building should be delivered mid 2021.

2.5.3 Stoney Lane - Works have begun on site for an extension to the practice with a phased approach involving the practice exiting the current premises for a period of 6-8 weeks once the shell is complete (utilising space at other practice sites during this time) for a refurbishment of their existing premises. It is anticipated that work will conclude around April / May 2020.

2.5.4 Newtown Medical Centre - Site works have commenced and are progressing well.

2.5.5 Great Barr Group Practice - Site works continue to progress. Topping out took place on 17 Jan. The project should be available for full occupation mid-2020.

2.5.6 Medical Centre - Following a short pause during Modality’s restructure the project team have now declared that the previously approved financial model has a problem created by increased construction costs and increased DV valuations during the delay period. The Practice have requested permission to amend the business case and seek revised approval. As several of the original building size assumptions have slightly changed since the business case was approved the estates team feel that a slight reduction of GMS floorspace may be necessary to mitigate increased costs in the resubmission. The estates team continue to work with the Practice to try to deliver an appropriate revised proposal to PCCC as soon as possible.

2.5.7 Hawes Lane - The estates team are continuing to work with SMBC on options for the Practice but all potentials at present rely on successful financial close at Wednesbury and therefore have significant lead in times. The existing leased accommodation raises a number of concerns around capacity, security of tenure and unfulfilled landlord repairing obligations. The Practice are being forced to carryout building fabric repairs at their own costs to maintain functionality. A new replacement building for this site would be in line with strategy expectation

2.5.8 Committee noted the report.

2.6 Digital Update

2.6.1 Waiting Room Self Service Kiosks - It was acknowledged that the development of the ‘task alerts’ for results which were identified as abnormal or requiring immediate follow up had been completed for both SystmOne and EMIS Web clinical systems. A paper recommending that the kiosks are returned to operation has been submitted to the Quality & Safety

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Committee with a view that practices will receive the new updates to their systems on the 11th and 12th February.

2.6.2 The Midlands & Lancashire CSU have also been commissioned to support the CCG to carry out a full evaluation of the kiosks, this evaluation period was expected to begin in April 2020 with a view to having a final report completed by the end of June 2020.

2.6.3 Following a request made at a previous Committee, it was confirmed that an application for additional funding for waiting room screens had been successful. Communications to practices were currently being prepared with further details whilst it was noted that funding covered the capital costs and not license fees, further details would be provided in the future.

2.6.4 The content and management of the relevance of the messages was queried. It was confirmed that stock health promotion messages were available through the screens which were updated regularly, it was also noted that the CCG would have some monitoring and management capabilities centrally if required.

2.6.5 The importance of the appropriate positioning of screens for maximum effect and benefit to patients was discussed and it was suggested that patients could help advise around this (such as Patient Advisory Group engagement).

2.6.6 Committee noted the update.

2.7 Engagement Update

2.7.1 Key highlights from the engagement update included:

2.7.2 Listening Exercise our proposals on the future of walk in centres – It was confirmed the listening exercise on the future of Walk-in Centres was launched on the 6th January and concludes on the 14th February.

2.7.3 Digital Strategy Listening Exercise – It was noted that we have launched a listening exercise on the development of a digital strategy for Sandwell and West Birmingham. One of our biggest challenges is that many of our population have little or no basic digital skills so we need to work with partners such as the local authorities on solutions to this.

2.7.4 It was suggested that formulation of a digital engagement strategy would be necessary given the level of information and number of digital tools now available to patients. It was suggested that there could be benefit in engaging with banks in the local area given there had been several schemes run around building confidence and knowledge in using computers and the internet. It was also suggested that libraries across the patch could also be contacted to see what they currently offer.

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2.7.5 What matters to young people most - As part of our roadshow we recently asked young people aged 16 – 25 years old “What Matters to You” regarding their physical and mental health and wellbeing. We listened to the views of 197 young people across five venues. Young people reported their main issues with the NHS was getting a timely appointment or referral and waiting times to be seen. Several young people meditate, exercise and socialise for the good of their mental health and generally they value the NHS and the staff who help them.

2.7.6 Committee noted the update.

2.8 PCN Contract Network DES Draft Service Specifications

2.8.1 A summary of the recent content of the draft PCN contract Network DES Service Specifications and its consultation process which ran from between 23rd December 2019 to midday 15th January 2020 was shared with committee.

2.8.2 It was noted that the report provided some further detailed summary of the content of the draft specifications along with BMA guidance. It was also noted that the specifications included system wide benefits and a requirement of involvement with other professionals particularly those within the community (with the specification consultation timing coinciding with standard contract proposed changes).

2.8.3 It was noted that both nationally and locally there had been concerns raised around the content of the draft specifications and whilst there had been some speculation that there could be significant changes no formal confirmation or response to the consultation had been provided by NHS England. NHS England had confirmed that the final service specifications will be agreed as part of the overall contract negotiation process and a further update would be provided to committee when details of the final agreed contract have been published.

2.8.4 Committee noted the update.

2.9 Development of PCCF 2020/21

2.9.1 A summary of the feedback received from the first stage of consultation and the proposed revisions / additions contained within version 2 of the PCCF document for 2020/21 were presented to Committee prior to a further period of consultation for 2 weeks before final approval at March’s committee.

2.9.2 It was noted that whilst it was previously thought that final approval of the PCCF document for 2020/21 would be delayed to April in order to ensure that there was no duplication with the expected Network DES specifications, following release of the draft specifications and

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assessment of guidance from NHS England and NHS Improvement this was no longer felt to be necessary given the confirmation that there was no direct overlap between the newly proposed services forming the PCN DES.

2.9.3 It was also noted that the funding associated with the PCCF for 2020/21 would remain the same as PCCF 2019/20.

2.9.4 Concern was raised in relation to standard 2 DMARDS and the proposed reduction of the 100% blood monitoring target to 95% given the potential serious consequences for patients on those medications. During discussions there was acknowledgement of the importance of all patients receiving appropriate monitoring but also the issues with an absolute 100% target.

2.9.5 Effective Shared Care Agreements (ESCAs) were also discussed. It was noted that discussions had been ongoing with secondary care partners and that practices should be able to request agreements for those patients on their registers who have not yet received one.

2.9.6 It was also queried if additional consideration was necessary in relation to the lung cancer pathway and the national 28-day target and whether detail around air quality should be included within the respiratory standard.

2.9.7 Decision: Committee approved the second draft of the 2020/21 PCCF document to go back out to members for consultation for a period of two weeks, feedback from committee members would be considered as part of this consultation period.

2.10 Sub-Contracting of GMS Services at Your Health Partnership (YHP)

2.10.1 An application received from Your Health Partnership (M88004 – Regis Medical Centre, Darby Street, Rowley Regis, B65 0BA) seeking approval to sub-contract the service delivery of their GMS Contract to Sandwell and West Birmingham Hospitals NHS Trust (SWBHT) on 1st April 2020 was discussed.

2.10.2 It was noted that as part of the sub-contracting arrangements proposed in the application that staff would remain at their current sites and there would be no change to service delivery. It was also noted that the proposal stated that patients would not experience any change in the service received, with the same locations and staff.

2.10.3 Staff excluding contract partners would be employed by SWBHT and therefore would be subject to Transfer of Undertakings (Protection of Employment) Regulations. Contract partners would continue to hold the GMS contract as a partnership and would remain self- employed.

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2.10.4 No financial implications had been identified as part of the application review given the current contractual arrangements were in place to pay for GMS services. An Equality Impact Assessment had also been conducted and had not identified any negative impact to staff or patients.

2.10.5 The CCG had sought legal advice in relation to the application which had recommended that the CCG request further clarity from the applicant in some key areas (e.g. which specific services will be sub-contracted, handling of premises, consequences of termination of arrangements and handling of disputes between the parties).

2.10.6 Committee were asked to consider the recommendation to seek the further information from the applicant as suggested within the legal advice prior to a final decision being made. Should this recommendation be approved, it was hoped that additional information could be bought back for committees review at March’s meeting.

2.10.7 Following query, it was noted that there were examples of such arrangements across the country and notably in neighbouring Wolverhampton with much learning available from a variety of models available.

2.10.8 Suggested areas of consideration in terms of messaging to patients and their perceptions in the event of the application being approved were highlighted. It was also queried if the greater collaboration between the two parties could represent an increased inequality for other practices (such as less availability of consultant lead clinics for other practices).

2.10.9 It was noted that as previously approved by committee that the trust currently held two primary care contracts.

2.10.10 It was queried if there was any additional information outlining how the arrangement could positively impact access for patients, it was noted that no specific information had been shared around this, but it could be sought.

2.10.11 It was noted that the practice had made their patient participation leads aware of the proposal but had not notified or engaged with their wider patient population prior to a decision being made.

2.10.12 Decision: Committee approved the recommendation to seek additional supporting information around the application in alignment with the legal advice which had been given to the CCG.

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2.11 Friar Park Surgery Business Case

2.11.1 A summary of the business case for Friar Park Surgery, a relocation of the existing 156a Crankhall Lane Medical Centre to a nearby site already owned by the practice and for the redevelopment of the site which was previously a health facility was provided to committee.

2.11.2 It was noted that a consultation had previously been undertaken around the proposed relocation which had been agreed. It was noted that committee were being asked to review the case and the recommendation to approve the associated uplift in rent reimbursement (equating to an estimated additional £31,710 annual revenue cost). It was noted that the Estates Strategy value for money indicator had been applied based upon all current information and subject to post development Distract Valuer assessment, this indicator gave an estate cost per patient head of just under £14 which was slightly under the target banding of £15 to £20 representing good value for money.

2.11.3 It was confirmed that although this particular scheme was not highlighted within the original estates strategy plan, it was felt on balance that given the circumstances and assurances of the schemes readiness, value for money, benefit to the patient population and anticipated growth in demand that it would be correct to support the development.

2.11.4 Supporting information had been offered in relation to current scheme spend, additional funding of £122k had been verbally confirmed by NHS England. Should this additional funding not be shared from NHSE an overspend was forecast but it was noted that the current total committed funding would remain significantly within the total estimated commitment detailed within the Estates Strategy.

2.11.5 Decision: Committee approved the business case and the associated uplift in rent reimbursement.

2.12 Financial Plan 2020/21 – Early View

2.12.1 An early view of the financial plan for 2020/21 was shared with committee. Based on current understanding of allocations of £89.8m and planned applications of £91.3m there was an identified variance of £1.5m.

2.12.2 In light of the anticipated challenges it was acknowledged that a set of next steps had been proposed to conduct a refinement of budgets upon receipt of final guidance from NHSE&I, development of a management plan within the Primary Care Operations Group and to update PCCC accordingly at March’s meeting.

2.12.3 A query was raised around whether the planned contingency amount within the drafted plan (£426k) would be adequate given some of the recent examples of unforeseen costs the CCG had incurred such as caretaking arrangements. It was acknowledged that this had been

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considered as a part of initial planning and would likely be subject to further discussions within the Primary Care Operations Group should there be any potential risks. It was also noted that as part of the new management structure that there would be a single director of primary care across the Black Country and an increased level of collaboration which could act as a mitigating factor in any emergency situations.

2.12.4 Committee noted the contents of the report and the associated risks pending inclusion of feedback and concerns raised in relation to available contingency.

3. RECOMMENDATIONS

3.1 Members of the Governing Body are asked:

To note the contents of the report and the decisions made by the Primary Care Commissioning Committee.

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GOVERNING BODY Report Title: Report Author and Title: Audit and Governance Committee Report Jodi Woodhouse Acting Head of Corporate Governance

Date of Governing Body: 4th March 2020 Contact Details: Agenda No: 8.4 [email protected] Enclosure No: 7

Sign off from Chief Officers:

Chief Finance Officer: Yes

Chief Officer for Quality:

Chief Officer for SCR:

Chief Officer for Transformation:

Supporting Documents/further Reading:

Appendix 1 – Closure recommended risks

Previous Decision

Summary of purpose and scope of the report:

The aim of the report is to provide the Governing Body of the issues discussed at the Audit and Governance Committee held in January 2020

Recommendations:

• Note the report from the Audit and Governance Committee for assurance • Review and agree the recommendation to close the risk detailed in Appendix 1

The Governing Body/Committee are requested to: Action Approve X Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified X Conflict noted, conflicted party can participate in clinical discussion but not decision

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Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:

Strategic Priorities related to the report: Quality & Safety x Finance & Performance x Strategic Commissioning and Redesign x Organisational Development x Primary Care Co-Commissioning x Collaborative Commissioning x Implications: Financial State any financial implications for the CCG Assurance Framework The Audit and Governance Committee have delegated responsibility to review the Assurance Framework and provide assurance to the Governing Body

Risks and Legal Obligations The Audit and Governance Committee Review the corporate risk register on behalf of the Governing Body.

Equality and Diversity Statutory and External Influences

Further implications not stated

Consultation: X

Patients

Staff

Committees

Public

Partners Sponsored By: (Chief Officer or Committee Julie Jasper, Lay Member and Audit Chair Chair) Date Report received for Governing Body 27th February 2020

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SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP

Report to the Governing Body

Subject: Audit and Governance Committee

Date: Thursday 23rd January 2020

Author: Jodi Woodhouse, Governance Manager

Remit of Committee

The Audit and Governance Committee is a committee of the SWBCCG Governing Body. The Committee will inform the Governing Body of its deliberations formally by means of a report to the Governing Body meeting after the Committee has met, and informally by other means of communication.

The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the organisation's activities (both clinical and non-clinical), that supports the achievement of the organisation's objectives.

Progress last Month

The committee discussed :

• Internal Audit • Progress & Recommendation Tacking Report • Financial Systems Report • QIPP Arrangements Report • Serious Incidents Follow-up Report • Conflicts of Interest Management • Integrated Urgent Care Team Governance Arrangements

• External Audit • External Audit Report

• Governance • Update on Board Assurance Review

• Counter Fraud - Counter Fraud Progress Report - Fraud Champions Network

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• Risk Registers • A&G risk • Closure requested risks • PCCC risk Register for review and Assurance

Internal Audit

• Progress & Recommendation Tracking Report The year-to-date cumulative internal audit opinion remains at significant assurance. Since the last meeting five audit reports have been finalised and are detailed further below. Work is currently on track to deliver against the agreed internal audit plan. Since the last report the percentage of recommendations that remain open has reduced from 40%to 30%. However, there are currently 20 recommendations over 6months due.

• Financial Systems Report The Internal Audit for Financial Systems was given Significant Assurance with full assurance in 9 of the 10 areas audited. The audit confirmed that the CCG has sound financial systems in place, however waivers are not always authorized in line with the Standing Financial Instructions. One recommendation was made in relation to the waivers and this has been actioned.

• QIPP Arrangements Report The internal audit for QIPP arrangements was awarded significant assurance. The findings of the audit have been discussed with the Head of Financial Planning and Strategy and the Deputy Chief Officer, Strategic Commissioning and Redesign. Actions to resolve control weaknesses have been agreed where necessary and will be monitored for implementation on the recommendation tracker.

• Serious Incidents Follow-up Report The internal audit for Serious Incidents in 2018/19 was awarded moderate assurance and therefore by default a follow up review has taken place during 2019/20. Progress has been made to implement the recommendations raised in the 2018/19 Serious Incidents report with 11 of the 14 actions having been implemented. The Quality Team developed an action plan and this audit has found evidence to support that the issues raised have now been addressed.

• Conflicts of Interest Management Report The internal audit for Conflicts of Interest Management has been awarded significant assurance, with full assurance in 2 out of the 5 areas audited. Three recommendations have been made and actions agreed to resolve control weaknesses.

• Integrated Urgent Care Team Governance Arrangements Report The internal audit on Integrated Urgent Care Team Governance has been awarded significant assurance for Lead Commissioner Governance Arrangements and Moderate Assurance for Alliance Lead Governance Arrangements. The findings of this audit have been discussed with the Deputy Chief Officer for Integrated Urgent and Emergency Care West Midlands. Actions to resolve control weaknesses have been agreed where necessary.

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External Audit

• External Audit Plan 19/20 Audit planning has commenced, and risk areas identified have been included in the plan for focus. The risk assessment within the plan draws upon historic knowledge of the business, the industry and the wider economic environment in which the CCG operates.

Counter Fraud

• Counter Fraud Progress Report Progress has continued against the plan with both pro-active work and investigations. The National Fraud Initiative continues with matches being reviewed as required. There are currently no NFI issues that needed o be brough to the attention of the committee. Two enquiries from last financial year are continuing, and two issues have been reported this financial year for investigation.

• Fraud Champions The NHS Counter Fraud Authority has written to the CCG for support in the introduction of Fraud Champions across the NHS. The CCG are asked to Nominate a Fraud Champion to join a network with their champion role to support and promote the fight against fraud at a strategic level and with other colleagues within their own organisation. The audit committee agreed that rather than having one champion across the CCG it would be beneficial to have a number of champions placed within different areas. Nominations will be made by the end of February 2020. Governance

• Update on Board Assurance Review. The Board Assurance Framework review by the Governing Body is now complete and the risks that were identified as part of the review are now included on the Board Assurance Framework. This piece of work satisfies recommendations made by Internal Audit during 2018/19.

Risk Registers

• Audit and Governance Risk Register The committee reviewed and updated the risk register.

• Closure Requested Risks The Committee reviewed the one risk that had been requested for closure. The committee Recommended closure of the risk detailed in the appended report that is subject to approval from the Governing Body.

• Primary Care Commissioning Committee Risk Register The committee received assurances from the Head of Primary Care on the Identification and Management of risk by the Primary Care Commissioning (PCC) Committee. The audit and governance committee were assured that the processes followed by the PCC committee are robust and in line with CCG policies.

Sandwell & West Birmingham CCG Page 5 of 6 Audit & Governance Committee Report

Items for Governing Body and Staff

• Overall Significant assurance for head of internal audit opinion • Fraud Champions Network • Open Audit Recommendations

Sandwell & West Birmingham CCG Page 6 of 6 Audit & Governance Committee Report Governing Body - Closure Approved by Audit and Governance

27 February 2020 Page 1 of 2 SC19_11b Description early exit of the provider of NHS 111 (Care UK), the CCG holds a risk in identifying and mobilising a new service provider in the time provided, potentially resulting in major service disruption.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 4 16 S5 - Integrated Urgent and Emergency Care Opened Current Probability Current Impact Current Risk Grading Committee 1 1 1 SCR - Angela Poulton Reviewed Controls Actions and Updates 12/12/2019 Significant IU&EC Team staffing time, legal advice and resources have gone in to securing an Risk identified during Governing Body review of Board Assurance Framework and risks against Strategic Aims. SCR alternative provider for the service. Regular updates including options appraisals and impact committee ownership identfied. statements delivered to S&WB CCG Governing body throughout the process. Underpinning 15th May 19 – Meeting called by Care UK following their Board decision to not seek an extension to the current the GB is a weekly Transition Board and Clinical Governance Group contract. Care UK preference is for an alternative provider to be found and mutually agree and early exit. 2 Caveats - All service transition had proved successful and achieved good performance over the first few staff must be TUPE’d and New Provider to take on Nav Point. Initial Risk Level months. 28th May – Care UK confirmed full commitment to delivery until July 2020 & would yield up the contract earlier providing Navigation Point would transfer to a new provider. 31st May –Confidential talks with WMAS CEO take place for them to be the step-in provider. 28th June – Agreement reached on transfer of111/IU to WMAS Current Risk Level Rating Tracker 1st July – Care UK meeting confirmed they would not challenge any interim / step in arrangement from Nov 19. 9th August Letter to Care UK to confirm CCG has secured the early transfer of the service to WMAS on the 5th C - Very Low (1-3) November. 18th September – Weekly Transition Board established to plan mobilisation of new service and decommissioning of Care Status UK. Weekly Transition plan highlight teleconference also established. Open - On BAF 5th November – WMAS step-in as service provider for West Midlands NHS 111/CAS. 1st – 7th November - - Daily WM Alliance 111/CAS put in place. Closure Requested Gaps in Controls 5th November - Full service offer transitioned from Care UK to WMAS. All contracts signed for this arrangement to No Gaps in Controls identified. continue in place to 31st March 2020 Closure Reason 6th January 2020 - Recommended that risk is now closed. 8/01/2019 - It was reported at the meeting of the Governing Body that the service performed extremely well during the Mitigated christmas period. Ambulance Response times were within the monthly aggregated national standards for the entire period. Front end 111 performance was above the national average and progress continues to be made in reducing the Closure Approved Internal Assurances volume of activity that is directed from 111 to 999 or ED. Transition of the service to the new provider has proved Monthly updates to GB from SRO Rachael Ellis. sucessful and therefore risk is mitigated. Reduced to 1 Closure Requested. Closure Approved Date Updates also issued on a frequent basis to West Midlands Alliance member CCGs and STP leads 23/01/2019 - risk reviewed at Audit committee for closure. Closure recommended to Governing Body.

23/01/2020 Closure Rules External Assurances Approval Required Very strong engagement in weekly Transition Board from all parties. Board underpinned with from GB weekly teleconference calls with all workstream leads throughout September and October 2019 Responsibility NHS Midlands lead sits on weekly Transition Board Rachael Ellis Gaps in Assurances ID 26/10/19 - None Identified 360

27 February 2020 Page 2 of 2

GOVERNING BODY Report Title: Strategic Commissioning & Report author and Title: Dr Manir Aslam & Redesign (SCR) Committee Update to Angela Poulton (DCO-Strategic Commissioning) Governing Body

Date of Governing Body: Contact Details: Wednesday 4th March 2020 [email protected] Agenda No: 8.5 0121 612 3471 Enclosure no: 8 Sign off from Chief Officers:

Chief Finance Officer:

Chief Officer for Quality:

Chief Officer for Strategic Commissioning: Sharon Liggins

Chief Officer for Transformation:

Supporting Documents/further Reading:

Previous Decisions: Extension of Integrated Medical Holdings Limited Ear, Nose and Throat service to 31st March 2020 – SCR February 2019

Neurodevelopmental pathway for Birmingham and Solihull – commitment given by SWB CCG to ensuring best outcomes for children and young people (CYP) but request for recurrent investment not approved owing to concerns regarding the pathway specification and lack of assurance regarding the key changes, benefits and outcomes that would be achieved through implementation of the proposed pathway – SCR September 2019

Approval of the Eye Care Business Case – SCR August 2018

Approval to commission a glaucoma enhanced case finding service for one year via direct award – SCR December 2019

Approval of joint procurement of Tier 2 emotional wellbeing services for specific targeted children and young people, led by Sandwell Council, to allow 12 months for the wider service model review and the associated CCG funding – SCR November 2019

Approval to proceed to procurement of the non-obstetric ultrasound service following notice being served by current provider – SCR July 2019

Two-year extension to the Birmingham Community Healthcare NHS Trust contract to provide the Community Lymphoedema service subject to conditions – SCR October 2019

Approval of Dermatology Business case, with SWBHT as the prime provider – SCR September 2018

Approval of the recommendation to develop the integrated dermatology service model with YHP Primary Care Network (PCN) – SCR September 2019 1

Approval to recruit 2 interim Learning Disability nurses to support GPs to increase the number of health checks for people with Learning Disabilities – SCR November 2019

Summary of purpose and scope of the report: This report to Governing Body updates on the business of the Strategic Commissioning & Redesign Committee meetings held on 16th January and 13th February 2020.

Recommendations: Governing Body members to note the contents of the report, decisions taken and approve the recommendations made by SCR.

The Governing Body are requested to: Action Approve X Assurance X Decision X Conflicts of Interests: The recommended action by the author of the report is: No conflict identified Item 4.8 Current NOUS provider hosts sessions at Oakham Surgery for which YHP receives a small financial payment – pecuniary interest Item 4.13 Dr Ian Sykes is a GP member of Your Health Partnership – pecuniary interest Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:

Strategic Priorities related to the report: Quality & Safety X Finance & Performance X Strategic Commissioning and Redesign X Organisational Development Primary Care Co-Commissioning Collaborative Commissioning X – working with BSOL CCG to develop Neurodevelopmental Pathway (0-16 years) Implications: Financial X – IMHL Ltd ENT contract extension for 12 months to allow for pathway review (£63K); West Birmingham Neurodevelopmental Pathway (annual recurrent investment £229K, non-recurrent maximum £130K for potential Waiting List Initiative; system resilience contingency funding £160K; direct award for 12 months Primary Mental Health Worker service to allow Tier 2 service model review £265K; Sandwell Healthy Minds non-recurrent investment for waiting times £375K;Agewell Support 12-month contract extension

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£15K; School workshops non-recurrent £76K; QIPP – dry eye self-care; Assurance Framework X – BSOL CCG Neurodevelopmental Pathway (0-16 years) waiting times; website publication of SEND health local offer; School workshops/Tier 2/CAMHS – achievement of Children and Young People’s 34% access target; Sandwell Health Minds - Improving Access to Psychology Therapies (IAPT) Long Term Conditions 22% and 25% access requirements for March 20 and March 21 for West Birmingham; Delayed discharges – system resilience contingency funds, Agewell Support; Risks and Legal Obligations X – compliance with Procurement regulations in relation to commissioning contract extensions and NOUS procurement Equality and Diversity X – consideration given as part of all commissioning/investment decisions Statutory and External Influences Further implications not stated Consultation: Patients X Staff Committees X Public Partners X Sponsored By: (Chief Officer/Committee Chair) Dr Manir Aslam Date Report received for Governing Body 27th February 2020

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Strategic Commissioning & Redesign Committee Update

1. INTRODUCTION

1.1 This report provides a summary of the Strategic Commissioning & Redesign Committee which took place on 16 JANUARY 2020 and 13 FEBRUARY 2020.

2. MATTERS ARISING 2.1 The Committee noted the incorrect use of terminology in reference to the Urgent Care Centre report discussed at the November 2019 and approved the retrospective change to the minutes replacing “consultation” with “engagement”.

2.2 The Committee were advised that Sandwell and West Birmingham NHS Trust (SWBHT) has served notice on the provider of the out of hours non-emergency transport (OOH NEPT) provider. Step in provision is being sourced owing to the need to commission an alternative provider to commence on 1st February 2020. There was discussion regarding hospital discharges during the night and responsible commissioning in this respect. The Committee gave virtual approval for the direct award of OOH NEPT, which was confirmed at the February meeting, to ensure continuity of provision via a 12-month contract that will allow time for improved data collection to inform future commissioning. The value of the direct award is within the delegated financial tolerance.

2.3 The Committee gave virtual approval for additional non-recurrent investment to respond to the waiting list issues that became known during the mobilisation of the Healthy Minds (Sandwell) service by Black Country Partnership Foundation NHS Trust (BCPFT) that commenced on 1st October 2019 following the procurement. The additional investment is within the delegated financial tolerance.

2.4 The Committee agreed to receive a paper on the Urgent Treatment Centre engagement exercise (due to conclude on 21st February 2020) for virtual approval in advance of the March 2020 Governing Body.

3. REVIEW OF ACTION REGISTER 3.1 The action log was updated, with actions closed as appropriate.

4. ITEMS FOR DECISION MAKING

4.1 Integrated Medical Holdings Ltd. (IMHL) Ear, Nose and Throat (ENT) Service

4.1.1 The Committee received a paper providing an update regarding the position of the IMHL ENT contract and a proposal for future commissioning. There was discussion about the National Institute of Health and Care Excellence (NICE) guidance regarding ear wax removal and implications within primary care, the growth in activity and the increase in the value of contract by 17% to a forecast £62K by year end.

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4.1.2 The Committee was advised of the need for pathway redesign work and noted that this service was not currently a CCG or Sustainability and Transformation Partnership (STP) priority. The proposal made was to extend the contract for a further 12 months at the increased annual value to allow for redesign work that has the potential to reduce secondary care activity. There was discussion about the redesign work being undertaken as part of an STP exercise.

Decision: The Committee agreed to extend the IMHL ENT contract for 12 months ending 31st March 2021 subject to financial controls being put in place. It was agreed that a commissioning manager is assigned to deliver the redesign work from April 2020 subject to no other competing work demands taking precedence, and that this work considers best practice and a Black Country approach.

4.2 Neurodevelopmental Pathway

4.2.1 The Committee was reminded of the previous paper presented by Emma Ambler from Birmingham and Solihull (BSOL) CCG in September 2019 requesting recurrent investment for West Birmingham to address significant waiting times and demand continuing to exceed capacity. Concerns regarding the pathway and lack of clarity regarding the changes, benefits and outcomes to be achieved resulted in the decision not to approve the additional funding.

4.2.2 The revised paper set out the case for supporting the additional recurrent investment from April 2020 and proposed an upper limit for in-year non-recurrent investment for a waiting list initiative before the end of March 2020. The annual value of the additional funding is within the financial tolerance.

4.2.3 It was confirmed that the model proposed will bring greater alignment with the Sandwell service and that there is currently no waiting list for Sandwell patients. The Committee was advised that despite the maximum waiting time not being defined i.e. 52 weeks, 18 weeks or 6 weeks and the absence of the associated trajectory to achieve this, there is a growing urgency to demonstrate that the CCG is taking action to achieve parity of provision and reduce waiting times for this cohort of children and young people.

4.2.4 The Committee was advised that recruitment had commenced by one of the providers at risk including the 4 Attention Deficit and Hyperactivity Disorder (ADHD) nurses, 3 of which are currently in training. In addition, Birmingham Community Healthcare NHS Trust (BCHC) have been asked by BSOL CCG to submit a waiting list initiative proposal to be completed before the end of March 2020 for which finance approval by both CCGs will be required. A Service Development Improvement Plan (SDIP) has been developed and the recommendation made that BSOL CCG provide West Birmingham activity and finance for performance monitoring purposes. There was a discussion about the absence if the waiting list reduction trajectory and the challenges in BCHC’s reporting capability currently being addresses.

Decisions: The Committee approved:

• option 3: to provide the additional recurrent annual investment to recruit the additional workforce required to establish Phase 1 (0-16 years) of the all-age integrated neurodevelopmental pathway for West Birmingham

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• the additional 2019/20 part-year investment up to a maximum of £160,300 to fund part year new staff costs and the waiting list initiative to be undertaken before the end of March 2020 requested by BSOL CCG.

4.3 Children and Young People with Special Educational Needs or Disabilities (SEND) Local Offer

4.3.1 The Committee was informed that the CCG is required to publish the local SEND offer on its website and presented with the proposed content for upload. It was noted that engagement work is required to improve the wording but in order to meet requirements approval for publication in the current form was requested.

4.3.2 There was discussion about the current narrative needing to be less technical and more patient/public friendly. Various amendments were discussed and the suggestion that a flowchart be included to explain the process. The plan was to work on the document with Sandwell Parents of Disabled Children in order to produce an improved version in due course. The need to alignment with the Local Authority SEND offer was discussed.

Decision: The Committee did not agree for the SEND service offer description to be uploaded to the CCG website. A re-draft was requested that explains the health offer more clearly and uses plain language for approval via the consent agenda in March 2020.

4.4 System Resilience Contingency Budget

4.4.1 The Committee received an update on the utilisation of the system resilience contingency fund in response to system pressures. The request was made for the Committee to retrospectively approve the recommendation made by the Accident and Emergency (A & E) Delivery Board for the commitment of £160K of the contingency funds in the following areas: • expansion of the nursing home pilot to cover up to 20 homes until 31st March 2020 • purchase of bariatric scales for access by community teams • expansion of the Birmingham facing Own Bed Instead scheme until 31st March 2020, and • commissioning of 5 additional end of life beds for a 3-week period to enable preferred place of death to be provided.

4.4.2 It was confirmed that the Committee will be informed about how the rest of the contingency fund will be spent at a future meeting.

Decision: The Committee approved the recommendations made by the A & E Delivery Board for the commitment of contingency funds.

4.5 Glaucoma Enhanced Case Finding Service Specification

4.5.1 The Committee was reminded that it had approved the commissioning for the glaucoma enhanced case finding service in December 2019 and asked to approve the service specification.

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4.5.2 There was discussion regarding the specific amendments made to the specification further to a meeting with the provider. The specification seeks to ensure patients are seen in a timely manner in order to reduce the number of false positives in secondary care and associated costs. In addition, the mobilisation plan, tariff, workforce, quality requirements and key performance indicators were discussed.

Decision: The Committee approved the Glaucoma Enhanced Case Finding service specification.

4.6 NHS Oversight Framework

4.6.1 The Committee were reminded about the need for the CCG to complete the assessment template and owing to the submission to NHS England/NHS Improvement in February the request was made for virtual approval owing to the next Governing Body being scheduled for March.

4.6.2 There was discussion about the CCG’s duty to involve, and the need for the organisation to evidence how engagement activities undertaken influence the commissioning of services. In 2019 the CCG achieved a ‘good’ rating and the ambition is to maintain this rating if not achieve ‘outstanding’.

4.6.3 Members discussed the need to demonstrate that the participants in engagement events reflects the population in the CCG’s geography, the inclusion of the Time to Talk services and other suggested areas.

Decision: The Committee agreed to virtual approval of the CCG’s Oversight Framework assessment submission.

4.7 Primary Mental Health Workers (PMHW) – Contract with Kaleidoscope for Tier 2 Emotional Wellbeing Services

4.7.1 The Committee was informed that Sandwell Council were not longer able to provide their element of the funding and asked to approve a direct contract award of the service to Kaleidoscope for one year to allow time for the wider service model that will ensure the 35% access rate can be achieved by March 2021. It was confirmed that the provider will be able to deliver the service within the current CCG investment (financial value within the approval limit of this Committee).

4.7.2 Updates to the paper since issue were discussed e.g. requirements in relation to Level 2 Safeguarding training and the performance monitoring template.

Recommendation: The Committee agreed that the CCG commission the Tier 2 PMHW Emotional Health and Wellbeing Service for Sandwell via direct award to Kaleidoscope until 31st March 2021.

4.8 Non-Obstetric Ultrasound Service (NOUS) Procurement Contract Award Recommendation Report

4.8.1 The Committee received the Procurement Contract Award Report prepared by Arden and Greater East Midlands Commissioning Support Unit. An outline of the process, scoring/moderation and outcome was given. The Committee was asked to recommend approval of the contract award to the highest scoring bidder.

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4.8.2 There was discussion regarding some of the issues that had arisen through the contract award to the current provider in the context of feedback from the patient/public engagement, quality, integration and additional costs. Further assurance was felt to be required to enable the Committee to make its recommendation.

Resolution: The Committee requested further information for assurance and on receipt, agreed to determine their recommendation to Governing Body.

4.9 Agewell Own Bed Instead (OBI) Support Contract

4.9.1 The Committee was advised that the contract is due to expire on 31st March 2020 and requested a further extension of 12 months to the end of March 2021.

4.9.2 Members were reminded that the service provides support to patients within the OBI service enabling them to remain well in their usual place of residence, thereby relieving pressure on clinical teams. The OBI service is funded by the Sandwell Better Care Fund but the Agewell support is a CCG contract to the annual value of £15K.

4.9.3 The Committee was informed that Sandwell Council are investing in a Community Support offer due to mobilise in April 2020 which may impact on future commissioning of the Agewell element of the OBI service.

4.9.4 There was a discussion about contract management, outcomes of the service and cost control.

Decision: The Committee approved the extension of the Agewell Support to the OBI model for 12 months ending 31st March 2021.

4.10 Supporting Self Care for Dry Eye

4.10.1 The Committee received a paper detailing the actions taken to reduce the level of prescribing of dry eye treatments deemed suitable for self-care according to NICE guidance in addition to providing an update on the Minor Eye Conditions Service (MECS) that commenced in August 2019.

4.10.2 SWB CCG are currently the worst performing CCG in the country for expenditure on over the counter ocular lubricants. There is clear guidance on what should be prescribed and what should be purchased from a pharmacy, optician or supermarket by patients without a prescription. The CCG has been leading a Black Country STP working group seeking to harmonise the MECS product formulary and align service specifications to promote self-care. The Quality, Innovation, Productivity and Prevention (QIPP) was discussed.

4.10.3 There was discussion about the importance of clear guidance for Ophthalmologists and GPs regarding what conditions are appropriate for self-care. This will ensure GPs do not get clinical letters advising the prescribing of medicines where they can be purchased, and patients are not advised that their GP will prescribe.

4.10.4 The impact of this initiative on the elderly exempt from prescription charges was discussed as if the recommended medicines can be purchased there is a financial implication for this patient group. There was discussion about the categorization of dry eye and associated interpretation of what is mild to moderate. The difficulty GPs will

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face in achieving the shift to self-care was acknowledged, particularly where Ophthalmologists have advised patients that their GP will issue prescriptions. It was noted that engagement with the Local Optical Committee was good regarding MECS.

4.10.5 Assurance was given that the Integrating NHS Pharmacy and Medicines Optimisation Programme is continuing to work closely, the group comprising pharmacy leaders from the 4 acute Trusts, 2 mental health Trusts, Black Country CCGs and community pharmacies.

Decision: The Committee supports the Medicines Quality Strategy promoting self-care of dry eye symptoms.

4.11 Tier 2 Children and Young People Services, Access Targets and Child and Adolescent Mental Health Service (CAMHS) Waiting List Initiative

4.11.1 The Committee was informed that the CCG has recently reviewed currently commissioned models of services delivering Tier 2 emotional health and wellbeing services in the context of the distance from the ambition of achieving the 35% access standard by March 2021.

4.11.2 SWB CCG and Sandwell Children’s Trust currently commissions Kaleidoscope to provide the Primary Mental Health Worker service and the Children’s Society to deliver therapeutic interventions via BEAM and Kooth. The Children’s Society contract ends 31st March 2020.

4.11.3 A review of the BEAM and Kooth service offer has identified the need for changes. Currently the drop-in service activity provided by BEAM can not be counted and is therefore excluded in the calculation of the CCG’s performance against the access target. Discussions with the provider have failed to determine changes in the service model that would allow the activity to be counted.

4.11.4 Exploratory discussions have been had with Murray Hall Community Trust to assess whether they have the interest and will to provide Tier 2 services in the event that BEAM are not able to make changes so that the activity can be recorded and thereby contribute to the access performance. If BEAM can not change, the proposal made was to allow the BEAM contract to lapse and re-invest the funding with an alternative Tier 2 provider using an appropriate process to commission.

4.11.5 There was discussion about the need for proportionate public/patient engagement if the CCG opts to cease drop-in provision prior to ceasing the current provision. In addition, despite the contract ending at the end of March it was acknowledged that best practice requires the CCG to give an appropriate notice period to the current provider which in turn allows consideration of any Transfer of Undertakings in the Protection of Employment (TUPE) implications.

4.11.6 The Committee were made aware that the CCG’s current distance from the 2019/20 yearend 34% access target means that commissioned services need to be compliant with standards and continuing to invest in BEAM may not be defensible if the service offer can be counted. 4.11.7 The Committee was informed that the latest performance data shows the CCG to be achieving a 21% access rate against the required yearend rate of 34%. The CCG

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is an outlier compared to the other Black Country CCGs and there is the need to take action to assure NHS England that action is being taken to improve performance.

4.11.8 To respond to this, the CCG has been working with Inclusion Support within Sandwell Council and identified an opportunity to deliver prevention and early intervention work to address needs through a series of workshops within schools that meets requirements for reporting as eligible activity to contribute to delivery of the access target. Workshops will target year 11 children taking GCSEs through the delivery of 4 workshops per participating school. Two out of the four workshops must take place before the end of March to enable the figures to be captured against this year’s targets. The Committee were asked to approve non-recurrent funding (within financial tolerance) to be made available to two providers to deliver the workshops.

4.11.9 The Committee was informed that Sandwell children are waiting up to 18 weeks for initial assessment by the CAMHS. The Committee was asked to approve non- recurrent investment (within financial tolerance) to recruit staff to undertake a waiting list initiative that will reduce waiting times to 4-6 weeks by June 2020 and thereafter maintain the maximum waiting time.

4.11.10 There was discussion about the reason for investing more funds with BCPFT when they are contracted to deliver the service to the waiting time standards. The high volume of Did Not Attends was given as a contributory factor to the Trust not meeting the standard. It was confirmed that a review of the Single Point of Access will also be undertaken to ensure using staff to reduce the waiting list does not impact upon the existing capacity of the service.

4.11.11 The Committee were advised that the business case was not sufficiently developed as there was the need to understand the current workforce and capacity and have a clear trajectory showing how the additional staff will reduce the waiting times and in what timescales. Whilst there was agreement on the commitment to reducing waiting times and working with BCPFT to improve the way the service is organised and delivers, further information and analysis is required to enable a decision to be taken.

Decisions: The Committee

• agreed in principle to allow the BEAM contract to end (with appropriate notice) and the investment to transfer to an alternative provider subject to: ­ no solution being agreed with BEAM to enable the activity to contribute to the achievement of the access target ­ the engagement requirements established and delivered if ‘drop-in’ provision is no longer available ­ determination of the commissioning approach that is fair, transparent and legitimate ­ the cost implications any change in providers and notice periods. • agreed the non-recurrent investment to direct award to two providers to deliver the prevention and early intervention workshops in schools • recognised the need to reduce CAMHS waiting times and did not approve the non-recurrent funding for the waiting list initiative pending more information, analysis and provision of a clear trajectory for waiting times reduction.

4.12 Community Lymphoedema

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4.12.1 The Committee was reminded that at the October 2019 meeting a two-year extension to the contract with BCHC was agreed subject to agreement to a SDIP for procuring a wound management solution, the implementation of a product formulary and resolution of the FP10 prescribing financial dispute.

4.12.2 BCHC is not in agreement with the requirements. The Committee was asked to agree that if agreement cannot be reached that a one-year extension be agreed to allow for procurement but if the issues are resolved to agree to the two-year extension. The contract value is within the delegated financial tolerance.

Decision: The Committee agreed to extend the contract for 1 year if the issues are not resolved to allow for open procurement and to extend the contract for 2 years if the areas of dispute are resolved.

4.13 SWBHT and Your Health Partnership (YHP) Integrated Dermatology Service

4.13.1 The Committee was provided with an updated status and the integrated dermatology service specification for approval. The paper included the indicative plan and spend for the pathway and requests agreement to the cease the Dermatology element of the YHP community outpatient contract and transfer the respective current annual investment of £45K to SWBHT as the prime provider for the Integrated Dermatology service. YHP will be a sub-contractor within the new service.

4.13.2 It was confirmed by Finance that the transfer of the funding to SWBHT was agreed provided it transferred as a block payment to protect the CCG from higher tariff payments for activity.

Decisions: The Committee approved the Integrated Dermatology Service Specification and to cease commissioning the Dermatology element of the YHP community outpatient contract and transfer the respective funding to SWBHT on a block contract basis.

5. ITEMS FOR INFORMATION

5.1 Sandwell Healthy Minds (previously referred to as the Primary Mental Health and Talking Therapies Service)

5.1.1 The Committee was reminded that the Healthy Minds Service contract was awarded to BCPFT and commenced on 1st October 2019, providing low and high intensity services.

5.1.2 When the service mobilised, the staff who transferred via TUPE it was discovered that they held their own waiting list and as such had not been identified prior to service transfer from the former provider. The additional work required to manage this waiting list cohort has placed delivery of the service at risk. It was found that a significant number of patients (950) had been waiting longer than is reasonable and a separate list had been held for patients requiring interpreter input awaiting assessment giving rise to additional costs (140 patients).

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5.1.3 Funding for the over performance of the contract will need to be framed around the cost of the workforce required to handle it. Due to the shortfall of low intensity Increasing Access to Psychological Therapies (IAPT) staff, the only solution available was reported to be the diversion of high intensity staff to address the additional activity which carries an extra cost burden.

5.1.4 Due to the risk these issues pose to contractual performance requirements, the Committee were informed that BCPFT will not sign the contract for the service. The proposed additional case by case funding approach was shared, requiring a non- recurrent maximum investment of £375K should all patients attend for treatment.

5.1.5 There was a discussion about the monitoring of the former contract and the procurement process and the need to ensure any lessons are learnt. Assurance was given regarding the waiting list being validated, that patients would be seen in order of longest wait and that the expectation is that all patients on the waiting lists will have commenced or at least completed treatment by end of April/early May 2020.

Resolution: The Committee agreed to receive a formal report for the additional non-recurrent investment of £375K for virtual approval.

5.2 CCG Financial Sustainability Review

5.2.1 The Committee was informed that SWB CCG is required to deliver £10 million surplus in 2020/21. This will impact on the level of growth provider Trusts will receive and consideration of priority outcomes. Little or no investment money will be available for the next financial year and ideas for QIPP delivery next year are needed.

5.2.2 There was a discussion about STP versus place-based priorities and the need for these to be confirmed. Reference was made to the work of Sandwell and West Birmingham Integrated Care Partnerships (ICPs) and the need to reduce the risk of duplication. The Committee noted the need to be sighted on the plans and development of the new structure.

Resolution: The Committee noted the contents of the report.

5.3 Learning Disabilities (LD) Health Checks

5.3.1 The Committee was reminded that the target for GPs and CCGs to improve access to healthcare for people with learning disability is to achieve 75% of people on a GP Learning Disability register in England having an annual health check. SWB CCG achieved 32.4% last year and were the worst performer out of the Black Country CCG’s.

5.3.2 SCR previously agreed to recruit two interim band 5 LD nurses to support GP practices in carrying out LD Health Checks in order to achieve the targets set. As no applications were received at Band 5 and when the posts later advertised as band 6, two Band 6 agency nurses have now been recruited commencing 20th January 2020. Roles and expectations have been outlined. The nurses will be making contact with GP practices to provide learning and advice on LD health checks as well as to discuss interest in carryout out the LD health checks at scale, with an initial focus upon practices that will benefit the most based on last year’s achievements.

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5.3.3 Whilst the ambition for 2020/21 is to achieve 50% concerns were expressed regarding achievability given that the nursing staff will only have been employed for two months. There was a discussion about learning lessons from better performing CCGs such as Dudley where achievement of the Health Checks target is embedded within their Quality Outcomes Framework.

Resolution: The Committee noted the update and encouraged conversations to take place between SWB CCG and Dudley CCH who are high achievers

5.4 Draft Integrated 999/111 Service Specification

5.4.1 The Committee received an update on the transfer of the 111 service to West Midlands Ambulance Service (WMAS) and overall the service appears to be very stable and performing at a level about the national in terms of the front-end service.

5.4.2 The process and engagement to develop version 2 of the integrated 999/111 service specification was shared, highlighting the opportunities given to CCGs, WMAS and clinicians to contribute to its development. Based on feedback from WMAS, a list of service development areas has been created to be discussed with WMAS on 14th February with a view to agreeing milestones and delivery dates.

5.4.3 It was noted that WMAS now understands the need for the service to integrate with other healthcare professionals, including GPs and practices and also the need for GPs to be working within the service.

5.4.4 There was a discussion about the cost of the service and the impact of activity shifts between 999 and 111 demand and improvement of the 111 service potentially leading to a reduction in ambulance despatches, one of many benefits of integrating to a single provider. It was confirmed that work had been done on the required payment mechanisms for the future to ensure a more balanced approach for system wide benefits and create a move towards more appropriate measures.

5.4.5 The suggestion was made that a conversation is had with GPs around what type of patients they might want to see face to face compared to those they would like to assess over the telephone as a means to including them in the conversations about how to best use the service. The triage system was confirmed.

Resolution: The Committee received the draft of the Integrated 999/111 Specification for assurance.

5.5 IAPT Access BSOL CCG Trajectory

5.5.1 The IAPT access trajectory requested further to the additional investment made was reported to be outstanding although verbal assurance has been given that the 25% target will be achieved by 2023/24.

5.5.2 There was an update regarding the change to the determination of prevalence that potentially will increase the numbers who will need to access services to achieve the target. For Sandwell, if the prevalence change which NHS England is proposing is effective from 1st April 2020, to achieve our 25% target this year 13,602 patients must access services and for next year this would increase to 21,082 patients representing a significant challenge, particularly in relation to having the workforce to deliver and

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locations available to see patients. By comparison, BSOL CCG have an increase from 24,254 patients to be seen under IAPT to 31,618 next year.

5.6 NHSE End of Life Funding Allocation

5.6.1 The Committee was informed that the CCG were notified by NHS England and NHS Improvement in late 2019 that they had been allocated £234,000 as a result of this additional investment.

5.6.2 It was agreed that a large proportion of the funding (175k) would need to be ringfenced to support Acorns Children’s Hospice. This left £59k unallocated to spend which will used to provide training and also recruit a Community Facilitator to work with the ‘hard to reach’ groups in order to increase access and advanced care planning.

Resolution: The Committee noted the use of the NHSE End of Life Funding Allocation.

6. STRATEGIC ESTATES REVIEW GROUP (SERG)

6.1 No report - meeting scheduled for 8th January was cancelled.

7. PROGRAMME MANAGEMENT ASSURANCE GROUP (PMAG) REPORT

7.1 The January meeting invited project leads for Dermatology, Social Prescribing, Initial Accommodation Healthcare and Dementia to discuss current status, reasons for slippage and risks/issues. There was a detailed discussion about the Urgent Treatment Centre engagement at the February meeting.

7.2 The latest Right Care performance and status of delivery initiatives was presented. Based on the QIPP reports provided by Finance, delivery remains on track overall. There was discussion about the under and overperforming schemes.

Resolution: The Committee approved the PMAG reports.

8. RISK REGISTER

8.1 The risks were reviewed and updated.

8.2 SC19_11a – There was discussion about the lack of clarity regarding this risk and its mitigation. Lisa Maxfield to be invited to the March SCR meeting to discuss Integrated Care Partnerships.

8.3 SC19_11b – Closure requested as the 111 service has transferred to the new provider, confirmation outstanding

8.4 A new risk was added to the register:

“If SWBHT Neurology Department do not review brain scan reports or identify an alternative option to manage patients, there is a risk of suspected brain cancers being missed and potentially leading to harm.”

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9. CONSENT AGENDA

9.1 The items were noted and there were no questions.

10. ANY OTHER BUSINESS 10.1 It was agreed for an agenda item to be included for the March meeting to discuss the future of the SCR Committee in the context of the emerging governance framework across the 5 places.

Contact Officer with contact telephone number Angela Poulton, Deputy Chief Officer, 0121 612 3471

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GOVERNING BODY Report Title: Integrated Urgent Care Update Report author and Title: Rachael Ellis Chief Officer - Transformation Date of Governing Body: 4 March 2020 Contact Details: Email: [email protected] Agenda No: 8.6 Telephone: 0121 612 1560 Enclosure no: 9 Sign off from Chief Officers:

Chief Officer for Transformation

Supporting Documents/further Reading: N/A Previous Decision N/A Summary of purpose and scope of the report:

This report provides a monthly update from the Transformation Directorate, which are the Regional Commissioners for the Urgent and Emergency Ambulance Service, OOH GP, Clinical Advice Service and 111.

Recommendations: Members are asked to receive the report for information.

The Governing Body are requested to: Action Approve Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified X Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:

Strategic Priorities related to the report: Quality & Safety X Finance & Performance X Strategic Commissioning and Redesign Organisational Development Primary Care Co-Commissioning Collaborative Commissioning

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Implications: N/A Financial Assurance Framework Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated Consultation: Patients Staff Committees Public Partners Sponsored By: Rachael Ellis, Chief Officer Date Report received for Governing Body 24th February 2020

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TRANSFORMATION UPDATE TO SWB CCG GOVERNING BODY

1. INTRODUCTION

The purpose of this paper is to provide a monthly update to the Governing Body on the performance and development of regional services, commissioned by the Transformation Directorate (as lead commissioner for 20 CCGs).

2. URGENT & EMERGENCY AMBULANCE SERVICE

2.1 In January the West Midlands Urgent and Emergency Ambulance Service responded to 98,424 incidents, 4.91% below the planned activity. At month 10, the year to date position is 1.98% above plan.

2.2 Performance was strong in January, with WMAS achieving all National Standards during the month and significantly above the national average for most standards.

Ambulance Mean 90th centile Service (min:sec) (min:sec)1 Category 1 England 7:08 12:30 West Midlands 6:59 12:03 Category 2 England 21:05 42:55 West Midlands 12:29 22:45 Category 3 England 0:57:34 2:14:31 West Midlands 0:32:47 1:11:44 Category 4 England 1:15:00 2:52:43 West Midlands 1:54:58 2:30:28

NOTE – Cat 3 & 4 Mean Times shown for Information only – they are not a National Response Standard.

Response Type

2.3 National Ambulance Quality Indicators report on the four dispositions below, which saw the following distribution in January (England Average in brackets):

• Hear & Treat 3.3% (6.5%) • See & Treat 34.3% (30.2%) • See & Convey to ED 56.0% (57.7%) • See & Convey elsewhere 6.4% (5.6%)

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2.4 The See & Convey to ED rate was the 3rd best in country (range: South Western Ambulance Service 53.4% - 61.8% South East Coast Ambulance Service)

Patient Handovers at ED

2.5 Patient Handovers at ED’s remain challenging at a small number of Emergency Departments in the West Midlands. 52,464 handovers took place in January, with 49,355 having handover times recorded.

2.6 Of those recorded:

• 46,883 took place within 45 minutes – 94.99% • 1,146 took place between 45-60 minutes – 2.32% • 1,326 took longer than 1 hour – 2.69%

2.7 There remains a financial remuneration mechanism in place for WMAS, for delays of 45 minutes and above.

3. INTEGRATED URGENT CARE (111 & Clinical Assessment Service)

3.1 In January 2020, the 111 Service Answered 107,515 calls, which was 26,659 decrease on Decmeber 2019 (134,174 answered calls).

Clinical Triage (source 111 NHS MDS)

3.2 Of the calls answered, 105,302 received a triage tool. The outcomes are as follows:

19/20 Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec Jan Outcomes Ambulance 13,590 13,400 14,230 13,812 12,907 13,171 13,731 13,037 12,703 14,946 14,748 16,813 13,655 Dispatches ED 8,261 7,862 8,859 8,439 8,593 8,636 9,049 8,602 8,378 8,444 8,323 11,063 10,035 Attendance GP, OOH 38,665 35,216 37,514 39,072 35,591 32,102 33,878 48,010 43,538 45,878 31,736 75,497 62,579 GP, UTC, WIC - Face to Face GP, OOH 13,873 12,193 12,574 12,706 11,120 10,009 9,571 9,514 9,395 10,353 10,179 17,032 13,232 GP, UTC, WIC – Speak To Dental 2,491 2,418 2,782 3,314 3,265 2,710 2,808 3,635 2,831 2,686 2036 5,420 4,929 Pharmacy 267 281 310 348 276 264 308 263 222 233 144 402 351 Other 5,210 4,692 5,550 5,663 5,798 5,486 5,230 5,489 4,622 4654 4,267 2,786 2,530 Services Advice, Self 10,631 8,922 9,553 9,739 9,754 9,428 10,139 10,221 8,778 9,277 11,982 21,311 16,503 Care & Non clinical Service

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Ambulance Dispatch from 111

3.3 The ambulance despatch rate of the service was 12.96% (of triaged calls) which is a decrease on the previous month (December - 13.21%). The split across the Ambulance Categories is as follows:

• Cat 1/2 – 10.53% • Cat 3/4 – 2.43%

3.4 Note - Where NHS pathways determines a Cat 3 or 4 Ambulance is required, the majority (87.45%) of those calls are then subject to input by a Clinician (Clinical Validation) prior to transferring the call to the Ambulance Dispatch system. This validation ensures Ambulances are only sent to low acuity cases where Clinically appropriate.

Call Handling Performance 111

3.5 The average speed to answer calls in January was 3 seconds, with 97.91% of calls answered within 60 seconds. The percentage of calls abandoned after 30 seconds was 0.14%. WMAS were the highest performing provider in the country for both of these metrics.

Clinical Assessment Service

3.6 The CAS is a Multi-disciplinary GP Lead service, which includes Paramedics, Pharmacists, Advanced Nurse Practitioners, Mental Health Nurses, Dental Nurses. The service accepts activity from:

• Triaged Calls from 111 • Calls directed by the 111 Telephony System • Ask NHS App (digital)

19/20 Outcomes Jan Ambulance Despatch 4,478 Dental 1,392 ED disposition 4,677 Other Outcome 4,724 Other Service 141 PCS Bookable 10,848 PCS Speak to 2,869 Pharmacist 135 Self Care 556 Total 37,205

4. RECOMMENDATIONS

4.1 Members of the Governing Body are asked to note the content of the report.

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GOVERNING BODY Report Title: OD Committee Assurance Report author and Title: Alice McGee, Director of HR and OD

Date of Governing Body: 4th March 2020 Contact Details:

Agenda No: 8.7 Enclosure no: Enc 10 Sign off from Chief Officers:

Chief Finance Officer:

Chief Officer for Quality:

Chief Officer for Strategic Commissioning:

Chief Officer for Transformation: n/a Content supported by Therese McMahon as Chair of Committee

Supporting Documents/further Reading:

December 2019 OD Committee Minutes

Previous Decision

Summary of purpose and scope of the report:

This report seeks to provide the Governing Body with assurance of the discussions and decisions at the February 2020 Organisational Development Committee.

Recommendations: The Governing Body are asked to: - note the content of the report

The Governing Body are requested to: (Mark the appropriate box that you are asking the Governing Body) Action Approve Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: (mark the appropriate box to highlight any conflicts of interest) No conflict identified X Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion

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Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision: There are no conflicts identified in the remit of the committee for any of the GB members

Strategic Priorities related to the report: (Identify what priorities the report is linked to) Quality & Safety Finance & Performance Strategic Commissioning and Redesign Organisational Development X Primary Care Co-Commissioning Collaborative Commissioning Implications: (Mark the box to identify any implications to the associated area) Financial Assurance Framework Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated Consultation: (Mark the box to identify who has been consulted) Patients Staff Committees X Public Partners Sponsored By: (Chief Officer) Therese McMahon, Chair of Committee Date Report received for Governing Body 25th February 2020

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Organisational Development Committee February 2020 Assurance

1. INTRODUCTION The OD Committee meet bi-monthly and is chaired by Therese McMahon. This report seeks to provide a summary of the February 2020 meeting to provide assurance to the Governing Body.

2. OD Committee agenda

2.1 Staff Council Update The Staff Council met in January 2020 shortly after the publication of the Governing Body in Common (21st January 2020) papers to staff. Staff were pleased to have the opportunity to see the papers and discussed some of the challenges that staff were currently facing in relation to workload, the impending changes and the implications of the Governance structures, the corporate offices and the executive structure.

2.2 Workforce Dashboard The committee received a dashboard for the year to date, up to December 2019 and a discussion was had in relation to the workforce indicators. The PDR compliance showed an increase in compliance to 77% (up from 66% in December 2019) of staff having a PDR in the last 12 months.

The statutory training has increased slightly to 91% when reviewed by OD Committee, work continued to ensure that all staff have completed their mandatory training and this is included within any request for study leave and the annual increment review process

2.3 Primary Care Workforce

This item was deferred to the April meeting

2.4 Black Country and West Birmingham CCG’s staff engagement and development

Following debate in the November 2019 OD Committee, the committee received a draft proposal that was currently being considered in relation to the approach for staff engagement and development across the four CCG’s. The approach considered the mechanism for engaging with staff and the training and development corporate programmes for 2020/21. The committee noted that the proposal has been discussed at a number of staff forums across the four CCG’s, and most recently at the Black Country and West Birmingham CCG’s change council.

The OD committee were supportive of the proposed approach and were assured that the approach to invest and support staff through a period of change was being proactively considered.

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2.5 Black Country and West Birmingham CCG’s staff forums

The committee was provided with an update from the recently formed Staff Health and Well Being Forum and the Change Council, both of which have staff representatives from across the four Black Country and West Birmingham CCG’s. The committee were informed of the positive progress made in engaging with staff and the ongoing approach to ensuring staff have influence on the proposed organisational development approach

2.6 Future OD Committee meetings

The Committee considered the new Black Country and West Birmingham CCG’s governance structure noting the addition of a OD Committee that will report directly to the Remuneration Committee from 1st April 2020. The OD committee recognised that the SWB CCG approach to OD committee had been successful and that the membership of management, staff side and lay members had meant that each meeting had good debate and assurance on the OD processes and development for the organisation. The OD Committee noted that a meeting in March and a final meeting in June before handing over any outstanding actions and risks to the new governance structure would be sufficient to ensure that the old way of working and new way of working was appropriately handed over.

2.10 CSU Scores

The committee noted that all CSU services were now being scored as satisfactory or performing well.

2.11 OD Risks

The OD risks were reviewed and updated.

3. RECOMMENDATIONS 3.1 Members of the Governing Body are asked to: • note the content of the report for assurance

Alice McGee Director of HR and OD

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GOVERNING BODY Report Title: Report Author and Title: Board Assurance Framework Update Jodi Woodhouse Acting Head of Corporate Governance

Date of Governing Body: Contact Details: Agenda No: [email protected] Enclosure No:

Sign off from Chief Officers: (Before the report is presented to the Governing Body any implications relating to Finance, Quality and Commissioning must be agreed and signed by the Chief Officer. (see guidance note) Without this information the report will not be taken to the Governing Body)

Chief Finance Officer:

Chief Officer Quality: yes

Chief Officer for SCR:

Chief Officer for Transformation:

Supporting Documents/further Reading: (Highlight any documents or further reading for members which supports this report) • Appendix 1 – Board Assurance Framework Risks

Previous Decision (Inform the Governing Body/Committee if the paper has been reviewed or monitored by another committee and their recommendation or decision)

Summary of purpose and scope of the report: (Highlight key points you wish to bring to the attention of members)

The aim of the report is to provide the Governing Body with detail of the current Board Assurance Framework Risks.

Recommendations:

• Receive the report for information

The Governing Body/Committee are requested to: Action Approve Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified x Conflict noted, conflicted party can participate in clinical discussion but not decision

Sandwell & West Birmingham CCG Page 1 of 2 Board Assurance Framework Update February 2020

Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:

Strategic Priorities related to the report: Quality & Safety x Finance & Performance x Strategic Commissioning and Redesign x Organisational Development x Primary Care Co-Commissioning x Collaborative Commissioning x Implications: Financial Assurance Framework This report provides an update on the Board Assurance Framework including a breakdown of risks by risk grading.

Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated

Consultation: X Patients Staff Committees Public Partners Michelle Carolan Sponsored By: (Chief Officer or Committee Chair) Date Report received for Governing Body 25th February 2020

Sandwell & West Birmingham CCG Page 2 of 2 Board Assurance Framework Update February 2020

NHS Sandwell and West Birmingham CCG

BOARD ASSURANCE FRAMEWORK UPDATE

1. INTRODUCTION The CCG has maintained an assurance framework as an essential part of its governance arrangements to ensure that the principal threats to achievement of the organisation’s strategic aims and objectives are clearly identified, mitigated and monitored. In-year review allows the CCG Board and Integrated Audit and Governance Committee (IAGC) to maintain an appropriate focus on risks to the delivery of key objectives.

The Board Assurance Framework (BAF) provides an important source of assurance.

2. BACKGROUND The enclosed Board Assurance Framework (BAF) presents the updated framework in the light of the CCG board development workshops during 2019/20 which identified an additional strategic objective and the key risks against the 7 corporate objectives.

3. UPDATES

The BAF currently comprises a total of 10 risks relating to the 7 strategic objectives of the CCG for 2019/20.

The risk ratings within the BAF are broken down as follows:

Risk Category Number of risks Risk References High (16+) 4 SC19_11c SC19_11a AG18_06a QS19_01a

Moderate (8-15) 3 PC10_18b OD01_19a QS19_11

Low (5-7) 1 SC02_19a

Very Low (1-4) 1 SC19_11b (awaiting closure) QS05_19a (awaiting closure)

The ‘High’ rated risks are detailed below (please see appendix for full detail)

Reference Likelihood Impact Committee Owner Description

SC19_11c 4 4 SCR Rachael Due to urgent transition of the 111 Ellis service (SC11_19b) there is an opportunity to redesign the service spec to integrate 111&999. timescales and lack of suitable providers mean there is a risk of a contract award without open procurement. SC19_11a 4 4 SCR Sharon If the Integrated Care Partnerships do Liggins not deliver increased efficiencies (finance and Quality) through integration during 2021, this will have a negative impact on service delivery, patient experience and financial strategy for next year. AG18_06a 4 4 A&G James Potential reputational damage to the Green CCG if Vanguard do not deliver value for money following the investment made by NHSE nationally. QS10_01a 4 4 Quality and Michelle If the CCG cannot engage and support Safety Carolan the provider market successfully, in order to meet the needs of the TCP patients Then the treatment of patients will potentially be unsafe and/ or of poor quality.

4. RECOMMENDATIONS

It is recommended that the Governing Body receive the updated BAF for information. Audit Governance Report - Open on BAF

25 February 2020 Page 1 of 13 AG18_06a Description Potential reputational damage to the CCG if Vanguard do not deliver value for money following the investment made by NHSE nationally.

Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 4 16 S2 - Support the establishment of Integrated Provider Partnerships Current Probability Current Impact Current Risk Grading Committee 4 4 16 A&G - Julie Jasper Opened Controls Actions and Updates 29/07/2016 29/07/2016 - Quarterly national assurance visits; Partnership Vanguard Boar 29/07/2016 - Gain detailed financial information through Partnership Board 15/11/2016 - The CCG have a new care models programme board. Within this work stream is 15/11/2016 - Further updates due in December 2016. Reviewed a gateway assurance process. 17/11/2016 - Comment from A&G: Should this risk be moved to the Partnerships risk register? What is the mechanism 21/12/2016 - Payments have been suspended as no information has been received. BDO are for testing value for money, especially as the Vanguard had Prime Minister's challenge funding twice - how would this be 23/01/2020 currently undertaking work on our behalf with a report expected at the end of January 2018 accounted for separately from CCG investment. Initial Risk Level 20/12/2016 - Risk reviewed, remains the same. 20/02/2017 - Value for money managed through quarterly assurance visits between NHS E/Care Connected Partnership. I - High (16+) CCG has oversight however still need to consider reputational risks. Risk to be transferred to NCM Risk Register when committee has been established formally. Current Risk Level Rating Tracker 14/03/2017 - Risk closed - Transferred to NHS E, as is not owned by SWB CCG. Risk reduced to 1 (Transfer) 20/04/2017 - Reviewed by A&G Committee: Closure request rejected. Committee should re-consider what residual C- High (16+) 14/03/2017 - Risk reduced to 1 (Transferred) remains for the CCG, even if controls lie with other organisation. 21/12/2017 - Risk increased to 16 (transferred to A&G) 25/05/2017 - NCM advised there are no residual risks, therefore risk Transferred and closed. Status 15/06/2017 - A&G advised that the risk still exists. If it has been transferred, please state to whom. Open - On BAF 27/11/2017 - Risk is held by NHS E, therefore close (Transferred to NHSE). 21/12/2017 - Reviewed at A&G and it was felt that this is still a risk to the CCG from an assurance point of view. Closure Requested Gaps in Controls Payments have been suspended as no information has been received. BDO are currently undertaking work on our behalf 29/07/2016 - Lack of financial detail submitted to board- high level lines only with a report expected at the end of January 2018 Risk should be transferred to the A&G risk register and rated at 4 x 4 Closure Reason (16) 18/01/2018 - Risk Reviewed at A&G. work by BDO is continuing and a report is expected by end of January risk currently remains the same 15/02/2018 - Risk Reviewed at A&G committee, work is ongoing. BDO added as standing item on A&G agenda for Closure Approved Internal Assurances update and discussion. 29/07/2016 - CCG membership of Partnership vanguard Boar. 15/03/2018 - Risk Reviewed at A&G committee - Remains the same Closure Approved Date 15/11/2016 - NCM Programme Board. 19/04/2018 - Risk Reviewed , Remains the Same 20/12/2016 - NCM Working group. 24/05/2018 - Risk Reviewed , Remains the Same 21/06/2018 - Risk Reviewed, Remains the same. Risk reference changed to reflect A&G committee ownership. 19/07/2018 - Risk Reviewed at A&G and as part of the BAF. Remains the same pending receipt of a final report. Closure Rules External Assurances 16/08/2018 - Risk Reviewed, NHS E and BDO are still finalising the report. The report finalisation is expected to take a few more months. Risk remains the same pending final report. 29/07/2016 - NHSE assurance quarterly vanguard meetings Approval Required 25/09/2018 - Report awaited. Risk remains the same from GB 15/11/2018 - Risk Reviewed, Remains the same pending receipt of final report. 20/12/2018 - Risk Reviewed, Remains the same Responsibility 21/02/2019 - Risk Reviewed, still awaiting finalisation of report. Remains the same James Green Gaps in Assurances 21/03/2019 - Risk Reviewed by A&G committee, BDO have been chased for finalised report but as yet this is still to be received, . Risk remains the same ID 29/07/2016 - No detailed financial breakdown report (continued on Page 2 of risk) 52

25 February 2020 Page 2 of 13 AG18_06a.1 Description Potential reputational damage to the CCG if Vanguard do not deliver value for money following the investment made by NHSE nationally.

Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 4 16 S2 - Support the establishment of Integrated Provider Partnerships Current Probability Current Impact Current Risk Grading Committee 4 4 16 A&G - Julie Jasper Opened Controls Actions and Updates 29/07/2016 (continued from page 1 of risk) (continued from page 1 of risk) 21/12/2016 - Payments have been suspended as no information has been received. BDO are 18/04/2019 - Risk Reviewed, a date is being arranged for the final report to be discussed between BDO and the CCG. Reviewed currently undertaking work on our behalf with a report expected at the end of January 2018 Risk remains the same pending outcome of meeting. 23/05/2019 - Risk Reviewed, Remains the same 23/01/2020 18/07/2019 - Risk Reviewed, remains the same Initial Risk Level 17/10/2019 - Risk Reviewed, a discussion with NHS E has been undertaken, awaiting update following this. Risk remains the same. I - High (16+) 21/11/2019 - Risk Reviewed, committee discussed in detail, howeveer, no frther update has been received from NHS E. CFO will chase up. Remains the same Current Risk Level Rating Tracker 23/01/2020 - Risk Reviewed, meeting scheduled to discuss today following audit committee. No change until further update received. C- High (16+) (See page 1 of Risk) Status Open - On BAF Closure Requested Gaps in Controls ( see page 1 of risk) Closure Reason

Closure Approved Internal Assurances (continued from page 1 of risk) Closure Approved Date 20/12/2016 - NCM Working group.

Closure Rules External Assurances Approval Required (see page 1 of risk) from GB Responsibility James Green Gaps in Assurances ID (see page 1 of risk) 347

25 February 2020 Page 3 of 13 OD01_19a Description There is a risk of an increase in staff turnover due to uncertainty of the future of the CCG and if it is not properly managed then this could have an impact on remaining staff, delivery of CCG functions and significant loss of organisational memory.

Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 4 16 S4 - Review / Performance Monitor, take corrective actions / discharge public accountabilities Current Probability Current Impact Current Risk Grading Committee 3 4 12 OD - Alice McGee Opened Controls Actions and Updates 15/01/2019 OD Committee review turnover on a monthly basis to identify trends 15/01/2019 - risk Reviewed, Draft OD strategy and plan for staff engagement approved at committee today. Risk Chief Officers review vacancies as they arise to consider replacement or change in function and remains the same Reviewed delivery 12/02/2019 - Risk Reviewed, the workforce dashboard currently shows an increase in turnover in January, however, this 09/05/2019 - GB have already approved an interim arrangement for the AO position following is expected to reduce over the next couple of months. CCG senior team continue to talk to staff and communicate 07/11/2019 Andy Williams giving notice to resign. Options for the interim chair arrangements have been messages. Staff survey is now live which may give an indication of level of future risk. The OD plan will include plans for Initial Risk Level identified and are being taken to the next meeting of the governing body for a decision. resilience and supporting staff. Remains the same, continue to monitor 12/03/2019 - Risk Reviewed, work is continuing between the black country CCG's to discuss staff retention. Risk appetite I - High (16+) to be discussed in more detail at a GB development session. Any additional related risks will also be identified and brought back to OD next month. Remains the same Current Risk Level Rating Tracker 15/05/2019 - Risk Reviewed, work is ongoing and the OD plan and Staff survey action plan are in motion. OD committee are considering the potential impact of the AO and Chair both resigning. GB have already approved an interim C - Moderate (8-15) arrangement for the AO position following Andy Williams giving notice to resign. Options for the interim chair arrangements have been identified and are being taken to the next meeting of the governing body for a decision. Status Remains the same. Open - On BAF 08/07/2019 - Staff turnover has decreased but could peak in early autumn when the Single Accountable Officer is appointed. Committee agreed for risk to stays the same. Closure Requested Gaps in Controls 03/09/2019 - Risk Reviewed at OD, Turnover of staff has flattened but it is anticipated that this will increase again going OD Strategy and plan to ensure staff retention is a key plan for the next 12 months into the Autumn months. Remains the same. Closure Reason 07/11/2019 - Risk Reviewed at OD, we haven't seen the spike to the extent that we were anticipating, some of this may be due to the CCG supporting secondment opportunities rather than staff permanently leaving. Work continues to engage staff and there are two all staff events for all staff from the 4 CCG's to attend together. CCG have invested in staff development via the growing you programme. Some small organisational changes have been made to ensure workload Closure Approved Internal Assurances pressures are alleviated as much as possible. OD would like each directorate to provide detail in terms of pressure points Reviewed by OD committee for the next meeting. Risk Remains the same. Closure Approved Date 15/01/2019 - draft OD strategy and Plan for staff engagement approved at OD committee 08/07/2019 - there is good staff engagement from Staff Council and Staff Survey with an action plan to be developed and implemented over the next 12 months Closure Rules External Assurances Approval Required 07/11/2019 - HR director position will be appointed across all 4 CCG's following the successful from GB recruitment of the single AO. Responsibility Alice McGee Gaps in Assurances ID 329

25 February 2020 Page 4 of 13 PC10_18b Description If Primary Care Networks (PCNs) do not mature at the pace the CCG requires this could have an impact on the delivery of the CCGs commissioning intentions from 2019/20.

Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 4 16 S2 - Support the establishment of Integrated Provider Partnerships Current Probability Current Impact Current Risk Grading Committee 3 3 9 PCCC - Carla Evans Opened Controls Actions and Updates 04/10/2018 04/10/2018 - Primary Care Networks have received £1.50 per head of population in 2018/19 04/10/2018 - CCG officers are working both with PCNs to generate momentum and progress along the maturity matrix. to support their formation and the development of a workforce strategy for their individual External facilitation for PCNs where required has been commissioned to support the process of them coming together Reviewed network. and forming their governance and action plans. All efforts are now being focused on the development of PCNs. Monthly Primary Care Leads meetings are in place to generate momentum and progress along 19/10/2018 - PCCC have approved a number of schemes funded from the GPFV transformation money to support the 23/01/2020 the maturity matrix. continued development of the PCNs. The schemes approved are as follows: Initial Risk Level The leads, deputies and operational staff from the PCNs have completed 'Time for Care 1. Each PCN will receive £30k fixed costs and circa 50p per patient for signing up to a new MOU which requires Fundamentals of Change' and 'Improvement Two Day Leadership Programme'. them to reach stage 3 of the I - High (16+) Each PCN has produced an organisational development plan and received £5k of funding to maturity matrix by March 2020. hold an OD event for their network. 2. Bespoke OD Support for PCNs will be commissioned to offer intensive organisational development dependent Current Risk Level Rating Tracker upon their own varied needs. 3. Clinical backfill is being funded to allow the release of staff from practices to attend their PCN’s series of Action C - Moderate (8-15) Learning Sets (part of the Releasing Time for Care Programme). Status 4. A legal workshop for PCNs to explore the options open to them in forming organisations will be held. Open - On BAF 5. The original £1.50 per head of population funding given to PCNs in 17/18 will be made available to networks who take on the two practices Closure Requested Gaps in Controls that are not currently part of a network. No gaps in controls. 15/11/2018 - By the end of November all PCNs will have completed their first Action Learning Set as part of the Releasing Closure Reason Time for Care Programme. Monthly PCN Leads meetings are continuing to support and galvanise the PCNs and the legal session to explore the options open to networks in forming organisations is being held on 20th November. We are currently working on drawing up an MOU for PCNs which describes what is expected for the additional investment being made in order for them to reach stage 3 of the maturity matrix. Closure Approved Internal Assurances 13/12/2018 - Risk reviewed at PC Ops , no change to current risk. 04/10/2018 - PCDMs are aligned to PCNs and their roles re-focused to influence, facilitate and 24/01/2019 - The operating plan guidance has been confirmed recurrent funding of £1.50 per head for PCNs from Closure Approved Date enable the PCNs to progress along the maturity matrix. 2019/20 onwards. In addition, we understand that a PCN Directed Enhanced Service will also be commissioned from Other teams within the CCG are working to realign themselves based on networks rather than 2019/20, bringing with it further additional funding. This will allow networks to move forward the work of the PCN. The LCGs. draft 2019/20 MOU for PCNs has been taken through PCCC in January and discussed with PCN leads on 17/01. The final version of this will come back to PCCC in February for approval. This will provide PCNs with a clear focus of what is Closure Rules External Assurances required to ensure they continue to mature as organisations and put themselves in the best place to engage in the emerging ICS system. Discussions between networks have also started on a place basis as they start to think about how 04/10/2018 -A Primary Care Networks Guide has been published by NHSE. Approval Required they can form a strong Sandwell and West Birmingham primary care voice within the place based alliances. A regional PCNs event is due to take place on 16th October. from GB 28/02/2019 - Risk reviewed, the five-year framework for GP contract reform to implement The NHS Long Term Plan was published on 31st January providing further detailed information around the Network Contract DES which will come into Responsibility force on 1st July 2019. It is clear from the framework that the £1.50 recurrent funding required from CCGs will form a Carla Evans Gaps in Assurances Network Administration payment within the DES. It was agreed at the February PCCC that we would await the detail of the DES before making a decision on whether to invest further in PCNs to deliver a local MOU linked to the network ID 04/10/2018 - The longer term financial support for Primary Care Networks is not clear. maturity matrix. There is also an ongoing conversation around the acceptable geography for the PCNs with CCGs being 319 required to approve the final network configuration toward the end of May 2019 remains the same.

25 February 2020 Page 5 of 13 PC10_18b.1 Description If Primary Care Networks (PCNs) do not mature at the pace the CCG requires this could have an impact on the delivery of the CCGs commissioning intentions from 2019/20.

Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 4 16 S2 - Support the establishment of Integrated Provider Partnerships Current Probability Current Impact Current Risk Grading Committee 3 3 9 PCCC - Carla Evans Opened Controls Actions and Updates 04/10/2019 (Continued from Page 1 of risk) (continued from page 1 of risk) Each PCN has produced an organisational development plan and received £5k of funding to 16/07/2019 - Our 15 PCNs officially went live on 1st July 2019 and are delivering the requirements of the Network Reviewed hold an OD event Contract DES. Toby Lewis attended the PCN Clinical Directors meeting in July to discuss the formation of the two place for their network. based alliances and networks are now in discussions around the level on which they wish to sign up to the alliance. 23/01/2020 Four cohorts of 'Action Learning Sets' are being put in place for PCNs. 08/08/2019 - The PCN Development Support Guidance and Prospectus has been published by NHSE setting out the Initial Risk Level ambitions and expectations of PCNs by March 2020 and over the next 5 years. We continue to work closely with our PCNs to support their development against these. I - High (16+) 12/09/2019 - Risk Reviewed - 5 PCNs have been accepted onto the Dartmouth PCN Development Programme which aims to support PCNs in developing clinical transformation within their teams. It is aimed at enabling each PCN team to Current Risk Level Rating Tracker develop key capabilities and apply essential measures and tools for integrating health and care. In addition we are due to receive an allocation from the central STP pot to support PCN development this year. Discussions are currently C - Moderate (8-15) ongoing to determine the options for spending this. Remains the same 24/10/2019 -Risk Reviewed, 14 of our PCNs have now summitted the first iteration of their business plans which are all Status at the appropriate stage of development against the LIS. Feedback has been provided to individual networks on points Open - On BAF to consider/include for the next quarterly update and further engagement will continue with the individual networks via the PCDMs and GPFV clinical leads. Risk score reduced to 9 (3 and 3). Closure Requested Gaps in Controls 28/11/2019 - Risk Reviewed, We now have the first itteration of all PCNs Business Plans and all networks presented a No Gaps in Controls single slide summarising their strategies at this months PCN Clinical Director's meeting. We have asked them to Closure Reason complete a strategy on a page. 23/01/2010 - Risk Reviewed, The PCN DES service specifications were published on 23rd December and the view of our PCNs is that they are undeliverable in their current form. We are awaiting the outcome of the national consultation and contract negotiations to understand what the requirements will actually be for 20/21. PCN assurance visits have Closure Approved Internal Assurances commenced and to date are confirming the different stages of maturity of each of the PCNs. (continued from page 1 of risk) Closure Approved Date The development of PCNs is a standing agenda item on the GPFV Monitoring Group monthly meetings. The two GPFV clinical leads and the new care models clinical leads are supporting and Closure Rules External Assurances Approval Required (see page 1 of risk) from GB Responsibility Carla Evans Gaps in Assurances ID (See page 1 of risk) 350

25 February 2020 Page 6 of 13 QS05_19a Description BSOL CCG does not have a designated lead for Adult Safeguarding and there is a risk that this could affect the safety of our patients belonging to West Birmingham practices.

Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 4 16 S1 - Partnerships with Other Commissioners Current Probability Current Impact Current Risk Grading Committee 1 1 1 Q&S - Michelle Carolan Opened Controls Actions and Updates 20/05/2019 20/05/2019 - No control for SWB CCG 20/05/2019 - The safeguarding assurance group in may were made aware of 2 risks that are on BSOL CCG's risk register. The risks are as follows: Reviewed - • “There is a risk in that we have no co-ordinated response to managing enquiries delegated to the CCG. Adults with care and support needs who are in need of protection (Care Act 2014, section 42 Enquiries and delegated enquiries – 24/02/2020 process to determine what actions are necessary to safeguard an adult)." Initial Risk Level - • “Statutory processes relating to Deprivation of Liberty (DoLs) standards may not be consistently applied by all providers because effective systems and processes are not in place”. I - High (16+) BSOL CCG provides adult safeguarding under the MOU for our West Birmingham member practices. The lack of resource is a risk for SWB CCG and its west Birmingham practices. Current Risk Level Rating Tracker Update from BSOL states: Part of reviewing structures. Plans to mitigate. working through employment issues for ensuring a) dedicated administrative resource – band 3/4 resource is identified within the quality and nursing directorate C - Very Low (1-3) to track and progress section 42 enquiries and complex cases. B) dedicated safeguarding adults/ mental capacity act operational professional oversight of cases. Status 17/06/2019 - Risk Reviewed, Adult SG resource I is yet to be identified at BSOL CCG. BSOL CCG are not compliant with Open - On BAF statutory requirement for adult Safeguarding. Chief Nurse is now appointed and in post and the restructure will now commence. Remains the same Closure Requested Gaps in Controls 09/08/2019 - Risk Reviewed, Chief Nurse for BSOL CCG now in post and has met with Deputy Chief Officer for SWB CCG. 20/5/2019 - BSOL CCG have stated that limited controls are currently in place to ensure CCG Awaiting progress update. Remains the same Closure Reason has an effective process in place. Operationally, no dedicated resource to track, co-ordinate 21/10/2019 - recruitment to the post is currently underway. Remains the same and analyse the responses within the existing structures. Operational; delivery of tracking, co- 16/12/2019 - Diane Rowden, Head of Safeguarding at Birmingham & Solihull is overseeing adults safeguarding, remains Mitigated ordinated monitoring and timely analysis of cases. the same 24/02/2020 - Risk Reviewed, Post has now been appointed into and all functions are now covered. Risk fully mitigated. Closure Approved Internal Assurances Closure requeusted. 20/05/2019 - Regular updates via Safeguarding Assurance Group Closure Approved Date

Closure Rules External Assurances Approval Required 20/05/2019 - BSOL CCG Internal monitoring and reporting structure into the Safeguarding from GB Assurance Group, escalating by exception through to Quality and Safety Committee. Meeting held on 13.3.2019. Operational lead and associated resource to be identified as part of Nursing Responsibility & Quality re-structure - in progress. Eileen Welch Gaps in Assurances ID 20/05/2019 - although work is being absorbed by other members of the team there is a freeze 344 on recruiting to posts until after the restructure.

25 February 2020 Page 7 of 13 QS19_01a Description If the CCG cannot engage and support the provider market successfully, in order to meet the needs of the TCP patients Then the treatment of patients will potentially be unsafe and/ or of poor quality.

Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 4 16 S4 - Review / Performance Monitor, take corrective actions / discharge public accountabilities Current Probability Current Impact Current Risk Grading Committee 4 4 16 Q&S - Michelle Carolan Opened Controls Actions and Updates 21/01/2019 21/01/2019 - Risk added to Q&S risk Register. TCP paper presented to Q&S today in relation to figures of Sandwell and West Birmingham Patients. Work is ongoing but SWB CCG are an outlier in terms of numbers. Risk graded at 16 Reviewed 18/02/2019 - Risk Reviewed at Q&S committee. Remains the same 18/03/2019 - Risk Reviewed at Q&S committee. Remains the same 24/02/2020 15/04/2019 - Risk Reviewed at Q&S committee . Remains the same Initial Risk Level 20/05/2019 - Risk Reviewed at Q&S committee . Remains the same. the Q&S committee discussed routes for escalation of this risk. Detailed updates required for this risk in order to identify where mitigating actions can be taken. Summary I - High (16+) around the challenges and actions required for June committee. 17/06/2019 - Risk Reviewed, TCP are engaging on a black country level with the market of providers to mature the Current Risk Level Rating Tracker services available. There is a plan in place for procurement for a complex framework across the black country. Remains the same C- High (16+) 21/01/2019 - Initial Rating 16 (on BAF) 09/08/2019 - Risk Reviewed, whilst we continue to engage effectively with the market, because of the small numbers of patients involved the issue is around the viability of creating new services. Remains the same Status 21/10/2019 - Risk Reviewed, a system response to market engagement has been initiated to try and identify sustainable Open - On BAF options for placements moving forward. Remains the same 16/12/2019 - Risk Reviewed, Remains the same Closure Requested Gaps in Controls 24/02/2020 - Risk Reviewed, no update received at meeting, to be chased. Remains the same

Closure Reason

Closure Approved Internal Assurances 21/01/2019 - Reviewed monthly at Q&S committee Closure Approved Date

Closure Rules External Assurances Approval Required The TCP board meet monthly with all partners to provide assurance of delivery of the Black from GB Country Transforming Care Programme and oversees progress across all of its sub- programmes and projects Responsibility Michelle Carolan Gaps in Assurances ID 330

25 February 2020 Page 8 of 13 QS19_11 Description If the rates of dementia screening and diagnosis don’t increase within sandwell and West Birmingham there could be a risk to patient outcomes and quality of life in addition to a failure to meet nationally set targets

Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 3 12 S7 - Deliver and improve against national and regional clinical priorities Current Probability Current Impact Current Risk Grading Committee 4 3 12 Q&S - Michelle Carolan Opened Controls Actions and Updates 16/12/2019 Dementia screening is included as a standard in the PCCF. Risk identified at GB development session during review of the BAF. 24/0 16/12/2019 - Risk Reviewed. Remains the same, update through Primary Care Commissioning Committee and to be Reviewed brought back to February’s Quality & Safety meeting. 24/02/2020 - Risk Reviewed at Q&S. SCR committee have committed additional funding to provider two individuals to 24/02/2020 spport practices in increasing dignosis rates through new ways of working and support in terms of guidence. Further Initial Risk Level more detailed update in terms of rates and figures to be sought. Remains the same

I - Moderate (8-15)

Current Risk Level Rating Tracker C - Moderate (8-15) Status Open - On BAF Closure Requested Gaps in Controls

Closure Reason

Closure Approved Internal Assurances 24/02/2020 - SCR have committed additional funding to secure two individuals to support Closure Approved Date practices in increasing assesments and dignosis. SCR to receive update on screening and dignosis rates 24/02/2020 - PCCF is monitored via PCCC Closure Rules External Assurances Approval Required from GB Responsibility Gaps in Assurances ID 363

25 February 2020 Page 9 of 13 SC02_19a Description Because of a decision made by Governing Body to support SWBHT to withdraw services from Halcyon Midwifery Led Centre and close the facility without prior service user engagement, the CCG are at risk of Legal challenge and potential reputational damage.

Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 4 16 S4 - Review / Performance Monitor, take corrective actions / discharge public accountabilities Current Probability Current Impact Current Risk Grading Committee 2 2 4 SCR - Angela Poulton Opened Controls Actions and Updates 07/02/2019 14/03/2019 - WHN have been invited to engage with CCG through the Maternity Voices 07/02/2019 - Risk Discussed by SCR and added to the risk register. Communication received citing CCG’s legal duty to Partnership. involve and engage with service users. Reviewed Meeting arranged however was cancelled due to last minute changes to meeting terms. Update from JSS required. 28/02/2019 - There were 2 meetings in February - 7th Feb with the Women's Health Network and another 13th February 16/01/2020 with Malcolm Alexander and the Women's Health Network. There was discussion around the decision re Halcyon and Initial Risk Level other issues/concerns. It has been agreed that the CCG will work with the WHN in the coming months to work through issues raised and seek to make any changes in service provision where appropriate as a response. Propose risk I reduced I - High (16+) to 2x2 SCR to discuss 14/03/2019 - Risk Reviewed, There have been 2 meetings held in February - 7th Feb with the Women's Health Network Current Risk Level Rating Tracker and senior members of the CCG and another 13th February with Malcolm Alexander (Chair of Healthwatch and Public Involvement Association - HAPIA) and the Women's Health Network and senior members o the CCG. AO channelled the C - Low (4-7) 14/03/2019 - Risk Reduced 2x3 meeting to focussing those present to raise the issues, discuss them and if Halcyon presents itself as the solution then 09/05/2019 - Risk reduced to 4 this can be discussed. It has been agreed that the CCG will identify specific resources to work with the WHN to consider Status their concerns/issues and where agreed that a response is required any necessary actions will be implemented. The Open - On BAF WHN have been invited to engage with the CCG through the Maternity Voices Partnership. An action plan will be drawn up over the coming months, and this process will commence at the meeting with local women and their representatives Closure Requested Gaps in Controls scheduled for April. The intention is to engage the WHN and secure their agreement to the action plan developed and there is the view that the risk needs to remain on the register until the plan has been delivered. Risk reduced due to Closure Reason communication between parties. 2x3 04/04/2019 - The first meeting of the Maternity Voices Partnership has been held, further update required regarding risk from Engagement team. Remains the same 09/05.2019 - Risk Reviewed, SERG are having conversations and exploring options for alternative use of the space. Jayne Salter-Scott updated the committee around the risk of legal challenge and Closure Approved Internal Assurances it is considered that this element is no longer a risk to the CCG. The risk around reputational damage to the CCG remains 07/02/2019 - CCG have sought advice from its legal services provider. somewhat. MVP continue to engage with the community who raised a dispute over the closure or Halcyon, despite huge Closure Approved Date 14/03/2019 - CCH have held 2 meetings with concerned parties and have agreed on steps to efforts no one has come forward to take responsibility for the lease costs. SERG will continue to explore options and move forward. update to SCR. As one element of the risk has been identified as no longer posing a risk the risk is being reduced to 2x2 13/06/2019 - Risk Reviewed, MVP work is ongoing Remains the same 18/07/2019 - Risk Reviewed, Remains the same 12/09/2019 - Risk Reviewed, committee agreed that the duty to engage Closure Rules External Assurances with the public was weighed with the duty to protect the public purse and had extensive information on its utilisation to support the decision. The case was also supported fully by Sandwell Health and Wellbeing Board. Remains the same 07/02/2019 - SWBHT presented statistics of usage of the centre to the CCG that show very Approval Required currently. 10/10/2019 - Following the Maternity Voices Partnership paper received today (item 5.7) this will mitigate little use of service. from GB some of this risk. Following discussion, it was agreed that the risk should remain unchanged at this stage 14/11/2019 - 12/09/2019 - decision was fully supported by Sandwell Health and Wellbeing Board The advert is out for the Chair of the Maternity Voices Partnership and procurement advisors in Arden & Gem CSU are Responsibility reviewing the best way to procure. Risk to remain the same Jayne Salter - ScottGaps in Assurances 12/12/2019 - Risk Reviewed, The Maternity Voices Partnership procurement is underway, and the service will launch from 1st April 2020. The CCG will request an action plan from the successful organisation from the point at which they ID commence the service. Once the action plan is received, this risk can be closed 334 16/01/2020 - risk reviewed, no change

25 February 2020 Page 10 of 13 SC19_11a Description If the Integrated Care Partnerships do not deliver increased efficiencies (finance and Quality) through integration during 2021, this will have a negative impact on service delivery, patient experience and financial strategy for next year.

Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 4 16 S2 - Support the establishment of Integrated Provider Partnerships Current Probability Current Impact Current Risk Grading Committee 4 4 16 SCR - Angela Poulton Opened Controls Actions and Updates Financial Management, responsive commissioning where necessary, Quality control and Risk identified during Governing Body review of Board Assurance Framework and risks against Strategic Aims. SCR strident performance monitoring by the CCG. committee ownership identfied. Reviewed 12/12/19 - Risk reviewed, no change 16/01/2010 - Risk Reviewed. Committee discussed he risk and what level of control the SCR commmittee has in 16/01/2020 mitigation the risk. Further understanding required. Lisa Maxfield to be invited to next meeting to discuss alliance work Initial Risk Level and how SCR committee keep informed of the progress being made. No change currently

I - High (16+)

Current Risk Level Rating Tracker C- High (16+) Status Open - On BAF Closure Requested Gaps in Controls CCG do not singularly control the development and maturity of either ICP. Closure Reason

Closure Approved Internal Assurances Executive representation on Both ICP boards. Healthy lives partnership fortnightly meetings Closure Approved Date chaired by an independent chair.

Closure Rules External Assurances Approval Required Independent chair for both ICP boards. ICS is mandated and ICP’s will make up ICS (in from GB conjunction with Black country places) Responsibility Sharon Liggins Gaps in Assurances ID ICP’s do not report to SCR. 359

25 February 2020 Page 11 of 13 SC19_11b Description early exit of the provider of NHS 111 (Care UK), the CCG holds a risk in identifying and mobilising a new service provider in the time provided, potentially resulting in major service disruption.

Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 4 16 S5 - Integrated Urgent and Emergency Care Current Probability Current Impact Current Risk Grading Committee 1 1 1 SCR - Angela Poulton Opened Controls Actions and Updates Significant IU&EC Team staffing time, legal advice and resources have gone in to securing an Risk identified during Governing Body review of Board Assurance Framework and risks against Strategic Aims. SCR alternative provider for the service. Regular updates including options appraisals and impact committee ownership identfied. Reviewed statements delivered to S&WB CCG Governing body throughout the process. Underpinning 15th May 19 – Meeting called by Care UK following their Board decision to not seek an extension to the current contract. the GB is a weekly Transition Board and Clinical Governance Group Care UK preference is for an alternative provider to be found and mutually agree and early exit. 2 Caveats - All staff must 12/12/2019 service transition had proved successful and achieved good performance over the first few be TUPE’d and New Provider to take on Nav Point. Initial Risk Level months. 28th May – Care UK confirmed full commitment to delivery until July 2020 & would yield up the contract earlier providing Navigation Point would transfer to a new provider. 31st May –Confidential talks with WMAS CEO take place for them to be the step-in provider. 28th June – Agreement reached on transfer of111/IU to WMAS Current Risk Level Rating Tracker 1st July – Care UK meeting confirmed they would not challenge any interim / step in arrangement from Nov 19. 9th August Letter to Care UK to confirm CCG has secured the early transfer of the service to WMAS on the 5th C - Very Low (1-3) November. 18th September – Weekly Transition Board established to plan mobilisation of new service and decommissioning of Care Status UK. Weekly Transition plan highlight teleconference also established. Open - On BAF 5th November – WMAS step-in as service provider for West Midlands NHS 111/CAS. 1st – 7th November - - Daily WM Alliance 111/CAS put in place. Closure Requested Gaps in Controls 5th November - Full service offer transitioned from Care UK to WMAS. All contracts signed for this arrangement to No Gaps in Controls identified. continue in place to 31st March 2020 Closure Reason 6th January 2020 - Recommended that risk is now closed. 8/01/2019 - It was reported at the meeting of the Governing Body that the service performed extremely well during the Mitigated christmas period. Ambulance Response times were within the monthly aggregated national standards for the entire period. Front end 111 performance was above the national average and progress continues to be made in reducing the Closure Approved Internal Assurances volume of activity that is directed from 111 to 999 or ED. Transition of the service to the new provider has proved Monthly updates to GB from SRO Rachael Ellis. sucessful and therefore risk is mitigated. Reduced to 1 Closure Requested. Closure Approved Date Updates also issued on a frequent basis to West Midlands Alliance member CCGs and STP leads 23/01/2019 - risk reviewed at Audit committee for closure. Closure recommended to Governing Body.

23/01/2020 Closure Rules External Assurances Approval Required Very strong engagement in weekly Transition Board from all parties. Board underpinned with from GB weekly teleconference calls with all workstream leads throughout September and October 2019 Responsibility NHS Midlands lead sits on weekly Transition Board Rachael Ellis Gaps in Assurances ID 26/10/19 - None Identified 360

25 February 2020 Page 12 of 13 SC19_11c Description Due to urgent transition of the 111 service (SC11_19b) there is an opportunity to redesign the service spec to integrate 111&999. timesclaes and lack of suitable providers mean there is a risk of a contract award without open procurement.

Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 4 4 16 S5 - Integrated Urgent and Emergency Care Current Probability Current Impact Current Risk Grading Committee 4 4 16 SCR - Angela Poulton Opened Controls Actions and Updates Significant IU&EC Team staffing time, legal advice and resources have gone in to securing an Risk identified during Governing Body review of Board Assurance Framework and risks against Strategic Aims. SCR alternative provider for the service and capitalising on the opportunity to commission a joint committee ownership identfied. Reviewed 999/111 service for 2020-2025. 15th May 19 – Meeting called by Care UK following their Board decision to not seek an extension to the current contract. Regular updates including legal updates, options appraisals and impact statements have been Care UK preference is for an alternative provider to be found and mutually agree and early exit. 2 Caveats - All staff must 16/01/2020 delivered to S&WB CCG Governing body & West Midlands CCG AO’s throughout the process. be TUPE’d and New Provider to take on Nav Point. Initial Risk Level 31st May –Confidential talks with WMAS CEO take place for them to be the step-in provider. 9th June - Significant consultation and work has taken place with CCGs legal advice partner. As this is new ground- I - High (16+) breaking healthcare redesign, that responds to factual local learning and emerging policy, it does carry a level of risk and the legal advice rates the risk as small to medium. Current Risk Level Rating Tracker 28th June – Agreement reached on transfer of 111 to WMAS 8th July - Options appraisal on future commissioning routes and legal analysis circulated to West Midlands CCG AO’s C- High (16+) 9th August Letter to Care UK to confirm CCG has secured the early transfer of the service to WMAS on the 5th November. Status 16th August - West Midlands CCG AO informed in writing that legal advice has been sought in respect of compliance with Open - On BAF The Public Contract Regulations, specifically the regulations which allow for a direct award where services can only be supplied by one economic operator. Closure Requested Gaps in Controls 17th October - West Midlands CCG AO informed in writing that temporary Contract created that includes a bespoke No Gaps in Controls identified. mechanism to monitor actual costs on a monthly basis. This has been developed to retain the agreed financial principle; Closure Reason where monies are not utilised during mobilisation, they will be returned to Commissioners. 5th November – WMAS step-in as service provider for West Midlands NHS 111/CAS. Further work on the development of the 999/111 service specification and contract vehicle on-going 9th December – Draft service specification issued to all CCGs for comment. Deadline for feedback is 20th December Closure Approved Internal Assurances 8th January 2020 - Final draft to be issued to CCGs and WMAS week ending 17th January 2020 Monthly updates to GB from SRO Rachael Ellis. 16/01/2020 - risk reviewed. Spec to be brough to SCR when in final draft form. Remains the same Closure Approved Date Updates also issued on a frequent basis to West Midlands Alliance member CCGs and STP leads

Closure Rules External Assurances Approval Required NHS Midlands lead sits on weekly Transition Board from GB Responsibility Rachael Ellis Gaps in Assurances ID 29/10/19 - None Identified 361

25 February 2020 Page 13 of 13

SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP Audit & Governance Committee

Minutes of the Meeting held on Thursday 21st November 2019 Board Room 2F Kingston House 10:00 – 12:00hrs

Members: Julie Jasper JJ Chair Karl Grindulis KG Lay Member Janette Rawlinson JR Lay Member Priyanand Hallan PH Clinical Director Theresa MacMahon TcM Vice Chair

In Attendance: David Hughes DH Deputy CFO Matthew West MW Financial Controller Tracey Barnard-Ghaut TBG Assistant Director CW Audit Susan Astley SA Interim Executive Assistant to CFO James Green JG Chief Finance Officer Jodi Woodhouse JW Governance Manager Kathy Lyons* KL Partnership Development Manager

Apologies: Paul Capener PC Head of IA CW Audit Ranjit Sondhi RS Lay Member Paul Westwood PW Counter Fraud

*Denotes part attendance

This meeting will be recorded purely as an aide memoir for the minute taker to ensure an accurate transcript of the meeting, decisions and actions. Once the minutes have been approved the recording will be destroyed.

Item Subject 1. Apologies: Apologies were noted and the Chair declared the meeting quorate.

2. Declarations of Interest:

Sandwell & West Birmingham CCG Page 1 Audit & Governance Committee Thursday 21st November 2019

To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item.

• No conflicts of interests were identified.

3. Minutes of the previous meeting held on Thursday 17th October 2019 The minutes of the previous meeting held on Thursday 17th October were accepted as correct.

4. Action Register: The action register was discussed and updated accordingly as per the updated action register.

5. Chairman’s Report JJ discussed committees in common going forward and future Governance arrangements. Governance leads are producing a paper together to be tabled at the meeting scheduled for 4th December with all governing bodies around future governing structures. Following the meeting on the 4th December, the governance leads will put a report together which will be presented to the Transition Board on the 12th December, following Transition Board a report will be presented to GB in January.

JR asked what the timings were around these meetings and how do lay members feed in to get their views across if they are unable to attend. JW reported that slides will be circulated to all lay members, there will be 3 options around setting corporate days for future meetings requesting lay members to state their preferences. Another ask will be that lay members who attend Transition meetings to feed-back from the meeting to lay members unable to attend. JW stated it had also been agreed for Transition Board minutes to be sent to all lay members.

JR asked JW about the list of various committees as she couldn’t see anything for CHC or PHB work that is ongoing. JW replied it has been kept to committees reporting into GB at present, they would need to consider several sub-committees and working groups.

6. Internal Audit and External Audit

6.1 Audit Progress Report TBG presented the Audit Progress Report TBG reported in terms of the audit plan and possible changes to audit plan, since the last A&G meeting they have issued engagement letters for partnerships working arrangements, TBG said they have received a query back from Sharon Liggins (SL) asking if it would be possible to defer that audit and not undertake it this year. SL has suggested that given the current environment and the fact there has been little change she is not sure it would add value at this point in time as there is a possibility that a lot of the recommendations have not

Sandwell & West Birmingham CCG Page 2 Audit & Governance Committee Thursday 21st November 2019

yet been implemented. TBG agreed with SL that this would be brought to A&G to gain members views to see if they would want it delayed or undertaken as originally planned. JW reported that a lot of the recommendations from that audit were ones that were listed under Andy Williams name.

JR said she felt nervous about not following the recommended process on something that was moderate. JR said she was also concerned that having been appointed as the partnership lead, there is a need to work in partnership. JR said in their wish to be efficient for the use of staff could they please ensure they fulfil all the duties they have for assurance.

JG felt that SL’s view was there would be another full audit rather than a follow up review. JG has clarified back to SL that it is just a follow up on those previously agreed actions. Members agreed to follow up on the recommendations, get an update, and report it back as a quick piece of work which does not require a full audit.

JJ summarised with regards to partnership work, they would carry on with follow up audit which will give an updated position and to maintain integrity regarding governance on moderate assurance. JG agreed to communicate back to SL.

TBG reported other potential additions to the audit plan will be brought to the next A&G meeting.

TBG stated at the time of writing the report they had issued conflicts of interest draft report, since writing the report they have issued the draft report for QIPP arrangements providing significant assurance, hopefully these will be signed off and agreed in time for the next meeting.

Cumilitive Head of Internal Audit opinion remains as significant assurance. The element around commentary regarding partnership arrangements may or may not change dependant on the follow up work.

KPI’s – TBG reported management responses are moving in right direction.

ACTION: JG to have conversation with SL regarding follow up review.

6.2 Internal Audit Recommendation Tracking Report – November 2019 TBG presented the Internal Audit Recommendation Tracking Report Members confirmed that they were happy with the new report format including rag rating and layout.

JJ raised concern over a long-standing recommendation under AW name. JW reported that the new PM3 system identifies any piece of work that can contribute to QIPP, everything on the PM3 system and its progress is discussed at PMAG which is a sub-committee of SCR, therefore she feels there is a lot more governance around QIPP. JW said they could add to the update and then close. JW to have a conversation with Angela Poulton (AG).

DH suggested TBG issue an updated statement prior to the next A&G meeting in January. TBG agreed to issue an updated report at the beginning of December in order to allow

Sandwell & West Birmingham CCG Page 3 Audit & Governance Committee Thursday 21st November 2019

sufficient time for system updates prior to the next A&G meeting. TBG to send to DH and MW.

ACTION: JW to have conversation with AP around closing recommendation under AW ACTION: TBG to send update report to DH and MW in December prior to next A&G Committee

6.3 Internal Audit Letter – DP Toolkit Phase 1 TBG presented the Internal Audit Letter TBG reported this review is in the plan as 2 phases, the letter relates to 1st phase checking processes and controls are in place for the area, phase 2 will be undertaken in quarter 4 looking at the toolkit and the evidence.

6.4 NHS Key Developments Briefing Updates – October 2019 TBG presented the NHS Key Developments Briefing Update TBG provided the report for information which was taken as read.

7 Governance 7.1 Latent TB Waivers KL Presented the Laten TB Waivers An overview of the Latent TB programme and funding allocation was provided to the Committee. It was noted that the joint programme management arrangements with BSOL were ended and the CCG reviewed the pathways and services supporting latent TB testing and developed a plan to increase screening through extending community screening and increasing awareness around TB and latent TB.

As a result of the time available a proposal was put to PCCC to offer a range of partners some additional funding from an underspend in the budget to support the extension of community screening. The partners included SWBHT, Brushstrokes in Sandwell and the Refugee Migrant Centre in Birmingham. The focus of the proposal was to target new arrivals into both Sandwell and West Birmingham.

The proposal was agreed and the additional screening has commenced. It was also noted that plans are in place to further extend the screening programme into the Initial Accommodation Centres for Asylum seekers, homelessness services and drug/alcohol services.

It was agreed that an updated report with screening numbers would be produced for PCCC in order to complete the governance process. KL left the meeting 7.2 Changes in Authorisation Limits MW Presented Changes in Authorisation Limits MW reported the CCG currently only have 2 officers with authority to sign off invoices on the ledger for invoices over £100k, those being the AO and the CFO. Due to the changes in AO post and Paul Maubach’s limited availability the decision has been taken from A&G to

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increase the Chief Operating Officers approval limited to £250k this will ensure sufficient staff available to approve the processing of invoices in a timely manner. JW said this was for assurance at A&G and does not pose a high risk.

JG reported this was not for SL to approve the commitments of expenditure it is only for the processing of invoicing. This would ensure in the absence of JG SL would be able to approve invoicing up to £250k.

8 Risk Registers 8.1 Audit & Governance Risk Register AG18_06a - risk remains the same – discussion took place, no further update from NHSE, JG to chase.

8.2 Closure Requested Risks QS22 – agreed to close

9 Key Points 9.1 Governing Body • Significant assurance for head of internal audit opinion • Website – all staff should be responsible and advise changes to the website. • Closure of risks • Meeting taking place on 4th December

9.2 To Share with Staff • Website – all staff should be responsible and advise changes to the website.

10 Any Other Business JJ asked JW if there were any updates on compliance regarding conflicts of interest (COI) with GB members. JW said a member of her team was carrying out a piece of work to review this.

TM asked how questions from the public was managed at GB following a situation that had arisen at previous GB from a member of the public. JW to speak to Ian Sykes (IS) on how they go forward, JW suggested an explanation be added to the agenda for the purpose of the public regarding questions being submitted in advance of the meeting.

DH said following discussions at the last meeting regarding cyber security and phishing exercise which had taken place in Yorkshire, members of the committee had asked for it to be incorporated in respect to cyber security going forward. DH reported they are looking to get NHS Digital to carry out a piece of work whereby they carry out a test exercise to understand what the likelihood is of something going wrong with phishing emails.

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Members agreed it would be an idea for GB members to have discussion around cyber security. 11 Date and Time of Next Meeting 16th January 2020 @ 10am 2nd Floor Boardroom

Sandwell & West Birmingham CCG Page 6 Audit & Governance Committee Thursday 21st November 2019

Minutes of the SWBCCG Quality and Safety

Monday 16th December 2019 1-3pm, 2F, Boardroom, Kingston House

Present: Parmjit Marok – Quality & Safety Clinical Lead (Chair), SWBCCG

Karl Grindulis – Secondary Care Consultant, SWBCCG

Jon Boyd – Head of Medicines Quality, SWBCCG

Adele Hickman - Head of Contracts, SWB CCG

Marie Kelly - Designated Nurse for Safeguarding Adults, SWBCCG, in attendance on behalf of Gene Kelly

Tom Richards – Quality Manager, SWBCCG

Rebecca Martin – Lead Nurse for Quality, SWBCCG

Bev Morris - Head CHC Services, SWBCCG

Therese McMahon - Governing Body Nurse, Vice Chair, SWBCCG

Alison Hughes – Deputy Chief Officer for Quality, SWBCCG

Ranjit Sondhi - Lay Member, SWBCCG

Sharon Allen, Quality Improvement Lead, SWBCCG

In attendance: Kelly Fojan – Minute Taker

Apologies: Michelle Carolan – Chief Officer for Quality, SWBCCG

Jodi Woodhouse – Governance Manager, SWB CCG

Gene Kelly – Designated Nurse Safeguarding Children, SWBCCG

Simon Somers - Primary Care Quality Lead, SWBCCG

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*Part Meeting

Christina Wilson – Operational Lead Pharmacist, SWBCCG

1.2 DECLARATIONS OF INTEREST

Members noted that prior to the meeting taking place; a review of the conflicts of interest checklist in compliance with the Conflicts of Interest guidance took place.

1.3 MINUTES OF THE PREVIOUS MEETING HELD ON MONDAY 21st October 2019

The minutes of the previous meeting held on Monday 21st October were accepted as an accurate record.

1.4 QUORACY OF THE MEETING

The Chair confirmed the meeting to be quorate.

1.5 ACTION REGISTER/MATTERS ARISING

All actions are updated in the action log.

REGULAR ITEMS QUALITY REPORT – TOM RICHARDS 2. The Quality report were circulated prior to the meeting. TR shared key highlights of the report: -

The following comments were noted: -

TR noted the new format of the provider summary that corresponds with the Exec to Exec meeting, going forward the Trusts IQPR will be added as an appendix to the quality report.

KG referred to Unity and queried the delays in clinics due to Unity. Action - AHI to raise the query virtually and discuss further at Februarys Quality & Safety meeting.

RS asked how well the now format of the CQRG Exec: Exec meetings were working at SWBH?

AHU confirmed that David Carruthers, Medical Director at Sandwell & West Birmingham Hospital is doing a piece of work around themes, trends and problematic areas, AHU noted that the trust missed their thrombolysis target, therefore David Carruthers will be bringing a paper to the next Exec to Exec pertaining to actions taken and the impact it has had on patients. To be added to February’s quality report.

PM referred to care home issues pertaining to Amberley court, and the more recent Safeguarding concern that has been raised, BM noted that a collaborative approach is being undertaken between Sandwell & West Birmingham CCG and Birmingham and Solihull CCG to move forward.

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PM referred to the Gables care home and the possible abuse to a patient. BM confirmed after a recent whistleblowing incident, the CHC team visited the Gables and found no evidence to back up the concern.

BM confirmed that the continuing health care team, safeguarding team and the local authority have scheduled regular monitoring visit at Sandwell & West Birmingham care homes.

The Quality & Safety Committee received the report for information and assurance.

RISK REGISTER AND RECOMMENDATIONS - ALL 3 QS17 – Staffing issue for Sandwell & West Birmingham Hospital, TR noted that Sandwell &West Birmingham CCG are awaiting information from the trust. QS22 – AHU – The committee to consider closing QS22 and opening a new risk pertaining to PHB targets. QSG11_16a – MK - Birmingham & Solihull CCG have appointed a new Safeguarding heads of service, Diane Rowden. QS06_18a – Remains the same QS19_01b – Remains the same QS19_01a – Remains the same QS05_19a – Diane Rowden, Head of Safeguarding at Birmingham & Solihull is overseeing adults safeguarding, remains the same. QS19_11 – Remains the same, update through Primary Care Commissioning Committee and to be brought back to February’s Quality & Safety meeting.

The Committee to consider adding a quality risk pertaining to care homes to the risk register, due to the highlighted concerns within the quality report. The committee agreed to add to the risk register.

AHU noted a potential risk pertaining to staff vacancies within the core quality team, those vacancies are quality nurse, infection control nurse, Interim post in safeguarding and care home quality assurance with continuing health care team. The Committee agreed to add to the risk register.

ITEMS FOR DECISION POLICIES 4. SERIOUS INCIDENT POLICY Serious Incident reporting policy updated to incorporate recommendations of internal auditors.

KG suggested including within the policy the Root Cause Analysis process and Serious Incident managing handbook and the escalation process via Michelle Carolan, Chief Officer for Quality.

AHU noted to include the assurance pertaining to the quality of Root Cause Analysis and action plans to be added in policy and the escalation process and who to contact, AHU noted the escalation contact will be Michelle Carolan, Chief Officer for Quality.

The committee noted the amendments and agreed to approve the policy in principle subject to the above

amendments.

VISIT POLICY 4.1 Revision of Quality Assurance Visit Policy which includes the following two key updates: 1)Inclusion of an internal sign-off process for visit reports produced by the CCG. 2)Extension of the turnaround time for visit reports from 10 working days to 25 working days.

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TM referred to 4.3 of the policy pertaining to governing body who will receive an annual unannounced/Announced summary as part of the annual Quality Report and queried if the information can be published on the CCG website due to the sensitive information.

Action - AHU confirmed that TR will change the wording in 4.3 to - due to sensitive nature of the

information, staff are reminded to be aware of the information that is published in the report that will be sent to Governing Body.

AHU made a recommendation to appendix 1, pertaining to the flow chart for the assurance visits. TR to change the wording to - Sandwell & West Birmingham CCG will inform the most Senior member of staff on the day of any announced visits prior to the meeting taking place.

The committee were happy to approve subject to the above amendments. 4.2 PARTNERSHIP WORKING POLICY Action - JB noted that amendments pertaining to the sponsorship costs need to be amended within the policy, JB to amend and send to the committee for virtual approval.

WEST MIDLANDS AMBULANCE SERVICE TERMS OF REFERENCE 5. The Terms of Reference have been updated to reflect the current Clinical Quality Review Group. The purpose of the group is to ensure the quality and safety of the emergency 999 service, currently provided by West Midlands Ambulance service, in accordance with the NHS contract.

This group will include provision for the 6 STP areas and the 16 West Midlands CCG areas.

The committee agreed the revised West Midlands Ambulance Service Terms of Reference

6. NHS 111 TERMS OF REFERENCE The Terms of Reference (ToR)have been updated and reviewed to reflect the current Clinical Quality Review Group considering the transition of West Midlands NHS 111 from Care UK to West Midlands Ambulance Service. The ToR sets out the purpose of the group to assure quality and ensure that adequate mitigations are in place to support quality improvement and improved patient experience.

The following comments were noted: - Queried if the Revised Terms of Reference have been discussed with providers? AHU confirmed that the revised Terms of Reference were discussed at Novembers Clinical Quality Review Group and confirmed that no issues were raised pertaining to the terms of Reference.

7 PRIMARY CARE QUALITY FRAMEWORK/TERMS OF REFERENCE

This report sets out the new approach to assuring primary care quality, presenting the annual assurance plan, newly developed primary care quality framework and assurance checklist. The paper informs Quality and Safety committee of changes to Primary Care Operations Group in order to provide more focused support to SWBCCG GP Practices in line with current regulatory processes recently amended by the Care Quality Commission.

The following comments were noted: -

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JB noted that the Medicines Quality team can offer additional support to the Primary Care Quality Working Group, JB to pick up outside the meeting with Simon Somers and discuss the options of implementing the medicines quality document into the training for GP’s.

PM queried when the framework will go live? RM confirmed once it is approved at the Quality & Safety committee it will be sent out to all GP practices via Comms.

ASSURANCE REPORTS 8. MEDICINES MANAGEMENT

The Medicines Management report was circulated prior to the meeting.

The following comments were noted;

AHU referred to page 9, under “to dip or not to dip” pertaining to checking with elderly patients with a urine infection, whether there is collaborative working between the CCG, Richard Thompson, Lead Pharmacist - Enhancing Health in Care from the local authority and the Infection Prevention Nurse within the Local Authority that support care homes? JB confirmed that the medicines quality team do regularly link in with Richard Thompson. JB to check with the team to confirm if they link in with the Infection prevention control nurses in the local authority.

PM referred to the Prescribing Ordering Direct (POD) and asked if the safety checks have been incorporating into the POD system? JB confirmed it will be part of the planning as the service moves forward.

CW confirmed that the medicine quality team will be giving the minor aliments scheme significant drive in GP practices has the data shows there has been poor uptake.

KG noted that the report was an enjoyable read and congratulated the team on their hard work.

KG referred to the Biosimilars and asked if patients have the choice to revert to their original medication.

JB confirmed that patients will be given the medication and advised to try for a month and if the patient is not happy then they can revert to the original prescribed medication.

JB confirmed that moving forward the medicine quality report will include data from all four CCGs in the

Black Country.

8.1 PROTECTED LEARNING TIME (PLT) 2020/21

It was acknowledged that Dr Parmjit Marok would hold an interest in the item, however there would be no pecuniary advantage therefore no mitigation was required.

The committee agreed the proposed protected learning dates for GP’s and agreed that a robust review is to be undertaken of the planner for the next financial year.

9. SAFEGUARDING HIGHLIGHT REPORT The committee welcomed the highlight report for information.

MK confirmed that the Memorandum of Understanding (MOU) is an ongoing agenda item at the Safeguarding Assurance Group meeting. UPDATE ON LIBERTY PROTECTION SAFEGAURDS (LPS) The paper was circulated prior to the meeting, the following comments were noted; Sandwell & West Birmingham CCG Page 5 Enc 1 - Minutes

9.1 MK confirmed that the clinical Commissioning Group will become an authorising body for the LPS, which will commence October 2020.

MK noted that going forward there is an expectation that section 12 assessment will be provided by the GP.

Action - MK recommended adding the change in LPS to the Quality Risk Register due to the additional clinical/financial resources that will be required.

AHU noted that clarity is required in terms of scoping at an STP level. MK confirmed that it is being implemented across the four CCG’s and needs to be flagged at an Exec level. RS added that it will be a reputational risk for the CCG and the team need to make sure robust resources are in place before this happens.

The committee supports the proposal for the scoping subject to the financial and capacity implications being discussed further with the relevant directorates.

Action - MK to liaise with finance to discuss the cost implications going forward. MK to update outside the

meeting.

It was confirmed from January 2nd Marie Kelly will be the Local Area Contact for Sandwell & West

Birmingham CCG and the lead for LeDeR as Sophie Read – Willets will no longer be taking on this role.

DEVELOPMENT OF AN “APP” FOR CHILDREN LEAVING CARE 9.2 The paper was circulated prior to the meeting, the following comments were noted;

The plan is to develop a mobile smartphone and tablet application that can be used by young people containing key contacts, appointments and other pertinent health information. The concept is that young people will be able to download and install the application from the relevant application store (Android or Apple).

The launch of the passport app is due to take place on Thursday 16th January.

The committee noted the report and congratulated the team on the development of the app.

CARE HOME QUALITY UPDATE 10. The report was circulated prior to the meeting, the following comments were noted;

The committee accepted the report for information and assurance.

TUBERCULOSIS 11. There have been 642 cases of TB recorded between 2015 and 2018 for Sandwell and West Birmingham CCG. The CCG is seeing an increase in TB in complex patient cases such as homelessness, substance misuse and co-existence of other conditions such as HIV, Hep C etc. These patients are falling outside the standard commissioned pathways and therefore a multi-agency approach is needed to develop the right packages of support for these patients.

The purpose of the paper is to cite the committee on the trends and themes in relation to Tuberculosis in Sandwell & West Birmingham CCG and discuss the risks, impact and recommendations.

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RM noted one of the risk - No single person identified in the CCG to liaise with PHE. The current person who fulfils this role leaves mid December 2019.

RM noted that the recommendations are listed within the report. it was noted that there are currently challenges in recruiting an - Infection Control into a fixed term post and attempts to support a secondment had not been successful.

The committee agreed the recommendation, subject to financial implications being identified.

BASAL CELL CARCINOMA REPORT 12. The report was circulated prior to the meeting, the following comments were noted;

Any patient presenting with suspected Basal Cell Carcinoma (BCC) in a community setting should be referred to Acute services to ensure safe removal, however Sandwell and West Birmingham hospitals identified several histology reports where this procedure has been undertaken by community dermatologists.

Incident Reports were raised for each case, with all reports concluding that community dermatologists are acting appropriately based on the presenting symptoms of the patient, and that awareness of the pathway is good.

AHU noted that the pilot has been agreed to continue in community dermatologist and was being monitored very closely, however the monitoring report is to feeding back through Strategic Commissioning and Redesign committee (SCR).

TR to feedback to Balvinder Macadam who is leading on the community pilot.

Action - TR to share/feedback through Strategic Commissioning & Redesign.

TR confirmed that there have been no incidents pertaining Basal Cell Carcinoma since summer 2019.

LEARNING FROM EXPERIENCE REVIEW OF FALLS 13. The paper was circulated prior to the meeting, the following comments were noted;

SA noted that she has gone back to the Sandwell & West Birmingham trust and asked them to provide further assurance pertaining to the June and October spike.

The Quality & Safety Committee received the report for information and assurance.

CONSENT AGENDA

14. ASSURANCE AND PLANNING MEETING MINUTES

15. SAFEGUARDING ASSURANCE GROUP (SAG) MINUTES DATED 29TH NOVEMBER 2019

The committee noted the minutes for information, no further comments were raised.

REVIEW OF DECISIONS

16. REVIEW DECISIONS COMMITTEE HAVE AGREED

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Three Policies updated – subject to the amendments noted • West Midlands Ambulance Service terms of Reference • NHS 111 Terms of Reference • Primary Care Quality Framework/Terms of Reference

Protected Learning Times dates and times confirmed.

17. ISSUES TO ESCALATE TO PROVIDERS/GOVERNING BODY (IF APPLICABLE) Liberty Protection Safeguards to be added to the risk register

Clinical quality capacity added to the risk register

ANY OTHER BUSINESS Waiting Room Self-Service Kiosks 18. In September 2019, concerns were raised by one of the pilot sites around the set-up of the kiosks. The concerns that was raised was the risk of abnormal results being recorded in the patient record without any alert to the practice clinical system directly. This would therefore not allow the practice to intervene in a timely manner.

The committee discussed the waiting room kiosk pilot and noted that further clarification is required. MB noted that there will be a revised paper sent around to the committee for virtual approval. AHU noted that there needs to be further investigations pertaining to the kiosk. RM from the quality directorate and a member from Strategic Commissioning and Redesign team will be attending the practice amongst IT to clarify the issues.

Action – MB to feedback virtually after the practice demo

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SWBCCG Strategic Commissioning & Redesign Committee Sandwell & West Birmingham CCG Minutes of the Strategic Commissioning and Redesign Committee On 12th December 1300 – 1600hrs Yemeni Community Association Greets Green Access Centre, Tildasley Street, West Bromwich, B70 9SJ

Present: Manir Aslam (MA) GP Sandwell – Chair Dr P Hallan (PH) GP Sandwell – Vice Chair Adnan Khaliq (AK) Head of Financial Management Alison Hughes (AH) Deputy Chief Officer, Quality Dr Karl Grindulis (KG) Secondary Care Consultant Jenna Phillips (JP) Senior Operations Manager (Strategic Commissioning and Redesign) In Attendance: Katie Weston (KW) Business Support Officer Dr Wajid Ali Observer/Newport Medical Centre

Apologies Sharon Liggins (SL) Chief Officer – Strategic Commissioning Jodi Woodhouse (JW) Acting Head of Corporate Governance Martin Stevens (MS) Head of Business and Contract Performance Adele Hickman (AH) Head of Contracts Angela Poulton (AP) Deputy Chief Officer – Strategic Commissioning Jayne Salter-Scott (JSS) Head of Engagement & Communications

Item Subject

1. INTRODUCTION 2. Apologies for absence 2.1 13:00 Dr Ian Sykes (IS) and Gursharan Kaur (GK) joined the meeting

Apologies noted above.

Jenna Phillips (JP) is deputising for Angela Poulton (AP) as designated representative for Strategic Commissioning, in line with section 2 of the Terms of Reference.

3. Declarations of Interest

3.1 MA and PH declared an interest as General Practitioners (GPs) in receipt of income from SWB CCG for the provision of General Medical Services.

3.2 JP declared a conflict of interest under item 6.1 (‘BCPFT Carers Service’) as her husband is a Director at Black Country Partnership NHS Foundation Trust. There was also conflict within presentation of the Eating Disorder Specification as BCPFT are existing providers of this service.

3.3 JP noted within enclosure 11 that GPs may be conflicted moving forward in the event of a procurement.

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4. Minutes of previous SCR meeting

4.1 The previous minutes were agreed as an accurate record of the meeting.

Matters Arising

• Out of Hours (OoH) NEPT

4.2 Sandwell & West Birmingham Hospital Trust (SWBHT) sub-contract the Out of Hours (OoH) Non- Emergency Patient Transport (NEPT) provision to Elite. SWBHT advised Sandwell & Birmingham CCG that if SWBHT were unsuccessful in the NEPT contract award, notice would be served on this contract. SWBH were unsuccessful and the contract was awarded to West Midlands Ambulance Service (WMAS). Notice was subsequently served to Elite and their contract is due to end on 31st January 2020. SWB CCG are currently in discussions with WMAS to pick up the OoH service element as a temporary measure whilst a procurement for this service is undertaken. An update is to be provided in January 2020.

Action: Update to be provided on the Out of Hours NEPT contract in January 2020.

• Extension of Health Harmonie Non Obstetric Ultrasound Service (NOUS) until end of June 2020

4.3 The Health Harmonie contract has previously been extended until 31st March 2020. During preparation for the procurement process, the CCG has challenged the Transfer of Undertakings (Protection of Employment) Regulations (TUPE) list as provided by Health Harmonie. In light of this, it was noted that it is unlikely the new service could commence before 1st July 2020 and the committee have been asked to approve the contract extension until 30th June 2020.

4.4 As there is a cost pressure with extending this contract, the Committee agree to extend ‘up to’ 30th June 2020 to retain the right to end this contract sooner in the event the procurement process is concluded earlier than anticipated.

4.5 • Community ENT Service

The Committee agreed for virtual approval of the Community Ear, Nose and Throat (ENT) service paper, the paper will seek to extend the contract for 12 months from 1st April 2020. Gursharan Kaur (GK) is to confirm the current ENT service offer, as provided by the other three Black Country CCGs and to ensure that the current outcome measures are included within the ENT service paper.

Action: GK circulate paper for Community ENT Service for virtual approval.

Action: GK to confirm virtually the current ENT service offer within the 3 other Black Country CCGs.

5. ITEMS FOR DECISION MAKING 5.1 Phase 3 Treatment Policies

5.1.1 The report details the treatment policy development, the process steps, the clinical and public engagement outcomes, the governance oversight and policy endorsement process. The Committee was asked to approve both the phase 3a and phase 3b clinical treatment policies to be implemented from 1st April 2020.

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5.1.2 It was noted there has been clinical input into all of the policies and will contribute to Quality, Innovation, Productivity and Prevention (QIPP).

5.1.3 GK highlighted that the Equality Impact Assessment (EQIA) has been endorsed and signed off by Jayne Salter Scott (JSS) and the patient leaflet has been revised as a result of the public consultation.

5.1.4 The 3a policies incorporate the Black Country CCGs and 3b policies have been developed collaboratively with Birmingham and Solihull CCG (BSoL CCG). It was noted SWB CCG and BSoL CCG policies are all aligned and have been working together as a joint committee for a number of years. Dudley, Walsall and Wolverhampton CCGs are taking the phase 3a paper to their Governing Body with a view to approve and align policies.

5.1.5 Alison Hughes (AH) raised that the Quality team has not seen the Quality Impact Assessment (QIA). GK confirmed that the QIA’s will be complete following approval from SCR.

5.1.6 There was discussion regarding the possibility of policies being approved for SWB CCG patients and not for the other Black Country CCGs. There was concern that if this circumstance occurred, this would create local variation between patients within Sandwell and West Birmingham and the rest of the Black Country and Birmingham, and potentially lead to SWB CCG being open to challenge for not providing aligned services to all patients. IS responded although working closely together there is not a statutory requirement to be aligned.

5.1.7 There is a Black Country Commissioners group that meets monthly where discussions are had around policies nationally and locally. There will be a mapping exercise to compile a list of all policies across the Black Country Sustainability and Transformation Plan (STP) and confirm what the position is across each CCG.

5.1.8 Following endorsement by and sign off from the Committee, the CCG will write to SWBHT to inform that the policies have been approved. There will be a meeting with senior management around the implementation of the policies and how this will be cascaded to clinicians. As part of the national initiative NHS England (NHSE)/NHS Improvement (NHSI) has written to all CCGs and Trusts to undertake a review of their waiting list against the national policies. The CCG is planning to undertake an audit following the correspondence from NHSE/I and therefore are in ongoing conversations with SWBHT. Responsibility will sit with the Trust to contact patients on the waiting list for the procedures not routinely commissioned.

5.1.9 It was highlighted there needs to be engagement with all GPs to inform them of the change to routinely commissioned procedures.

5.1.10 Within the report the financial modelling suggests that Phase 3 policies programme will lead to a minimum of £500,000 in QIPP savings. GK is to verify this with Denis Lenihan (SWB CCG).

Action: Gursharan Kaur to verify the QIPP savings stated in the Phase 3 treatment policies report with Denis Lenihan.

Decisions: • The Committee approve for the Phase 3 clinical treatment policies to be implemented from 1st April 2020 subject to the completion of the QIA with approval from the Quality directorate.

Action: Communications to be sent to the Trust, GPs and patients around the implementation of the new Phase 3 treatment policies.

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5.2 Glaucoma Enhanced Case Finding

13:50 Natasha Dupree (ND) joined the meeting

5.21 This paper is subsequent to the Eye Care Business Case which was approved at SCR in August 2018. The paper focuses on glaucoma pathways and around reducing patients that do not need to be referred to hospital through a community triage called Glaucoma Enhanced Case Finding.

5.22 The proposal is to commission Glaucoma Enhanced Case Finding through a direct award short term contract with Primary Eye Care Limited for 12 months. During the 12 months, the impact of the service can be monitored to inform future commissioning arrangements for the Black Country.

5.23 There was a discussion around where optometrists are going to be placed, and Natasha Dupree (DP) stated there are gaps in the Wednesday and Rowley Regis area however there is still funding for optometrists to take up the training.

5.24 SWBHT have been heavily involved with the development and have been delivering shadowing and training for local optometrists within the hospital.

5.25 Decisions:

• The committee approve the commissioning of Glaucoma Enhanced Case Finding through a direct award short term contract with Primary Eye Care Ltd for 12 months

5.25.1 Action: Natasha Dupree to attend SCR in January 2020 with the Glaucoma Enhanced Case Finding service specification and update the committee on the work being progressed by the other Black Country CCGs.

5.3 Sustainability and Transformation Partnership (STP) Mental Health One Commissioner Eating Disorder Specification

13:58 Jim Cole (JC) joined the meeting

5.31 As part of the Black Country STP Mental Health Work programme, eating disorders was designated as one of the work streams. Wolverhampton CCG has led on the development of the specification for an all age eating disorder service/pathway. During the development a group was formed and SWBCCG was represented by the Children and Young People’s Commissioner.

5.32 It was raised that the Mental Health and Learning Disabilities Clinical Lead, Dr Elizabeth England flagged some concerns with the specification and feels that it does not reflect the work that was undertaken.

5.33 It was noted that this specification has been approved by the three other Black Country CCGs to move forward as part of the programme.

5.34 AH raised that on page 30 of the report there is a list of the quality requirements however it does not state the quality outcomes and how these are going to be measured.

5.35 Decision: The Committee do not approve STP Mental Health One Commissioner Eating Disorder specification.

5.35.1 Action: Jim Cole (JC) to collate concerns around the Eating Disorder specification and respond to the STP Mental Health Programme.

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5.4 Paediatric Continence Service for Sandwell patients

5.41 JP picked up this piece of work due to the Children & Young people’s commissioner being off on extended absence. A paper was previously presented to SCR in July 2019 entitled ‘Level 2 Enuresis’. Upon deeper analysis the model proposed within the paper actually described a wider continence service. Approval was granted by SCR to direct award a contract to SWBHT to commission a paediatric continence service for Sandwell patients, in line with school nursing contract that had been moved over to SWBHT from Birmingham Community Healthcare (BCHC), as enuresis had been removed from this contract at the point of transfer between providers.

5.42 It is not understood how the figure of £123,000 per annum was calculated in the original paper. Following engagement with SWBHT the annual cost has been calculated to be £148,710 per annum up until 31st March 2022.

5.43 The CCG need to determine the anticipated requirement for the continence products to ensure this cost is effectively monitored if the provision of such products is to be on a ‘pass through’ cost basis. There was some concern that without the modelling of likely requirement of continence products, robust monitoring of the costs arising from the issue of continence products could not be maintained. This is to include access criteria to provision of such products.

5.43.1 Action: JP to determine the estimated numbers of continence products requirement to ensure there is equity.

5.44 Provision of such service is in place in West Birmingham and is provided to Children and Young People by Birmingham Community Healthcare NHS Trust.

5.45 It was noted there should be GP input into the key performance indicators (KPIs).

5.46 Decision: The committee approve to extend the Paediatric Continence Service contract award value subject to a confirmation of the clear criteria to access, and robust monitoring of, continence products.

5.5 Autism West Midlands Contract

5.51 Since 2012 the CCG has held a contact with Autism West Midlands to provide an Autism support group for registered patients living with higher functioning autistic spectrum disorders including Asperger Syndrome.

5.52 It was noted that the Sandwell Council (MBC) Local Authority is leading a piece of work to consult with families, carers and users of services including Autism West Midlands to look at developing a strategy for Sandwell. A commissioning plan will follow the development of the strategy.

5.53 The Black Country STP has now committed to establishing a single diagnostic pathway for autism and is looking to develop a neurodevelopmental pathway.

5.54 It was highlighted that if the committee does not support the extension of the existing contract, there will be a gap from 1st April 2020. JP questioned if Autism West Midlands are the only provider in the local area. JC advised that it is a diverse sector with lots of different types of support being provided for this cohort of people, therefore there is not one consistent model to identify other possible providers.

5.55 The CCG need to have sight of the patient experiences of this service and ensure there are outcome measures.

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5.56 Decision: The Committee agreed to extend the Autism West Midlands contract until 31st March 2021, subject to including quality outcomes being included within the contract.

5.6 Section 75 Agreement

14:14 Paul Moseley (PM) joined the meeting

- Sandwell

5.61 The paper is to inform the committee of the national requirement for the Health & Wellbeing Board to enter into their section 75 (S75) agreement in respect of the Sandwell Better Care Fund (BCF) Programme and to seek the committee’s endorsement of the draft agreement.

5.62 The S75 agreement provides a framework for joint working arrangements between Local Authorities and CCGs and provides a legal basis for CCGs to access the pooled budgets.

5.63 The current draft agreement for 19/20 differs from the 18/19 agreement as the pooled budget has increased to £52 million compared to 42 million last year. The redundancy liability for the pooled budget has also increased from £113,350 to £250,000 due to the recruitment of the BCF Programme Team hosted by Sandwell Metropolitan Borough Council (SMBC).

5.64 JP noted that the request for approval of the S75 agreement for 2019/20 has been pushed back well in to the second half of the 2019/20 financial year and this should have been considered earlier.

5.65 The Committee commended the work of the Sandwell BCF team and partnership working.

5.66 Decisions: • The Committee agreed to Sandwell and West Birmingham Clinical Commissioning Group formally entering into a S75 agreement with Sandwell Metropolitan Borough Council for the purposes of creating a pooled budget to deliver the Sandwell Better Care Fund programme in 2019/20. • The Committee endorsed the proposed Section 75 Agreement in respect of the Sandwell Better Care Fund. • The Committee granted delegated authority to the Chief Officer (acting as Chief Operating Officer) to enter into the S75 Agreement on behalf of Sandwell and West Birmingham CCG.

- West Birmingham

5.67 It was noted that SWB CCGs commitment for West Birmingham patients within the Birmingham S75 agreement is £12.1 million.

Discussions were held regarding the Newton work being undertaken in Birmingham on a number of 5.68 projects. It is understood that this work is commissioned by for the whole of the city of Birmingham. However, it is not understood if the CCG holds any responsibility to contribute to these fees. AK to identify any financial commitment to the CCG to fund this work.

5.68.1 Action: AK to identify any financial commitment made by SWBCCG to fund the Newton work, as commissioned by Birmingham City Council.

5.69 The Committee requested that BSoL update their report to split BSoL’s contribution and SWB CCGs contribution for West Birmingham patients and include quality outcomes.

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5.69.1. Action: DH to split the S75 report to separately identify BSOL contribution and SWBCCG contribution, and include quality outcomes

5.70 Decisions:

• The Committee agreed to SWB CCG formally entering into a S75 agreement with Birmingham City Council and BSoL CCG for the purposes of creating a pooled budget to deliver the Birmingham Better Care Fund programme in 2019/20. • The Committee endorsed the proposed S75 Agreement in respect of the Birmingham Better Care Fund. • The Committee granted delegated authority to the Chief Officer for Strategic Commissioning and Redesign (acting as Chief Operating Officer) to enter into the S75 Agreement on behalf of SWB CCG.

5.7 Swanpool Pain Management Clinic Evaluation

14:31 Bal McAdam (BM) joined the meeting

5.71 The report is an evaluation of a historic Community Pain Management Service originally commissioned by Sandwell Primary Care Trust, and subsequently by Sandwell & West Birmingham CCG. In January 2019 the decision was made by SCR to evaluate this service.

5.72 The contract is due to finish on 31st March 2020 and an evaluation of the service has been conducted, along with an independent clinical audit led by the Public Health Team at SMBC. Patient feedback of the service was positive with satisfactory results, however following the clinical audit the report highlights that the standard of documentation at the clinic was poor and management plans were frequently undocumented.

5.73 Once the clinical audit was instigated, the service wrote to SWB CCG to inform of their intention to cease the service from 31 March 2020.

5.74 The CCG met with the service on 4th December 2019 to discuss the exit strategy of patients that are currently under Dr Bhimji’s service to allow for them to be referred on to an alternative provider. It was noted that the CCG feels there are appropriate services available at SWBHT Community Orthopaedic service which is delivered at a number of different community sites. Early discussions have commenced with SWBHT around the cohort of patients.

5.75 A letter is to be drafted jointly from the service and the CCG to inform patients that the service will no longer continue after 31st March 2020. Within the letter clear information is be included around the alternative service that patients can access. It was raised that the CCG need to take into consideration vulnerable patients.

5.76 Decision: The Committee approved the recommendation to allow the Swanpool Pain Management Clinic contract to cease with future provision through existing alternative providers, with specific consideration to be given to supporting vulnerable patients.

5.8 Update on Urgent Treatment Centre Designation

14:41 Hannah Ship (HS) joined the meeting

5.81 The purpose of this report is to provide an update on the status of the designation process for Parsonage Street and Summerfield as Urgent Treatment Centres (UTCs) and requested to approve the additional financial resources to achieve the required clinical standards required for UTC designation

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5.82 It had been envisaged that by December 2019 the existing walk in centres will be designated as UTCs, however following recent meetings with providers and NHSE there is additional work that needs to be undertaken to meet the necessary criteria. The work includes digital elements and additional clinical capacity at both services as the requirements for designation has changed significantly.

5.83 The digital element of this work is being picked up regionally with input from NHSE. The aim is that all urgent care service provision within the region use the same technical platform to enable all providers to have access to the same clinical information and have sight of capacity for all providers within the system. NHSE have verbally agreed to commit to provide the funding for this roll out, although written confirmation is being sought.

5.84 It was noted if the funding is withdrawn by NHSE, SWB CCG have installed systems following the split of the walk-in and Alternative Provider Medical Services (APMS) contracts that have the functionality to link with NHS 111. However, this would not link with all of the providers.

5.85 A total financial resource of £459k per annum is required to support the additional clinical capacity at both UTCs, this will ensure safety and the mitigation of risks.

5.86 It was noted that the national requirement of patients being assessed within 15 minutes of arrival will not be included within BSoL CCG specification for UTCs.

5.87 If funding is agreed by the committee, NHSE would like the UTCs to commence from 31st March 2020.

5.88 Decision: The Committee support the allocation of additional financial resource to support achievement of clinical standards required for UTC designation.

5.89 MA highlighted that one of the new proposed risks (SC11_19c) is around the opportunity to develop a new service specification seeing integration of 111 and 999. Hannah Ship (HS) confirmed that a draft specification has been shared with the urgent care commissioning team and there are tight timescales in terms of feedback, review and governance. The specification is due to go to Governing Body in quarter 4 of 2019/20 financial year, however the designated commissioning team has identified that the specification should be bought through SCR before going to Governing Body. HS is to have a conversation with Jason Evans.

5.89.1. Action: HS to confirm with Jason Evans (Deputy Chief Officer, Integrated Urgent and Emergency care) requirement for specification of integrated of 111 and 999 to come to SCR prior to presentation at Governing Body.

5.9 West Midlands Home Oxygen Service Contract Extension Approval Request

15:04 Mohammed Khalil (MK) joined the meeting

5.91 The national Home Oxygen procurement was undertaken by NHS England on behalf of the Home Oxygen Service (HOS) regions. This procurement was managed by a Home Oxygen Services Joint Commissioning Committee (HOSJCC). The contract was due to end on 30th September 2019 and SCR previously approved to extend the contract until 31st January 2020.

5.92 Each CCG has been requested, via the Home Oxygen Contracting lead, that formal approval is granted to be part of the Collaborative Contract through the internal governance processes. The contract is for 7 years with the option to extend for a further 3 years.

5.93 It was noted there are some efficiency savings built into the contract however further work is to be undertaken around unit prices and the activity. AK commented that it looks like there has been a

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reduction in price, however AK is yet to model the activity against the new price of the 10 cost categories to verify the savings.

5.94 It was questioned if NHSE are going to include patient experience as result of this procurement. MK responded that the CCG will be working more closely with the Home Oxygen assessment review service as a result of the new contract. On a quarterly basis Baywater Healthcare UK limited will meet with the other providers to discuss the KPIs and raise any issues that are developing to resolve with clinicians.

5.95 The cost is fixed for two years therefore there will be no additional inflation applied during this period. When moving into year 3 the cost will have to be considered with each CCG for approval prior to application. KPI measures are to be included in the local contract.

5.96 Decision:

• The Committee approved Sandwell and West Birmingham CCG to become party to the NHS West Midlands Regional Contract • The Committee endorsed the decision of the Home Oxygen Services Joint Commissioning Committee (HOSJCC) to award Lot 5, NHS West Midlands Regional Contract, to Baywater Healthcare UK Limited subject to the application of local caveats relating to quality and finance.

6 ITEMS FOR INFORMATION AND DISCUSSION 6.1 Black Country Partnership Foundation NHS Trust (BCPFT) Carers Service – Progress Report

15:24 Paul Russell (PR) joined the meeting

6.11 The BCPFT Carers Service was reviewed in 2017 and a revised service specification was developed and presented to SCR in January 2019 for approval. The new service model was implemented and operational from 1st April 2019.

6.12 The service has implemented all changes as requested and has expanded the scope to include the additional caseloads of Child and Adolescent Mental Health Service (CAMHS), Autism and Learning Disability cases. Referral pathways have been extended to improve accessibility into the service.

6.13 There is now a “time limited model” in which all carers will usually receive no more than 12 sessions from the service before being discharged, and if required referred on to relevant social carer support services or peer support groups. This has reduced the caseloads from 500 to 221 to enable the service to provide additional capacity to manage new referrals efficiently.

6.14 AH queried if there is any service provision availability for supporting siblings. PR confirmed that there is a young carers service with whom BCPFT work directly, and that the service manager links in with Sandwell Local Authority on the carers strategy group.

6.15 It was noted there is an opportunity to ask the carers if the person they care for has had their annual learning disability health check. PR agreed to speak to Kulbinder Thandi (KT)(Senior Commissioning Manager – LD) regarding this.

6.15.1. Action: PR to confirm with Kulbinder Thandi if carers are asked if the person with LD they care for has received an annual health check

Determination: The Committee were assured regarding the implementation of the redesigned Carers Service provided by BCPFT.

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6.2 PMAG Report

6.21 At the last Programme Management Assurance Group (PMAG) meeting there was no finance representation therefore the group were unable to discuss QIPP in detail. The standard QIPP presentation was circulated.

6.22 PMAG spent time a significant period analysing all open risks currently held on PM3 and discussed whether they felt all of the risks had been captured. The discussion held on each risk is detailed within the monthly report.

6.23 A pilot project has now commenced with 7 projects where finance leads input QIPP information directly in to PM3.

6.24 There has been a review of the suite of documentation and a number of changes have been made to the templates. This includes the Initiation Brief, Business Case, Project Initiation and Project Closure.

6.25 It was noted JP meets with the PMO staff from Walsall and Wolverhampton CCG bi-monthly. Dudley CCG do not have a PMO department.

6.26 AH requested that future reports identify patient experience, safety and clinical outcomes to be included in the report. JP queried this as each of these elements is represented within the constituent projects being cited.

Determination: The Committee approved the PMAG report.

6.3 Acorns Hospice Update

15:32 Diane Osborne (DO) joined the meeting

6.31 The Acorns Hospice paper is to update members on the current contract and future arrangements moving forward as there had previously been a proposed closure of the Walsall Hospice. The current contract has been uplifted and in addition Acorns will potentially be receiving further funding out of the £25m that has been promised by the current government.

6.32 A comprehensive review of the current contract and service has been planned in partnership with commissioning colleagues across the Black Country. Following the review, the plan is to have one service specification across the Black Country. The review is due to commence early in the new year with a single specification and updated contract by 1st April 2020.

6.33 AH alluded to the 3 cases noted within the report and raised that there is an opportunity to engage with providers to increase their capacity to deal with complex children.

6.34 There is a 14-day limit at the point at which a child is admitted and following this there is a daily charge of £850. In February 2018 the 14-day limit was applied and previously children who were in the hospice for extended periods of time were covered by the grant funding to them. It was also raised local providers are discharging patients into Acorns Hospice without identifying these admissions to the CCG, therefore the CCG is only made aware of these patients once they have breached the 14-day limit. The new service specification will state that the CCG will only accept the daily charge 14-days post notification to the CCG of admission of a patient, rather than post admission.

6.35 Diane Osborne (DO) to provide an update on the conclusion of the Acorns Black Country service review and proposal moving forward in March 2020. DO to also provide the committee with oversight of the BSoL model.

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Actions:

6.35.1. • Diane Osborne to provide an update on the conclusion of the Acorns Black Country service review and proposal moving forward in March 2020. 6.35.2. • Diane Osborne to provide the committee with oversight of the BSoL hospice model.

Determination: The Committee noted the contents of the report.

6.4 Risks Register

- Current

6.41 SC01 – no change to risk.

6.42 SC07_17d – Kulbinder Thandi to attend SCR in January to provide an update.

6.42.3. Action: KW to request that Kulbinder Thandi attend SCR in January 2020 to provide an update. 6.43 SC02_19b – Currently in moderation, risk to remain the same. 6.44 SC02_19a - The Maternity Voices Partnership procurement is underway, and the service will launch from 1st April 2020. The CCG will request an action plan from the successful organisation from the point at which they commence the service. Once the action plan is received, this risk can be closed. 6.45 SC19_09 – Risk to remain the same. 6.46 SC19_10 – Risk to remain the same.

- Proposed Additions

6.47 Following an internal audit of the Board Assurance Framework (BAF), the Governing Body had two development sessions where they reviewed the BAF in line with the corporate objectives. Subsequently after the first session there was an update paper that was taken to Governing Body regarding the progress, and at the second development session the owning committees for each of the risks were decided. Three of the risks that were previously held at Governing Body have been determined to more appropriately sit with the SCR committee. The Committee have been asked to formally accept the three risks.

6.48 SC19_11a – Accepted, subject to rewording and clarity regarding how the risk will be monitored for clarity and confirmation is needed as to what will be monitored.

6.49 SC11_19b & SC11_19c – Accepted. The Committee will need to receive risk update information regarding appropriate mitigation, informing or escalating to Governing Body, as appropriate.

7. Consent Agenda

7.1 The Committee noted the consent agenda and there were no questions.

8. Any Other Business

8.1 It was noted moving forward that SWB CCG need to ensure that papers being approved by the Committee need to align with Black Country and West Birmingham STP priorities and the 3 other CCGs across the Black Country.

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9. Review of Decisions

The Committee:

• approved the Phase 3 clinical treatment policies to be implemented from 1st April 2020 subject to the completion of the QIA with approval from Quality. • approved the commissioning of Glaucoma Enhanced Case Finding through a direct award short term contract with Primary Eye Care Ltd for 12 months • did not approve the STP Mental Health One Commissioner Eating Disorder specification. • approved the extended Paediatric Continence Service to be commissioned by direct award subject to a clear criteria and robust monitoring of continence product numbers. • agreed to extend the Autism West Midlands contract until 31st March 2021, subject to including quality outcomes within the contract. • agreed that SWB CCG formally enter into a S75 agreement with SMBC for the purposes of creating a pooled budget to deliver the Sandwell Better Care Fund programme in 2019/20 and the associated Section 75 Agreement in respect of the Sandwell Better Care Fund. • granted delegated authority to the Chief Officer for Strategic Commissioning and Redesign (acting as Interim Chief Operating Officer) in relation to the S75 Agreement on behalf of the CCG. • agreed that SWB CCG formally enter into a S75 agreement with Birmingham City Council and BSoL CCG for the purposes of creating a pooled budget to deliver the Sandwell Better Care Fund programme in 2019/20, the associated S75 Agreement in respect of the Birmingham Better Care Fund and delegation to the Chief Officer for Strategic Commissioning and Redesign (acting as Interim Chief Operating Officer) in relation to the S75 Agreement on behalf of the CCG. • approved the recommendation to allow the Swanpool Pain Management Clinic contract to cease with future provision through existing alternative providers. • supported the allocation of additional financial resource to support achievement of clinical standards required for UTC designation. • approved Sandwell and West Birmingham CCG to become party to the NHS West Midlands Regional Contract for the commissioning of the HOS and endorsed the decision to award Lot 5 of the NHS West Midlands Regional Contract to Baywater Healthcare UK Limited subject to the application of local caveats relating to quality and finance.

10. Date of Next Meeting

10.1 16th January 2020 13.00 – 16.00 at the Yemeni Centre, West Bromwich

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Sandwell and West Birmingham Clinical Commissioning Group

Primary Care Commissioning Committee

Date: 5th December 2019 Time 10.00 – 11:45

Venue: Kingston House Room: Boardroom

PUBLIC MINUTES

Attended: (RS) Ranjit Sondhi Lay Member (Chair) (CE) Carla Evans Head of Primary Care (JR) Janette Rawlinson Lay Member (JMc) Jane McGrandles Head of Primary Care Contracts (Contracts) (CS) Carly Sheldon Senior Primary Care Accountant (Finance) (PL) Phil Lydon Senior Engagement Manager (MW) Matt West Financial Controller (Finance) (LMa) Leon Mallett Commissioning Transformation Manager (GPFV) (KG) Dr Karl Grindulis Secondary Care Consultant (SS) Simon Somers Primary Care Quality Lead (Quality) (TM) Therese McMahon Board Nurse (JM) Jaspreet Mander Primary Care Contracts Manager (HP) Hannah Peach High Cost Drugs Pharmacist (Medicines Quality) (RSu) Dr Ray Sullivan GP and Sandwell Local Medical Committee (AC) Andy Cave Chief Executive Officer, Healthwatch Birmingham (AA) Dr Ayaz Ahmed GP Representative (MB) Manoj Behal* CCG IT Lead

In attendance: (CO) Craig O’Keeffe Business Support Officer (notes) (KJ) Kally Judge* Commissioning Engagement Manager – For Item 14

Apologies: (JSS) Jayne Salter-Scott Head of Engagement & Communications (CMP) Carlos Marques Pestana Primary Care Contracts Manager (BM) Dr Robert Morley Executive Secretary, Birmingham Local Medical Committee (JJ) Julie Jasper Lay Member (AL) Andrew Lawley Head of Premises and Capital Development (Estates) (SL) Sharon Liggins Interim Chief Operating Officer

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INTRODUCTION 1. Apologies for Absence

1.1 Apologies were shared with committee members (please see page 1).

2. Declarations of Interest

2.1 Members noted that prior to the meeting taking place; a review of the Conflicts of Interest checklist in compliance with the Conflicts of Interest guidance took place.

2.2 It was noted that AA and RS as member GP’s in SWBCCG Primary Care Networks held a direct pecuniary interest in item 8 (GPFV Update), given there were recommendations for additional funding in support of networks. It was agreed that AA and RS could stay part of the meeting and contribute towards discussion during the item but would not be able to participate in any decision making. It was noted that RS was attending in his LMC capacity and as such as already a non-voting member.

3. Minutes of Previous Meeting

3.1 The minutes of the previous meeting held on 7th November 2019 were agreed as a true and accurate record, one amendment was noted:

3.2 • Page 9, Item 13 (PCCF 2018/19 Evaluation), Paragraph 13.4, last sentence changed to “particularly in relation to practices being aware of patient’s secondary care treatment and if practices were supportive.”.

4. Action Log and Matters Arising

4.1 The actions were reviewed and updated or closed as required.

5. Chair’s Actions

5.1 No chairs actions had been taken.

PERFORMANCE 6. Finance Update

6.1 CS updated the Committee on the Delegated Primary Care Financial Position as at 31st October 2019 (month 7), the forecast outturn for 2019/20 before the implementation of the management plan is a £570k overspend, with a YTD underspend of £167k. The main reason for this forecast overspend is due to a reduction in the delegated allocation due to GP indemnity fees and additional expenditure in relation to Primary Care Networks.

6.2 The largest movements noted in month 7 were confirmed to relate to a £114k increase in costs relating to caretaking cover arrangements due to the extension of one of the contracts. This increase has been offset partially with a movement of expenditure against the GPFV GP

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resilience allocation. A reduction in forecast against the additional role reimbursements due to the delay in recruitment was also noted.

6.3 At month 7 savings of £1,168k had been identified to mitigate the 2019/20 start point cost pressure of £1,408k as a part of the primary care finance management plan. It was confirmed that £837k of the savings were included in the financial position and £331k was to be confirmed resulting in a balance of £240k to be identified. Work was still underway to review other items to contribute towards the management plan.

6.4 As highlighted in previous reporting to committee, it was confirmed that funding for four GPFV programmes (practice resilience, GP retention, reception and clerical staff training, online consultations) would now be allocated on an STP basis rather than to individual CCGs. It was noted that in month 7 the allocation for GP resilience was transferred to the CCG, this funding had been fully utilised against the caretaking arrangements for two practices. An allocation of £334k was also transferred to the CCG from the STP for PCN Development, committee would be asked to consider recommendations for decision around the £334k funding.

6.5 Identified risks being monitored were confirmed to relate to; the start point cost pressure for delegated primary care in 2019/20 covered within the outlined management plan, GPFV allocations through the STP and SWBCCG needing to ensure appropriate representation at the programme board and potential additional spend should caretaking arrangements for two of the CCGs primary care contracts continue past the expected period.

6.6 JR queried if there was any additional information available around the progress of the second stage of the appeals process for the 2018/19 PCCF. JMc confirmed that a panel had been setup which contains an independent lay representative from a neighbouring CCG in addition to other representatives from CCG teams. Whilst the exact figure was not available to share it was suggested that the costs in relation to the second stage appeal would not be significant against the management plan.

6.7 JR queried if the CCG could gather any additional learning from neighbouring CCGs based upon what work they had conducted to contribute to savings. CS confirmed that the finance team actively liaise with colleagues within neighbouring CCGs to discuss progress and share ideas where possible.

6.8 Committee noted the update.

7. Risk and Issue Register report

7.1 CE provided a summary of the presented risk and issue register report following a review of all risks which were conducted by the Primary Care Commissioning Operations Group on 28th November 2019.

7.2 Recommended updates were shared with committee for endorsement, these included a risk score alteration:

7.3 • PC08_19b – Committee were asked to consider a recommendation to reduce the overall risk score to 4 given the provided update and that contingency funding had already been built into finances to allow for any issues around the closure of the practice.

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7.4 Decision: Committee noted and accepted the recommended updates and risk score reduction for PC08_19b.

8. GPFV Update MB joined the meeting (10:21)

8.1 It was noted that AA and RS as member GP’s in SWBCCG Primary Care Networks held a direct pecuniary interest in item 8 (GPFV Update), given there were recommendations for additional funding in support of networks. It was agreed that AA and RS could stay part of the meeting and contribute towards discussion during the item but would not be able to participate in any decision making. It was noted that RS was attending in his LMC capacity and as such as already a non-voting member.

8.2 LMa summarised the GPFV update report which included four recommendations for committee’s decision.

8.3 Following allocation of £334k from the STP to SWBCCG for PCN development support with the intention for funding to contribute towards PCN development and a specific Clinical Director development programme, committee were asked to consider the following recommendations for this allocated funding:

8.4 • Dartmouth programme backfill funding: It was confirmed that the programme had been set out by the STP to support delivery of PCN projects and to enable PCN teams to develop key capabilities and comprised of 8 workshops between October and December 2019. Four of the CCG’s PCNs were participating in the programme with recommendation for the STP outlined backfill arrangements (costing up to a maximum total of £59,674.32, based upon 6 clinicians attending per PCN) to be top sliced from the allocated development funding. It was confirmed that the final actual cost would only be determined when the scheme concluded in December 2019.

8.5 • Additional leadership capacity (‘deputy CD’ role): A recommendation for funding retrospectively from December 1st 2019 to March 31st 2020 to supplement CRG representative funding resource to further support PCNs to free up leadership time to prepare for the variety of upcoming demands and overall PCN development. It was confirmed that the funding would equate to £4,824 per PCN (equivalent to 1 session per week) and a total of £72,367 for all 15 networks.

8.6 • PCN Development Plan Schemes: It was recommended that remaining funds would be allocated to support other PCN-generated development plans for approval by the CCG, with clear guidelines on expected outcomes to be given with the intention to allow for pump priming of opportunities to work collaboratively, creating additional efficiencies or increased effectiveness based on specific PCN needs. It was noted that the total value per PCN would depend on the committee agreeing top slicing of the Dartmouth programme backfill funding and how much the final commitment for the backfill would be (a minimum of £13,464 per PCN if agreed and £17,442 if not).

8.7 Following further query, LMa confirmed that the length of the additional leadership capacity was intended to be a temporary support to aid with network preparation over the period specified and that this would be made clear to PCNs. Committee queried if the role would need to be a clinician or if the role could be a wider support role which could be filled by a

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non-clinician. LMa agreed to alter the wording around this to reflect discussion and make clear the funding related to a support role to PCNs which could be for a clinician or non-clinician.

8.8 Committee approved the three proposed recommendations for PCN Development from the allocated STP funding based on the additional leadership capacity including the use of funding for a support role to include either clinical or non-clinical representative.

8.9 A final recommendation was outlined for committee’s consideration relating to the renewal of the Blue Stream Academy e-learning platform for a further 12 months from 1st February 2020 to 31st January 2021. The e-learning platform was made accessible to SWBCCG practices to help ensure mandatory training requirements were met through the tailored package.

8.10 The report noted that 93% of practices were actively using the platform and that not extending the service would result in practices needing to find an alternative source of mandatory training provision. It was noted that SWBCCG staff also have access to the platform with a SWBCCG core contribution of £2k and £12k of SWBCCG Training Hub funding provisionally supported against the total cost of £37,816.48 for the extension. It was noted that this cost represented a reduction from the £55k cost the previous year.

8.11 JR highlighted the suggested value in having the assurance that mandatory training was being provided and that the content and standard of the training offer was of equal quality across practices. Committee approved the recommendation to extend the service.

8.12 Decision: Committee approved all recommendations outlined in the report but requested that wording and the scope of funding to support additional PCN leadership capacity was made clear to include a clinical or non-clinical role.

9. Contracting Update Dr Sullivan (RS) joined the meeting (10:35) 9.1 JM summarised the circulated contract update report;

9.2 • 3 contract variations had been processed with effective dates from early November 2019.

9.3 • Following previous Estates Updates, it was noted that Crankhall Lane Surgery had submitted an expression of interest to relocate the practice premises to a nearby location which was approximately half a mile away from its current position.

9.5 A patient and public consultation exercise had been conducted and it was noted that a Premises Relocation Panel held on the 20th November had approved the relocation in principle, the practice would now develop a full business case which would be presented to the Strategic Estates Review Group (SERG) who would make a recommendation for decision to committee.

9.6 JR queried if it would be possible to receive an update in relation to the number of single- handed practices within SWBCCG. It was agreed that an update would be provided in a future contracting update to committee.

Action: JM agreed to include an update in relation to single-handed practices within SWBCCG as part of the next contracting update report.

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9.7 Committee noted the update.

10. Estates Update

10.1 It was noted that although AL was required to submit his apologies to the committee, an update report had been shared with members for their review. CE agreed to share any feedback or queries with AL following the meeting.

10.2 CE confirmed that as part of the report, committee should note that due to major resource issues within the Government Valuers Office there had been an impact on their ability to assess the revised business case for Handsworth Wood Medical Centre as well as any other DV input required elsewhere with resulting delays.

10.3 JR highlighted the Wednesbury Town Centre update within the report and the reference to a slip in the expected financial close of the project and queried if further information was available around this in relation to whether this would result in a delay in the opening of the centre and how this would be communicated to the public.

Action: CE agreed to share JR’s request for further information around the delay to the Wednesbury Town Centre project to AL.

10.4 Committee noted the update.

11. Engagement Update

11.1 PL briefly summarised the circulated report;

11.2 • Primary Care Network Support: The engagement team were currently working to support PCNs to develop their plans for communication and engagement including a branding workshop which had received positive feedback from the attendees. The team were also working with PCNs to form patient engagement models for PCNs being referred to as Patient Voice Partnerships, with some initial events planned in the new year ahead of an expected roll out to all PCNs. It was noted that current engagement had highlighted the challenge around conveying a clear message around what networks and their purposes were.

11.3 • What matters to young people roadshow: The engagement team had been attending a number of sites between 18th and 30th November to ask young people what mattered to them about their physical and mental health and wellbeing, an electronic survey had also been made available for people to complete. Feedback from the events were currently being reviewed whilst it was suggested that mental health had been flagged as a particularly key area.

11.4 JR highlighted some areas on SWBCCG’s website which were now out of date including the requirement to update the Accountable Officer position and updating information relating to public board. It was also suggested that events information could possibly be more effectively shared (such as recent Cancer Awareness events).

Action: PL agreed to share this feedback with communications colleagues and review accordingly.

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Kally Judge (KJ) Joined the meeting (11:00)

11.5 KG discussed recent references in a number of different reports to Sandwell, Ladywood and Perry Barr rather than West Birmingham and raised a concern around the confusion this could possibly create given the organisation was formally Sandwell and West Birmingham CCG.

11.6 Whilst it was acknowledged that the change in language was more aligned with wards, PL agreed to seek clarification around its use moving forward.

Action: PL agreed to seek further clarification around the use of Ladywood and Perry Barr in place of West Birmingham in future.

12. Digital Update

12.1 MB briefly summarised the Digital Update report and asked committee to consider recommendations in relation to Online Consultations and use of available funding.

12.2 Online Consultations Positive progress was reported by the majority of the 8 PCN’s still participating as part of the proof of concept, with a network now live and four others nearing a launch. The CCG had a total of £207k funding available to be utilised towards Online Consultations, the GPFV Monitoring Group had agreed the following recommendations for committee’s consideration:

12.3 • Offer an opportunity to the remaining 5 networks that did not initially respond to identify a practice to join the Online Consultations proof of concept.

12.4 • Seek 4 practices that are taking part in the proof of concept to undertake an official evaluation of ‘Video Consultation in GP Practice’ which would include funding of equipment.

12.5 • Recruit a business change specialist for 6-9 months to oversee the proof of concept to help ensure optimum use of the online consultations and undertake evaluations.

12.6 It was confirmed that should committee accept the outlined recommendations, a full costed proposal would be developed and agreed with the finance team to ensure that the £207k limit was not exceeded.

12.7 JR queried the evaluation and if it was in alignment with relevant evaluation examples elsewhere and up to date research. MB confirmed that the CCG had been working hard to ensure that this was the case but welcomed JR’s offer of sharing some possibly useful sources of information from her work with the National Institute for Health Research (NIHR).

12.8 Waiting room self-service kiosks MB confirmed that development of alerts and tasks for identified areas following suspension of the pilot had been progressing and that discussions had been ongoing with the supplier of the kiosks around the associated costs. Given acknowledgement of the considerable cost in terms of time and resource already made by the supplier it had been felt appropriate by the Primary Care Operations Group to agree contribution of the requested £6,800 funding.

12.9 JR discussed the importance of allowing sufficient time for a thorough evaluation of the pilot, MB agreed and confirmed the evaluation would take place over a 6 month time period. Page 7 of 11

12.10 Decision: Committee approved the recommendations for Online Consultations funding based on costs not exceeding the £207k outlined and a full costing plan being approved by the Finance team. Committee also noted the update in relation to the Waiting Room Self- Service Kiosks.

GOVERNANCE AND BUSINESS 13. Primary Care Quality Assurance Framework

13.1 SS provided a summary of the paper and associated appendices in relation to the proposed Primary Care Quality Assurance Framework, Primary Care Quality Working Group (as a sub- group of the Primary Care Operations Group), assurance visit letters and assurance visit content.

13.2 It was noted that as a part of the proposed framework and associated documents, that contractual visits would instead in future be focused around appropriate areas such as extended access provision and PCCF and that any identified contractual issues as a part of quality visits would be shared with the contracts team in what was already close working relationship.

13.3 JR thanked SS and the team for their work in producing the comprehensive document and shared some feedback. It was queried if the primary care quality overview information sources listed could also include further areas such as mystery shopping, practice staff exit interviews and if any other sources of triangulated informal / soft intelligence could be included. JR also noted that an ‘outstanding practice’ embedded document within appendix 3 did not seem to work.

13.4 JR queried if Carers should be included as an addition to the 6 vulnerable patient area groups identified within the document. It was noted that the 6 population groups within the document were aligned to the CQC’s classification.

13.5 JR queried if it would be of benefit to include patient / lay representation in the working group, SS agreed to note this suggestion for further consideration.

13.6 RS thanked SS and the team for their work also and noted that the Sandwell and Birmingham LMCs also endorsed the framework and associated documents which had been developed. Following query, it was acknowledged that the CCG through their contact with the CQC would support practices with all available appropriate intelligence they gather.

13.7 Decision: Committee agreed the framework and its associated documents incorporating the feedback provided through discussion by members.

14. Five Ways Health Centre Options Report

JM provided a summary of the report outlining two options available to the CCG following the 14.1 termination of the GMS Contract M85064 for Five Ways Health Centre (patient list dispersal or contract re-procurement).

14.2 As of 20th November 2019, it was confirmed that 2,660 patients were registered with the practice and that there were 5 practices within a 1-mile radius of the site (and a further 13

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when the radius was expanded to 1.5 miles). It was noted that these nearby practices had been approached to advice of their capacity as part of the options appraisal. It was noted that of the practices who responded, some had highlighted the capacity for new registrations based on recruitment / addition to their workforce. JM noted that Birmingham and Solihull CCG had written to the CCG as part of the consultation process to highlight concerns around the impact on their local practices and the financial implications should a decision be made to disperse the patient list.

14.3 KJ was welcomed to summarise the consultation exercise which was also conducted by the CCG over a period of 4 weeks from 21st October until 15th November 2019 (included as a separate annex to the report).

14.4 The consultation included engagement with 29 participants over a range of three public meetings, a provider meeting, 2 phone calls and 2 letters (from Healthwatch Birmingham and the Birmingham and Solihull CCG Primary Care Team). It was noted that the engagement team had offered an online means of providing feedback as part of the consultation whilst also offering an interpreter at patient events, events were also purposely held at different stages in the day to encourage a fairer representation of patients who had different commitments.

14.5 A total of 22 questionnaires had been completed with a total of 68% indicating a preference for list dispersal against 32% indicating a preference for re-procurement of the contract.

14.6 JM confirmed that an impact and risk matrix had been formulated based around all available information. This included considerations over the financial impact of re-procurement and suggested lack of appetite for a relatively small contract. It was also noted that the current premises were privately owned and is permanently closed meaning a new site would be necessary. A recommendation for dispersal of the registered patient list was noted.

14.7 Based upon some of the feedback highlighted within the consultation, JR queried if it would be beneficial to include some information and guidance around CQC and their ratings on the CCG’s website. PL agreed to consider this as part of the earlier action that had been raised in relation to the CCG’s website.

14.8 Following query, KJ confirmed that responses would be shared with the providers who had submitted letters as part of the consultation depending on the decision taken by committee.

14.9 Decision: Committee approved the recommendation for the dispersal of the registered patient list.

15. Five Ways Health Centre Caretaking Contract

15.1 Following approval of the recommendation for dispersal of the practices registered patient list, committee were asked to consider a recommendation for extension of the caretaking arrangements currently in place to manage the transition period whilst patients exercise their choice to re-register over the list dispersal period.

15.2 It was proposed to extend the care taking arrangements for patients until 31st March 2020, the cost of which was confirmed to equate to £135k.

15.3 Decision: Committee approved the extension of caretaking arrangements at Broadway Health Centre until 31st March 2020. Page 9 of 11

16. Application for PCN Transfer (Walford Street, M88618)

16.1 JMc summarised the paper outlining an application for PCN transfer of Walford Street (M88618, patient list size 2,335) from Citrus Health network to Oldbury and Langley network.

16.2 The application had been made following a change of contract holders at the practice to two holders who are also partners at the Oldbury Health Centre, with Dr Andreou also acting as Clinical Director for Oldbury and Langley network.

16.3 The process for a PCN transfer was outlined with confirmation that agreement had been made between both networks for an effective transfer date of the practice to Oldbury and Langley network from 1st January 2020 should it be approved by committee.

16.4 As part of the CCG’s review of the application it was acknowledged that the GPFV Monitoring group had reviewed the request and supported the application with no concerns having been identified and noting that the move did not reduce either networks combined patient list size under 30,000 and made geographical sense.

16.5 Decision: Committee approved the application and recommendation for the transfer of Walford Street (M88618) from Citrus Health Primary Care Network to Oldbury and Langley Primary Care Network. ANY OTHER BUSINESS 17. Any Other Business

18.1 Localised community outbreaks of influenza / influenza like illness service (ILI) – contract renewal The chair noted the circulation of an additional paper for committees review and decision earlier the same day. KL summarised the paper which outlined options in relation to the SWBCCG localised community outbreaks of influenza / ILI service provider.

18.2 It was noted that the current service provided through The Slieve had been delivering the service since April 2018 during which period its standard operating process and service pathways had been effectively tested through care home outbreaks and a service review conducted by key partners (NHS England and Public Health England) who were satisfied with the service response and pathways.

18.3 A breakdown of the funding received by the provider was outlined and total costs, which were dependant on activity for 2018/19 (£12,300) and 2019/20 to date (£4,800, whilst it was noted that more cases were to be expected before March 2020).

18.4 Two commissioning options were outlined to either extend the contract with the current provider for a further 12 months (31st March 2021) (in line with an option within the NHS England standard contract) or re-procurement of the contract for between 1st April 2020 to 31st March 2021.

18.5 A recommendation to extend the current contract was detailed given that a wider Black Country and West Birmingham STP response would be reviewed post March 2021 and the suggested financial and capacity implications of a relatively short length and low value contract.

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18.6 Following query, it was noted that the current provider had confirmed they had sufficient capacity to continue provision of the service.

18.7 JR queried from a wider flu perspective if there was a scope for immunisation of staff within care homes also. KL confirmed that this was something which was being discussed further with BCF colleagues who had identified some potential funding.

18.8 Decision: Committee approved the recommendation for extension of the current service to 31st March 2021.

18.9 Thank you and farewell to Saba Rai & Kathy Lyons Committee members thanked Saba and Kathy for their dedication, hard work and valuable contributions to the CCG and wished them well in their future endeavours.

18. DATE AND TIME OF NEXT MEETINGS: • Time Reserved for any potential urgent matters - 9th January 2020, 10:00 – 11:00, Oldbury Health Centre Seminar Room.

• 6th February 2020, 09:30 – 13:00, Kingston House, Boardroom.

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SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP Organisational Development Committee Meeting Thursday 7th November, 4 Front, Meeting Room 1, Kingston House 13:30pm – 15:30pm

MINUTES

Therese (TM) Chair McMahon Non-Executive, Board Nurse Alice McGee (AM) Director of HR and OD Sandra Fritz (SF) Senior HR and OD Associate Jodi Woodhouse (JW) Governance Manager Sharon Liggins (SL) Chief Officer - SCR Julie Jasper (JJ) Vice Chair Lay Member

In Attendance Sarah Billingham (SB) HR Officer, Minutes Bev Bulloumah (BB) Vice Chair of Staff Council

Apologies Debra Howls (DH) Chair of Staff Council Lisa Maxfield (LM) Deputy Chief Officer - Primary and Community Transformation

Item Subject Lead INTRODUCTION 1. Apologies for Absence Verbal Therese Mcmahon

1.1 JJ opened the meeting by welcoming attendees and announcing apologies had been received from Debra Howls.

1.2 It was confirmed that going forward Leon Mallett would be part of the attendance for Primary Care Workforce instead of Lisa Maxfield. The Committee thanked Lisa for her contributions to the Committee.

2. Declarations of Interest Verbal Therese Mcmahon

2.1 It was noted all staff members of the committee would be conflicted on Christmas Half Day Leave which would be raised under AOB.

2.2 There were no others declarations of interest.

3. Minutes of Previous Meetings Enc 1 Therese Mcmahon 3rd September 2019

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3.1 The minutes of the previous meeting were asked to be reviewed before being agreed as an accurate discussion of the meeting.

4. Actions from Previous Meeting Enc 2 Therese Mcmahon 4.1 The actions were updated or closed as required in Enclosure 2.

5. Staff Council Update Verbal Bev Bulloumah update 5.1 BB gave the Committee an update on the Thematic Areas which there were 4 areas, Social Club, Health and Wellbeing, Environmental and Estates. It was noted that some areas had progressed work better than other. Health and Wellbeing Area have excelled by organising Fruity Tuesday’s where the CCG Staff will receive Fruit on a weekly basis and arranging for a make-up artist to be here for Halloween.

5.2 AM advised the Committee that under AOB of Staff Council it was discussed the behaviour of CCG staff who were attending the Growing You Courses, it was noted that some staff were behaving disrespectful and not engaging. HR were currently reviewing attendance lists and gathered feedback from others who have attended he courses to talk to Chief Officers of the individuals.

5.3 The Committee discussed the general mood of staff and the organisation, it was felt that staff was feeling the pressure, but the organisation was being supportive. It was noted that some staff didn’t take away the right message from Paul Maubach when he attended the CCG, work needed to be done to set the tone forward and for staff to recognise he wasn’t the same leader as Andy.

SL left the meeting.

The Committee acknowledged and accepted the Staff Council update. 6. Workforce Dashboard Enc 3 Alice McGee

The Committee took the Workforce Dashboard as read.

6.1 It was asked whether the dashboard included the people who were moving organisations such as secondments outside of the CCG, it was confirmed that it did include them as they was still on the CCG payroll, which could give false information. To correct this the four CCGs are working together to look at data and how this is presented to reflect the truth.

SL re-entered the meeting.

6.2 It was noted the four CCGs had the Training Passport in place meaning that staff can transfer their mandatory training rather having to repeat.

The Committee acknowledged and accepted the Workforce Dashboard. 7. Staff Awards Enc 4a Alice McGee Enc 4b 7.1 AMc gave an update on Staff Awards which would be hosted on Friday 31st January 2020 in the afternoon with a closing ceremony and the bar opening for staff to celebrate with refreshments. Invites have gone out to all Staff, GB Members and GP Directors. The event with be co-hosted by Sharon Liggins and James Green. So far 44 nominations have been received with work being done to remind and encourage staff to nominate as his closes next Wednesday.

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7.3 The Committee reviewed the award choice and decided the winning award and decided for staff who would be winning a long service award, they could choose their own prize which was either an Engraved Vase, Champagne Glasses or a Hip Flask.

The Committee acknowledged and accepted the Staff Awards update. 8. JCC and STP Workforce Update Verbal Alice McGee Update

8.1 AMc explained to the Committee that the advert for the Deputy Accountable Officer closes on the 18th November 2019 with interviews scheduled for the 29th November 2019. The process is not being led by CCG but by Claire Shaw who is from Capsticks Solicitors. She is also leading on the appointment of the HR Director. It was noted that there is some internal interest for the Deputy Accountable Officer position and a communication plan will be put in place to complete the outcome to Staff and stakeholders.

8.2 In regards to the Director of HR Appointment it was believed for this to be completed within the next 4 weeks, then after both the Deputy Accountable Officer and the Director of HR is appointed there will be a pause, with executive structures to be looked at in the new year.

8.3 As part of the process to engage with Staff engagement events have been organised which will be two half day’s at a venue that will be big enough to hold 550 staff. At the moment the proposed venue is in Wolverhampton with engagement colleagues visiting to make sure fit for purpose. The first session will be what we do and what we love and how we can build on this, whilst the second event will look at values and how we are going to behave in the new world.

The Committee acknowledged and accepted the JCC and STP Workforce Update. 9. Change Council Enc 5a Alice McGee Enc 5b 9.1 AMc talked through Enclosure 5a with the Committee, advising that the document detailed what Transition Board and the Joint Commissioning Board do but noted didn’t describe what they have been doing. Therefore, it was suggested that this document was parked.

9.2 Enclosure 5b was the purpose for what the Change Council should be to be able to engage with Staff throughout the Transition Period, this was talk through with Paul Maubach and JCC Colleagues at the last JCC Staff Side Meeting which was received well. Staff will be asked to nominate themselves to be part of this group and AMc will update the Committee on the progress of the Change Council going forward.

The Committee acknowledged and accepted the Change Council. 10. Primary Care Workforce Update Verbal Alice McGee Update 10.1 Due to Lisa Maxfield going on secondment she will no longer be able to attend OD Committee, therefore going forward Leon Mallett will be added to the membership for Primary Care Workforce. It was requested for the Committee to be sent a copy of the presentation that he delivered at Governing Body yesterday.

Action: SB to share with the Committee a copy of the Presentation LM Delivered to Governing Body.

The Committee acknowledged and accepted the Primary Care Workforce Update. 11. Growing You Programme Update Enc 6 Alice McGee

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11.1 SB presented Enclosure 6 which was the number of Staff who was attending the Growing You Courses, attendance was good, however it was noted that some staff wasn’t sending apologises which was being managed by HR. Also following feedback received from the last Staff Council work was being done to identify the staff who were attending the courses and not engaged or behaving disrespectful. AMc was discussing this with the Chief Officer for that directorate and the Head of Service.

11.2 It was discussed if the other CCGs had any similar programmes to the Growing You Programme but they hadn’t, and work was being doing to look at a single approach to training and a single budget for the Black Country and West Birmingham CCG.

The Committee acknowledged and accepted the Growing You Update. 13. Black Country and West Birmingham Training Verbal Alice McGee and Development Update

13.1 AMc explained to the Committee that across the four CCGs each has a different approach and here at SWB they have a much larger budget and approach to it, whilst others hardly have any budget and haven’t been able to put on programme such as the Growing You and Business Fundamentals. Therefore, training budgets will be reviewed and whilst she doesn’t want to drum down here at SWB the budget will change. She will update the Committee as and when she has more information on this matter.

13.2 Mental Health First Aid Training is the first programme that the 4 CCGs have done together with dates booked in December 2019 and January 2020, with aim for more dates to be booked in for Summer 2020.

The Committee acknowledged and accepted the Growing You Update. 14. Terms of Reference - Membership Enc 7 Therese McMahon

14.1 AMc presented the Terms of Reference – Membership which the Committee reviewed and made the following changes:

• Head of HR and OD to be changed to Director of HR and OD • Deputy Chief Officer (SCR) to be changed to Chief Officer (SCR) • Chief Officer removed • Communication and Engagement Lead to be removed • Clause 5.1- Vice Chair to be changed to Director of HR and OD

14.2 Leon Mallett will be invited in attendance to update the Committee in relation to Primary Care Workforce.

14.3 The Committee discussed whether anymore management or staff representatives was needed but it was decided that this group will probably change going forward and will review if needed too. SB would update document with changes before going to Governing Body for approval.

Action: SB to update Terms of Reference with Changes, before submission to Governing Body for approval.

The Committee acknowledged and accepted Terms of Reference- Membership changes. 15. Bluestream Renewal Option Enc 8 Alice McGee

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15.1 AMc presented Enclosure 8 which was a paper explaining the renewal option for Bluestream which was the mandatory training system that the CCG used written by Simon Somers, Primary Care Quality Manager. The CCG had used Bluestream for free for the last two years due to the CCG rolling this out to practices and care homes for their training. Due to the CCG going through a period of change its recommended that they extend the contract with Bluestream for a further 12 months, also the CCG wouldn’t have the time to go out to procurement for a new system due to the contract expiring in January 2020. The Committee supported the renewal option of Bluestream for a further 12 months.

The Committee supported the renewal of Bluestream.

16. CSU Scores Enc 9 Therese McMahon

16.1 The Committee took the CSU Scores as read.

17. OD Risks Verbal Therese McMahon Update 17.1 The Committee reviewed the Risk Register and made the following comments:

17.2 OD02_17b: Risk Reviewed, Workforce update presented at GB this month. PCN Workforce Strategies are due for return by December 31st, and PCNs have been encouraged to access the necessary skills where they appear to be lacking to develop a robust and meaningful strategy. The CCG continues to work with STP partners to address recruitment and retention, with specific schemes for all stages of GP careers (early, mid and latter), as well as schemes to promote retention among the general practice nursing workforce - the was underpinned by the launch of the GGPN Strategy for the STP in October 2019. Through the Training Hub the CCG continues to work with practices to address skills development and support the nursing career pathway in particular.

OD01_19a: Risk Reviewed at OD, we haven't seen the spike to the extent that we were 17.3 anticipating, some of this may be due to the CCG supporting secondment opportunities rather than staff permanently leaving. Work continues to engage staff and there are two all staff events for all staff from the 4 CCG's to attend together. CCG have invested in staff development via the growing you programme. Some small organisational changes have been made to ensure workload pressures are alleviated as much as possible. OD would like each directorate to provide detail in terms of pressure points for the next meeting. Risk Remains the same.

It was agreed AMc would discuss at next Chief Officer meeting how pressure points are to be 17.4 feedback to the Committee and give update at the next meeting.

Action: AMc discuss at next Chief Officer meeting how pressure points are to be feedback to the Committee and give update at the next meeting.

The Committee reviewed and accepted the OD Risks.

18. AOB Verbal Therese McMahon Update 17.1 Christmas Half Day: Each year OD Committee review and support Staff receiving an unrecorded half a day leave in December to be used for Christmas Shopping. No other Black Country CCG receives this and therefore this year it’s recommend that the CCG is consistent

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with the others, meaning that this half a day isn’t given to Staff. OD Committee supported this but asked for this to be re-considered for next year.

There was no any other business. 18. DATE AND TIME OF NEXT MEETING Tuesday 14th January 2020 10:30am-12:30pm 4Rear, Meeting Room 1

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Black Country and West Birmingham Joint Commissioning Committee (JCC)

Minutes of Meeting dated 10 October 2019

Members: Dr Salma Reehana, Chair, Wolverhampton CCG (Chair) Mike Abel, Lay Member, Walsall CCG Simon Collins, Specialised Commissioning, West Midlands Dr Ruth Edwards, Clinical Executive for Integrated Assurance, Dudley CCG James Green, Chief Finance Office, Sandwell and West Birmingham CCG Matt Hartland, Chief Finance and Operating Officer, Dudley CCG Mike Hastings, Director of Operations, Wolverhampton CCG Julie Jasper, Lay Member, Sandwell and West Birmingham CCG Steven Marshall, Director of Strategy and Transformation and Deputy Accountable Officer, Wolverhampton CCG Sharon Liggins , Chief Operating Officer, Sandwell and West Birmingham CCG Paul Maubach, Accountable Officer, Dudley CCG and Walsall CCG and preferred candidate for Accountable Officer for Black Country CCGs Alastair McIntyre, Portfolio Director, Black Country and West Birmingham STP Peter McKenzie, Corporate Operations Manager, Wolverhampton CCG Helen Moseley, Lay Member Dudley CCG Peter Price, Lay Member Wolverhampton CCG Ian Sykes, Chair Sandwell and West Birmingham CCG Jayne Salter-Scott, Head of Communications, Sandwell and West Birmingham CCG Manisha Patel, Personal Assistant to Dr Helen Hibbs MBE, Dr Salma Reehana Chair of the Governing Body, Jonathan Fellows Independent Chair of the STP Wolverhampton CCG (note taker)

Apologies: Laura Broster, Director of Communications, Dudley CCG Jonathan Fellows, STP Independent Chair David Hegarty, Chair, Dudley CCG Dr Helen Hibbs, Accountable Officer Wolverhampton CCG Dr Anand Rischie, Chair, Walsall CCG Sally Roberts, Chief Nurse and Director of Quality, Wolverhampton CCG Andy Williams, Accountable Officer, Sandwell and West Birmingham CCG

1. INTRODUCTION

1.1 Welcome and introductions as above.

1.2 Apologies noted as above.

1.3 No declarations of interest were made.

1.4 The minutes of 12 September 2019 were accepted as an accurate record of the meeting. The action log was reviewed and the action log has been updated accordingly.

2. CLG Update

The Committee were presented with the draft minutes of the Clinical Leadership Group meeting from 19 September 2019. In Sally Roberts’ absence, members were asked to pass on any comments directly to Sally Roberts.

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3. Matters of Common Interest

3.1 Performance and Assurance Return

Alastair McIntyre presented the STP Performance Report for information. Key points noted were:

• The System Review Meeting had taken place on Tuesday 8 October 2019. • Urgent Care system continues to be challenged in meeting the 4hour standard. • The System Review Meeting had ask that the BCWB STP Urgent Care Board looks at unwarranted variation in UEC, shares best practice and looks to demonstrate greater system level working to resolve delivery challenges. • There had been an improvement in 2 week breast in Wolverhampton to 22 days which was positive but had deteriorated in Walsall to 28 days due to patients from Wolverhampton being seen there. A plan was in place to address this. • Mental Health out of area placements was also highlighted at this meeting. • Steven Marshall gave a brief background on mental health beds throughout the Black Country.

ACTION: Steven Marshall - Mr Marshall to bring an update to the next meeting on assessments on out of hour placements which could also be shared with NHSE/I. The update should also include finances with regards to private and NHS funding.

3.1a Urgent Care Board

The agenda and terms of reference were attached for information.

ACTION: Alastair McIntyre - Mr McIntyre was asked to review the Terms of Reference to ensure Mental Health representation at the UEC Board meetings.

3.2 Place Based Commissioning Update – Dudley

Paul Maubach presented the Dudley place based commissioning update. The meeting was pleased to hear that the aim is to have the MCP in place by 1 April 2020.

3.3 Brexit Update

Mike Hastings shared a paper for assurance and information. This paper had also been sent to CCGs for sharing at CCG Governing Body Meetings. The paper gave information on:

• EU Exit Preparedness • Operational Updates • Medicines, Non-medicines, Freight, MHRA, Non Clinical Good & Services, Social Care, Workforce, Reciprocal Healthcare and cost recovery, Clinical Trials, Research & Networks, Vaccines, Blood and Transport, Data and Regional Update. The group plan to produce a standard IG proposal and collectively approve and submit. Matt Hartland confirmed that a submission has been made for ETTF funding to support the workstream.

ACTION: Mike Hastings - Mr Hastings to share SITREP information and to bring further updates to the JCC if there are major changes.

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4. Formally Delegated Areas

4.1 Transforming Care Partnership

Alastair McIntyre provided an update on behalf of Dr Hibbs.

• Moorhouse Consulting were currently providing support until the end of October 2019. • Transformational funding had been approved by the Board and • The Board had signed off the restructured governance review. • The numbers relating to Wolverhampton and NHSE had both improved by 1 each since the report had been produced. • A meeting had been scheduled for Midlands region with Ray James, National Director on 16.10.19. • Discussions with Dr Helen Hibbs and Paul Maubach on the recruitment of a TCP Programme Director will proceed outside the meeting with the aim of having support in place from early November.

4.2 Mental Health - Collaborative Commissioning Update

This item was deferred to the next meeting.

ACTION: Steven Marshall - Mr Marshall to bring update to next meeting.

5. CCG Transition Board

A verbal update was given under this item and highlighted:

• Listening Exercises to be undertaken with Stakeholders around the move towards a single CCG. • Following the assessment and recruitment day held on 25 September 2019, Paul Maubach had been identified as the preferred candidate. • Work has begun looking to align governance across the CCGs.

6. Risk Register

Alastair McIntyre and Peter McKenzie had met to discuss aligning governance and risk registers across the four CCGs. It was agreed that the four CCG Commissioning Committee risj registers should be combined to form a single commissioning risk register.

7. Feedback from Governing Bodies

There was no feedback to be discussed at this meeting,

8. Update from STP

Matt Hartland updated on the submission of the Long Term Plan. Submissions required by the 27 September 2019 had been completed and the review process was now in place. The draft did require more work until the final submission on 15 November 2019.

Further work is required to close the planning (financial) gap identified in the draft plan. Matt Hartland would be attending the Clinical Leadership Group meeting to ask for support in modelling various scenarios.

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James Green spoke of the financial targets that had been set for the Trusts and CCGs which were more challenging than anticipated and more detail had been requested from NHSE/I. Alastair McIntyre, James Green and Matt Hartland are to meet with NHSE to discuss this.

Matt Hartland also wanted to highlight that the misalignment of activity in the SWB Trust and CCG plans needed to be resolved.

10. Any Other Business

There were no items to discuss under any other business.

Meeting closed

11. Date of Next Meeting

Thursday 14 November 2019, 09:00-10:30, Board Room, Dudley CCG, Health and Social Care Centre, Venture Way, Brierley Hill, West Midlands, DY5 1 RU.

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JCC Action Log

No. Date Action Lead Deadline Status Update 160 11 July Sharon Sidhu to draft proposal for Sharon 8 August Nothing further 2019 submission to each CCG Governing Sidhu 2019 to update at Body to recommend as a key present. principle policy position, that we seek to harmonise these policies across the Black Country and West Birmingham. 161 11 July Agreed that BCWB would join the Sharon 8 August Nothing further 2019 existing SWB and BSOL group and Sidhu 2019 to update at look to greater involvement of present. Clinicians. 162 11 July A revised paper to each CCG GBs Sharon 14 Shared and 2019 to seek investment and for Liggins November taken through approval. 2019 governance. To be kept on action log. 172 12 The IUC team to be asked ‘what the Paul 14 Verbal update September plan is for a primary care Maubach November required for 2019 engagement strategy’ 2019 next meeting. Anand Rischie happy to converse Action to be with IUC and West Midlands reallocated to Ambulance Service regarding Paul Maubach. primary care engagement. 175 12 26 week choice letter to be brought Neill 14 A workshop September to attention of Elective Care Board Bucktin November and follow up 2019 2019 meeting have taken place in relation to this.

Looking to focus on general surgery in the first instance, subject to confirmation that all providers will offer and receive patients. This should be confirmed by 8 November.

Specific session to agree the Standard Operating Procedure – 18 November.

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No. Date Action Lead Deadline Status Update Weekly (Friday) STP teleconference to take place to review capacity issues across the system commencing Friday 22 November.

176 10 October Mr Marshall to bring an update to Steven 14 On agenda 2019 the next meeting on assessments Marshall November on out of hour placements which 2019 could also be shared with NHSE/I. The update should also include finances with regards to private and NHS funding.

177 10 October Mr McIntyre was asked to review Alastair 14 Completed 2019 the Terms of Reference to ensure McIntyre November prior to the Mental Health representation at the 2019 board meeting UEC Board meetings. and MH trust representation was present and terms of reference amended 178 10 October Mr Hastings to share SITREP Mike 14 Process has 2019 information and to bring further Hastings November since been updates to the JCC if there are 2019 stood down major changes. until further notice (Likely Jan 2020)

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Black Country and West Birmingham Transition Board

Minutes of Meeting dated 10 October 2019

Members: Dr Salma Reehana, Chair, Wolverhampton CCG (Chair) Mike Abel, Lay Member, Walsall CCG Dr Ruth Edwards, Clinical Executive for Integrated Assurance, Dudley CCG James Green, Chief Finance Office, Sandwell and West Birmingham CCG Matt Hartland, Chief Finance and Operating Officer, Dudley CCG Mike Hastings, Director of Operations, Wolverhampton CCG Julie Jasper, Lay Member, Sandwell and West Birmingham CCG Steven Marshall, Director of Strategy and Transformation and Deputy AO, Wolverhampton CCG Sharon Liggins , Chief Operating Officer, Sandwell and West Birmingham CCG Paul Maubach, Accountable Officer, Dudley CCG and Walsall CCG and preferred candidate for Accountable Officer for Black Country and West Birmingham CCGs Peter McKenzie, Corporate Operations Manager, Wolverhampton CCG Helen Moseley, Lay Member Dudley CCG Peter Price, Lay Member Wolverhampton CCG Deborah Rossi, Transition Program Director, Black Country & West Birmingham CCGs Ian Sykes, Chair Sandwell and West Birmingham CCG Jayne Salter-Scott, Head of Communications, Sandwell and West Birmingham CCG Manisha Patel, Personal Assistant to Dr Helen Hibbs MBE, Dr Salma Reehana Chair of the Governing Body, Jonathan Fellows Independent Chair of the STP Wolverhampton CCG, (note taker)

Apologies:

Dr David Hegarty, Chair, Dudley CCG Dr Helen Hibbs, Accountable Officer Wolverhampton CCG Dr Anand Rischie, Chair, Walsall CCG Andy Williams, Accountable Officer, Sandwell and West Birmingham CCG

1. INTRODUCTION

1.1 Welcome and introductions as above.

1.2 Apologies noted as above.

1.3 No declarations of interest were made.

1.4 The minutes of the meeting held on the 12 September 2019 were agreed as an accurate record.

1.5 The action log was reviewed and actions confirmed as delivered, updated or others taken within the agenda.

2. PROGRAMME MILESTONES

Deborah Rossi presented a paper on the Programme Milestones. Member of the Committee had suggestions to improve the aesthetics of the spread sheet which would be picked up outside of the meeting.

3. A.O RECRUITMENT

3.1 Recruitment & Decision Making Process

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The recruitment day for the Accountable Officer for Black Country and West Birmingham CCGs had taken place on Wednesday 25 September 2019 and Paul Maubach had been identified as the preferred candidate.

3.2 Appointment Follow Up Actions & OD Plan

Paul Maubach presented a confidential paper on a proposed change management timeline including the recruitment of a HR Director and Deputy Accountable Officer which was received by the committee for assurance.

3.3 AO – Next Steps

This was discussed under Item 3.2.

4. COMMUNICATION 4.1 Listening Exercise – verbal update Deborah Rossi advised that the listening exercises had commenced and that a common set of questions were being used at each session and then a template of responses completed at each one. The last exercise was due to take place on 23 October 2019 and the committee were asked when they would like the paper collating and this information to be taken to the respective Governing Bodies as it would be very tight to meet the November 2019 Governing Body meetings deadline. The regulator date for application had now been extended from 31 July 2020 to 30 September 2020 so the committee felt that it would be beneficial to review all information collated at the 14 November 2019 Transition Board Meeting before being sent to the Governing Body Meetings in early January 2020.

It was accepted that due to CCGs being membership organisations that there may be resistance from GPs to accept new proposals and that this might impact on the 2 options which were to either merge the CCGs or continue to work in a collaborative way. Paul Maubach felt that a risk assessment needed to be conducted around GP voting. Deborah Rossi said that there would be engagement around this area.

ACTION - Deborah Rossi to conduct a risk assessment conducted on GP voting for next steps and then report to be brought back to the Transition Board.

ACTION – Comms & Engagement & Deborah Rossi to present a paper at November Transition Board which summarises the feedback and insight gained from the Listening Exercise

(Further actions to be discussed between Deborah Rossi and Paul Maubach)

4.2 Comms & Engagement Plan – review

This was discussed under item 4.1.

5. GOVERNANCE 5.1 New Model Constitution – Verbal Update

Peter McKenize updated the committee that a briefing paper on new model constitution was due to be taken to Governing Body Meetings in November 2019. Points included a clear definition of substantive changes being made by Governing Bodies as non-substantive changes can be made without GP votes.

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5.2 TOR – Draft Updated Version

Deborah Rossi presented a draft version of a revised Terms of Reference for the Transition Board.

The following comments were made:

• Regarding membership – there needed to be information about aligning commissioning • Delegation from Governing Bodies • Clear and specific information about attendees/membership and stakeholders • 2.1 - Clear definition regarding the Vice Chair and representation of a nominated deputy. If a Lay Member was deputising for the Chair of a Governing Body could another Lay Member attend as their deputy. • 2.2 – Clarification required around the one vote per one role per CCG. • 3.6 – Clarification around quoracy required. • 3.9 – Specific information around attendance other than the Accountable Officer. • That papers produced for the Transition Board are clearly marked if they are confidential should there ever be a request for Freedom of Information.

ACTION – Deborah Rossi to take on board comments and committee members to send any other comments to Deborah and a revised TOR to be presented at the next Transition Board

6. FINANCE

6.1 Running Costs - Update

The paper on running costs was shared with committee for assurance.

Matt Hartland left meeting.

7. TRAINING & DEVELOPMENT SESSIONS

7.1 GP & Lay Engagement Development – Update

A verbal update was given by Alice McGee and Deborah Rossi on the programme of work aimed for the Governing Members. A series of programmes had also been started with Lay Members and would also be rolled out to GPs.

7.2 Training – Alignment across 4 CCGs

Deborah Rossi presented a second paper on the alignment of training which included the additional information that had been requested around PDRs and Staff Surveys, and outlined current collaboration across HR Teams and their future intentions.

8. SUMMARY OF ACTIONS AND ANY OTHER BUSINESS

There were no items to be discussed under this item.

9. DATE OF NEXT MEETING

Thursday 14 November 2019, Dudley CCG,Meeting Room T051, Board Room, Dudley CCG, Brierley Hill Health and Social Club Centre,Venture Way, Brierley Hill, West Midlands, DY5 1RU.

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Action Log

Date Action Lead Deadline Status No. Update 018 13 June Deborah Rossi to create a ‘Lessons Learnt’ Deborah 8 August Deferred to 2019 from CCG Merger events/engagement with Rossi 2019 November CCG’s who have merged 2019. 028 12 Running costs update to the next meeting. James 10 October Karen September Green 2019 Rhodes has 2019 been engaged to provide extra capacity and to lead from a HR perspective this piece of work. Karen is meeting with Mike Hastings and Alice McGee on Friday 4th October 2019 to discuss the workplan and requirements for commencem ent w/c 7th October 2019. The work in relation to management allowance and structures, posts and risks will be updated at November’s meeting Post Meeting Update: Karen Rhodes has declined to progress working on the OD Plan and Key Recruitment

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Date Action Lead Deadline Status No. Update 030 12 To ensure the milestone timeline is Deborah 10 October On agenda September reflected in the Transition Board agenda Rossi 2019 and further 2019 and ensure that the management of change discussions approach is also included in the timetable. to take place with various committee members outside of this meeting. 031 12 Transition Board TOR to be reviewed and Deborah 14 On agenda September redrafted as required based upon feedback Rossi November and 2019 received at October’s meeting and Lay 2019 discussed at member responses (TOR circulated to all October 2019 Lay members of each TB) meeting. 032 12 Conduct a risk assessment on GP voting Deborah 14 September for next steps and then report to be brought Rossi November 2019 back to the Transition Board. 2019 033 12 Present a paper at November Transition Comms 14 September Board which summarises the feedback and & November 2019 insight gained from the Listening Exercise Engage 2019 ment /Deborah Rossi

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