Retention of Records: This agenda will be confidentially destroyed 2 years after the date of the meeting, in line with CCG policy and guidance from the Department of Health.
Meeting: Southampton City Clinical Commissioning Group Board – PART 1
Date: 25th November 2020
Time: 14:30 – 17:00
Location: Microsoft Teams
Item Time Subject Lead Purpose no
1. Welcome and Apologies
Dr Mark Receive and 2. Declaration of Interest 14:30 Kelsey Consider
Minutes of the Previous Meeting and Dr Mark 3. Approve Matters Arising Kelsey
ASSURANCE
14:35 4. Board Assurance Framework James Rimmer Receive
FORWARD LOOK
Dr Mark 15:20 5. CCG Reform Kelsey/James Receive Rimmer
15:40 Comfort Break
FINANCE AND PERFORMANCE
15:50 6. Finance and Performance Report Kay Rothwell Receive
QUALITY
Stephanie 16:10 7. Quality Exception Report Receive Ramsey
GOVERNANCE
Dr Mark Terms of Reference Kelsey 16:30 8. - Clinical Governance Committee Ratify Stephanie - Joint Commissioning Board Ramsey
Policies 16:40 9. - Serious Incident Policy Beccy Willis Ratify - Corporate Card Policy
FOR INFORMATION
10. Freedom of Information Report James Rimmer Information
16:50 Dr Mark 11. Sub Committee Minutes* Information Kelsey
17:00 12. Date of Next Meeting: 27th January 2021, 14:30 – 17:00
Please send apologies to: Emily Penfold, Business Manager, [email protected]
*The Board are requested to note that it is not intended that the starred (*) agenda items be discussed, unless a specific written of email request to the contrary is submitted to the Board and Sub-Committee Administrator prior to the meeting or, exceptionally, a request is made to the Chair at the beginning of the meeting Type of Interest Date of Interest
Declared Interest Non- Non- Current position(s) held (Name of the Name Financial Financial Financial Indirect Nature of Interest Action taken to mitigate risk in the CCG organisation and From To Interest Profession Personal Interest nature of business) al Interest Interest
Will not be part of any decision making that will Victor Street Surgery Salaried GP Jul-20 Present financially benefit Victor Street Surgery or myself
Chair, Dr Mark Kelsey GP Board Member, Paid clinical advisor for STP Will not be part of any decision making that will Southampton City CCG Hampshire and Isle of Digital Programme and Oct-18 current financially benefit the STP digital programmes or Wight STP Wessex Care Records myself Programme
Will not be part of any decision making that will Living Well Partnership GP Partner Jan-18 Current financially benefit the Living Well Partnership or (LWP) personally benefit myself Southampton Primary LWP is a shareholder in Will not be part of any decision making that will Jan-18 Current Care Limited (SPCL) SPCL financially benefit SPCL
University of Module Lead for Primary GP Board Member, Jan-14 Current If I receive any information in my role within the Dr Pritti Aggarwal Southampton Medical Care Southampton City CCG CCG which could be seen as creating a Conflict of Interest where I could pass on or share Royal College of knowledge, in line with the Standards of Business General Practioners Wessex Faculty Board Nov-18 Current Conduct and Conflicts of Interest Policy, I will make (RCGP) it clear to the sender of my conflict, not share it and University Hospital Husband is a UHS Care of take any further mitigating actions Mar-14 Current Southampton (UHS) Elderly Consultant
If I receive any information in my role within the CCG which could be seen as creating a Conflict GPwER for the Wessex of Interest where I could pass on or share University Hospital Cancer Alliance Rapid Aug-20 Current knowledge, in line with the Standards of Business Southampton (UHS) GP Board Member, Diagnostic Service Conduct and Conflicts of Interest Policy, I will make Dr Sarah Young Southampton City CCG it clear to the sender of my conflict, not share it and take any further mitigating actions
Southampton Primary Will not be part of any decision making that will Locum GP May-20 Current Care Limited (SPCL) financially benefit SPCL Living Well Partnership GP Partner Will not be part of any decision making that will Apr-18 Current (LWP) Finance Partner financially benefit the Living Well Partnership Southampton Primary LWP is a shareholder in Will not be part of any decision making that will Apr-18 Current Care Limited (SPCL) SPCL financially benefit SPCL
Living Well Primary Care Will not be part of any decision making that will PCN Clinical Director Feb-20 Current Nerwork (PCN) financially benefit Living Well PCN GP Board Member, Dr Chris Sanford Southampton City CCG If I receive any information in my role within the Redeemer Trustee Jan-20 Current CCG which could be seen as creating a Conflict Winchester of Interest where I could pass on or share knowledge, in line with the Standards of Business Conduct and Conflicts of Interest Policy, I will make Christchurch it clear to the sender of my conflict, not share it and Trustee Dec-18 Current Southampton take any further mitigating actions
GP Partner Clinical Role as GP Prescribing Lead for Will not be part of any decision making that will Shirley Health Practice (2019 onwards) Sep-13 Current financially benefit the Shirley Health Partnership or Partnership Deputy Board Member West PCN representative at West PCN for practice
Southampton Primary Will not be part of any decision making that will GP Board Member, Practice is a shareholder Nov-14 Current Dr Hana Burgess Care Limited (SPCL) financially benefit SPCL Southampton City CCG
Husband has a joint If I receive any information in my role within the academic and clinical CCG which could be seen as creating a Conflict position at consultant level of Interest where I could pass on or share University Hospital within the respiratory Jan-19 Current knowledge, in line with the Standards of Business Southampton (UHS) department at UHS. The Conduct and Conflicts of Interest Policy, I will make position is held jointly it clear to the sender of my conflict, not share it and between University of take any further mitigating actions Southampton and UHS. Southampton Primary Ad-Hoc sessions for SPCL Will not be part of any decision making that will 2016 Current Care Limited (SPCL) Hub financially benefit SPCL South Central NHS 111 Covid Clinial Will not be part of any decision making that will Ambulance Service Assessment Service (CAS) May-20 Current financially benefit SCAS for the CAS service (SCAS) sessions Video and telephone Doctor Care Anywhere Consultations-private Jun-20 Current (DCA) patients Locum GP across GP practices - various Oct-16 Current Southampton City
Aldemoor Surgery GP Retainer Sep-20 Current
Spouse is a Consultant University Hospital Paediatric 2011 Current GP Board Member, Southampton (UHS) Dr Shiba Qamar Gastroenterologist If I receive any information in my role within the Southampton City CCG CCG which could be seen as creating a Conflict of Interest where I could pass on or share knowledge, in line with the Standards of Business Conduct and Conflicts of Interest Policy, I will make it clear to the sender of my conflict, not share it and take any further mitigating actions Wessex Appraisal GP appraiser Oct-19 Current Service
Sister and Brother-in-Law own a company which Sidqam Ltd Oct-19 Current offers software solutions for the healthcare sector Will not be part of any decision making that will Royal Bournemouth Cardiologist Apr-19 Current financially benefit NHS Royal Bournemouth Hospital (NHS) Hospital
Dorset Heart Clinic Will not be part of any decision making that will Cardiologist Apr-19 Current (Private) financially benefit Dorset Heart Clinic
If I receive any information in my role within the CCG which could be seen as creating a Conflict Secondary Care Doctor, of Interest where I could pass on or share Dr Mark Sopher British Heart Rhythm Southampton City CCG Member of Council Apr-19 Current knowledge, in line with the Standards of Business Society Conduct and Conflicts of Interest Policy, I will make it clear to the sender of my conflict, not share it and take any further mitigating actions
Technomed Ltd - Supplier of ECG and Medical Advisor and Will not be part of any decision making that will ECG Monitoring Apr-19 Current Shareholder financially benefit Technomed Ltd equipment and reporting services
If I receive any information in my role within the Chief Executive Officer, Sisters Father in Law sits CCG which could be seen as creating a Conflict Southampton City CCG Patient and Public on the Patient and Public of Interest where I could pass on or share Maggie MacIsaac Hampshire and Isle of Engagement Group in Engagement Group in Feb-19 Current knowledge, in line with the Standards of Business Wight Partnership CCGs Whitchurch Whitchurch , which is in the Conduct and Conflicts of Interest Policy, I will make and West Hampshire CCG West Hampshire patch. it clear to the sender of my conflict, not share it and take any further mitigating actions Hampshire and Isle of Will not be part of any decision making that will Finance Director Sep-17 Current Wight STP financially benefit my role at HIOW STP
Southern Health Foundation Trust University Hospital Foundation Trust Member Apr-13 Current Southampton South Central Ambulance Service
National Finance Vice Chair Sep-14 Current Working Group
South Central Healthcare and Financial Executive Branch Jun-16 Current If I receive any information in my role within the Managing Director and Management Committee Member CCG which could be seen as creating a Conflict James Rimmer Chief Financial Officer, Association (HFMA) of Interest where I could pass on or share Southampton City CCG knowledge, in line with the Standards of Business HMFA Audit Committee Chair Dec-16 Current Conduct and Conflicts of Interest Policy, I will make it clear to the sender of my conflict, not share it and take any further mitigating actions HMFA Trustee Dec-15 Current
Member of the Allocations NHS England Apr-16 Current Steering Group
Independent Governor and Solent University Audit Committee Member Oct-18 Current (WEF September 2019)
NHS Clinical Commissioners Co-chair Jul-18 Current (NHSCC)
If I receive any information in my role within the Director of Quality and CCG which could be seen as creating a Conflict Jointly appointed between Integration SCCCG / SCC of Interest where I could pass on or share Southampton City SCCCG/SCC as the Stephanie Ramsey Chief Nurse, Southampton 2012 Current knowledge, in line with the Standards of Business Council (SCC) Director of Quality and City CCG Conduct and Conflicts of Interest Policy, I will make Integration it clear to the sender of my conflict, not share it and take any further mitigating actions If I receive any information in my role within the CCG which could be seen as creating a Conflict Director of System of Interest where I could pass on or share Peter Horne Delivery, Southampton Valley Leisure Ltd Trustee Mar-12 Current knowledge, in line with the Standards of Business City CCG Conduct and Conflicts of Interest Policy, I will make it clear to the sender of my conflict, not share it and take any further mitigating actions
Chair of Performers List NHS England 2014 Current Decision Panel If I receive any information in my role within the CCG which could be seen as creating a Conflict Lay Member - of Interest where I could pass on or share Henry Slater Governance, Hill Lane Surgery Patient at Hill Lane Surgery 1994 Current knowledge, in line with the Standards of Business Southampton City CCG Conduct and Conflicts of Interest Policy, I will make South Central it clear to the sender of my conflict, not share it and Ambulance Service Foundation Trust Member 2013 Current take any further mitigating actions (SCAS) If I receive any information in my role within the CCG which could be seen as creating a Conflict Lay Member - Patient and of Interest where I could pass on or share Matt Stevens Public Involvement, Mulberry Surgery Patient at Mulberry Surgery 2012 current knowledge, in line with the Standards of Business Southampton City CCG Conduct and Conflicts of Interest Policy, I will make it clear to the sender of my conflict, not share it and take any further mitigating actions
Interim Director of Public Debbie Chase Health, Nil N/A N/A N/A N/A N/A N/A N/A N/A Southampton City Council
Non-Voting Members
If I receive any information in my role within the CCG which could be seen as creating a Conflict of Interest where I could pass on or share University Hospital Lesley Gilder Healthwatch Member Apr-12 Current knowledge, in line with the Standards of Business Southampton (UHS) Conduct and Conflicts of Interest Policy, I will make it clear to the sender of my conflict, not share it and take any further mitigating actions
Councillor Councillor Lorna Fielker Nil N/A N/A N/A N/A N/A N/A N/A N/A Southampton City Council
Executive Director Wellbeing (Health & Grainne Siggins Nil N/A N/A N/A N/A N/A N/A N/A N/A Adults) Southampton City Council
These meeting minutes may become available to the public under the Freedom of Information Act 2000.
Retention of Records: These minutes will be confidentially destroyed 2 years after the date of the meeting, in line with CCG policy and guidance from the Department of Health.
Meeting Minutes
Southampton City CCG Board
The meeting was held on Wednesday 30th September 2020, 14:00 - 17:00 Microsoft Teams meeting
Present: NAME INITIAL TITLE ORG Dr Mark Kelsey MK GP Chair SCCCG (Chair) James Rimmer JR Managing Director SCCCG Stephanie Ramsey SR Chief Nurse / Director of Quality SCCCG and Integration Dr Hana Burgess HB GP Board Member SCCCG Dr Chris Sanford CS GP Board Member SCCCG Dr Shiba Qamar SQ GP Board Member SCCCG Dr Pritti Aggarwal PA GP Board Member SCCCG Henry Slater HS Lay Member - Governance SCCCG Dr Mark Sopher MS Secondary Care Doctor SCCCG
Matt Stevens MS Lay Member – Patient and Public SCCCG Involvement Andrew Mortimore AM Consultant in Public Health SCC Kay Rothwell KR Deputy CFO SCCCG Grainne Siggins GS Executive Director Health and SCC Adults Lesley Gilder LG Member Healthwatch Councillor Dave DS Cabinet Member – Stronger SCC Shields Communities
In Attendance: Beccy Willis BW Head of Governance SCCCG Katherine Elsmore KE Head of Safeguarding SCCCG Emily Chapman EC Business Manager SCCCG (minutes)
Apologies: Maggie MacIsaac MM Chief Executive Officer SCCCG Councillor Lorna LF Cabinet Member – Health and SCC Fielker Social Care Debbie Chase DC Director of Public Health SCC Dr Sarah Young SY GP Board Member SCCCG
1. Annual General Meeting
The Annual General Meeting for Southampton City CCG took place.
2. Welcome and Apologies
All members were welcomed to the meeting. Apologies were noted and accepted.
It was noted that this meeting was being recorded, all attendees agreed to the recording of the meeting. The full recording will be made available on Southampton City CCGs website.
3. Questions From The Public
There were no questions from the public.
4. Declaration of Interest
A conflict of interest occurs where an individual’s ability to exercise judgement, or act in a role is, could be, or is seen to be impaired or otherwise influenced by his or her involvement in another role or relationship.
SQ declared she has joined Aldermoor Surgery; this will be updated on her COI EC/SQ form. It was agreed this didn’t present any conflicts of interest for this meeting.
No other declarations of interest were made in relation to any items on the agenda.
5. Minutes of the Previous Meeting and Matters Arising
th The minutes of the previous meeting that took place on the 29 July 2020 were agreed as a true, accurate record of the meeting.
Matters arising There were no matters arising.
6. Board Assurance Framework
The Board received the Board Assurance Framework (BAF). Each Director talked through their risks
KR updated that the SC001 risk score has reduced due to receiving guidance. This risk will continue to be reviewed.
It was noted that risk SC012 score has also reduced due to the improvement in discharge processes.
MS queried the workforce issue and the positive interest that joining healthcare professions had generated at the beginning of the pandemic, are there any indicators of the impact on this? SR responded that on a regional call yesterday we are seeing a reduction in vacancies, and a significant increase in applications for both nursing and some other allied health professional roles. This will be positive in workforce in the longer term. We need to ensure we support and sustain that workforce.
The Board noted the Board Assurance Framework. Page 2 of 6
7. Managing Director Report
The Board received and noted the Managing Director Report JR outlined the highlights of the paper.
HS raised the work at Oakley Road and if anything has been done with regards to air circulation? JR responded that Oakley Road has no air conditioning so air circulation isn’t a big concern. There is mixed guidance in relation to air circulation, but it doesn’t present issues within the building.
MS raised the question if we need to return to a physical workspace? JR responded that there is a recognition nationally that working from home can be isolating and we need to ensure not everyone has the facilities to work from home long term. Risks and priorities for individuals need to be considered going forward.
8. CCG Reform
MK provided a verbal update on the CCG reform. The Board met last week jointly with Boards across the Hampshire and Isle of Wight, and agreed the merger across the 6 CCGs under Maggie MacIsaac’s leadership.
The merger will take place form the 1st April 2021, a formal application is being made to NHS England this week and is currently being finalised.
The process of designing the new organisation is ongoing over the coming months and is being dealt with at pace. The Programme Board that oversees this continues and is chaired by MS.
HS asked if the Programme Board has the remit to watch the developments of the Integrated Care System (ICS). JR responded there is an application for the ICS currently being worked on to submit to NHS England, the Chief Executives JR oversee this and an update can be brought on this to the November Board meeting.
9. Finance and Performance Report
The Board received the Finance and Performance report and KR outlined the highlights of the report.
HS asked if we are looking at a “non-covid” deficit at year end? KR responded there is a gap; there will be a retrospective allocation to cover the gap. The surplus fluctuates in terms of forecasting but the retrospective allocation will cover this.
MS raised the performance numbers in A&E, how does this work in relation to funding? KR responded that the NHS Providers are wording in a block basis in terms of contractual funding this year, this allows al organisations to have security on this.
MK queried the dementia diagnosis performance and the numbers. SR responded that is month on month and we have started a new financial year. HB raised that this particular cohort of people have been affected by the impact of Covid. Memory clinics are up and running virtually now, however there has been a delay in people presenting with these symptoms and also a delay/reduction in referrals.
Page 3 of 6
GS asked about the CHC performance, CHC assessments have now restarted and there is significant backlog, has this been factored in for the budget next year. KR responded that the CHC budget has been modelled for the second half of the year and there is approximately at £3m pressure identified, this will be considered when moving into the budget setting for 20/21.
MS queried if the switch from block contracts should be included on the risk register. KR responded that this will be kept under review, we are expecting continuous NHS England guidance on how this is managed, but isn’t a risk we would face alone as a CCG.
JR left the meeting.
10. Quality Exception Report
The Board received and noted the Quality Exception Report and SR outlined the highlights of the paper.
HS raised the regular reporting has changed; it doesn’t state the areas of concern and mitigating actions. SR responded that regular monitoring of performance still takes place and is looked at in detail by the Clinical Governance Committee. The detailed report that is reviewed at that Committee can be shared.
HB presented the Medicines Management Annual Report for 2019/20 to the Board and outlined the highlights of the report.
MK queried the e-repeat dispending numbers. HB responded repeat dispensing is different to e-repeat dispensing (ERD), ERD allows batch dispensing during the pandemic.
PA asked if we have plans for B12 injections. HB responded that there are plans for longer term management, interim guidance was released but this has been replaced by the longer term plan. Information on this will be included in FYI Friday (newsletter sent out to Primary Care).
SR presented the Infection Prevention and Control Annual Report for 2019/20 and outlined the highlights of the report.
HS asked about the flu vaccinations for children in Southampton is lower in every age group than other areas. SR responded this is a priority in children’s SR services and will follow this up with the IPC lead.
MS raised there has been information in the media about the potential shortage of influenza vaccines. HB responded that there have been delays in vaccine deliveries. SR raised it is acknowledged there are delays, and there are plans to prioritise who can receive those vaccines on who is most at risk.
GS raised the work that has been done with health and social care (page 90), what improvements have been made on the work in care homes. SR responded that significant improvements have been made on the work with care homes and care providers. There has been a lot more training that has taken place. All homes have had dedicated one to one training and time has been given on how to use PPE etc.
DS left the meeting.
Page 4 of 6
11. Safeguarding Annual Report 2019-20
The Board received the Safeguarding Annual Report for 2019/20. SR outlined the highlights of the report.
MS raised the Ofsted report from the Local Authority and asked if this is a system failure or a provider failure? SR responded that lots of work has been done with the behaviour resilience service to allow children to have support and input. There have been challenges in CAMHs waiting times, and this is part of our current investment plans.
PA asked if we have had an SIRI’s reported over the last 6 months? SR responded we have had an SIRIs reported in relating to CAMHs and waiting times. SR/PA to discuss outside of this meeting.
The Board noted the Safeguarding Annual Report for 2019/20.
A future Safeguarding Board Briefing to take place in October. SR/KE
KR/CS left the meeting.
12. Primary Care Commissioning Committee Terms of Reference
The Board received and ratified the Primary Care Commissioning Committee terms of reference which have been updated in line with their review date. Only one minor change was made under the membership section.
13. Home Working Policy
The Board received the Home Working Policy which has been written by the Partnership. BW outlined the highlights of the policy.
HS asked if the policy should include information relating to areas such as IG and Cyber Security when working from home. BW responded that in Southampton City CCG has an Information Handbook in place which covers those areas, but this feedback will be made back to HR for when the policy is reviewed.
The Board ratified the Home Working Policy.
14. Data Security and Protection Report
The Board received the Information Governance report for information.
15. Sub Committee Minutes
The Board received the following Sub-Committee minutes for information:
- Joint Commissioning Board – 20th February 2020 - Finance and Audit Committee – 20th May 2020 and 16th June 2020 - Clinical Executive Group – 8th July 2020 - Primary Care Commissioning Committee – 9th June 2020
Page 5 of 6
- Clinical Governance Committee – 3rd June 2020, 1st July 2020 and 5th August 2020
16. Date And Venue Of Next Meeting
th 25 November 2020, 14:30 – 17:00, Microsoft Teams Meeting
Page 6 of 6 Southampton City CCG Board Assurance Framework Summary- November 2020
Current Anticipated Initial Risk Risk Score Potential Risk Description Residual Score Risk Score Following Mitigation Risk Ref
High-level potential risks are unlikely to be fully resolved and require on-going control Impact Impact Impact current residual risk residual current Likelihood Likelihood Likelihood RAG Status RAG Status RAG Status Change from initial risk to
SC001 There is a risk the CCG fails to achieve its in year breakeven position in line with its approved financial plan 4 4 R 4 3 A 2 4 A SC002 The risk is that patients have an increased waiting time for their elective activity. The impact is that patients wait longer for treatment and that potentially their condition deteriorates whilst they are waiting.
There is a risk that where providers stop/reduce services or change patient pathways in response to COVID-19 pressures then there is the potential for those patients to 5 4 R 5 4 R 3 4 A experience longer waits resulting in increased harm/deterioration.
There is a further risk that where referrals have decreased significantly, due to reduced services and potential changes in patient health seeking behaviour that there will be a spike in referrals and an increase in complexity of referrals
SC003 There is a risk the CCG fails to achieve the 4 hour A&E performance. 4 5 R 4 4 R 4 3 A There is a risk that ED will be under significant pressure if attendances continue to rise and admission flow does not improve. SC005 There is a risk of sustainability due to pressures on Primary Care - due to increasing demand, workforce supply constraints and risks to viability of some practices 4 4 R 4 4 R 4 2 A
SC006 There is a risk that recruitment and retention across the City of qualified healthcare staff such as registered nurses, specialist practitioners including mental health staff 3 5 R 3 4 A 2 4 A and non-registered support staff is insufficient to meet demand SC007 There is a risk that the sustainability of high quality Mental Health services in the City via Southern Health Foundation Trust (SHFT) and Solent NHS Trust will not be maintained. 5 3 R 4 3 A 3 3 A There is a risk that there is an increased demand in psychological support services due to heightened anxiety levels caused by current COVID-19 then this could result in some service users not being able to access services resulting in service users being at risk of harm. SC008 Significant progress has been made with implementing the BetterCare scheme including development of integrated working, effective rehab and reablement, supporting carers, services to reduce falls. Despite this whole system transformational 4 3 A 4 3 A 3 2 A change overall performance is off track and locality integrated working is variable and further work is required to increase effectiveness. The development of Primary Care SC009 There is the risk that patients breach key cancer constitutional standards. The impact is the patient's diagnosis or treatment is delayed which may affect their clinical outcomes. 5 4 R 5 4 R 4 3 A There is a risk that changes in patient behaviours in seeking advice have lead to decreased referrals. This may negatively impact on the stage at which diagnosis is made and outcomes of treatment SC011 There is a risk that due to the current wheelchair provider struggling to achieve the 18 week waiting time for children or provide wheelchairs for adults in a timely way, there are prolonged waits . This is primarily due to difficulties recruiting and retaining qualified clinical staff within a challenging national workforce position. Whilst it cannot 3 4 A 3 4 A 1 3 A be proven that this is impacting on patient safety, it does have an impact on quality and poses a reputational risk for the CCG. There is an added reputational risk that the procurement for the new contract which commences April 2021 will not attract many bidders as the market is limited. SC012 The standard of discharge planning has changed in line with national guidance (due to Covid 19) and the discharging hospital has potentially not been giving receiving provider / discharge hub adequate information to sufficiently meet the ongoing health 5 4 R 4 3 A 3 3 A needs resulting in poor patient experience, potential patient harm including possible readmission to hospital. SC015 There is a risk that system wide capacity could be severely reduced by pressures in the home care market due to staffing difficulties, e.g. staff sickness/self isolation/ fears re PPE resulting in patients not being able to be discharged, being admitted to hospital 3 4 A 3 4 A 3 2 A and beds in the acute sector becoming blocked. There would also be the same risk if there was an infection outbreak within a home SC016 There is a risk that there is an inability to source appropriate and sufficient D2A placements for people with complex health needs, e.g. dementia and challenging 3 4 A 3 4 A 3 2 A behaviour resulting in delayed discharge Risk Ref Obj No Objective Date Raised Description of the Risk and Impact Original Current Key Controls in Place - what is in place to control the risk Key assurances in place - How Gaps in Control/Assurances Actions required Target Deadline Responsible Delegated Action Progress Date of Last Comments Link to Risk Risk do we know the controls are working Risk for Action Individual Owner Review evidence Score Score Score (for listed action) (IxL) (I x L) (I x L) SC001 Obj 2 Comply with the 01/05/2020 There is a risk the CCG fails to All budgets delegated to directors and authorisation limits of all staff reviewed. Bi monthly Board Finance and Performance None at present although we The CCG is clear about the financial challenges it faces The financial framework for the NHS in 2020/21 has changed significantly as a result of the Covid emergency situation. The financial regime in place for the first four months of the year has been extended to the end of September. The cost of responding to the Covid requirements of achieve its in year breakeven Monthly financial reporting and forecasting is used to forecast risk areas. The report + Deputy CFO internal monthly have to recognise the financial through the staff news letter and staff briefings. situation and any overspending in the underlying CCG position are being retrospectively funded, bringing the CCG to a break-even position. the annual position in line with its approved forecasts are reviewed at a number of places including CCG Contract Review review of year end forecasts. Business challenge of the NHS planning financial plan Meeting (CCOG). Business Management Team to focus upon QIPP delivery. Management Team receive reports on Organisations around us and The financial regime for the second half of this year has now been confirmed, including CCG allocations and system level allocations for Covid-19 funds, top-up funds and growth. A Hampshire and Isle of Wight system level financial plan, reflecting the Phase 3 plans guidance Monthly STP DoFs meetings which includes inter company balances ensuring that financial forecasts . The Primary Medical the impact that could have Chief already submitted was submitted on 20th October. Organisational level plans in line with this were submitted on 22nd October. For Southampton CCG the plans see us deliver a break-even position for the second half of the year. 16 12 8 Chief Financial delivering commissioner and provider income and expenditure aligns to mitigate risks. Deputy Care Commissioning Committee of the CCG upon us and our patients. Mar-21 Financial 20/10/2020 Finance Report (4x4) (4x3) (2x4) Officer financial balance CFO reviews all budgets and forecast at Day 6 meeting with the finance team. gives additional focus to the primary care Officer All allocations are now prospective and known, the exception to this for the CCG being the Hospital Discharge Programme, which will continue to provide funding for all patients discharged from hospital who fall under this scheme. For those discharged before the and sustainability delegated budgets. And the CCGs Finance beginning of September this funding will continue until their ongoing needs are assessed and will then pass to the relevant funding body (scheme 1). For those discharged after 1st September this funding is limited to a maximum of 6 weeks. The progress of clearing and Audit Committee undertake a twice a the scheme 1 backlog clients and monitoring scheme 2 assessments is being undertaken in partnership with the LA and monitored through the Continuing Healthcare Oversight Group. year financial deep dive into a specific risk area. SC002 Obj 1 Ensure the 01/05/2020 The risk is that patients have an Working with community providers and acute providers to maximise the use of Monitoring of RTT performance against Uncertainty of continuation of System task and finish groups to focus on key pathways and Elective restoration and recovery plans in place and agreed. However, activity levels remain impacted by a number of factors including: decrease in productivity due to Covid-19 restrictions, IPC and cleaning schedules, a decrease in staffing due to shielding and those quality and increased waiting time for their community services. specialties and total referrals. independent sector contracts analyse clinical benchmarking, inc. speciality reviews, adopt at high risk, patient choice which is impacted by isolation protocols and some operational issues. UHS have identified 7 specialities where NHS England targets around returning to pre-pandemic levels may not be achieved (ophthalmology, endoscopy, T&O, safety of elective activity. The impact is that Weekly scrutiny of activity against plan via with NHS E from January and adapt. dermatology, gynaecology, urology, cardiology). commissioned patients wait longer for treatment and Ensure that referral pathways are clear and easy to follow on DXS. Referrals for data returns to NHSE and weekly meetings 2021 and a concern around services that potentially their condition pathways monitored by providers and by Commissioning Managers. with providers. Oversight from HIOW the underutilisation of existing Harm risk identification dashboard (HIOW) being developed RTT performance has improved month on month and is now 56.7% against the 92% standard. CCG Total Waiting List reduced during Covid-19 due to reduced numbers of GP referrals and clinical review/validation of lists; however, during July-Sept the waiting list (‘Patients first, deteriorates whilst they are waiting. Primary Care informed of current performance so as to inform patient choice in Restoration and Recovery Board through IS capacity, in particular by Covid Quality Cell increased at a faster rate than elective and outpatient Activity. It now sits at 12,676, higher than our March 2020 position (though some data validation is required on STC figures). Patients waiting over 52 weeks continue to grow with 416 waiting at the end of every time’), light of COVID pandemic. the Elective care programme. CCG scrutiny inpatient activity at Spire and September. This will take a significant period of time to address. including the There is a risk that where providers of actions at monthly business meeting. Nuffield and day case activity Monthly performance meetings with UHS. Weekly meetings NHS stopped/reduced services or changed Maximise the use of Advice and Guidance and virtual ways of working so that first at Practice Plus. Key issues with IS providers and NHS regional representatives, plus To address this: Constitutional patient pathways in response to outpatient slots can be utilised for the most unwell patients. relate to anaesthetist additional meetings focused on specific issues as required. • Continued system wide monitoring and support to maximise utilisation of independent sector to support UHS in their elective programme. Independent Sector (IS) contracts confirmed until end December with a new national Framework Agreement to be implemented Standards COVID-19 pressures then there is the capacity, other staffing Weekly data returns inc. narrative from all providers. Daily from then, although detailed information on this is awaited. potential for those patients to Some organisations have undertaken quality impact assessments of service shortages, and patient calls between IS and UHS. UHS have appointed senior Director of Senior • Clinically led prioritisation processes in place using Royal College of Surgeons guidelines to ensure patients are prioritised according to their clinical urgency. All patients lists categorised according to priority, panel in place to ensure most urgent treated first followed 20 20 12 Performance experience longer waits resulting in changes cancellation/withdrawal within manager to oversee. HIOW Planned Care programme led by Mar-21 System Commissioner for by longest waiters. IS providers are part of regular panel meetings to ensure consistency and mutual aid mechanisms in place. 26/10/2020 (5x4) (5x4) (3x4) Report increased harm/deterioration. 3 days of treatment (so no Planned Care Network Board. Delivery System Delivery • Ongoing validation supported by CSU validation exercise and modelling tool. Harm prevention tools are in place backfill possible). • Robust Clinical Assurance Framework in place in UHS to provide assurance that any safety risks relating to longer waits are understood and mitigated. Process in place for a structured review of any patient over 52 weeks where there is the risk of harm, part of a There is a further risk that where PPE, staffing and medication pilot for HIOW clinical harm review tool due to be evaluated in October referrals decreased significantly Continued system wide monitoring and support to maximise utilisation of shortages will impact on acute • Continued use of virtual appointments and ways of working, and advice and guidance. UHS launched e-grading system to assist with clinical triage, starting with gastro and neurology. during COVID-19, due to reduced independent sector providers; processes to review, categorise and prioritise provider capacity; IPC • Focus on key specialities with the longest waits and potential for harm. These are 5 system wide specialty reviews underway (trauma and orthopaedics, ENT, urology, ophthalmology, and dermatology). services and changes in patient patient lists. controls reducing productivity. health seeking behaviour, that there Providers need to provide will be a spike in referrals and an System level work focusing on key specialities with longest waits and potential for assurance that improvement increase in complexity of referrals harm, inc. 5 speciality reviews, adopt and adapt programme. plans can deliver sustained improvements in performance, and to ensure that IS capacity is maximised. SC003 Obj 8 Redesign and 01/05/2020 There is a risk the CCG fails to Key focus on non-ED conveyance pathways, alternative service/management via Currently monitored daily by region with Trust need to provide Continued system monitoring of new changes to pathways in Southampton City CCG met the 95% standard for all type in May (95.1%), June (95.9%) and July (96.1%). strengthen the achieve the 4 hour A&E performance South West Hants Connect (pilot) and 111 First (to commence Q3) internal <80% flagged and reviewed. Commissioners assurance to both CCG and response to Covid pandemic urgent and improvement processes, admission flow, workforce and estates improvement. meet fortnightly with UHS as part of UEC regulators that improvement August CCG performance 89.8% and September CCG performance 93.5% emergency care There is a risk that ED will be under recovery to ensure progress and plans can deliver sustained system to ensure significant pressure if attendances engagement with key initiatives to reduce improvements in performance UHS ED activity levels have increased over the summer and are now back to over 2000 attendances per week. that patients continue to rise and admission flow ED attendances and improve performance receive the right does not improve. UHS are leading on system pathway development work including the South West Connect pilot to improve pathways into the hospital and admission avoidance alongside the concept of an emergency village and the roll out of 111 First. This work pulls together all of Director of Senior Finance and care in the right 20 16 12 the learning from new ways of working during Covid-19. Mar-21 System Commissioner for 10/09/2020 performance place first time (4x5) (4x4) (4x3) Delivery Urgent Care As attendance levels continue to increase a continued focus on embedding new ways of working and monitoring of the impact on performance will be necessary. report
Regular meetings with local UTCs in place to share learning and prepare for winter.
SC005 Obj 5 Build a model of 01/04/2019 There is a risk of sustainability due to Established practice profile, link manager roles, regular contract meetings, quality Practice link roles and quarterly review GP practices are mainly Continued development of link roles, quality framework and Primary Care Services have responded well in the face of the COVID19 pandemic. This has been overseen by the CCG working collaboratively with Primary Care Networks, Southampton Primary Care Limited, Public Health and other relevant stakeholders. general practice pressures on Primary Care - due to framework and quality review meetings to improve engagement with practices and meetings. independent contractors and GP engagement arrangements to further promote trusting Transformation of services to respond to the COVID19 pandemic has included: that will be increasing demand, workforce supply better real-time view of practice quality and performance. To understand practices Quality framework and quality review visits. the flexibility to direct is relationships with practices. strong, effective constraints and risks to viability of of concern and escalate CCG support and other interventions. Primary care profile, monthly review somewhat challenged by this - 100% remote triage first model - including all practices offering e-consult and video consultations and sustainable some practices meetings and exception reporting feeding situation. Support and advice to practices as required including - separation of patients who need face-to-face assessment who are suspected to be Covid-19 positive from those who are suspected to be Covid-19 negative foundation of our Menu of support in place including but not limited to GPFV Resilience Programme, into Clinical Governance Committee and emphasis on those identified via practice exception reporting - Delivery of centralised "hot" services for patients who are suspected to be Covid-19 positive - including a hot clinic at St Marys Surgery and hot visiting service integrated health Section 96 emergency payments, training and other support coordinated by Vulnerable practices group. Contractual levers are very and Vulnerable Practices group. - Delivery of "cold" services from most GP practice sites for patients who are suspected to be Covid-19 negative and social care Primary Care Team. Contingency plans for practice failure in place Regular assurance meetings with practice limited as is nationally - Delivery of services for patients who are shielding or vulnerable to Covid-19 infection system with adverse CQC report. negotiated Continued development of arrangements for engaging Investments including Enhanced Access, Acute visiting service, Care homes Primary Care leadership including Primary Care Network These changes are aligned with NHS England notices and requirements for Primary Care response to Covid-19 pandemic. The changes have included temporary contract variations and some additional investments. PC Committee initiative to provide additional primary care capacity Regular engagement with PCN Clinical Clinical Directors. Director of 16 16 8 Associate Director Primary Care Directors Mar-21 System During April and May 2020 GP practices in the city experienced a significant reduction in demand / contacts from patients compared to 2019. However demand is now increasing due to the restoration and recovery of services. In August 2020 GP appointments 16/10/2020 (4x4) (4x4) (4x2) of Primary Care Quality & Supporting the establishment and development of Primary Care Networks (PCNs) Ensuring primary care development is a key element of the Delivery (including e-consult) were 5% higher in the city compared with August 2019. In comparing the activity breakdown between August 2020 and August 2019 there has been a reduction of face-to-face appointments by 38% balanced with increases in phone consultations to promote primary care resilience. Arrangements in place for engaging Primary Through our controls we have better lines of Better Care workforce programme of 125% and e-consults by 818%. This is in line with CCG and NHS England expectations and Covid-19 operating model. It is also worth noting that there are significant numbers of workforce in Primary Care who are limited in terms of their ability to see patients face- Performance Care leadership within city including CCG Clinical Board members and PCN communication / relationships with practices to-face due to outcomes of their personal risk-assessments. The CCG is currently working with practices to undertake an Equality Impact Assessment on the changes to the operating model, most notably e-consult. reports Clinical Directors. – we will see it coming if there are risks to sustainability In response to the escalating Covid-19 pandemic, the CCG is now working with practices, Public Health, Primary Care Networks and Southampton Primary Care Limited to take stock of the Covid-19 response. In October 2020 it was agreed that hot services will continue to be centralised and hosted by SPCL. The CCG has identified additional resources to strengthen the hot service response, PCN escalation plans and additional telephone clinical assessment capacity for Covid-19 and 111 First
SC006 Obj 1 Ensure the 01/04/2019 There is a risk that recruitment and All Health providers required to produce monthly safer staffing data which is Monthly reports from with Health providers Further work needed re Providers reporting to include other staff groups beyond Ongoing monitoring in place with all providers via attending provider meetings rather than holding CRM and CQRM's. quality and retention across the City of qualified monitored by reviews undertaken by Quality Managers (nursing focused). and CCG quality leads attending provider escalation in care home nursing to be further enhanced. Influencing providers to work Solent NHS Trust have extended their pool of bank staff as part of Covid-19 response safety of healthcare staff such as registered Monthly workforce data from CSU quality meetings sector - promotion via weekly together, sharing intelligence, holding joint recruitment Discussions with providers to support staff with newly acquired skills as part of redeployment for Covid-19 to retain those skills commissioned nurses, specialist practitioners Updates included in contract reviews specifically for adult MH in relation to Reports from health providers including teleconferences events, links with University. Ensuring providers are sharing Work underway across HIOW which Southampton is linked into, to support cross system movement of staff e.g. training passport services including mental health staff and non- Antelope House. SHFT have an action plan in place updates on adult MH action plan Skills set and familiarity of learning Additional £140k to be used in 2020/21 to support workforce activity. Focus on leadership, associate practitioner and specialist practitioner development. Plan agreed and being implemented by Southampton and SW Hants leads for HR and Quality (‘Patients first, registered support staff is insufficient Exception reporting is in place where staffing concerns may be impacting on the Contract reviews with health and care setting for deployed/returning Impact of Brexit on providers to be kept under review HIOW and local Southampton and SW system work on Home First Community model - detailed on integrated model and skill set required every time’), to meet demand quality of care providers have focus on workforce issues staff Ensuring providers are learning from experiences elsewhere PCNs have submitted workforce plans for Additional Roles for 2020/21 . Primary Care team to facilitate and monitor delivery Additional training available across range of areas to support staff working in new settings . PCN's have pharmacists and pharmacy including the Monitoring wider staffing concerns/intelligence e.g. Solent staff issues in Monitoring via capacity tracker (care homes) in their organisation technician support in place as agreed for each area. Local providers linked into national recruitment processes for staff from abroad. Providers have had access to nursing staff on emergency register to support activity NHS There is a risk that significant Portsmouth Monitoring in providers includes all staff CCG triangulating information and signposting providers to Mutual aid arrangements in place in the social care sector but not currently activated Constitutional workforce reductions owing to staff Care homes and home care providers supported via leadership training and peer groups potential solutions/options for consideration. Standards sickness (Covid 19 related) within all support network which promotes access to training and wider support Escalation routes are clear in health Encouraging providers to think differently about skill mix and Hotel care staff available to support care providers if needed statutory health and care sectors will Additional £140k funding available from the HIOW people programme to support providers profiling, commissioners promoting providers to think result in severe service restrictions, further developments in Southampton and SW Hants IPC. Plans in development Development of mutual aid arrangements - differently about staffing models Ongoing work across HIOW to support mutual aid between health providers, this is an ongoing process with staff flowing from redeployed posts back to substantive roles as part of recovery. If Covid-19 cases increase redeployment is likely to be reactivated potential ward closures, inability to for submission by 28/09/2020 Workforce development element of Home First ensure staff movement is appropriate and CCG sharing information with NHS England and Health Change in risk score run primary care hubs. This includes 15 12 community model development well managed. Education Wessex about concerns 8 Staff testing for Covid-19 in place for all NHS staff, some issues about contracted private providers and their ability to access tests currently being reviewed Health and Care organisations have had an ongoing focus on staff wellbeing . As part of Restoration and Mar-21 Chief Nurse Deputy Chief Nurse 28/10/2020 from 15 to 12 as of Finance report Primary Care, Secondary Care, (3x5) (3x4) Redesign of services includes quality impact assessments Monitoring of sickness absence in care Work with Solent University to bring student nurse (2x4) Recovery programme staff are returning to their original roles - impact of this and mitigation being reviewed. People Board planning to enable people maintain to maintain skills developed. Social Care and Monitoring of care home staffing via capacity tracker homes via capacity tracker and IPC calls to placements into nursing homes, primary care and CCG. November 2020 Independent/Voluntary sector PPE provision and training homes with Covid positive cases Facilitate workforce planning and maximisation of As formal Contract Review Meetings have been (currently) stood down, and recognising the need to avoid duplication and adopt a system wide approach, CCG attending SHFT internal divisional performance and quality meeting. Work is taking place with SHFT to services Testing of Key workers for Covid-19 Daily self-assessment and reporting of GP opportunities within PCN DES and Additional Roles help shape the content of these meetings so that they provide assurance for their own internal needs as well as CCG needs. National drive to encourage retired and non-working healthcare staff back to practice resilience Reimbursement. practice Ongoing flagging to care home sector of escalation routes via CCG and provider staff list detailing those staff that can currently be deployed to ICU Hub and Capacity Tracker support providers (clinical and non clinical) Regular quality lead calls with providers and escalation of Providers running induction and additional training for new staff and staff being issues as appropriate via the Quality Cell. deployed Link with workforce cell System of mutual aid from NHS to Care Home sector for registered nurses Development of protocol to support the provision of staff to Primary Care business continuity plans refreshed to include consolidation of sites care homes if needed (in progress) and teams in event of workforce shortages
SC007 Obj 6 Improve mental 01/05/2018 There is a risk that the sustainability Mental Health Matters Strategy and aligned investment into priority areas (ref monitoring of RTT performance against Trust needs to demonstrate Evidence of robust recruitment and retention plans New Divisional Director of Nursing in place for Southampton - internal candidate who is an experienced Mental Health Nurse wellbeing and of high quality Mental Health services investment this is not currently the case, we have not yet been able to agree specialties and total referrals. sustained improvement in provide in the City via Southern Health investment for 20/21 due to MHIS financial flows clarity awaited) with clear sustaining workforce levels Reduce use of out of area placements Significant out or area placement reduction during Covid-19 response, focus on maintaining this position accessible Foundation Trust (SHFT) and Solent outcomes. Formal escalation of issues to Contract and consistent leadership support at the NHS Trust will not be maintained SHFT implementation of quality improvement plan, including reduction in Review Meetings, if necessary. especially related to service Evidence of consistent leadership during management Additional capacity in NHS111 Mental Health Nurse Triage Service, and web access now available right time to community team caseloads restructure restructure avoid getting into There is a risk that there is an New leadership team in place from May 2019 for Southern Health Changes to Psychiatric Liaison Service with ED diverts in place responding to Covid-19, discussions underway to reinstate pathways crisis increased demand in psychological Regular recruitment events at Antelope House. Investment into CAMHS services Implementation of action plan following ligature related support services due to heightened to reduce waiting times serious incidents Confirmed attendance of quality manager at Southampton based quality meeting and learning from deaths forum for SHFT, new patent safety lead appointed for Southampton division, anxiety levels caused by current All providers have increased their non face-to-face capacity (enhancing capacity) 24/7 MH Triage arrangements in place (NHS111) and psychiatric liaison within University Hospital Southampton NHS Foundation Trust . COVID-19 then this could result in including IAPT. Focus on reducing waiting times for services in CAMHS and The Lighthouse mobilised to be virtual, maintaining access 4pm-midnight 7 days per week. Supported 202 virtual visits during April. Supported over 600 virtual visits during April-June with 130 unique contacts. some service users not being able to IAPT therapeutic offer to include impact of COVID-19 and increased access to opportunities for earlier intervention in children and young Greater use of digital technology for assessment, psychological treatments and patient care access services resulting in service PTSD, Social Anxiety Disorder, OCD or Health Anxiety and new modality peoples emotional health and wellbeing Pilots to try virtual GP referral meetings Senior Clinical users being at risk of harm. 15 12 Persistent Complex Bereavement Disorder. 9 Increase in presentations from people not previously known to services or who haven't accessed secondary care support for a number of years Current risk score and Mar-21 Chief Nurse Commissioner for 06/09/2020 Governance (5x3) (4x3) Agreement in place between CCG and DHC (IAPT) to proceed with LTP expansion (3x3) IAPT ( ‘Steps to Wellbeing’) Increased use of digital technologies based on national guidance during lockdown. Working towards restoring face to face appointments, and will identify those who cannot access telephone or online treatment options target risk score reduced plans in 20/21 whilst awaiting clarity on MHIS financial flows, resulting in increased Mental Health surge in referrals relating to emotional and mental health – anxiety, depression, trauma – anecdotally this is already impacting on capacity in primary care and secondary care Committee capacity to meet original LTP access trajectory Explore opportunities for accelerated integration through Primary Care Network development bringing together primary care, IAPT, secondary care mental health services and voluntary sector
CAMHS - During COVID there has been a significant decrease in referrals received and this has enabled Solent to reduce both initial waits and those waiting for treatment - Evidence highlights that there is likely to be a significant increase in emotional and mental health issues in the wake of Covid-19 and it is likely that CAMHS will see a significant increase in referrals when CYP return to school. This will continue to be monitored - The service has increased their remote offer but continue to see initial and high risk/vulnerable young people face to face. The move to remote contact has seen a decrease in WNBs as well as an overall increase in contacts
Mental Health Matters Strategy and aligned investment into LTP priority areas with clear outcomes supported by 20/21 MHIS financial flows clarity now in place. Agreement in place between CCG and DHC (IAPT) to proceed with LTP expansion plans in 20/21 supported by MHIS financial flows clarity, resulting in increased capacity to meet original LTP access trajectory, achieved Q2 access target.
SC008 Obj 3 Better Care 01/04/2019 Significant progress has been made *Cross system sign up to Better Care Strategy and Transforming Health & Care Better Care Southampton governance and Stability in care market to Implementation of Health and Care Five Year Strategy - Five year Health & Care Strategy work streams (Start Well, Live Well, Age Well, Die Well) have been reassessed against the impact of the COVID pandemic and priorities revised for the short, medium and longer term. These have been signed off by the Better Care Southampton - with implementing the BetterCare outcomes for people of Southampton oversight with clear outcomes and meet increased demand following COVID impact assessment Steering Board and Joint Commissioning Board (JCB). Detailed implementation plans have now been developed and agreed at Better Care Steering Board and approved at September Joint Commissioning Board. Work together scheme including development of *Five Year Health and Care Strategy in place performance indicators Clarity on operating model Active work through integrated commissioning with market to Learning from the COVID response has been incorporated into the review of the work streams with a view to embedding best practice moving forward. across health integrated working, effective rehab *Programme Manager in place to support development of integrated local support Quarterly monitoring of 5 Year Health and within localities and alignment develop capacity to support timely discharge and flow The Better Care Steering Board has resumed meeting monthly and will be receiving regular updates on delivery of the 5 Year H&C Strategy work streams with each work stream reporting every 4 months. Updates are then presented 6 monthly to the JCB and social care and reablement, supporting carers, *Locality Development of cross organisational leadership teams in place and work Care Plan of Primary Care Networks Build on opportunities linked to recommissioning of Home to deliver services to reduce falls. Despite this plans developed Care Framework and the new development of So Linked The Better Care Board is also reviewing the model of local leadership with a view to strengthening delivery of integrated locally based care, supporting the PCNs. integrated, whole system transformational *Strength based approach in Social Care Operating model and implementation plan for locality and person centred, change overall performance is off *HIOW wide development of New Models of Care - now Community model of PCN development joined up care track and locality integrated working Home First Work on Primary Care Networks In terms of addressing longstanding performance challenges: and support for is variable and further work is *Investment in out of hospital model including into the Voluntary Sector Work on Integrated Care Team model at pace people in required to increase effectiveness. *Primary Care Strategy Identify learning from response to COVID-19 pandemic, Admission avoidance Southampton to The development of Primary Care embed positive progress made into existing and new work - Specifically a key work stream is focussing on an integrated model of care across primary, community and acute sectors for supporting the shielded population and this will provide a bedrock for integrated care teams moving forward, based on risk stratification, reduce the health Networks needs to be supported streams anticipatory care planning and integrated working. Pilots have been set up for West PCN, Living Well Partnership and Central and North PCNs with good PCN engagement - recently gone live inequalities in alongside this - Roll out of the Enhanced health in Care Homes (EHCH) model has been accelerated in response to COVID and is now operating across all homes. This will be further developed over the course of 20/21 with PCNs to agree a model for the future. There has been Associate Director Joint Southampton 12 12 6 significant support to care homes also through the CCG and Council's Care Home Action Plan which has provided additional training and support Change in Target Mar-20 Chief Nurse of System 09/07/2020 Commissioning (4x3) (4x3) (3x2) - Considerable progress has been made in response to COVID in developing a coordinated community offer to vulnerable people, supported by SO:Linked, with an increase in volunteering activity. Work is underway to further embed and sustain this. score in July Redesign Board - Work is underway to develop a single point of triage in the community building on the Single Point of Access for hospital discharge established in response to Covid to improve and better coordinate the response to patients requiring urgent intervention in the community to prevent an admission (it should be noted that implementation will be dependent on increased investment in community services)
Delayed Discharge In response to the Government's discharge requirements in responding to Covid-19, the system has also moved to a new discharge to assess model with the establishment of a new community based Single Point of Access/hub. The system has also moved to discharging patients earlier in the process at medically optimised for discharge (MOFD). Clear governance arrangements and processes have been established and system wide KPIs are in place to oversee performance. The CCG has agreed funding this year to bring on line an additional 20 D2A beds, bringing the total number of D2A beds up to 47. Work is underway to secure this additional capacity; however there are challenges in terms of securing nursing homes willing to take this on - the aim is to get the additional capacity in place by 1 November (original plan was 1 October). Recent national requirements for designated Covid positive provisions which mean that no Covid-19 positive patients can be discharged from hospital into a care home bed unless it is a designated provision, assessed by the CQC, will result in increased discharge delays over the coming weeks. Southampton is currently in negotiations with one home to secure designated Covid-19 positive provision but this will need to be assessed and agreed by the CQC Risk Ref Obj No Objective Date Raised Description of the Risk and Impact Original Current Key Controls in Place - what is in place to control the risk Key assurances in place - How Gaps in Control/Assurances Actions required Target Deadline Responsible Delegated Action Progress Date of Last Comments Link to Risk Risk do we know the controls are working Risk for Action Individual Owner Review evidence Score Score Score (for listed action) (IxL) (I x L) (I x L) SC009 Obj 7 Cancer and 01/04/2019 There is the risk that patients breach NHSE/I have mandated that Cancer treatment will continue. Monthly review of cancer performance Provider assurances with Implementation of Wessex Cancer Alliance Delivery Plan August 2020 data shows that for Southampton City CCG 9 out of the 10 standards were met. The metric which was not achieved was 31 Day Surgery and was missed by 6.5% and due to low numbers (4 of 32 patients breached; 3 of these were due to Capacity both Planned Care - key cancer constitutional standards. against the trajectories submitted, including regards management of Support implementation of Rapid Diagnostic Service in Inpatient and Outpatient). Activity for the 2 metrics hardest hit by the pandemic (2ww and 28 day) have continued to increase in month 5 and are now just 9% and 7% lower than the same month last year respectively. Latest weekly data (27/09/2020) shows 7 104 day Increase earlier The impact is the patient's diagnosis Modifications to v10 Cancer Waiting Times breakdown by specialties. cancer services during COVID- Southampton waiters without a date to come in; this is now back to pre-pandemic levels. detection and or treatment is delayed which may 19 period Implementation and ongoing review of targeted lung health treatment of affect their clinical outcomes. 28 day faster diagnosis standard data continues to be collected (but not subject to Monthly discussion at Cancer Strategy check programme There remain risks in terms of: cancer and financial performance management) Meeting, UHS Performance Board. Uncertainty of independent Cancer Education work - seeking to address behaviours, 1) Patient behaviours with patients not presenting with symptoms for investigations/treatment due to Covid-19 concerns, likely to result in later diagnoses transform There is a risk that changes in patient sector contracts with NHS E prevention, early intervention 2) Suspension of national screening and national programmes; although they are beginning to re-start now there are issues surrounding some of the screening, in particular for breast screening and social distancing regulations. There are significant backlogs. planned care behaviours in seeking advice have Cancer PTL collected from January 2021 onwards, Support Wessex Cancer Alliance work on endoscopy review, 3) Diagnostic capacity, the most notable is endoscopy capacity Board papers Director of clinical pathways lead to decreased referrals. This may 20 20 may impact on capacity adopt and adapt 12 Director of System Mar-21 System 26/10/2020 Business to improve negatively impact on the stage at (5x4) (5x4) Regular communications with Primary Care to inform referral options in light of (4x3) Delivery Actions include: productivity and which diagnosis is made and COVID pandemic Delivery • Wessex Cancer Alliance developing Delivery Plan for September 2020-March 2021 Management provide care outcomes of treatment • Rapid Diagnostic Service launched in Poole in August, expanding to Southampton in November 2020. Team closer to home • Wessex Cancer Surgical Hub has been established to address capacity issues, though this has not been required to date • Targeted lung health check programme restarted in Southampton on 24 August • Wessex Cancer Alliance leading work to review and improve endoscopy capacity • Communication with GPs to increase FIT testing • Adopt and adapt programme launched in August; South East leading on cancer performance programme.
SC011 Obj 1 Ensure the 12/12/2019 There is a risk that due to the current Regular Contract Review Millbrook Healthcare improvement plan in place. New Monthly reporting against new KPIs. CRM Provider ability to recruit and Refresh recovery and improvement plan with MB to take Further to a robust and competitive procurement process, the new contract which commences 1 April 2021 has been awarded to Millbrook Healthcare. The service has been redesigned and is underpinned by NHSE's model specification and the Operating Model for quality and wheelchair provider struggling to KPIs established to provide greater transparency along the pathway. Millbrook and CQRM. Monthly meetings also retain clinical staff. account of impact of COVID response - new trajectory to be NHS Commissioned Wheelchair Services developed by the National Wheelchair Managers Forum. Further enhancements to the specification have been made following learning from existing local wheelchair service provision and from other wheelchair services safety of achieve the 18 week waiting time for Healthcare Workforce plan in place with identified actions for workforce planning, incorporate a dedicated section on Ensuring that the provider is set for improvement nationally, recommendations from an Independent Occupational Therapist with both wheelchair services and equipment experience, extensive public engagement, and market engagement. Key changes/adaptations to the model include: commissioned children or provide wheelchairs for pay and reward, recruitment and retention, learning and development, staff mobilisation. Action plans in place with sufficiently resourcing its local - continued development of individual wheelchair budgets - the provider must provide and actively promote the essential features of Personal Health Budgets within the wheelchair service to support a local offer of Personal Wheelchair Budgets which will ensure services adults in a timely way, there are engagement and health & wellbeing. A range of specific workforce projects also regular scrutiny delivery teams to be equally Communications and Engagement: establish dedicated work services are personalised and offer increased choice and control for service users accessing the service (‘Patients first, prolonged waits . This is primarily being explored including internal training of REs and OTs, peripatetic posts, joint Continuous feedback mechanisms with focussed on mobilisation of stream with senior comms and engagement management - broadening the offer of the service to children under three years of age - the provider will accept referrals for children under 3 years if they have postural support needs or functional wheelchair support needs which cannot be accommodated in a normal commercially every time’), due to difficulties recruiting and posts with community providers other providers and service users the new specification/contract oversight regarding publicity of newly tendered service available buggy that a parent would normally be expected to fund. (Currently this age range is met via the Individual Funding Request process). including the retaining qualified clinical staff within and on BAU including proactive comms to be developed and circulated to - a greater utility of digital initiatives - a number of digital implementations have been mandated from the point of service commencement which are currently lacking within existing service provision. This will be supported by further digital innovations being included NHS a challenging national workforce Robust arrangements in place for mobilisation of new April 2021 contract with key stakeholders as soon as decision becomes public within the Service Development and Improvement Plan (SDIP). Constitutional position. Whilst it cannot be proven senior level involvement from both CCGs, including quality leads and substantial knowledge. Rebranding and publicising of new service - increased use of Direct Issue & Community Prescribing - the provider will be expected to develop and implement a Trusted Assessor model with local health and care providers. This has been implemented in other areas nationally and a local pilot of this approach is Standards that this is impacting on patient service user/public and community provider Trust involvement . New service - Robust workforce and recruitment strategy and continued in its infancy. The approach aims to maximize utility of highly skilled community therapists, enabling them to directly prescribe wheelchair equipment to reduce the need for unnecessary repeat assessments within the wheelchair service. This improves patient safety, it does have an impact on specification underpinned by NHS England’s model specification and the work with other providers to explore and implement joint experience by negating additional patient contacts, but also helps support the wheelchair workforce where there is a nationally recognised shortage. quality and poses a reputational risk “Operating Model for NHS Commissioned Wheelchair Services” developed by the appointments/ rotations etc. - Supporting inpatient care – the provider is expected to work with local Acute Hospitals to provide training and develop appropriate sub-stores of equipment to support timely discharge from hospital. (The provider is expected to take a similar approach in the provision for the CCG. National Wheelchair Managers Forum. to specialist schools within the geography). Director of Associate Director ICU 12 12 Transition plan being implemented between current and new specification . Recruitment of dedicated commissioning lead 3 Mar-21 Quality & of System 01/11/2020 Management (3X4) (3X4) Dedicated commissioning lead being recruited to provide additional focussed (1X3) In addition a number of contract changes have been made to provide greater transparency, including the move to a block and variable payment mechanism ( a block price relating to fixed costs (i.e. premises, IT etc.) and a variable payment for equipment which will capacity to keep mobilisation on track. Integration Redesign include a handling fee payable on the successful acceptance of a wheelchair from the end user) and a new set of KPIs which provide visibility of the whole pathway. Team
Work is now underway to plan for mobilisation and a series of working groups are being established with representation from service users and local NHS Trust partners. The first of these, focussing on children and school clinics, continues to meet fortnightly and is progressing well. Criteria have been agreed jointly between the Wheelchair Service and community therapists about when to see a child in school clinic as opposed to the wheelchair depot; the planning/triage process for considering children jointly between the wheelchair service and community therapists has been reviewed and a new process put in place; communication processes have been improved. School clinics have now re-commenced.
A waiting list initiative with the provider has also been agreed and will bring in additional capacity - 3.3 additional WTE and 112 additional clinical appointments per month. There has been some delay in this starting owing to the recruitment of two additional locums (due to start in Sept but now, owing to Covid-19, will start in November). However, the service is above full staffing levels.
Latest performance for Sept is showing positive trends in terms of the ratio between new referrals and closed cases. However, there has been a deterioration in the very positive performance relating to triage times which was 96%+ of target over the Summer but has dipped in September and waiting times for assessments continue to be well below target - this will be picked up at the October performance meeting and the provider is being pushed to ensure that it is adequately resourcing itself to work on new contract mobilisation without this being at the expense of BAU.
The CCG is currently out to advert for the dedicated Wheelchair commissioner to ensure that there is sufficient focus on this contract - interviews are due to take place in November. SC012 Obj 1 Ensure the 11/04/2020 The standard of discharge planning Redesigned process in place with oversight from quality team Daily hub meetings to review cases to Receiving organisations to 1. Quality cell to share learning on quality/community Fortnightly learning and sharing event in place and proving valuable for early identification of concerns/issues and solutions quality and has changed in line with national Quality Manager involved in quality assurance meetings re discharge hub ensure receiving teams in the discharge hub understand route for provider telecom Quality assurance activity to support discharges in development safety of guidance (due to Covid 19) and the have sufficient information to make escalation Follow up via IDB Leaders to ensure all partners are engaged Ongoing review of incidents of poor discharge being fed back to UHS for learning. commissioned discharging hospital has potentially appropriate placements in improving the situation Quality assurance process still in development, group has started meeting burt further work to do to support quality expertise services not been giving receiving provider / FAQs being finalised for care homes about testing on discharge from hospital, shared with Care homes oversight group, to be shared with Southampton Care Homes and additionally proposed to share across HIOW via Care Homes network Director of Clinical (‘Patients first, discharge hub adequate information 20 12 9 Associate Director CCG quality lead linked into meetings to review discharges Current risk score and Mar-21 Quality & 06/09/2020 Governance every time’), to sufficiently meet the ongoing health (5x4) (4x3) (3x3) of Quality Latest D2A guidance has been published which clarifies further discharge criteria and the move away from the use of the term "medically fit for discharge" and sets out a revised set of criteria for people who should be in hospital. target risk score reduced including the needs resulting in poor patient Integration Committee NHS experience, potential patient harm Constitutional including possible readmission to Standards hospital.
SC015 Obj 1 Ensure the 03/04/2020 There is a risk that system wide Use of cancelled capacity from existing packages (currently being cared for by Development of mutual aid arrangements - We will continuously monitor Continue with current control measures and assurances. Ongoing work with the market to mitigate risks. Assessment being undertaken by ICU across Southampton City Council and the CCG on market sustainability. Implementation on actions being over seen by multi organisational Care Home Oversight Group and Health quality and capacity could be severely reduced family) ensure staff movement is appropriate and supply utilisation levels and Protection Board safety of by pressures in the home care, care well managed. ramp up control measures as commissioned home and wider social care market Implementation of framework for shifting of activity Agreement of shared principles around the needed. Development of Covid-19 Adult Care Market Impact Statement underway and due for consideration at JCB in November. services safe approach to using agency staff across (‘Patients first, Increased use of telecare options the sector - part of mutual aid discussions every time’), Ongoing support to providers including the Additional hotel capacity in place to provide interim care as alternative to home Additional support from quality team and NHS care, draft process to support this mitigation. training Constitutional Standards "Increased use of technology for remote advice from clinicians Monitoring local provider/ market sustainability risks and utilising the city's Director of Associate Director 12 12 6 Performance Access to palliative care advice line provider failure protocol as required. Mar-21 Quality & of Integrated 28/10/2020 (3x4) (3x4) (3x2) Board Integration Commissioning Commissioning agency nursing to be supporting more complex individuals in hotel or alternate setting
If placement is suggested in a placement that is unfamiliar CHC/ASC HDT team to exercise appropriate caution and checks – CQC check/call to local CCG to placement to check for any quality concerns.
Transmission of additional financial resources to providers to help with management of Covid-related cost pressures and to promote market sustainability.
SC016 Obj 1 Ensure the 01/04/2020 Additional beds secured at existing nursing homes where there are good Continuous feedback between the At this point in time there are Continue with current control measures and assurances. The additional Covid-19 D2A capacity in homes is now available after outbreaks have been well managed and resolved. There is ongoing pressure on sourcing placements for individuals on Pathway 3 with complex needs. Business case for additional 20 beds going to quality and relationships placement service and commissioning leads limited opportunities to CEG W/C 7 Sept. Once approved the aim will be to bring this additional capacity on line over the next 8 weeks. In additional extra nursing, therapy and social work capacity has been included in the business case to ensure timely assessment, planning and safety of to advice on the status of D2A supply in the increase D2A supply/ primary throughput as well as intensive rehab during the D2A period to support patients in reaching their full potential for independence. Work is also underway through a S&SWH wide D2A Task and Finish Group to share best practice and develop a consistent set of Director of Associate Director commissioned 12 12 Explore alternative options with other providers local market. focus is on bringing currently 6 principles and approaches across the system. This includes working with HCC and WHCCG on a single service specification for D2A beds with clear timeframes for assessment/acceptance and also developing processes to ensure flexible use of the total capacity Performance Mar-21 Quality & of Integrated 06/09/2020 services (3x4) (3x4) unavailable supply back on (3x2) commissioned across both Southampton and West Hampshire. Board (‘Patients first, Transmission of additional financial resources to providers to providers to help with line. Integration Commissioning every time’), management of Covid-related cost pressures and to promote market sustainability. including the NHS Supporting the sector to update vacancy details via capacity tracker
Southampton City Clinical Commissioning Group Board
Date of meeting 25 November 2020
Agenda Item (number) 5
CCG Reform Update
Topic Area CCG reform
Summary of paper and key information CCGs were established in 2013 and have statutory responsibility for commissioning services for the population they serve. Seven CCGs serve the population of 1.9 million people living in Hampshire & Isle of Wight. Our primary objectives are to improve the health and wellbeing of the populations we serve, and to ensure residents have access to high quality healthcare when they need it.
In line with national policy, the health and care system in Hampshire & Isle of Wight will be designated as an Integrated Care System by the end of 2020-21. As CCGs we welcome the introduction of the Integrated Care System which will further enable shared leadership and collaboration in order to deliver improvements for residents. Building on existing close working arrangements, North Hampshire CCG, West Hampshire CCG, Southampton City CCG, Isle of Wight CCG, Fareham & Gosport CCG and South Eastern Hampshire CCG have been working together since October 2019 to determine how commissioning should evolve to better meet the needs of the local population.
Hampshire CCG, West Hampshire CCG, Southampton City CCG, Isle of Wight CCG, Fareham & Gosport CCG and South Eastern Hampshire CCG have concluded that coming together to form one CCG is the appropriate next step to accelerate progress. During the period from June to September 2020 the CCGs developed a detailed case for change which was considered at a joint meeting of the Governing Bodies and Partnership Board on 24 September 2020.
Key/Contentious issues to N/A be considered and any principal risk(s) relating to this paper
(Assurance Framework/Strategic Risk Register reference if appropriate)
Are there any potential None conflicts of interest that the committee need to be aware of?
Please indicate which N/A meetings this document has already been to, plus outcomes
HR Implications (if any) N/A
Financial Implications (if N/A any)
Public involvement – N/A activity taken or planned
Equality Impact N/A Assessment required / undertaken
Report Author Liane Langdon (name and job title) FWOW Programme Director Hampshire, Southampton and Isle of Wight CCGs
Board Sponsor Dr Mark Kelsey, Chair (GP Board member or Matt Stevens, Lay Member Executive Director) James Rimmer, Managing Director
Date of paper November 2020
Actions requested The Board are asked to note the update. / Recommendations
2/3 Summary of the progress made to establish a single CCG for Hampshire, Southampton and Isle of Wight
1 Introduction 1.1 CCGs were established in 2013 and have statutory responsibility for commissioning services for the population they serve. Seven CCGs serve the population of 1.9 million people living in Hampshire & Isle of Wight. Our primary objectives are to improve the health and wellbeing of the populations we serve, and to ensure residents have access to high quality healthcare when they need it. 1.2 In line with national policy, the health and care system in Hampshire & Isle of Wight will be designated as an Integrated Care System by the end of 2020-21. As CCGs we welcome the introduction of the Integrated Care System which will further enable shared leadership and collaboration in order to deliver improvements for residents. Collaboration is key to successfully achieving our objectives, and significant strides forward have been made. CCGs work increasingly closely together and increasingly closely with local authorities, with NHS providers and with other partners to deliver our shared goals. 1.3 Building on existing close working arrangements, North Hampshire CCG, West Hampshire CCG, Southampton City CCG, Isle of Wight CCG, Fareham & Gosport CCG and South Eastern Hampshire CCG have been working together since October 2019 to determine how commissioning should evolve to better meet the needs of the local population. Emphasising a relationship-based collaborative approach to planning and delivery, our aim is to retain the benefits of the current CCG model – the local focus, local relationships with partners and local clinical leadership - whilst also gaining greater benefits of working together.
2 The Future of Commissioning for Hampshire, Southampton and Isle of Wight 2.1 North Hampshire CCG, West Hampshire CCG, Southampton City CCG, Isle of Wight CCG, Fareham & Gosport CCG and South Eastern Hampshire CCG have concluded that coming together to form one CCG is the appropriate next step to accelerate progress. During the period from June to September 2020 the CCGs developed a detailed case for change which was considered at a joint meeting of the Governing Bodies and Partnership Board on 24 September 2020. 2.2 The case for change included feedback drawn from extensive engagement with member practices, partners and other stakeholders (including patient and community groups) about the future ways of working which directly influenced the design of the future arrangements. 2.3 At their meeting on 24 September 2020 the joint meeting of the Governing Bodies and Partnership Board agreed to submit a formal application to establish a single CCG for Hampshire, Southampton and Isle of Wight following thorough consideration of feedback from stakeholders and a detailed discussion of the case for change. 2.4 In making this decision the CCGs considered potential health benefits and reduction in health inequalities to be delivered through new ways of working in collaboration, financial 1 and workforce implications, alignment to national policy, future roles and responsibilities within the Integrated Care System and practical benefits within the context of the resources required and risks associated with delivering organisational change. 2.5 Appended to this document are key elements from our case for change which underpinned the decision of the CCG Governing Bodies and Partnership Board setting out the intended benefits and how these are to be delivered. 2.6 This change is designed to deliver benefits for patients and residents, benefits for primary care, and benefits for health and care partners.
3 Submission to NHS England and NHS Improvement of the formal application to create NHS Hampshire, Southampton and Isle of Wight CCG 3.1 On 2 October 2020, in accordance with the decision of the joint meeting of the CCG Governing Bodies and Partnership Board on 24 September 2020, a formal application was made to NHS England and NHS Improvement to create NHS Hampshire, Southampton and Isle of Wight CCG with support from partners across the Hampshire and Isle of Wight Integrated Care System. 3.2 Following a process of panel interview and questions this application was reviewed by the NHS England through the South East Regional Support Group at their meeting of 22 October 2020. 3.3 As a result of this process, conditional approval has been granted by NHS England for the establishment of NHS Hampshire, Southampton and Isle of Wight CCG on 1 April 2021. 3.4 The merger application included production of a detailed programme plan which is now being enacted. This programme plan reflects the milestone deliverables within the ongoing NHS England assurance process for the establishment of new CCGs along with our local strategic and operational priorities. . Implementation of the plans to establish the new CCG, including technical changes required . Continuing management of the transition from the current to the new arrangements. . Continuing to involve staff and partners in order to implement the changes successfully and realise the intended benefits
2 3.5 This mobilisation phase of the programme continues to be overseen by the Future Ways of Working Programme Board with membership drawn from clinical, managerial and lay governing body/partnership board members from across the CCGs.
4 Steps to 1 April 2021 and beyond 4.1 Two streams of work are now underway to deliver the benefits of a single CCG for Hampshire, Southampton and Isle of Wight: 4.2 CCG technical merger – a programme which ensures that the legal and technical requirements for establishing a CCG are in place for 1 April 2020. For example: . Finalisation of the Constitution – requiring the support of the GP membership . Appointment of the statutory posts to the Governing Body . Refresh of key strategic documents to reflect further developments . Alignment of digital support mechanisms to support collaborative working . Streamlining contracting arrangements with NHS trusts . Legal registrations for the new organisation . Managed transfer of staff and resources to the new organisation . Ongoing communications and engagement with staff, member practices and partners 4.3 This stream of work can be delivered by the programme team without detriment to the resources available to, or demands on the attention of those attending to the COVID-19 response and NHS system recovery and resilience during the coming months. 4.4 Future Ways of Working – a programme which delivers the cultural change supporting delivery of the intended benefits for patients and residents, benefits for primary care, and benefits for health and care partners . For example: . Developing new ways of working together . Developing deeper relationships with partners . Building specialist teams to better support primary care . Aligning new ways of working in commissioning with new ways of working in the wider Integrated Care System to ensure that commissioning optimally serves the needs of the population and intent of the ICS. 4.5 It is this stream of work which will deliver meaningful change for the population we serve. To be successful it must be designed and developed in partnership with our stakeholders. We will take the time needed to fully understand the best way forward together, supported by the enablers to new ways of working established by the technical merger. 4.6 The timeframe and approach for this work will be adjusted to accommodate the participation of those involved in the COVID-19 response and NHS system recovery and resilience work which must take priority over the coming months.
5 The CCG is asked to: 5.1 Note the progress made to enact the decision to form a single CCG for Hampshire, Southampton and Isle of Wight for 1 April 2021. 5.2 Note the ongoing assurance mechanisms in place for the programme through the Future Ways of Working Programme Board.
3 Appendix - Summary Information from the Case for Change 1 Why we are changing
1.1 As clinically led membership bodies, CCGs’ purpose in commissioning services is to improve the health and wellbeing of the population they serve and to ensure that residents have access to high quality healthcare services when they need them. 1.2 One of the key strengths of CCGs has been their important local focus on the places and communities where people live and work. When at their best, CCGs have strengthened primary care delivery, leadership and engagement in the NHS; co-produced solutions with residents; enabled service transformation and improved patient outcomes, service quality and efficiency. CCGs have been most successful where they have worked in partnership with primary care, local government, providers, voluntary organisations and local people. CCGs are rightly proud of the good work that has been done to improve services, deliver better outcomes and enable people to be as healthy and independent as possible. . These strengths of CCGs will be retained. The new arrangements will build on the best aspects of what happens now, as well as adapting to what is needed in future. Hampshire, Southampton and Isle of Wight CCG will be a clinically led membership organisation, focussed on the needs of local people, and retaining the current partnership arrangements in place, in particular with Local Authorities and NHS providers. 1.3 However, notwithstanding the strengths of CCGs, we have concluded that CCGs need to change the way they work in order to accelerate improvements for residents and better support the health & care system in Hampshire & Isle of Wight to deliver its 5-year plan. Change is needed so that we can: . Overcome complexity and fragmentation . Reduce duplication and cost . Adapt to the new ways of working in an Integrated Care System . Align with national policy
2 What are we changing to? 2.1 In order to better support the planning and delivery of improvements in outcomes and service performance, we plan to: . Increase the support we provide to primary care and to the development of primary care networks. 4 . Pursue deeper integration of health and care with local council partners in order to make a step change in the impact we have on preventing ill health, reducing inequalities, joining up health and care delivery, and improving people’s independence, experience and quality of life. . Align CCG teams with local partnerships/alliances of providers and local authorities. . Create a single strategic commissioning function for the Hampshire & Isle of Wight ICS.
2.2 In the new CCG, teams, resources, structures and governance will be organised to provide the strong local focus and local decision making needed to support general practice, enable deeper integration with local government and support the development of alliances of providers, and to achieve the benefits of working together, creating a strategic commissioning function for Hampshire & Isle of Wight. 2.3 The health and care system in Hampshire & Isle of Wight will continue to evolve, and the arrangements for the ways of working in CCGs are being developed in parallel with the design and development of the ICS. Five local teams working together to meet the needs of the population 2.4 The CCG will be organised with 5 local teams, one for each of North & Mid Hampshire, Isle of Wight, Southampton City, South West Hampshire, and South East Hampshire. 2.5 Each local team will be accountable for improving health outcomes, service quality and NHS performance for the local population, and for the allocated population budget. The local team also has responsibility for supporting local primary care and PCN development, and for engagement with and acting as the interface with member practices. 2.6 Each local team will comprise of clinicians and managers who work together and with partners to meet the needs of the local population. The local team will be led by a clinical leader with a senior manager. The design and composition of the local team will be determined locally. The clinical leaders who lead the five local teams will be members of the CCG Board 2.7 Where there are existing integrated NHS and local government commissioning arrangements (for example the Joint Commissioning Board in Southampton) these will remain unchanged. Our aim is to further deepen integrated commissioning, building on these existing arrangements. 2.8 Members of local teams will work as an integral part of the partnerships of providers, local authorities and CCGs based around each acute hospital to support the transformation of delivery and care pathways: . Members of the Isle of Wight local team work with partners on the Isle of Wight . Members of the Southampton City and SW Hampshire local teams work with providers delivering care in Southampton & SW Hampshire . The North & Mid Hampshire local team works with providers in North & Mid Hampshire . Members of the SE Hampshire local team works with members of Portsmouth CCG to 5 support providers in Portsmouth & SE Hampshire to transform delivery and care pathways. 2.9 The figure below illustrates the design with local CCG teams aligned to each local authority area, supporting service transformation in local delivery systems.
2.10 As well as retaining a strong local focus, the aim is to also achieve the benefits of working together, designing and delivering strategic programmes together, bringing strategic coherence, sharing learning skills and capabilities. When we develop strategy and plans for Hampshire & Isle of Wight, we do so by harnessing the knowledge and expertise of local areas, coupled with this specialist expertise, in order to gain the benefits of scale as well as the benefits of local knowledge.
Operating as part of the Hampshire & Isle of Wight Integrated Care System 2.11 The arrangements for the ways of working in CCGs are being developed in parallel with the design and development of the ICS. The ICS Board is a non-statutory body that brings together NHS providers, local authorities and commissioners to provide collective leadership to the health and care system in Hampshire & Isle of Wight. The ICS Board responsibilities include aligning and agreeing system wide priorities, oversight of system performance, agreeing system-wide control totals, planning service delivery and reconfiguration where it makes sense to do it system-wide, and co- ordination of approaches across local authority footprints. 2.12 The CCG is the statutory body responsible for NHS commissioning. With levers such as the NHS budget, the CCG plays a crucial role helping the system to deliver its agreed strategy. The CCG Board sets commissioning strategy and policy and is accountable to NHS England for delivery in Hampshire & Isle of Wight. By deploying its skills, capabilities and functions the CCG supports and enables the Integrated Care System. 2.13 Whilst there is some overlap between the statutory responsibilities of the CCG and the functions it makes sense to undertake through and in the Integrated Care System, having a joint Executive (including a joint Chief Executive) means that there is one team with oversight of both sets of responsibilities, and maximum opportunity to use the skills, resources and capabilities in the system to improve health outcomes and health services.
Working with NHS Portsmouth CCG 2.14 NHS Portsmouth CCG is consulting with its members and partners about its future arrangements. Portsmouth CCG plans to remain a separate statutory body. Portsmouth CCG will also delegate functions and resources to the Hampshire & Isle of Wight strategic commissioning function, and will continue to work with the Portsmouth & South East Hampshire partners to align service transformation capacity. 6 3 Summary of benefits 3.1 CCGs are changing the way they work, including merging to create a single CCG, in order to deliver benefits for patients and residents, benefits for primary care, and benefits for health and care partners. 3.2 The table below summarises the expected benefits.
Benefits Why change will deliver this benefit Better health and . We will retain our local focus, local teams and relationships with better health local communities, continuing existing work to improve health and services for local health services patients and . Deeper partnerships with local government will enable us to go residents improve health outcomes and better join up health and care delivery . We will gain the benefits of scale which will enable CCGs to accelerate the delivery of improvements for local patients and residents - sharing skills and best practice across Southampton, Isle of Wight and Hampshire, putting in place more specialist support for local teams, focussing the collective effort on addressing the challenges we face . Reducing duplication will enable clinical and managerial resources to be redirected to tackling the critical issues faced by our patients and residents Better support for . The proposed changes enable us to increase the focus of local primary care teams on supporting local general practice and to increase support for PCN development . There will be shared, improved expert support for primary care eg for estates, IT and contracting – specialist roles which can be established as a result of the scale of the new CCG . The proposals ensuring a strong voice for primary care in planning and redesigning services in the ICS. Benefits for health . The changes create clear, consistent and coherent commissioning and care partners for Hampshire & Isle of Wight and the Integrated . The changes reduce duplication and complexity between CCGs Care System and between CCGs and the STP. Moving from six organisations to one takes out layers of bureaucracy. . The creation of a single commissioning system will streamline collaboration with NHS partners, with Hampshire County Council and with other partners in the Integrated Care System . CCG teams will be aligned with local authorities and NHS partners to improve health and health services . The changes enable increased efficiency and reduced costs
3.3 Whilst revised structures will support and enable change, the genuine transformation of health outcomes relies heavily on creating a culture and behaviours that enable people to work together to improve health and health services for residents.
7
Southampton City Clinical Commissioning Group Board
Date of meeting 25 November 2020
Agenda Item (number) 6
Finance and Performance Report
Topic Area Finance and Performance
Summary of paper and key Finance and Performance update to the Governing Body as at the information end of October 2020.
The CCG has now completed the first month of the adjusted financial regime in place from October 2020 to March 2021. Prospective allocations have now been received for M7-12 and it is currently forecast the CCG will break-even against these, in line with plans submitted in mid-October. The report attached currently shows a year to date and forecast position of £4,094k deficit. This is due to retrospective allocations not yet received to achieve break-even for M1-6 (£2,932k) and to cover Hospital Discharge Programme spend in October £1,701k. The CCG anticipates that these will be received by the end of November. Current performance is outlined in the attached. The monitoring of some metrics have been suspended by NHS England during the emergency period and these have been omitted from the report.
Key/Contentious issues to Key risks are: be considered and any SC001 – Financial balance; principal risk(s) relating to SC002 – Waiting times; this paper SC003 – A&E performance; SC009 – Cancer performance (Assurance Framework/Strategic Risk Register reference if appropriate)
Are there any potential Some Governing Body members have interests in some of the conflicts of interest that the contracts that are reported. However no decision is required. committee need to be aware of?
Please indicate which N/A meetings this document has already been to, plus outcomes
HR Implications (if any) None
Financial Implications (if See report any)
Public involvement – N/A activity taken or planned
Equality Impact N/A Assessment required / undertaken
Report Author Kay Rothwell (name and job title) Deputy Chief Financial Officer
Board Sponsor James Rimmer (GP Board member or Managing Director and Chief Financial Officer Executive Director)
Date of paper November 2020
Actions requested Information – the Governing Body is asked to note and discuss / Recommendations the report.
2/2 CCG Finance & Performance Report
Month 7 2020/21
Executive Summary Finance
• The CCG is currently forecasting a year-end position of break-even against the M7-12 prospective allocations received. This is alongside the M1-6 position where retrospective funding to break-even was in place. • The £4,094k deficit on the attached report is before anticipated retrospective allocations for M6 position £2,932k (Covid-19 and underlying); and M7 Hospital Discharge Programme (HDP) £1,701k. These allocations are expected by the end of November and will bring the position to break-even. • The month 6 retrospective allocations have been delayed as NHS England review expenditure. The CCG has not received any queries regarding our figures.
Activity
• At Month 5 (August) all our metrics, Urgent and Emergency Care and Planned Care, are significantly down both against plan and against the same period last year; this will be due to COVID-19 impact. • Planned Care metrics show a more significant reduction year on year with referrals witnessing a 56% reduction, Outpatients averaging a 34% reduction and Inpatients averaging a 62% reduction. • Urgent and Emergency Care metrics have seen less of a reduction year on year with Total A&E witnessing a 32% reduction and Non-Elective admissions averaging a 22% reduction. Performance vs. Op Performance vs. Previous Year Plan Year On Year YTD YTD Year On Year Aug Variance YTD Variance Aug-19 Aug-20 Variance 2019/20 2020/21 Variance against plan against plan Urgent & Emergency Care A&E Total A&E Attendances (SUS) 9,317 7,788 -16% 47,335 32,200 -32% -25% -40% Total Type 1&2 A&E Attendances (SUS) 6,372 5,770 -9% 32,498 23,729 -27% -17% -33% NEL Total Non-Elective Admissions - 0 LOS 1010 887 -12% 4986 3807 -24% -7% -24% Admissions Total Non-Elective Admissions - 1+ LOS 1,638 1,471 -10% 8,281 6,511 -21% -8% -20% Planned Care Referrals Total Referrals (General and Acute) 5,423 3,262 -40% 30,051 13,076 -56% -43% -57% Total GP Referrals (General and Acute) 2,906 1,719 -41% 15,979 6,319 -60% -45% -62% Total Other Referrals (General and Acute) 2,517 1,543 -39% 14,072 6,757 -52% -40% -50% Outpatients Consultant Led First Outpatient Attendances 6,200 3,801 -39% 33,066 17,627 -47% -35% -46% Consultant Led Follow-Up Outpatient Attendances 11,796 9,242 -22% 64,780 47,162 -27% -15% -25% Elective Total Elective Admissions - Day Case 2,156 1,127 -48% 11,204 4,236 -62% -45% -63% Inpatients Total Elective Admissions - Ordinary Case 347 234 -33% 1852 732 -60% -32% -62%
2 Data not published yet
Suspended due to COVID-19
CCG Performance Summary Please note that some figures included in the below table are based on provisional data and may be subject to change Target 2019/20 2020/21 Summary Mar Apr May Jun Jul Aug Sep
95% Off track, but improving Urgent & A&E A&E <4 hour waits (all Types) 87.40% 91.1% 95.1% 95.9% 96.10% 89.8% 93.5% 95% 78.31% 88.7% 92.0% 93.6% 94.15% 85.0% 90.3% Off track, but improving Emergency A&E <4 hours waits (Type 1, Main ED) Ambulance Category 1 – Life Threatening calls 7min (average) 0:06:06 0:05:13 0:05:57 0:05:49 0:05:43 0:05:37 On track Care Response Times Category 2 – Emergency calls 18min (average) 0:10:58 0:11:19 0:11:05 0:12:49 0:12:44 0:16:49 On track Category 3 – Urgent calls 2hr (90% of calls) 2:10:59 1:19:18 1:09:32 1:35:46 1:27:27 2:20:22 Off track, worsening Category 4 – Less Urgent calls 3hr (90% of calls) 4:03:29 2:11:57 2:20:44 2:53:42 3:10:49 3:10:05 Off track, but improving DTOC Rate 3.5% Suspended Discharge Daily DTOC Beds (average daily delays) 26.7 Suspended
92% Off track, but improving Planned Referral to Treatment (RTT) Incompletes Waiting <18 weeks 79.38% 71.46% 61.97% 49.95% 43.10% 48.7% 56.7% 0 11 40 98 156 238 328 416 Off track, worsening Care Incompletes Waiting >52 weeks Waiting List 11,584 11,464 10,911 11,136 10,539 11,299 11,778 12,679 Off track, worsening Diagnostics Patients Waiting <6 weeks for a Diagnostic 99% 91.39% 61.23% 53.14% 60.45% 66.22% 64.16% 66.95% Off track, but improving
Cancer 2 Week Waits All 93% 95.02% 95.60% 97.15% 95.01% 95.70% 96.67% 90.89% Off track, worsening Breast Symptoms 93% 100.00% 84.60% 83.33% 100.00% 91.67% 100.00% 100.00% On track 28 Day Waits Faster Diagnosis 70% 82.70% 71.10% 74.54% 81.55% 86.21% 84.79% 82.86% On track 31 Day Waits First treatment 96% 96.67% 98.10% 98.60% 98.75 98.89% 97.96% 98.11% On track Subsequent treatment (surgery) 94% 82.61% 88.20% 92.00% 100.00% 97.14% 87.50% 100.00% On track Subsequent treatment (anti-cancer drugs) 98% 97.92% 100.00% 100.00% 97.37% 100.00% 100.00% 100.00% On track Subsequent treatment (radiotherapy) 94% 83.78% 96.20% 96.30% 90.70% 100.00% 100.00% 91.17% Off track, worsening 62 Day Waits First treatment (urgent GP referral) 85% 79.17% 80.00% 88.89% 89.20% 97.67% 90.00% 87.04% On track First treatment (screening service referral) 90% 87.50% 60.00% 100.00% - 100.00% 100.00% 100.00% On track First treatment (consultant upgrade referral) 86% 100.00% 100.00% - 100.00% 100.00% 100.00% - On track
Mental Dementia Dementia diagnosis rate 66.72% 66.76% 64.84% 62.72% 61.85% 61.42% 61.56% 62.11% Off track, but improving 95% Suspended Health Care Programme People followed up within 7 days Access – people entering treatment 4.75% 5.92% 3.70% Off track, worsening Recovery – people moving to recovery 50% 51.39% 41.68% Off track, worsening IAPT Waits – people starting treatment within 6 weeks 75% 96.7% 96.90% On track Waits – people starting treatment within 18 weeks 95% 100.00% 100.00% On track No 60% Off track, worsening Severe Mental Illness Physical annual health checks in primary care Submission 23.1% 20.9% Children & Young People Eating Urgent referrals within 1 week 95% - 80.00% 80.00% Off track, but improving Disorders Routine referrals within 4 weeks 95% 87.50% 87.50% 88.89% Off track, but improving
Quality Mixed Sex Accommodation MSA Breaches 0 Suspended Healthcare Associated C. difficile infections 44 0 3 2 3 2 2 On track Infections MRSA 0 0 1 0 0 0 0 Off track, but improving E. coli blood stream infections 94 10 11 8 10 10 19 not mandated Wheelchairs Children waiting <18 weeks Q3 – 78.48% Suspended Personal Health Budgets Personal Health Budgets (cumulative) Q3 - 120 Suspended 3 £ Financial Performance CCG Finance Report Month 07
Financial Performance
• The CCG has now completed the first month of the adjusted financial • Clinical Corporate costs includes additional CHC assessor resource to regime in place from October to March. Prospective allocations have clear the backlog of scheme 1 HDP cases and to ensure scheme 2 now been received for M7-12 and it is currently forecast the CCG will patients are assessed within the 6 weeks HDP provided. The CCG will break-even against these, in line with plans submitted in mid-October. receive retrospective allocation to meet the costs relating to backlog clearance. • The report attached shows a year to date and forecast position of £4,094k deficit. This is due to retrospective allocations not yet received • Prescribing includes April to August actuals, with September to March to achieve break-even for M1-6 (£2,932k, made up of Covid-19 and forecast based on April to July. The August actuals were unusually low, underlying position) and M7 Hospital Discharge Programme with costs per prescribing day lower than the same period last year. retrospective allocation £1,701k. The CCG anticipates that these will be These have therefore been excluded when calculating the forecast until received by the end of November. it is clear if this is an ongoing trend or a one-off anomaly. Budgets are currently forecast to be break-even. • As per NHSE guidance M1-6 positions have been budgeted to break- even on all spend lines. Hence variances here reflect the position for • Delegated Primary Medical Services are currently forecast to overspend the second half of the year. Forecasts for year-end will be reviewed in by £1,030k. This assumes that all PCN additional roles are recruited to. detail in the coming months. An element of the funding for additional roles is currently held centrally by NHS England, along with funding for Care Home premium and the • The year to date overspend on Continuing Healthcare budgets reflects Impact and Investment Fund. As these are received and the year-end the in month spend on hospital discharge programme which will be spend becomes clearer it is anticipated Primary Care will break-even. reimbursed through a retrospective allocation. The year-end forecast is currently break-even. An estimate was included in plans for the impact • Running Costs are currently forecast to overspend by £307k. The CCG of HDP patients transferring to mainstream CHC packages. The spend will be within the published allocation for running costs (£5,204k), forecast will be reviewed over the coming months as more backlog although a portion of this has been removed non-recurrently following cases are assessed and proportions reverting to CHC versus NHS England's modelling. transferring across to LA or self-funding can be more accurately predicted.
5 CCG Finance Report Month 07 NHS Southampton City CCG Finance Report Month 7 2020/21 Forecast Outturn M7 YTD (Under) / Over (Under) / Over Plan Actual Spend Spend £'000 £'000 £'000 % £'000 % Acute University Hospitals Southampton FT 158,667 158,667 0 0% 0 0% Commissioning Portsmouth Hospitals NHS Trust 2,411 2,411 0 0% (0) (0%) Hampshire Hospitals FT 1,350 1,350 0 0% (0) (0%) Other NHS Acute 2,501 2,497 (4) (0%) 17 1% Non-Contracted Activity (NCA) 356 306 (50) (14%) 20 10% Ambulance Services 10,994 10,998 4 0% 1 0% Treatment Centre 0 0 0 ---- 0 ---- Minor Injuries Unit 1,904 1,904 0 0% 0 0% Other Independent Sector 5,284 5,315 30 1% (4) (0%) Mental Health Southern Health FT 30,508 30,508 0 0% 0 0% Commissioning Solent NHS Trust (CAMHS) 5,211 5,211 0 0% 0 0% Other Mental Health Contracts (inc NCAs) 6,856 6,743 (113) (2%) (108) (3%) Community Solent NHS Trust 36,616 36,616 0 0% (1) (0%) Services Other Community Contracts 3,427 3,452 25 1% 4 0% Non-NHS Continuing Healthcare and Special Placements 35,777 35,715 (62) (0%) 819 3% Commissioning Funded Nursing Care 4,048 3,585 (462) (11%) (146) (7%) Other Non-NHS (inc Covid-19 hotels and carers) 13,665 13,859 193 1% 185 2% Clinical Corporate Costs 5,761 5,968 207 4% 37 1% Primary Care Prescribing 39,205 39,205 (0) (0%) 125 1% Commissioning Delegated Primary Medical Services 39,638 40,669 1,030 3% 218 1% Local Enhanced Services 3,163 3,163 0 0% 1 0% Out of Hours (inc 111) 2,252 2,280 28 1% 0 0% Other Primary Care 4,797 4,827 29 1% 13 0% Managed Programmes 107 3,038 2,932 2743% 2,519 (208%) Running Costs Running Costs 4,770 5,077 307 6% 393 15% Total Expenditure 419,268 423,362 4,094 1% 4,094 2% Allocation Received 419,268 419,268 Retrospective M6 and HDP M7 Funding Awaited 0 4,094 1 The £4,094k deficit will be covered by M6 retrospective allocation (£2,932k) and retrospective allocation to cover M7 Hospital Discharge Programme expediture (£1,701k) 6 COVID-19 Expenditure April to October 2020
NHS Southampton City CCG Covid-19 Spend April to October 2020 £'000 %
Remote mangaement of patients 394 3% Hosptial Discharge Programme 11,646 81% PPE 279 2% CHC Support 1,272 9% Bank Holidays (primary care) 154 1% Support to patients, including transport 115 1% Primary Care 509 4% Other 55 0% 14,424 CCG Financial Control
Statement of Financial Position as at Opening Year to Date Cash usage £'000 Month 7 Balance Mvmt YTD Balance Annual Maximum Cash Drawdown 418,563 £'000 £'000 £'000 Cash usage YTD 262,684 Trade and other receivables 2 0 2 Percentage utilised 62.76% Total Non-Current Assets 2 0 2 Months completed 58.33% Cash and Cash Equivalents 702 2,776 3,478 Better Payment Practice Code Inventories 0 0 0 Administrative Duty: Current Trade and Other Receivables 6,946 16,777 23,723 The CCG is required to pay 95% of all valid invoices within agreed contractual terms or Total Current Assets 7,648 19,553 27,201 within 30 days of receipt of a valid invoice, whichever is the sooner. Current Trade and Other Payables (24,031) (9,984) (34,015) Number £’000 Paid on % paid on Paid on % paid on Current Borrowings 0 0 0 Paid Paid Current Provisions for Liabilities and Cha (1,905) 63 (1,842) time time time time Total Current Liabilities (25,936) (9,921) (35,857) YTD 14,319 14,298 99.85% 235,580 235,525 99.98% Total Assets less Current Liabilities (18,286) 9,632 (8,654) Receivables Non Current Liabilities (2,620) 27 (2,593) The total amount of outstanding receivables (income) due to the CCG as at the end of Total Assets Employed (20,906) 9,659 (11,247) October is £611k. The ageing of this debt is as follows: £'000 Financed by Taxpayers' Equity Not yet due 526 General Fund 20,906 (262,684) (241,778) Less than 30 days overdue 0 Revaluation Reserve 0 0 0 31-60 days overdue 63 Total Taxpayers' Equity 20,906 (262,684) (241,778) 61-90 days overdue 17 Statement of Comprehensive Net Expend 0 253,025 253,025 A number of small invoices that are being 91-360 days overdue 5 Total Taxpayers Equity 20,906 (9,659) 11,247 progressed.
8 Performance Urgent & Emergency Care A&E Activity & Performance
A&E Activity (Type 1) – CCG Level (UHS) A&E Performance – CCG Level A&E attendances (All providers, Type 1/Main ED) The % of patients waiting less than 4 hours to be seen
YTD vs Previous Year: -22% lower September: 93.5% vs. 95% standard
UHS (for SCCCG patients) Type 1 Only split by Age Group
September: 90.3% vs. 95% standard
10 A&E Activity & Performance (UHS Trust Level)
A&E Activity (Type 1, Main ED) Majors & Minors Activity (Type 1, Main ED) The charts to the left show a significant decrease in type 1 ED attendances at UHS from around week 52 2019/20 (week commencing the 22nd of March 2019 coinciding with the start of lockdown).
Type 1 attendances started to steadily increase again from week 4 2020/21 (week commencing the 26th of April 2020) at around an additional 100 per week.
From the end of September 2020 Type 1 attendances have been down on the same A&E Breaches (Type 1, Main ED) Majors & Minors Performance (Type 1, Main ED) time last year. The latest week’s data (week st commencing 1 November) type 1 A&E attendances are 23% lower than the same week last year.
At the peak of COVID-19 type 1 A&E attendances were 52% lower than the same week the previous year).
The number of breaches mirror the trend seen in attendances.
11 Non-Elective Activity
NEL Admissions (Total) NEL Short Stays (0 days) NEL Non Short Stays (1+ days) Emergency hospital admissions, all providers, all lengths of stay Emergency hospital admissions, all providers, where the patient was admitted <24hrs Emergency hospital admissions, all providers, where the patient was admitted >24hr
YTD vs Previous Year YTD vs Previous Year YTD vs Performance -24% lower year-on-year -19% lower year-on-year -27% lower year-on-year
SCCCG Level split by Age Group
12 Restoration & Recovery Actions A&E
Current problems/key areas of concern Key actions/priorities A&E Attendances increasing • NHS 111 First project has been brought forward from launching on the 30th • Type 1 A&E attendances have been consistently below the same November to the 25th November. This encourages patients to contact 111 before period last year from the end of September 2020 (did not follow attending A&E, and all calls that result in a recommendation to attend A&E get the post Summer holiday increase seen in 2019). The latest clinically validated (by the CAS within 111). Portsmouth are an early adopter and week’s data (week commencing 1st November) type 1 A&E they have shown that up to 60% of these calls can be downgraded, and either attendances are 23% lower than the same week last year. diverted to other services or be given advice about self-care. The national timeline • Performance has been much better than last year and has been is 1st December, although S&SWH are aiming to implement sooner. consistently the best in Hampshire and Isle of Wight and the • Positively, Major attendances have returned to previous levels but minors remains South East. low due to this work being diverted to Urgent Treatment Centres – work is ongoing to try and sustain this trend.
Changes to layout in Emergency Department • Investment/re-configuration needed to support the building and staffing of • ED has had to split itself in two to create separate COVID-19 and additional beds; UHS ED has been awarded £9 million capital funds to improve non-COVID-19 streams, this change in layout has hindered the layout and productivity of the department, with an additional £1 million of working and has contributed to why UHS’ performance is still revenue funding to support this. The final figure is still being confirmed by NHSE not above 95% even with lower attendances. (the original bid was for £12 million).
• Physical space within the department has always been a • Proposal to reconfigure ED space and create additional physical capacity in the constraint, and this is exacerbated by social distancing form of: requirements and infection control measures. Implementing bed • Waiting room space spacing as per infection control guidance could reduce bed • Majors bays capacity on wards by up to 25%. • Resus bays
• Continue the streaming of patients into COVID-19 and non-COVID-19 pathways
• Independent sector capacity is essential to allow current acute elective capacity to be converted to meet non elective demand
Workforce • Staff fatigue and potential shortages owing to build up of leave and social isolating.
13 Restoration & Recovery Actions A&E
Current problems/key areas of concern Key actions/priorities Poor Flow from ED to Reablement • High number of medically fit for discharge patients • Review of the Discharge Guidance has been undertaken with a clear action plan being developed to reduce the number of patients within acute setting with a Medically Optimised for Discharge • Services being commissioned to ensure timely discharge • Single Point of Access established with the Councils / Community
999 • Demand starting to increase again but all performance targets • SCAS reviewing modelling and staffing profile being met. PPE donning and doffing and clear up time is impacting on task time and SCAS have seen an increase in average times.
111 • Increased demand; latest week up by 16% • Staffing issues
Winter Planning • The South & South West Hampshire Winter plan was signed off on the 10th • Winter is challenging time for A&E and will have the added November, which supports the UEC programme. pressure of COVID-19 in 2020 • Additional winter capacity has been agreed and funded which will support the flow out of the hospital. • Bronze Command Meetings have also been stepped up from once a week to twice a week to support the rise in COVID-19 cases.
14 Performance Planned Care Referral to Treatment (RTT) Referral to Treatment (RTT) CCG Level The % of patients on an incomplete pathway (patients yet to start treatment) who have been waiting less than 18 weeks
September (provisional): CCG Total Waiting List Off track, but improving 56.7% vs. the 92% standard
CCG Backlog
Waiting List Movements:
June – saw a significant reduction to the WL as UHS deployed clinician engagement CCG Long Waiters – 26+ weeks and 52+ weeks in managing their own waiting lists; clinical teams spent a lot of time reviewing patients they were due to see. This has resulted in a number of patients being discharged with advice or a management plan, or having discussions with clinicians about entering active monitoring to assess the progress of their symptoms.
July / Aug / Sep – the WL increased due to GP Appointments (and subsequently referrals) growing at a faster rate than Elective and Outpatient activity. The majority of the increase in the WL was at the Treatment Centre; this is being investigated. 16 Referral to Treatment (RTT) Referral to Treatment (RTT) CCG Level RTT Waiting List by Weeks Waiting
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-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 26 - 52 weeks 575 608 577 489 631 669 750 848 912 925 896 1,076 1,498 2,121 2,260 3,029 4,045 3,957 52 week + 0 0 2 0 0 5 1 4 6 11 14 11 40 98 156 238 328 416
The above chart shows the proportions of the waiting list and trends over time; it is possible to see the COVID-19 impact from March 2020 with the proportion of patients waiting under 18 weeks reducing and the proportion waiting over 18, 26 and 52 weeks increasing. In September 2020 you can now see that the number of patients waiting 1-18 weeks is starting to increase with the increase in GP Appointments and therefore referrals, however the number of patients waiting over 26 and 52 weeks are also increasing.
17 Referral to Treatment (RTT) Referral to Treatment (RTT) CCG Level RTT Long Waiters by Specialty
September Over 26 weeks Over 52 weeks Trauma and Orthopaedics 1,173 115 Ophthalmology 914 50 ENT 603 72 Gynaecology 462 40 Urology 432 48 Other 285 36 General Surgery 352 23 Neurology 153 4 Gastroenterology 135 14 Dermatology 96 6 Thoracic Medicine 77 1 Cardiology 42 1 General Medicine 67 4 Plastic Surgery 22 1 Rheumatology 25 1 Geriatric Medicine 3 0 Oral Surgery 0 0 Neurosurgery 0 0
The above table shows the number of patients waiting over 26 weeks, and the cohort of patients waiting over 52 weeks, by specialty in September 2020. The chart to the right shows the movement in the number of patients waiting over 26 weeks between April and September 2020. Our 7 specialties with the highest numbers of patients waiting over 26 weeks continuing to grow.
Although Trauma and Orthopaedics and Ophthalmology account for the highest number of patients waiting over 26 weeks in September (1,173 and 914 respectively), their proportion waiting over 52 weeks is lower than some other specialties; ENT, Gynaecology and Urology.
Trauma and Orthopaedics backlog is expected to continue to grow due to the majority of patients sitting within category 4 in terms of priority (life changing).
18 Diagnostic Performance
CCG Level CCG Level, By Main Provider The % of patients waiting less than 6 weeks for diagnostics
September (provisional): 66.95% vs. Off track, but improving 99% standard
6 weeks+ breaches by Test (September 2020)
19 Restoration & Recovery Actions Elective & Outpatients
Current problems/key Key actions/priorities areas of concern • Postponement backlog • Returns to NHSE around elective care activity, including actual and planned activity for electives, diagnostics growing. and cancer care, broken down by CCG and provider, and use of IS. • Provider capacity and • Independent sector contracts confirmed until November/December. Enables providers to utilise up to 25% of throughput. capacity for private work but 75% must be reserved for NHS. Plans submitted for all local providers against • Utilisation of capacity at IS staffing denominator, awaiting feedback. providers • Submission deadline passed for NHSE national Framework Agreement post Nov/Dec to address backlogs . This • Non-urgent planned care is a 2 year contract with a potential 2 year extension, meaning national contracts will be in place for up to 4 activity in recovery but years. Details awaited about form and function of contract, and any impacts on local commissioning plans. capacity reduced due to • Weekly meetings continuing with IS, UHS and commissioners to ensure maximum utilisation of capacity, triage IPC measures. and clinical prioritisation of longer waiters and urgent patients. IS and UHS seeking to prioritise patients on the • Lack of anaesthetist basis of urgency, time waiting and availability of staffing across settings. UHS have established a panel to review availability. lists and have broadened this to include IS. UHS have also implemented a Harm Review Tool for patients • National phase 3 targets waiting 52+ weeks. focus on % activity • Support to IOW included in the Southampton/SW system, ongoing work to identify patients suitable for excluding use of IS capacity; treatment at Southampton Treatment Centre (STC). local system has always • IS seeking to increase utilisation of their capacity by doing procedures on their waiting lists where appropriate. used IS and so unlikely to • Restart elective services (high risk and low impact). achieve targets. • Ramp up use of non face-to-face activity, where appropriate. Extend use of video consultations across all specialties. • Use of secondary care clinician advice and guidance to GPs. UHS launched e-grading pilot. For neurology and gastro; awaiting dates for further roll out. • Ramp up the use of MyMedicalRecord to enable monitoring of patients, enable patient control and move some telephone follow ups to MMR. • Pathway transformation programme has identified key areas of work to be taken forward across SSW system. • Specialty reviews and Adopt and Adapt programmes underway at HIOW/ SE level. • Diagnostic waiting list • As above, discussion with IS and UHS to ensure that all capacity is appropriately utilised and patient growth and communications established to encourage patients to speak to a GP and to attend diagnostics appointments underperformance • Wessex Cancer Alliance leading work to review and improve endoscopy capacity. 20 Performance Cancer Cancer – September 2020 (CCG Level) Two Week Waits 31 Day Waits 62 / 28 Day Waits
2 Week Waits (All) 31 day wait for first treatment 62 Day Wait for first treatment (urgent GP referral)
2 Week Waits (Breast) 31 Day Wait for subsequent treatment (surgery) 28 Day Waits (Faster Diagnosis Standard) NEW
Metric Sep-20 Patients Standard Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Fe b-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Breaching 2 Week 2 w eek w aits 93% 95.20% 96.25% 98.16% 95.63% 97.10% 97.10% 95.02% 95.60% 97.15% 95.01% 95.70% 96.67% 90.89% 65 / 714 Breast 2 w eek w aits 93% 78.26% 89.77% 86.21% 91.11% 90.90% 96.88% 100.00% 84.60% 83.33% 100.00% 91.67% 100.00% 100.00% 0 / 21 28 Day 28 day w aits (faster diagnosis standard) 70% 73.90% 78.20% 82.10% 84.00% 79.50% 85.30% 82.70% 71.10% 74.54% 81.55% 86.21% 84.79% 82.86% 103 / 601 31 Day 31 day first definitive treatment 96% 86.96% 89.76% 85.71% 87.88% 88.10% 100.00% 96.67% 98.10% 98.60% 98.75% 98.89% 97.96% 98.11% 2 / 106 31 day treatment, surgery 94% 71.43% 62.22% 70.37% 83.87% 80.00% 81.08% 82.61% 88.20% 92.00% 100.00% 97.14% 87.50% 100.00% 0 / 33 31 day treatment, anti-cancer drug regimen 98% 97.83% 96.88% 97.92% 100.00% 100.00% 100.00% 97.92% 100.00% 100.00% 97.37% 100.00% 100.00% 100.00% 0 / 47 31 day treatment, radiotherapy 94% 90.91% 97.96% 91.49% 100.00% 100.00% 90.48% 83.78% 96.20% 96.30% 90.70% 100.00% 100.00% 91.17% 3 / 34 62 Day 62 day first definitive treatment, GP referral 85% 72.55% 67.65% 72.50% 82.22% 65.50% 90.63% 79.17% 80.00% 88.89% 89.20% 97.67% 90.00% 87.04% 7 / 54 62 day first definitive treatment, cancer screening service 90% 92.31% 76.47% 81.82% 93.33% 100.00% 100.00% 87.50% 60.00% 100.00% - 100.00% 100.00% 100.00% 0 / 6 22 62 day first definitive treatment, consultant upgrade 86% 33.33% 75.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% - 100.00% 100.00% 100.00% - - Restoration & Recovery Actions Cancer
Current problems/key areas of concern Key actions/priorities Continued work to improve performance • Wessex Rapid Diagnostic Service launched in Poole on 22 June as planned. Two further • Month 6 data shows 8 out of 10 cancer metrics Dorset PCNs going live from end July, and Sovereign and Coastal PCNs in Hampshire from achieved mid-August. Southampton PCNs are in phase 3, the planned timetable for this to begin is • 31 day radiotherapy was missed by just 2.83%, due from end of November 2020. to very low numbers (3 breaches) • Adopt and Adapt Cancer performance programme underway led by SE region as • 2ww has been missed for the first time since considered an exemplar. Potential to identify additional opportunities/ actions. Workshops February 2019, due to 54 breaches, 44 of which also taking place focused on CT/MRI (SW region) and endoscopy (London region) were head and neck. • Wessex Cancer Alliance delivery plan to end March 2021 • • Activity for 2 metrics hardest hit by pandemic (2ww Discussions with UHS regarding Head and Neck (ENT). Performance issues the result of staffing capacity as well as IPC guidance and lack of air handling units to perform required and 28 day) have continued to increase in month 4 aerosol generating procedures at RSH. Additional clinics are being put on, a locum ENT and now just 10% lower than same month last year surgeon has been recruited (above budget) and work to review and improve 2ww process and proformas. Restoration of screening programmes • Re-start screening programmes, looking at high risk patients first. Cervical screening • NHS screening programmes were all paused due to underway, though primary care workforce issues are causing challenges and there are some COVID-19; work to restart underway but challenges delays in sending results. Bowel screening also restarted. Breast screening more challenging, remain in restoring to previous levels and and currently focused on women with previously delayed appointments, as mobile units addressing backlogs. aren’t suitable for social distancing; this will take time to rectify. • Local targeted lung health check programme re- • Targeted lung health check programme restarted from 24 August with amended pathway started from 24 August 2020 but currently paused (virtual appointments, and no spirometry); has had to pause again as a broken power cable again. resulted in a mega volts surge and damage to the CT scanner. Engineers diagnosing damage and hope to resolve shortly. Cancer Diagnostic and Surgical backlog • Wessex Cancer Surgical Hub (WCH) set up at UHS to provide additional surgical capacity • Lack of endoscopic capacity. across Wessex Trusts. As yet, no referrals have been required through this route, with all • Reduced capacity due to IPC measures regional Trusts managing their own demand. • Virtual consultations where appropriate. • For colorectal patients, Primary Care have been asked to carry out FIT tests. • Adopt and adapt programmes on diagnostics; Wessex Cancer Alliance also leading work around endoscopy capacity.
23 Performance Mental Health Dementia Diagnosis Rate CCG Level
62.11% vs. the 66.72% standard
Standard missed by 112 patients
Off track, but improving
Main Issues Actions to resolve Latest Update • The CCG continues to work to improve the Older People’s Mental Health (OPMH) OPMH are rolling out their restoration plans for routine dementia diagnosis rate, however it is reliant on services develop and implement restoration memory assessments. Online appointments for those able to Practice engagement and a willingness of patients to plans in line with Royal College of Psychiatry use them have commenced and OPMH are attending the seek a diagnosis when anecdotal evidence from best practice and evidence base. shielded patients group. Exploring the return of clinics, but Carers organisations tells us this is often space is limited. Working with Enhanced Care in Nursing problematic and when a significant number of Homes Team to increase engagement with this sector. dementia cases in Nursing Homes continue to be Explore opportunities for GP collaboration OPMH working with CCG Mental Health Clinical Lead to undiagnosed. reducing risk related to multiple health develop pathways which minimise risks to vulnerable group
professionals involvement to minimise COVID- • Previously positive work has included Dementia 19 risk Diagnosis Rate (DDR) audits of care settings and medicines management reviews. COVID-19 has had Recovery of UHS scanning and understand Recovery plans in line with wider UHS recovery. Links to work a significant impact on the city's DDR rate and this is impact of attending scans on the higher risk being undertaken by CCG Clinical Lead for Mental Health. mirrored in other CCGs. group
25 Dementia Diagnosis Rate CCG Level
Main Issues Actions to resolve Latest Update
• A significant contributing factor to the reduction in Review GP coding where a formal diagnosis is Working with CCG Clinical Lead to develop increased primary diagnosis was the situation in care homes, where it not made as scanning not taken place care pathways and opportunities to diagnose while formal is estimated 3/4 of residents have dementia. In memory assessment, and clinics' service delivery is addition, Teams previously contributing to the limited. This will have a direct impact on DDR. identification and subsequent diagnosis of dementia Communication to Primary Care outlining Communication to be developed once plans are confirmed. have been focussed on intensive support restoration plans once in place elsewhere. Memory Services, whose input has ordinarily been required for diagnosis significantly Offer of iSPACE Dementia Friendly Surgeries 2 surgeries have signed up to the scheme and virtual reduced services to focus on managing COVID-19 remains in place engagement commenced. and to reduce exposure to vulnerable groups and the majority of memory assessments ceased. Scanning required to confirm early diagnosis was also significantly impacted.
26 IAPT – Entering Treatment / Moving to Recovery
CCG Level – Quarter 1 This metric measures the proportion of people who complete treatment who are moving to recovery
Entering Treatment 3.7% vs. the 4.75% standard Off track, worsening
Moving to Recovery 41.68% vs. the 50% standard Off track, worsening
Main Issues Affecting Performance Actions to Resolve
Entering Treatment: • Increasing promotion of the service COVID-19 has had a significant impact on the numbers entering • Offer services at flexible times to take account of children at home/work from home etc. treatment - a pattern reflected locally and nationally - however • Increase offer of online therapy we have seen an improving picture as the quarter • Consider recovery of face to face therapy progressed. In Month 1 anticipated numbers entering • Re-visit waiting lists and offer alternative therapies where online therapy was declined in the treatment were reduced by 55% but by month 3 this was only first instance 3%. The impact of the significant reduction early on in the • Develop COVID-19-specific response including online resources and therapy solutions pandemic however means there is still an element of recovery for this metric going forward.
Moving to Recovery: • Increase the number of psycho-educational online webinars offered at Step 2, such as COVID-19 has impacted on the recovery rate and this is a managing low mood and anxiety, and increased the number of interactive online groups at pattern reflected with HIOW partners and nationally. This Step 3, such as skills to manage PTSD symptoms, depression, health anxiety and
partly due to increased drop-out rates which when audited OCD. Working in partnership with SHFT to develop Step 3.5 service offer to meet increased found preference of face to face therapy options for some. In acuity needs and increase additional there are reports of greater acuity and inability for • Increase flexibility of service delivery, increase offer of interactive therapy sessions and some people to find required privacy for online consider restoration of face to face therapy therapy. Situational factors such as isolation and increasing • Implement early intervention therapy solutions financial hardship is emerging which impacts on recovery. • Engage with series of IAPT webinars in the context of adapting services to meet changing needs social anxiety disorder, behavioural activation, persistent complex bereavement disorder, OCD or health anxiety). Steps to Wellbeing to assign lead to develop learning from the webinars and roll-out into the treatment pathways • Local monthly data shows the Recovery metric being achieved with 50% in July and 52% in August; we anticipate the metric being achieved for Quarter 2 2020/21
27 Serious Mental Illness
CCG Level The number of annual physical health checks completed within a primary care setting by patients who are categorised as having a severe mental illness (SMI); All 6 Health Checks listed must be completed
Physical Health Check Q1 2019/20 Q2 2019/20 Q3 2019/20 Q4 201920 Q1 2020/21 Q2 2020/21 20.9% vs. the 60% standard Alcohol 60.1% 66.1% 62.7% - 48.4% 44.8% Blood Glucose 47.7% 33.3% 52.8% - 51.1% 49.2% Blood Lipid 41.7% 47.6% 47.3% - 49.7% 48.1% Off-track, worsening Blood Pressure 75.0% 77.1% 76.4% - 74.1% 69.3% BMI (Weight) 50.6% 57.5% 59.8% - 62.7% 60.0% * No submission was made for Q4 Smoking 69.2% 65.2% 65.3% - 63.8% 61.5% 2019/20 due to COVID-19 All 6 Health Checks 21.8% 18.2% 26.1% - 23.1% 20.9% Target 60.0% 60.0% 60.0% 60.0% 60.0% 60.0% Total on SMI Register 6,282 3,412 3,464 - 3,427 3,419
Current problems/key areas of Key actions/priorities concern • People with SMI are at increased risk of • Restoration and recovery work has commenced at both a city level (supported by Primary Care contracting COVID-19/more vulnerable in Network Clinical Directors and CCG board members) and at a system and Integrated Care System community level • Quality Outcomes Framework and Locally • SMI Locally Commissioned Services progressing Commissioned Services in primary care • Working with Solent Medical Services to help with the harder to reach patients were de-prioritised (and in some instances will have been suspended) to allow • Links with Clozapine Clinics to maximise physical health checks capacity to focus on COVID-19 response; • Maximise elements that can be completed virtually; assessment of alcohol consumption, weight this is in line with national guidance management, assessment of smoking status • Some elements can’t be completed virtually; blood lipid including cholesterol, blood glucose, blood pressure and pulse check 28 Children and Young People Eating Disorders
CCG Level Quarter 2 2020/21
Urgent referrals seen within 1 week 80.00% vs. the 95% standard Off track, but improving
Routine referrals seen within 4 weeks 88.89% vs. the 95% standard Off track, but improving
Barriers Actions to resolve / improve
Metric is based on very low numbers of • Urgent performance of 80% represents 1 breach (seen after 1 week) out of 5 patients seen in Quarter 2. patients This breach was at Solent.
• Routine performance of 88.89% represents 2 breaches out of 18 patients seen in Quarter 2. 1 breach at Southern Health and 1 at Solent. Southern Health provide a service for patients aged 18 which fall into this metric; this is a specialist service and the team have been contacted for commentary.
Reporting Errors • Solent originally missed the submission deadline for Quarter 2 however an extension was requested with NHS Digital and figures were published on the NHS Statistics Website on the 12th of November 2020. The analysis above is based on the complete submission downloaded from the NHS Statistics Website.
Patient Choice This metric is always heavily impacted by patient choice
29 I
Southampton City Clinical Commissioning Group Board
Date of meeting 25 November 2020
Agenda Item (number) 7
Quality Exception Report
Topic Area Quality
Summary of paper and key The Quality Exception Report outlines potential quality concerns information in commissioned services that have been reviewed by the Clinical Governance Committee. In light of the Coronavirus pandemic the work of the quality team has shifted to support this including restoration and recovery, and the report provides a summary of the key work streams the team is involved in at this time.
The Board has ultimate responsibility and accountability for the quality of commissioned services and this exception report highlights the key issues for review, detailing the extent of the issue and actions being taken by the provider, the CCG or both organisations to achieve positive outcomes for patients.
Key/Contentious issues to This report aims to identify potential quality concerns in be considered and any commissioned services and to provide assurance to the Board principal risk(s) relating to that actions are in place and effective monitoring processes in this paper place.
(Assurance The main concerns at this time are arising from the Coronavirus Framework/Strategic Risk pandemic including restoration and recovery of provider activity, Register reference if the impact of deferred assessments on the CHC team and high appropriate) levels of safeguarding activity
Are there any potential None identified at this time. conflicts of interest that the committee need to be aware of?
Please indicate which N/A meetings this document has already been to, plus outcomes
HR Implications (if any) N/A
Financial Implications (if N/A any)
Public involvement – N/A activity taken or planned
Equality Impact N/A Assessment required / undertaken
Report Author Carol Alstrom (name and job title) Associate Director of Quality / Deputy Chief Nurse
Board Sponsor Stephanie Ramsey (GP Board member or Director of Quality and Integration / Chief Nurse Executive Director)
Date of paper 16th November 2020
Actions requested The Board is asked to receive the Quality Exception Report. / Recommendations
2/2 NHS Southampton City Clinical Commissioning Group
Quality Exception Report – November 2020
Introduction
In light of the ongoing Covid19 pandemic quality activity in NHS Southampton City CCG has shifted from assurance and improvement to focus on supporting health and social care to deliver care in a very different way, removing some of the burdens of monitoring and reporting whilst still supporting providers in all settings to provide quality care. The focus of workload has shifted again, now to continuing services and managing the second wave of Covid-19. Quality Managers from the CCG continue to be involved in a number of Hampshire and Isle of Wight (HIOW) wide work streams to support restoration and recovery and wave 2.
The focus of our work over the last 2 months has been on supporting providers in health and care to enable safe services to be provided and facilitating early learning when issues arise. Alongside this work has been underway to support identification of harm or potential harm as restoration and recovery begins.
The Quality Team has been continuing to work to support the following aspects:
• Quality assurance of providers – from a distance and without placing a burden on providers. • Infection Prevention and Control – particularly in care homes and home care providers including testing in care homes. Supporting the activity of the Southampton City Council Health Protection Board. • Safeguarding – adults, children, looked after children, care homes and home care providers • Discharge to Assess and Deferred Assessments– the main pathway out of hospital with all patients funded by the NHS when requiring new or enhanced placements or packages of care on discharge. • Medicines management - supporting practices and ensuring business as usual is in place.
A short briefing on the key issues is outlined below
Quality Assurance
Quality assurance activity has continued to focus on seeking assurance from our providers without placing additional burden on them. Quality managers are continuing to attend provider meetings virtually to support assurance. This includes a range of assurance committees, serious incident meetings and other meetings relevant to quality. Providers are welcoming of this approach and including Quality Managers in a range of meetings. Work continues to develop a clinical harm review tool to support the management of people waiting more than 18 weeks whose pathway has been delayed. UHSFT have now adopted an electronic format of this process and have adapted the utilisation to ensure it is identifying patients who may have suffered harm. A further review is planned for January 2021.
Work is ongoing with UHSFT to ensure that the CCG has sight of the restoration and recovery of Ophthalmology services given the challenges this service was experiencing prior to the start of the Pandemic in March 2020.
Pressures have been noted in microbiology services at UHSFT and this is being followed up.
Ongoing challenges continue in the placement of children and young people waiting tier 4 Child and Adolescent Mental Health beds, this has been escalated to commissioners locally and within NHS England to establish what additional actions can be taken
Infection Prevention and Control (IPC)
Work continues to support the care home and home care sector, with a particular focus on early identification of Covid-19 cases and potential outbreaks. The weekly video conference open to all providers continues to be well attended and is being used by a wider group of CCG and SCC staff to support communication with the sector. Providers still have access to support on a minimum of a weekly basis and where needed up to daily contact when they have a Covid-19 case identified or an outbreak. The team have some capacity issues as the volume of work remains high. The Primary Care Quality Lead who has IPC expertise continues to provide vital support to our IPC lead, and both post holders are part of a wider on call system covering advice to Hampshire and the Isle of Wight. Additional funding has been secured from Southampton City Council to provide a 12-18 month infection control practitioner post to support activity in the City.
The new scheme of designated beds for patients being discharged from hospital to a care home who are Covid-19 positive and need 14 days of isolation has been progressing rapidly during October and November. A facility just over the border into Hampshire on the east of the City has been identified and we have been working in partnership with the provider, Southampton City Council, Hampshire County Council and West Hampshire CCG to ensure that this facility is available from the week commencing 16th November 2020. 19 beds have been identified and the facility has been assessed by CQC as meeting the infection prevention and control standards required.
Safeguarding
Safeguarding work has continued throughout the emergency period and many aspects have returned to business as usual work. An overall increase in safeguarding activity continues to be noted across the City in both children and adults.
Discharge to Assess / Deferred Assessments
On the 19 March 2020 the COVID-19 Hospital Discharge Bill suspended the use of Continuing Healthcare (CHC) assessments for individuals on the acute hospital discharge pathway and in community settings until the end of the COVID-19 emergency period.
During August updated guidance was issued and all patients who were discharged under the COVID-19 Discharge to Assess scheme between March and 31st August 2020 are now required to be assessed and moved to the appropriate funding stream for their needs, either CHC, local authority or self-funding (three normal routes). Plans are in place to ensure these deferred assessments are completed by 31st March 2020 and this is being managed by a project team with oversight by the Clinical Governance Committee. All patients funded on this scheme will continue to be funded in this way until their assessment process is completed. This workload is significant with an initial backlog of 440 cases identified who may potentially meet the criteria for a CHC assessment. This has quickly been reduced to 341, where it is clear individuals do not need a full assessment. This work is being done in partnership with Southampton City Council and currently we are anticipating that the 31st March deadline will be achieved. During November 2020 Southampton City Council has recruited additional social worker capacity to support this work and we anticipate this alongside the CHC staff will enable the assessments to move forward in a timely manner.
Clinical Governance Committee
The committee has reviewed the quality risks on the CCG risk register and made a number of recommendations for inclusion in the updates on key risks.
The Terms of Reference for the Clinical Governance Committee have been reviewed and recommends these to the Board for approval
The Serious Incident Policy has been reviewed; a few minor changes have been made. Nationally, a new framework is due to be published in 2021/22 and therefore this update is focused on maintaining the existing policy in preparation for the new framework when it is published.
The committee has also heard some patient feedback about access to general practice since the COVID-19 emergency commenced. The committee agreed that the quality team would undertake additional work to understand the patient feedback and explore access particularly for patients who may have difficulty accessing technology. In addition a deep dive into this work will take place during December and January to understand the additional actions practices have taken to support access. The CCG Primary Care Team are involved in this work.
The Clinical Governance Committee has been updated on the progress of the Hampshire and Isle of Wight Quality Board and the plans to develop a quality committee for the Southampton and South West Hampshire area.
The Committee has been briefed on the work of the Care Homes Oversight Group and will review the Care Homes action plan on a 2-monthly basis. The Committee recognised the significant amount of work that is being undertaken to support the sector from all aspects of the Integrated Commissioning Unit at this time and not just the Quality Team.
Conclusion The team has risen to the challenge of the pressures created by the Covid19 pandemic and the significant changes working remotely. We are continuing to review working practices and develop new ways of working to support quality assurance and improvement in Southampton. It should also be recognised that the workload of the team has increased significantly particularly with the changes to discharge and CHC processes.
The Governing Body is asked to note this report and approve the serious incident policy
Carol Alstrom Associate Director of Quality / Deputy Chief Nurse 16th November 2020
Southampton City Clinical Commissioning Group Board
Date of meeting 25 November 2020
Agenda Item (number) 8
Terms of Reference
Topic Area Governance
Summary of paper and key Clinical Governance Committee information The Clinical Governance Committee (CGC) Terms of Reference (ToR) have been updated in line with their review date.
Only minor changes have been made which can be seen via track changes within the document. This includes the removal of a sentence in section 3.4 and update on the membership in section 5.2.
Joint Commissioning Board The Joint Commissioning Board (JCB) Terms of Reference (ToR) have been updated in line with their review date.
The changes that have been made are a general tidy up of sentences, however the main changes are set out below:
• Inclusion of the following bullet points under the introduction:
o The Board will ensure the development and implementation of the Southampton Five Year Health and Care Strategy o The Board will maintain a focus on the commissioning of services to meet the outcomes of the citizens of Southampton, and those registered with GP’s in Southampton whilst working in the Southampton and SW Hampshire and wider Hampshire and Isle of Wight context.
• Clarity provided on the membership and sets out who is a member for each organisation. • More detail included in annex a which covers integrated commissioning and examples of potential scope
Key/Contentious issues to None be considered and any principal risk(s) relating to this paper
(Assurance Framework/Strategic Risk Register reference if appropriate)
Are there any potential No conflicts of interest that the committee need to be aware of?
Please indicate which Clinical Governance Committee – 4th November 2020, approved meetings this document has already been to, plus Joint Commissioning Board – 15th October 2020 - approved outcomes
HR Implications (if any) N/A
Financial Implications (if N/A any)
Public involvement – N/A activity taken or planned
Equality Impact N/A Assessment required / undertaken
Report Author Beccy Willis (name and job title) Head of Governance
Board Sponsor James Rimmer (GP Board member or Managing Director Executive Director)
Date of paper November 2020
Actions requested The Board are asked to ratify the Terms of Reference for: / Recommendations - Clinical Governance Committee - Joint Commissioning Board
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Clinical Governance Committee
Terms of Reference
1. Constitution
1.1 The Clinical Governance Committee is established as a committee of the CCG Governing Body
2. Purpose
2.1 The purpose of the Committee is to:
• Oversee and provide assurances to the Governing Body, and the local population, that the quality of commissioned services in Southampton is of a high standard meeting patient need and supporting improving patient outcomes.
• Champion and lead continuous improvement in the quality of services commissioned for patients.
• Ensure quality risks are managed in line with the Southampton City CCG Risk Policy. There will be a proactive approach with clinical leadership in triangulation of contract, performance, finance and quality information to identify issues at an early stage so early actions can be taken and where necessary formal escalation processes followed.
• Be accountable for monitoring effectiveness of implementation of the Equality and Diversity and Safeguarding Strategies and the CCG impact on health inequalities as assessed in the Joint Strategic Needs Assessment.
• Ensure the quality of services commissioned are monitored across Southampton City receiving via the quality reports produced by the Quality Team within the Integrated Commissioning Unit.
• Oversee and provide assurances to the Governing Body that Southampton City CCG discharges its statutory requirements associated with safeguarding children, adults and Looked After Children (LAC).
3. Responsibilities
3.1 The responsibility of the Committee is to provide an assurance to the CCG Governing Body on all matters concerning duties, obligations and responsibilities relating to quality including patient safety, clinical effectiveness/outcomes and patient experience, ensuring there is clear integration of clinical and corporate governance.
3.2 The Committee will make decisions and monitor the progress of the Clinical Governance Committee agenda in the discharge of the following activities: • Be proactive in approach with active clinical, user and provider involvement to ensure continuous quality improvement and positive impact on the health of the population, by ensuring this is embedded in commissioning and monitoring processes
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• Ensure a comprehensive and detailed focus on patient experience to improve commissioning for quality, including establishing and maintaining strong links with Health Watch and relevant patient groups. • Ensure that leadership and accountability for clinical quality are clearly understood and implemented across the CCG to effect change and agree quality and outcome standards. • Ensure that mechanisms are in place and provide assurance to the CCG on the quality of local commissioned services, including primary care general practices. • Ensure that mechanisms are in place to provide assurance to Southampton City Council on the quality of locally commissioned public health and social care services. • Ensure systems are in place for monitoring the quality of primary care General Practice services with the CCG as a delegated commissioner. • Monitor serious incident and never event reporting within providers to ensure they are appropriately reported and investigated, and lessons are learnt and shared and actions are embedded in providers to reduce recurrence • Ensure effective arrangements are in place to address child and adults safeguarding issues through engagement with local safeguarding boards, local authorities, and statutory agencies and other bodies including the voluntary and community sector. • Ensure Safeguarding Children and Adults is central to the CCGs commissioning and governance and key legislation embedded in day to day functions. • Provide a vehicle for the CCG to manage its responsibilities in relation to Equality and Diversity. • Ensure that learning from complaints, litigation and claims is systematically analysed and disseminated throughout the CCG to improve commissioning processes. • Ensure that national guidance from National Institute of Clinical Excellence (NICE), the Care Quality Commission (CQC) and other bodies is implemented across the CCG, and within our commissioned services. Ensure active patient and public engagement, including co-production, is in place in order to influence CCG decision making. • Ensure that good practice, ideas and innovations are systematically disseminated across the whole health and social care system. • Ensure that patients and the wider population have the opportunity to influence the CCG strategic direction. • Ensure that all commissioned services have clear outcomes for quality and safeguarding and understand the escalation process if standards fall below what is expected • Ensure there are effective early warning systems in place which draw on a range of quality indicators and other sources of information to identify gaps in assurance • Review the Annual Quality Accounts of providers and review commissioning statements of assurance • Review and scrutinise Information Governance arrangements as and when necessary
3.3 The Board has devolved responsibility to seek assurance in relation to the following areas of clinical governance: 3.3.1 Patient Safety including:
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• Safeguarding children and adults • Looked After Children • Infection prevention and control • Serious incident management • Use early warning systems, such as triangulation to identify potential concerns. • Complaints • Clear lines of accountability, including reporting to National Reporting and Learning system
3.3.2 Clinical Effectiveness including :
• Evidence based practice including national best practice guidance (e.g. NICE) • National and local clinical audits • Research based practice and governance • A focus on outcomes including patient reported outcome measures • Medicines Management
3.3.3 Patient Experience including:
• Patient insight reports including feedback from patients via GP’s • Complaints concerns comments and compliments • National and local patient and/or carer surveys • Equality and Diversity audits and implementation • Healthwatch Reports
3.4 The Committee will gain assurance by receiving, reviewing and, where appropriate, acting on regular updates, papers and/or minutes from relevant committees or groups of all the above areas., including Clinical Quality Review Meetings (CQRM) for all main providers.
4. Scope of authority and decision making
4.1 The Committee is required to work in accordance with these Terms of Reference and Southampton City CCG Governing Body’s Standing Orders, Standing Financial Instructions and Scheme of Delegation.
4.2 The Committee will work to the professional and legal standards required of its members (Nolan principles of public life).
4.3 The Committee will ensure that it reports to the CCG Governing Body on any matters which properly fall within the Board’s ‘Schedule of Delegation Reserved to the Board’.
5. Membership, Quorum and Attendance
5.1 The Committee will appoint an ‘independent Chair’, and the Director of Quality and Integration will be the Vice Chair. The Director of Quality & Integration is not an independent chair but will only be used in periods of absence or when a Conflicts of
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Interest arises. In exceptional circumstances s a Chair will be appointed from the membership.
5.2 The Committee will have the following membership:
• Independent Chair • Director of Quality and Integration / Chief Nurse (Vice Chair) • Associate Director of Quality / Deputy Chief Nurse • GP Board Member • GP Clinical Lead • Head of Safeguarding • Medicines Management Representative • Healthwatch Representative • Head of Communications Stakeholder Relations and Engagement • Quality Leads • Infection Prevention and Control Lead Nurse Specialist • Primary Care Quality Lead • Secondary Care Doctor • Clinical Lead for Continuing Healthcare
5.3 The meetings will be quorate when there are at least one half of the members appointed in attendance, at least one of those in attendance must be a currently registered health care professional and onetwo who are who is a Governing Body members.
5.4 The Committee must be quorate when any decisions are made or votes taken.
5.5 Others may be invited to attend for specific items for example NHS England Wessex for specialist commissioning issues, and from time to time other observers, with the prior agreement of the Chair or the nominated Clinical Governance Committee member.
6. Frequency
6.1 Meetings will be held monthly, with the flexibility to allow one meeting a year to be a seminar session.
7. Management
7.1 Decisions will generally be made on the basis of consensus. In certain circumstances it may be necessary for all members to vote, normally by a show of hands.
7.2 In the case of an equality of votes, the chair shall have a second vote which will be the casting vote.
7.3 The agenda and any papers shall be circulated to members five working days before the date of the meeting.
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8. Reporting Arrangements
8.1 The Clinical Governance Committee will report to the Southampton City CCG Governing Body. The approved Minutes of the Committee will be submitted to the Board.
8.2 The Quality Exception Report, highlighting priority issues and prepared after Clinical Governance Committee will received by the Southampton City CCG Governing Body and the Finance and Audit Committee.
9. Review
9.1 These Terms of Reference will be reviewed annually or before in light of significant changes
Revised November 2020June 2019
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Terms of Reference for the Joint Commissioning Board
1. Introduction
1.1. Southampton City Council (the Council) and Southampton City Clinical Commissioning Group (CCG) have developed a shared ambition for change ‘Integrated Health and Wellbeing Commissioning allows the city to push further and faster towards our aim of completely transforming the delivery of health and care in Southampton, so that it is better integrated, delivered as locally as possible, person centred and with an emphasis on prevention and intervening early to prevent escalation’. For the purpose of these Terms of Reference, Health and Wellbeing is defined as Health and Care services outlined in the scope Annex A.
If we are to realise this vision and meet the challenges we face then we will need to:
• Act as one for the city by - developing and delivering a single view of the city’s needs and how we can ensure they are best met - aligning and allocating our collective resources to achieve prioritised outcomes - working for the whole population • Support people to become more independent and do things for themselves by changing the relationship between citizens and services • Be innovative and have an appetite for risk to make the change • Make the most of new opportunities and powers • Build on our existing good work • Ensure that the health and care system is financially sustainable and flexible enough to meet current and future challenges.
1.2. There are a number of benefits from integrated commissioning that have been grouped under three broad headings
1. Using integrated commissioning to drive provider integration and service innovation. It is through these innovations that integrated commissioning has the greatest potential to benefit citizens and patients. 2. Improving the efficiency of commissioned services. This includes both streamlining process and reducing duplication and variation. This is particularly relevant for services/providers working across both commissioning organisations. 3. Increasing the effectiveness of commissioning – across the whole of the commissioning cycle. Combining the knowledge, expertise and importantly authority and leaderships of both organisation (clinical and democratic) has the potential to significantly increase the effectiveness of commissioning across the City.
1.3. The Council and CCG have therefore established a Joint Commissioning Board to commission health and social care in the City of Southampton. It will encourage collaborative planning, ensure achievement of strategic objectives and provide assurance to the governing bodies of the partners of the integrated commissioning fund on the progress and outcomes of the work of the iintegrated commissioning function (the Integrated Commissioning Unit). The Joint Commissioning Board hereafter will be referred to as the Board
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1.4. The Board will act as the single health and wellbeing commissioning body for the City of Southampton and a single point for decision makers. The Board will convene and exercise their functions following consensus / consultation with each other on those functions in scope. This includes those areas of health and social care commissioning covered by the Better Care Fund Section 75. (BCF)
1.5. The Board has been established to ensure effective collaboration, assurance, oversight and good governance across the integrated commissioning arrangements between Southampton City Council and Southampton City CCG.
1.5 As such, the Board will develop and oversee the programme of work to be delivered by the Integrated Commissioning Unit and review and define the integrated commissioning governance arrangements between the two bodies.
1.6 The Board will monitor the performance of the Integrated Commissioning unit integrated commissioning function and ensure that it delivers the statutory and regulatory obligation of the partners of the Better Care Fund and relevant Section 75 .agreements.
1.61.7 The Board will ensure the development and implementation of the Southampton Five Year Health and Care Strategy
1.8 Evidence based commissioning will be key to achieving our vision and the Board will be informed and driven by needs assessment, market analysis, user experiences, consultation and engagement.
1.9 The Board will maintain a focus on the commissioning of services to meet the outcomes of the citizens of Southampton, and those registered with GP’s in Southampton whilst working in the Southampton and SW Hampshire and wider Hampshire and Isle of Wight context.
2. Scope
2.1 The Board will have oversight of all schemes established under the Better Care Section 75 and other remaining Partnership Agreements which in some cases may have their own specific Partnership Board, under the NHS Health Act 2006 flexibilities, and Local Government Act 1972 (s.113). This will include shadow monitoring of schemes under development and scrutinising their suitability for future inclusion in the BCF Partnership Agreement or other Partnership Agreements. An example of schemes to be included is to be found in Annex A
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2.2 There are also be services in scope for which the commissioning responsibility/ decision making remains solely with the CCG or City Council but the funding is aligned to deliver a jointly agreed strategy. Examples can be found in Annex A
2.3 Beyond this, there could be areas of shared commissioning where the Council and CCG will want to discuss and share information about relevant commissioning intentions, budget and spend. The Board could also consider bids that are of joint interest. These 3 categories are described below:
• Jointly commissioned/funded services • Single agency commissioning aligned under a jointly agreed strategy • Other areas relevant for the achievement of the outcomes
2.4 The scope of the Board will cover joint NHS and City Council services commissioned by the Integrated Commissioning Unit.
2.5 The Board may, where appropriate, supportdevelop a wider range of services subject to final approval of the CCG Governing Body and Council
2.6 Subject to the agreement of the CCG Governing Body and the Council, the Board membership may be amended to include any other partner who jointly commissions with the City Council or Southampton City Clinical Commissioning Group and other agency representatives may be co- opted as necessary.
3 Role and Objectives
3.1 To agree shared commissioning priorities for the Council and CCG based on where a partnership approach will improve outcomes and promote greater efficiencies.
3.2 To approve and monitor the development and implementation of the Integrated Commissioning Plan to ensure it meets agreed priorities, objectives, savings and performance targets and aligns commissioning arrangements with partners’ financial and business planning cycles.
3.3 To ensure that all commissioning decisions are made in line with the principles set out in the Integrated Commissioning plan, including providing challenge regarding the scale and pace of integrated commissioning approaches.
3.4 To monitor the financial plans and financial performance of the integrated Ccommissioning Unit function, including forecasts for the year.
3.5 To ensure compliance with any specific reporting requirements associated with the formal pooled fund described in the Section 75 agreement.
3.6 To ensure compliance with rules and restrictions associated with any other blocks of funding, including specific grant funding.
3.7 To ensure the appropriate management of risks management response to risks identified and the assurances against them regarding the integrated commissioning function.
3.8 To agree, subject to the financial decision making limits of the council and the CCG, all financial planning commitments across areas of integrated commissioning responsibility for pooled or non- pooled budgetary provision.
3.9 To receive and consider reports on service development, budget monitoring, audit and 3 inspection reports in relation to those services which are the subject of formal partnership arrangements.
3.10 To seek assurance on the quality and safety of commissioned services in relation to key performance indicators and standards. Where performance is outside of expected threshold to receive exception reports. = 3.113.10 To provide system leadership and direction to the staff of the integrated cCommissioning Unitfunction.
3.123.11 To promote quality and identify how the health and wellbeing strategic intentions and priorities of partners will be supported and enabled through integrated commissioning.
3.133.12 To maintain oversight of the Section 113 arrangements between the two organisations for the Integrated Commissioning Unit.
4 Better Care Section 75 Partnership Agreement
The Board:
4.1 Shall oversee and review the schemes established under the Better Care S75 Partnership Agreement, ensuring adherence to the relevant legislation and protocols in the development of Partnership Agreements have been followed.
4.2 Shall receive, review and approve Business Cases for new pooled fund schemes to be established under the Better Care Section 75 Partnership Agreement (with reference to the respective Schemes of Delegation).
4.3 Shall receive and review quarterly reports on each Better Care pooled fund scheme on the exercise of the partnership arrangements. These reports shall include details of:
• Annual forward financial plans setting out the projected annual spend • Review of the operation of each scheme covering:
- evaluation of performance against agreed performance measures targets and priorities and future targets and priorities; - quality of service delivery and how the arrangements benefit and meet the needs of client groups; - any service changes proposed; - any shared learning and opportunities for joint training; - assurance that monitoring and evaluation processes take account of statutory guidance and policy directives pertaining to quality standards, best value and audit arrangements of the Council and the CCG. 4.4 Shall ensure the Services provided under each scheme are meeting the needs of the service users and their carers.
4.5 Shall ensure that commissioning decisions are the result of the wide ranging consultation and discussion with the key people involved in all aspects of the function of delivering joined up health and social care.
4.6 Shall encourage and ensure that service providers work collaboratively with service users, other providers and commissioners and that it is promoted through positive design of payment packages and risk and benefit share arrangements into commissioning contracts.
4 4.7 Shall ensure that commissioners listen to service users and providers and respond supportively to ideas to make services more effective for the user and more responsive to needs.
4.8 Shall assess and manage any liabilities or risks reported in relation to each of the Better Care pooled fund schemes and act upon these at the earliest opportunity and monitor their impact throughout the delivery of the services. This shall include consideration of proposed changes to the services and funding and how these may impact on each organisation.
4.9 Shall monitor financial contributions of the Council and the CCG and make recommendations regarding future financial contributions.
4.10 Shall provide the Council and CCG with an annual review report and forward plan of the S75 Better Care Partnership Agreement arrangements, incorporating financial and activity performance, risks, benefits and evidence of improvements for service users.
5 Risk Sharing principles
5.1 The pooled budget arrangements will be managed in such a way as to avoid destabilising either organisation, the detailed arrangements for managing the pooled funds are detailed in the Section 75 Pooled Fund Agreement and its scheme specifications.
5.2 Each organisation will retain responsibility for dealing with any deficit it has at the start of the pooled budget arrangement. F, foor the avoidance of doubt this includes a situation where commitments against the pooled fund are greater than or are likely to be greater than the budget set.
5.3 Each organisation will strive to achieve a balanced budget within the pooled budget.
5.4 The statutory requirements of each organisation must be maintained.
5.5 The pooled budget (in line with the Section 75 agreement) will contain a mechanism for dealing with significant changes to the funding or statutory responsibilities of either organisation that effect the areas in scope of the pooled budget arrangement.
5.6 Both organisations will provide robust management information in line with their responsibilities in the Section 75.
5.7 Both organisations will ensure the early identification of potential in year under or over spends and for remedial actions to be put into place.
6 Governance and Reporting
6.1 The Board will be accountable to the Council’s Cabinet and / or Council as appropriate and the CCG Governing Body. It will work in partnership with the Health and Wellbeing Board and the CCG Clinical Executive Group.
6.26.1 The Board will need to demonstrate contribution to the Health and Wellbeing Strategy outcomes
6.36.2 The Board will need to be informed by the Joint Strategic Needs Assessment, needs assessments, market analysis and feedback from consultation and engagement with residents and patients.
6.46.3 The Board will meet monthly and be minuted. Meetings in public will normally be bi 5 monthly with a seminar brieifing in the intervening months. Additional meetings of the Board Committee may be held on an exceptional basis at the request of the Chair.
6.56.4 At least one meeting each quarter will receive and review the performance of the Better Care S75 Partnership Agreement, undertaking those responsibilities as set out in Section 4.
6.66.5 The Board shall be entitled to call a meeting, at any time, outside of the agreed meetings schedule, for any purpose, subject to compliance with any statutory requirements in relation to decision making under the Local Government Acts and CCG Constitution.
6.76.6 All minutes and papers from the Board will be reported to the CCG Governing Body and made available to Council’s Cabinet.
6.86.7 Agendas will be jointly agreed in line with the Forward Plan and will need to be circulated at least 5 working days in advance of the meeting. All new agenda items are subject to agreement of the Chair or Vice Chair. Where a decision of the Council (Member or Officer) is required at a Board meeting then the requirements of the Local Government Act 2000 and Access to Information regulations must be adhered to (publication of notice of key decisions 28 days in advance, publication of reports 5 clear working days in advance, formal decision Notice signed by decision maker and Proper Officer (Democratic Services must attend for this purpose for these items). Decisions that are ‘key decisions’ within the meaning of the Local Government Act 2000 are subject to the Council’s ‘call-in’ procedures and cannot be implemented until the time for call-in has expired or the matter has been dealt with in accordance with Overview & Scrutiny Procedure Rules.
6.96.8 The agendas, minutes, decision notices and briefing papers of the meetings of this Board are subject to the provisions of the Freedom of Information Act 2000, the Environmental Information Regulations and the Data Protection Act 2018. If the Chair concludes that specific issues are exempt from publication and should not be made available under the terms of the Freedom of Information Act, a Part 2 meeting of the Board shall be convened to consider them.
6.106.9 Part 2 meetings have to be notified 28 days in advance of the meeting and reasons for excluding the public included on the report / agenda item or the decision cannot be taken. There are limited urgency provisions but these require prior consent from the chair of the Health Overview and Scrutiny Panel.
6.116.10 Meetings of the Board shall be advertised in advance on the calendar of meetings of the CCG Governing Body and Council and shall, unless notice of consideration of an excluded item has been given, shall be open to the public to attend.
6.126.11 The Chair will invite questions or statements by members of the public on matters pertaining to that agenda at the beginning of the meeting.
6.136.12 Administrative support for the Board will be a shared responsibility although agenda publication. etc. will be undertaken by both the Council and the CCG to meet both organisational requirements.
6.146.13 The Health and Wellbeing Board have delegated responsibility for Better Care and the Southampton City Five Year Health and Care Strategy implementation to the Board and the Board will be accountable to the Health and Wellbeing Board for this element.
6.156.14 The Board will receive the minutes from the Better Care Southampton Steering Board
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7 Membership
7.1 The council’s representation on the Joint Commissioning Board will be 3 Cabinet Members made through executive appointments. and theThe CCG hasve nominated 3 members from the CCG Governing Body. Both organisations have agreed to send deputies in any absences.
Members • The Leader of the Council (SCC) • Cabinet Member - Health and Adult Social Care (SCC) • Cabinet Member - Stronger Communities (SCC) • Chief Executive Officer (SCCCG) • Clinical Chair (SCCCG) • Lay Member for Patient and Public Involvement (SCCCG)
7.2 In exceptional circumstances for Southampton City Council, a decision maker can be changed from a cabinet member to the Leader of the Council as long as the forward plan has been amended in line with appropriate timescales and papers have not been published
7.3 Other attendees
• Key senior managers from the Council and the CCG as required. • The relevant commissioning lead for each of the pooled budgets under the S75 Better Care Partnership Agreement will attend as appropriate the quarterly meetings to present the performance report for the S75 Partnership Agreement.
7.4 The Chair will be a politician from the council or a member from the CCG Governing Body. The Vice Chair of the Board will be from the alternate partner organisation.
8 Quorum, Decision Making and Voting
8.1 The CCG Governing Body and SCC Cabinet may grant delegated authority (with any appropriate caveats) to those of its members or officers participating in the Board to make decisions on their behalf, whilst retaining overall responsibility for the decision made by those members or officers. It is therefore the individual member or officer who has the delegated authority to make a decision rather than the Joint Commissioning Board itself.
8.2 The Board will require consensus prior to any delegated decisions being taken; consensus will be demonstrated by a show of hands. It is important that given the nature of the decisions, securing the support of both partners will be critical to the success of this Board. The Board will be quorate if there are at least 4 members in attendance with a minimum of 2 from each organisation.
8.3 In those circumstances where consensus cannot be reached, the matter will be deferred for further consideration by the parties and will be reconsidered after discussions between the Chair and respective partner lead.
8.4 Schemes of Delegation to City Council Members and Council Officers shall be amended to reflect that decisions should not be taken under delegation and should stand either deferred to a future meeting or referred back to the parent body where a consensus of those present do not support the decision proposed. The Chair of the Board shall consult those present before deferring the decision or directing that it be referred back to each partner organisation.
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8.5 Legally, it is not possible to have a mechanism that requires individual decision makers to exercise their decision making function in accordance with the will of a majority or quorum of a Board. Any individual decision maker must consider any decision on its merits as a whole in accordance with established decision making principles. The process for seeking the support of the Board prior to exercising any delegation meets a requirement in the Scheme of Delegation to limit the power to exercise that delegation to situations only where the support of the Board is demonstrated. For the CCG the delegated authorisation limit is up to £1 million, for the City Council the delegated authorisation limit is up to £2 million with any decisions over £500k being classed as a key decision.
8.6 Functions outside the decision making scope of the Board, but related to health and social care will be discussed for information only at the Board, with the considerations and any recommendations of the Board formally minuted. Items will then be referred to the relevant decision maker (e.g. CCG Governing Body, Council).
9 Dispute Resolution
9.1 If disputes relating to the Better Care Section 75 Partnership Agreement arise then the Dispute Resolution process within that will be followed. Otherwise any matter of dispute will be referred for further discussion by the Leader of the Council and Chair of the CCG before referring back to the Board for further consideration. It is recognised that as the desire is to reach agreement on any matter by consensus that if this is not reached that matter may not move forward. There will be no formal and binding external arbitration procedure.
10 Scrutiny
10.1 Decisions of members of the Joint Commissioning Board will be subject to formal scrutiny normally undertaken by the Health Overview and Scrutiny Panel, on behalf of the Council and Call in. Health scrutiny is a fundamental way by which democratically elected councillors are able to voice the views of their constituents, and hold NHS bodies and health service providers to account. In Southampton the Health Overview and Scrutiny Panel undertakes the scrutiny of health and adult social care. The Panel meets every 2 months. However, there may be some major decisions may be considered by the council’s Overview and Scrutiny Management Committee.
11 Conflict of Interests
11.1 The Board will be bound by the Standing Orders/Standing Financial instructions and Codes of Conduct of both parent bodies. Declaration of interests will need to be declared annually and at each meeting of the Board in line with the agenda. Depending on the topic under discussion and the nature of the conflict of interest appropriate action will be taken and recorded in the minutes
12 Variation
12.1 The parent bodies may agree from time to time to modify, extend or restrict the remit of the Board.
The Terms of Reference will be reviewed annually
October August2020
8 Annex A Integrated Commissioning – Examples of potential scope
Jointly commissioned/funded services
1. These will be services currently in scope for the 2020/2117/19 Better Care Fund S75 agreement. In addition, the scope will include other existing partnership agreements/shared funding arrangements: • Support Services for Carers • • Integrated Services within the established 6 Better Care ClustersIntegrated Locality Teams (previously known as cluster working): Community health services for adults (Community Nursing, Continence, Podiatry, Community Wellbeing Services, Community specialist services for people with long term conditions, case management, Palliative Care, community navigation, Community Adult Mental Health Services and IAPT (Improving access to psychological therapies) , Adult Long Term Social Care Teams) • Support Services for Carers • Integrated rehabilitation, reablement and hospital discharge services (including the Hospital Discharge Team, Discharge to Assess, residential reablement and extra care, Falls Assessments) • Care TechnologyAids to Independence: including Joint Equipment Service, Wheelchair service and Disability Facilities Grant • Prevention and Early Intervention services – Behaviour Change, Older Person’s Offer, Information, Advice and Guidance, Community Solutions and Housing Related Support • Integrated Learning Disabilities provision Commissioning (placements) • Direct Payments Support servicesPromoting the uptake of Direct Payments • Transformation of Long Term Care provision (Adult Social Care additional/improved BCF funding to support transformation of Extra Care and conversion of a Residential Unit to Nursing Care as well as stabilising the Domiciliary Care and Care Home market) • Joint Equipment Service, Wheelchair Service, Orthotics and Disabled Facilities Grant • Integrated services for children with complex health needs (specifically Building Resilience Service and SEND integrated health and social care team).
9 Single agency commissioning aligned under a jointly agreed strategy
2. This would mean that commissioning responsibility/ decision making remains solely with the CCG or City Council but the funding is aligned to deliver a jointly agreed strategy. This could include: • Long Term Care provision (including domiciliary care, nursing and residential CHC and social care packages) – aligned to Better Care strategy • 0-19 prevention and Early Help, CAMHS, Community midwifery – aligned to 0-19 prevention and early help strategy/CAMHS Transformation • Sexual health (integrated level 3 service, voluntary and primary care prevention services, termination of pregnancies, vasectomies) – aligned to Sexual Health and Reproductive Strategy • Substance Misuse Services – aligned to Substance Misuse Strategy • Respite and Short Breaks – aligned to Replacement Care Strategy, services for children, e.g. Edge of care, Family Drugs and Alcohol Court, Looked After Children, Safeguarding – aligned to children’s strategy • Community development (definition to be agreed)
Benefits
3. The scope will increase the ability of both organisations to: • Realise a shared vision – e.g. a shared focus on prevention and early intervention and community solutions to promote independence & a shared commitment to realise it • Share risks and benefits associated with implementation of the shared vision, enabling us to do the “right thing” without unfairly disadvantaging or advantaging one organisation • Commission against a single agreed set of common outcomes and priorities – making best use of resources • Share needs data and good practice evidence – leading to more intelligent commissioning • Develop more innovative solutions to meet people’s needs in the round (as opposed to commissioning in silos for people’s “health” versus “social” needs – leading to improved outcomes for people • Bring together health, public health and social care resources and strip out duplication – leading to savings and efficiencies • Commission a more joined up health and care system, developing together whole pathways from prevention to care - fewer gaps • Enable providers to develop more innovative integrated pathways and organisational models – leading to less fragmentation • Shape and develop primary medical care as part of the integrated health and social care system • Better understand and manage demand through greater influence over assessment and review processes
10 Southampton City Clinical Commissioning Group Board
Date of meeting 25 November 2020 Agenda Item (number) 9 Policies
Topic Area Governance
Summary of paper and key Serious Incident Policy information The Serious Incident Policy has been reviewed in line with its review date, the policy has had a general tidy up.
Corporate Card Policy The Corporate Card policy has been updated in line with its annual review, the policy has had a general tidy up.
Key/Contentious issues to None be considered and any principal risk(s) relating to this paper
(Assurance Framework/Strategic Risk Register reference if appropriate)
Are there any potential No conflicts of interest that the committee need to be aware of?
Please indicate which Serious Incident Policy – Clinical Governance Committee, 4th meetings this document has November 2020, approved already been to, plus outcomes Corporate Card Policy – Senior Management Team, 12th November 2020, approved
HR Implications (if any) N/A
Financial Implications (if N/A any)
Public involvement – N/A activity taken or planned
Equality Impact Yes Assessment required / undertaken Report Author Serious Incident Policy – Carol Alstrom, Associate Director of (name and job title) Quality
Corporate Card Policy – Beccy Willis, Head of Governance Board Sponsor James Rimmer (GP Board member or Managing Director Executive Director)
Date of paper November 2020
Actions requested The Board are asked to ratify the following policies: / Recommendations - Serious Incident Policy - Corporate Card Policy
2/2
Serious Incident Policy
Supporting learning to prevent recurrence
DRAFT Final Version 2
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Subject and version number of Serious incident Policy Version 21.3 document:
Owner of the policy: Carol Alstrom Associate Director of Quality / Deputy Chief Nurse NHS Southampton City CCG [email protected]
Operative date (first created): May 2015
This document applies to: All staff involved in the management of Serious Incidents within NHS Southampton City CCG
Policy Implications: This policy sets out the processes by which Serious Incidents will be managed by NHS Southampton City CCG Equality Analysis Completed? This document includes a section about Equality Analysis (previously called Equality Impact Assessment), the aim being to encourage and support policy developers to demonstrate ‘due regard’ to the Equality Act 2010. This will be achieved if all new policies are assessed for equality impact at an early stage, and records kept of the equality analysis process and any actions identified. Consultation Process Clinical Governance Committee
Approved by: Clinical Governance Committee CCG Board
Date approved: 26th July 2017
Next review date: 2 years – Nov 2022July 2019
Dissemination of policy:
Action Date completed Uploaded to website N/A Available on the W drive, insert location Article in staff newsletter
Review Log: Include details of when the document was last reviewed:
Version Review Date Name of Reviewer Amendment description Number 1.1 25/05/2015 Carol Alstrom Updated following revision of national framework 1.2 27/06/2017 Carol Alstrom Routine review. 2 27/10/2020 Carol Alstrom Routine Review
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Contents
Section Page Number 1 Introduction and purpose 4 2 Scope and definitions 4 3 Management of serious incidents 7 4 Roles and responsibilities 9 5 Training 9 6 Monitoring the effectiveness of the policy 10 7 Review 10 8 References and links to other documents 10 Appendix 1 Equality Impact assessment 12 Appendix 2 Closure checklist 13 Appendix 3 Commissioner responsibilities 15 Appendix 4 Managing incidents in general practice – guidance 16
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1. INTRODUCTION AND PURPOSE
1.1 In March 2015 NHS England published the revised Serious Incident Framework which builds on and replaces the National Framework for Reporting and Learning from Serious Incidents Requiring Investigation (SIRI) issued by the National Patient Safety Agency in 2010. This policy details how Southampton City CCG will implement this framework and associated documents, including identifying, investigating and managing a serious incident.
1.2 The organisation where the incident occurred has overall responsibility for the investigation, the immediate dissemination of learning and implementation of subsequent action plans.
1.3 It is a requirement of all registered organisations to report serious incidents to the Care Quality Commission and this process in no way replaces this requirement.
1.4 This policy provides details on how Serious Incidents (SIs) will be managed by NHS Southampton City CCG.
2. SCOPE & DEFINITIONS
SCOPE
2.1 This policy applies to all staff within NHS Southampton City CCG who are responsible for the management of serious incidents including members of the Quality Team and all staff within the CCG who may be involved in a serious incident as part of their day to day work
DEFINITIONS
2.2 In broad terms, serious incidents are events in health care where the potential for learning is so great, or the consequences to patients, families and carers, staff or organisations are so significant, that they warrant using additional resources to mount a comprehensive response. Serious incidents can extend beyond incidents which affect patients directly and include incidents which may indirectly impact patient safety or an organisation’s ability to deliver ongoing healthcare.
The occurrence of a serious incident demonstrates weaknesses in a system or process that need to be addressed to prevent future incidents leading to avoidable death or serious harm1 to patients or staff, future incidents of abuse to patients or staff, or future significant reputational damage to the organisations involved. Serious incidents therefore require investigation in order to identify the factors that contributed towards the incident occurring and the fundamental issues (or root causes) that underpinned these. Serious incidents can be isolated, single events or
1 Serious harm: - - Severe harm (patient safety incident that appears to have resulted in permanent harm to one or more persons receiving NHS-funded care); - Chronic pain (continuous, long-term pain of more than 12 weeks or after the time that healing would have been thought to have occurred in pain after trauma or surgery ); or - Psychological harm, impairment to sensory, motor or intellectual function or impairment to normal working or personal life which is not likely to be temporary (i.e. has lasted, or is likely to last for a continuous period of at least 28 days).
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multiple linked or unlinked events signalling systemic failures within a commissioning or health system.
There is no definitive list of events/incidents that constitute a serious incident and lists should not be created locally as this can lead to inconsistent or inappropriate management of incidents. Where lists are created there is a tendency to not appropriately investigate things that are not on the list even when they should be investigated, and equally a tendency to undertake full investigations of incidents where that may not be warranted simply because they seem to fit a description of an incident on a list.
The definition below sets out circumstances in which a serious incident must be declared. Every incident must be considered on a case-by-case basis using the description below. Inevitably, there will be borderline cases that rely on the judgement of the people involved
Serious Incidents in the NHS include: • Acts and/or omissions occurring as part of NHS-funded healthcare (including in the community) that result in:
2 o Unexpected or avoidable death of one or more people. This includes - suicide/self-inflicted death; and - homicide by a person in receipt of mental health care within the recent past3;
o Unexpected or avoidable injury to one or more people that has resulted in serious harm;
o Unexpected or avoidable injury to one or more people that requires further treatment by a healthcare professional in order to prevent:— - the death of the service user; or - serious harm;
o Actual or alleged abuse; sexual abuse, physical or psychological ill-treatment, or acts of omission which constitute neglect, exploitation, financial or material abuse, discriminative and organisational abuse, self-neglect, domestic abuse, human trafficking and modern day slavery where: - healthcare did not take appropriate action/intervention to safeguard against such abuse occurring4; or - where abuse occurred during the provision of NHS-funded care.
This includes abuse that resulted in (or was identified through) a Serious Case Review (SCR), Safeguarding Adult Review (SAR), Safeguarding Adult Enquiry or other externally-led investigation, where delivery of NHS funded care caused/contributed towards the incident.
2 Caused or contributed to by weaknesses in care/service delivery (including lapses/acts and/or omission) as opposed to a death which occurs as a direct result of the natural course of the patient’s illness or underlying condition where this was managed in accordance with best practice. 3 This includes those in receipt of care within the last 6 months but this is a guide and each case should be considered individually - it may be appropriate to declare a serious incident for a homicide by a person discharged from mental health care more than 6 months previously. 4 This may include failure to take a complete history, gather information from which to base care plan/treatment, assess mental capacity and/or seek consent to treatment, or fail to share information when to do so would be in the best interest of the client in an effort to prevent further abuse by a third party and/or to follow policy on safer recruitment.
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• A Never Event - all Never Events are defined as serious incidents although not all Never Events necessarily result in serious harm or death. See Never Events Policy and Framework for the national definition and further information;5
• An incident (or series of incidents) that prevents, or threatens to prevent, an organisation’s ability to continue to deliver an acceptable quality of healthcare services, including (but not limited to) the following: o Failures in the security, integrity, accuracy or availability of information often described as data loss and/or information governance related issues o Property damage; Security breach/concern;6 o 7 o Incidents in population-wide healthcare activities like screening and immunisation programmes where the potential for harm may extend to a large population; o Inappropriate enforcement/care under the Mental Health Act (1983) and the Mental Capacity Act (2005) including Mental Capacity Act, Deprivation of Liberty Safeguards (MCA DOLS); o Systematic failure to provide an acceptable standard of safe care (this may include incidents, or series of incidents, which necessitate ward/ unit closure or suspension of services8); or o Activation of Major Incident Plan (by provider, commissioner or relevant agency)9
• Major loss of confidence in the service, including prolonged adverse media coverage or public concern about the quality of healthcare or an organisation10.
2.3 Lead Commissioners are responsible for monitoring the management of Serious Incidents by providers of NHS funded care. Where the incident is in relation to a patient whose treatment has been commissioned by NHS England as a specialist commissioner; Southampton City CCG will manage the incident on behalf of NHS England whilst maintaining communication via the NHS England Wessex Area Team.
2.4 Associate Commissioners are reliant on Lead Commissioners to ensure that Serious Incidents are appropriately managed within providers. The Lead Commissioner should liaise with Associate Commissioners and involve them in the sign off process. It is the responsibility of the Lead Commissioners to sign off the report.
5 Never Events arise from failure of strong systemic protective barriers which can be defined as successful, reliable and comprehensive safeguards or remedies e.g. a uniquely designed connector to prevent administration of a medicine via the incorrect route - for which the importance, rationale and good practice use should be known to, fully understood by, and robustly sustained throughout the system from suppliers, procurers, requisitioners, training units, and front line staff alike. See the Never Events Policy and Framework available online at: http://www.england.nhs.uk/ourwork/patientsafety/never-events/ 6 This will include absence without authorised leave for patients who present a significant risk to themselves or the public. 7 Updated guidance will be issued in 2015. Until that point the Interim Guidance for Managing Screening Incidents (2013) should be followed. 8 It is recognised that in some cases ward closure may be the safest/ most responsible action to take but in order to identify problems in service/care delivery , contributing factors and fundamental issues which need to be resolved an investigation must be undertaken 9 For further information relating to emergency preparedness, resilience and response, visit: http://www.england.nhs.uk/ourwork/eprr/ 10 As an outcome loss in confidence/ prolonged media coverage is hard to predict. Often serious incidents of this nature will be identified and reported retrospectively and this does not automatically signify a failure to report.
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2.5 The table in Appendix 3 demonstrates the responsibility for the management of serious incidents within NHS Southampton City CCG contracts
3. MANAGEMENT OF SERIOUS INCIDENTS
3.1 Contract Requirements
3.1.1 All contracts established by NHS Southampton City CCG will specify clear requirements for responding to serious incidents in line with the current national framework. This will include: • Having robust reporting arrangements in place which comply with national guidance • Report serious incidents to commissioners within 2 days of the incident being identified by the organisation, and appropriately reported on STEIS • Reporting serious incidents to the NRLS, STEIS and other bodies as appropriate e.g. police, HSE, Local Supervising Authority Midwifery Officer, Information Commissioner • Reporting Never Events in accordance with the Never Events framework • Report safeguarding incidents to the relevant local safeguarding service and where appropriate the safeguarding board itself. • Requirements to meet Duty of Candour
3.1.2 Additionally contract requirements will include types of incidents that should be reported, reporting requirements, monitoring requirements and demonstration of lessons learnt.
3.2 Reporting and Monitoring
3.2.1 Serious Incidents will in the main be reported by providers. There may be occasions when commissioners report serious incidents affecting commissioning or services it provides e.g. Continuing Healthcare Funding. Where Serious Incidents affect more than one provider the CCG will actively expect providers to work together to investigate, report and share any learning.
3.2.2 Serious Incidents should be reported on to the Strategic Executive Information System (STEIS) within 2 working days of the organisation identifying the serious incident. In the case of independent contractors and other providers who do not have access to STEIS the CCG will input the information relating to the serious incident onto the system.
3.2.3 In the majority of cases, the date of the incident occurring is the same as the date in which the reporting organisation identifies the incident. In some cases the date that the organisation identifies the incident may differ from the actual incident date, and an example of this would be when an incident comes to light following a retrospective case note review. Lead commissioners will make the final decision on what date applies in consultation with the reporting organisation
3.3.4 Any Serious Incident affecting NHS Southampton City CCG, either as the managing commissioner or as the organisation in which the SI has occurred, should be reported within the timeframes identified below and also reported via the National Reporting and Learning System (NRLS) who will forward relevant information to the CQC.
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3.3.5 Providers will complete Serious Incident root cause analysis reports within 60 working days of the incident coming to the attention of the provider and being reported on STEIS.
3.3.6 All reports will contain anonymised information in the interests of confidentiality. Investigation reports may be disclosable under the Freedom of Information Act 2000. Where providers fail to anonymise reports these will be flagged as information governance breaches. Unless the provider agrees with the patient / family that they will be referred to in a particular way.
3.3.7 A decision to report a domestic homicide onto STEIS should be made by the commissioner in conjunction with NHS England.
3.3.8 In the case of a safeguarding incident being reported, the Clinical Quality Assurance Lead or relevant Quality Manager must ensure that the CCG Head of Safeguarding (adults and children) is aware of the incident.
3.3.9 Where a Serious Incident involves two or more commissioners, the Quality Team will liaise with the relevant commissioner to ensure that all parties are notified and a co- ordinating commissioner identified.
3.3.10 In a very small minority of cases NHS Southampton City CCG may also be responsible for identifying the need for and arranging an independent investigation, this is likely to be when there has been a major systems failure with multiple stakeholders.
3.3.11 NHS Southampton City CCG Quality Team will work with providers and lead CCGs to ensure that reports relating to Serious Incidents are submitted by providers within the agreed timescales
3.3.12 The Quality Team will ensure all Serious Incidents are reviewed and feedback given to the Provider within 20 working days of receipt of the root cause analysis report. A closure checklist is included in Appendix 2 to support this process. • For most Serious Incidents a panel made up of quality team members will review the report and action plan to ensure they are robust and meet the requirements of the SI Framework. Where this is the case the provider will be advised that the SI is closed and expected to monitor the action plan to completion. • Serious incidents relating to pressure ulcers and falls will be reviewed by the Clinical Quality Assurance Lead and the relevant Quality Manager and closed unless there is reason to escalate this to the CCG serious incident panel • For Never Events and System Wide serious incidents a panel including representatives of the involved CCG’s will be convened and this will include at least 1 Board Member from NHS Southampton City CCG, representatives of the Quality Team and where required a representative from NHS England. Wessex Area Team. In all cases the action plan must be completed before closure.
3.3.13 Where Panels do not agree closure of Serious Incidents, feedback will be given to the provider to ensure that the Serious Incident can be reviewed and closed when additional information is available. Feedback should be transparent concise, clear and ensure that the additional information where needed will add value to the report / action plan.
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3.3.14 The system of monitoring Serious Incidents is outlined in section 7 of this policy. These reports which include trend and theme data and other relevant analysis will be used to support quality reviews and commissioning decisions.
3.3.15 Appendix 4 provides a guide for the management of incidents / significant events and serious incidents in primary medical care which the CCG will be working actively with practices to implement where possible
4. ROLES AND RESPONSIBILITIES
4.1 Overall responsibility for the management of Serious Incidents sits with the CCG Chief Officer, however this responsibility has been delegated to the Director of Quality and Integration.
4.2 The Director of Quality and Integration is responsible for the Management of Serious Incidents, overseeing the work of the Associate Director of Quality and the Quality Team to ensure the management of serious incidents is in line with national and local policy. The Director of Quality and Integration provides regular Quality Exception Reports to the Board, including serious incident management within the CCG.
4.3 The Associate Director of Quality is responsible for the day to day operation of the serious incident policy, ensuring that systems are in place for the management of serious incidents and that these are in line with national frameworks.
4.4 The Quality Managers are responsible for the day to day management of serious incidents, ensuring procedural arrangements are followed including submission of reports by providers in a timely fashion and ensuring key lessons are addressed. Quality Managers are responsible for ensuring review panel meetings are held in a timely fashion for those contracts the CCG is lead commissioner for and for participating in panels where the CCG is the associate commissioner.
4.5 The Clinical Quality Assurance Lead is responsible for ensuring providers submit required information in a timely fashion and following up with providers when this does not happen. The Clinical Quality Assurance Lead is also responsible for preparing reports including quantitative and qualitative analysis, and logging and updating incidents on STEIS.
4.6 All staff. Every staff member as a commissioner and or provider has a responsibility to ensure that all actual and potential incidents are reported in accordance with this policy.
5. TRAINING
5.1 This policy does not have any specific training requirements. Staff who are involved in the management of Serious Incidents will receive training as part of their induction and any staff asked to undertake investigations should have completed root cause analysis training or training in undertaking investigations and report writing
5.2 Further guidance and information on the management of serious incidents can be found in the guidance issued by NHS England outlined in section 9 of this policy
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6. MONITORING THE EFFECTIVENESS OF THE POLICY
6.1 Serious incidents in all providers and those occurring within Southampton City CCG will be reported monthly via the Provider Quality and Metrics report to Clinical Governance Committee and Patient Safety Report quarterly with any exceptions feeding up into the bi-monthly CCG Quality Exception Report to the Board.
6.2 All Serious Incidents affecting Southampton City CCG residents will be reviewed by the Quality Team or at a commissioner led panel to determine the robustness of the investigation and the action plan and to ensure any trends, themes or learning are gathered and shared as appropriate.
6.3 The more detailed quarterly report, referred to in 6.1 will provide a quantitative and qualitative analysis and includes details of any delays being encountered in the serious incident management process.
6.4 An annual report (April to March) will be prepared pulling together trends and learning across the previous twelve months which will be presented to the Clinical Governance Committee.. It will also include any comments or concerns arising from the implementation of this policy.
7.5 All reports will protect patient confidentiality at all times.
7. REVIEW
7.1 This document may be reviewed at any time at the request of either staff side or management, but will be reviewed as a minimum of every two years.
8. REFERENCES AND LINKS TO OTHER DOCUMENTS
8.1 Other key documents are listed below
NHS England, Serious Incident Framework, Supporting learning to prevent recurrence March 2015
NHS England, Serious Incident Framework 2015/16 frequently asked questions. March 2015
NHS England, Revised Never Events Policy and Framework March 2015
NHS England, Revised Never Events Policy and Framework, Frequently asked questions. March 2015
National Patient Safety Agency, ‘Seven Steps to Patient Safety’’, 2004 – 2009. Available at http://www.nrls.npsa.nhs.uk/resources/collections/seven-steps-to-patient-safety/
Royal Colleague of Surgeons (2014) Building a culture of candour: A review of the threshold for the duty of candour and of the incentives for care organisations to be candid. Available online https://www.rcseng.ac.uk/policy/documents/CandourreviewFinal.pdf
Human Rights Review (2012) Article 2: The Right to Life http://www.equalityhumanrights.com/sites/default/files/documents/humanrights/hrr_article_2. pdf
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National Patient Safety Agency, ‘Being Open: communicating patient safety incidents with patients, their families and carers’, November 2009, available at: http://www.nrls.npsa.nhs.uk/resources/?EntryId45=83726
Maria Dineen (2011) Six Steps to Root Cause Analysis (third edition) ISBN:978-0-9544328- 2-9
NHS England (2014) Principles for managing quality in specialised commissioning (including RASCI template) available at: https://nhsengland.sharepoint.com/TeamCentre/Operations/_layouts/15/WopiFrame.aspx?s ourcedoc={1CAE2D20-BB4F-47A3-BFB6- 3371A4D7AE6A}&file=Principles%20for%20managing%20quality%20in%20specialised%20 commissioning%20including%20RASCI%20template.docx&action=default
NPSA, RCA toolkit, available at: https://report.nrls.nhs.uk/rcatoolkit/course/iindex.htm
Work related deaths: A protocol for liaison (England and Wales). Available at: http://www.hse.gov.uk/pubns/wrdp1.pdf
Health and Social Care Information Centre guidance HSCIC Checklist Guidance for Reporting, Managing and Investigating Information Governance Serious Incidents Requiring Investigation (2015) Available at: https://www.igt.hscic.gov.uk/KnowledgeBaseNew/HSCIC%20SIRI%20Reporting%20and%2 0Checklist%20Guidance.pdf
Independent Schools Inspectorate (ISI) 2012- Integrated Handbook-framework
Home Office Multi-agency Statutory Guidance for the Conduct of Domestic Homicide Reviews (2013) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/209020/DHR_ Guidance_refresh_HO_final_WEB.pdf
Department of Health, No Secrets, available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidan ce/DH_4008486
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Appendix 1: Equality Impact Assessment
Serious Incidents Policy Equality Impact Assessment
To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval.
The Equality Impact Assessment Tool ensures relevant equality and equity aspects of documents have been addressed either in the main body of the document or in a separate equality & equity impact assessment (EEIA). The checklist is to enable the policy lead and the relevant committee to see whether a full EEIA is required and to give assurance that the proposals will be legal, fair and equitable.
Challenge Questions Yes/No What positive or negative impact do you assess there may be? 1. Does the proposal affect one group more or less favourably on the basis of: • Age No • Disability No • Gender re-assignment No • Marriage & Civil Partnership No • Pregnancy & Maternity No • Race No • Religion or belief No • Sex No • Sexual orientation (including lesbian, No gay, bisexual and transgender people)
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Appendix 2: Closure checklist
Commissioner SI Closure Checklist All elements need to be present to enable closure of the investigation
STEIS CCG PANEL CLOSED/NOT CLOSED (circle NUMBER: DATE: one)
IF NOT CLOSED, CCG REVIEWED ON (DATE): CLOSED/NOT CLOSED (circle one)
IF NOT CLOSED, CCG REVIEWED ON (DATE): CLOSED/NOT CLOSED (circle one)
Phase of Element Present Comments investigation : Y / N a) Was the appropriate evidence used (where it was available) i.e. patients notes/records, written account? b) Were interviews conducted?
c) Is there evidence that those affected (including patients/staff/victims/ perpetrators and their families) were PING involved and supported appropriately? d) Has Duty of Candour been met?
MAP e) Has a timeline of events been produced? GATHERING AND AND GATHERING
f) Are good practice guidance and
1. protocols referenced to determine what should have happened? g) Are care and service delivery problems identified? a) Is there evidence that the contributory
factors for each problem have been explored? b) Is there evidence that the most fundamental issues/ or root causes have been considered? c) Have appropriate lessons been identified for learning? d) Are there clear procedures for ANALYSING ANALYSING effective communication to facilitate
INFORMATION sharing of learning across the 2. organisation(s)?
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Phase of Element Present: Comments investigation Y / N a) Is there an action plan?
b) Does the action plan reflect all recommendations?
c) Is there a responsible person identified for each action?
SOLUTIONS
GENERATING d) Is there as timeframe for completion?
3.
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Appendix 3: Commissioner Responsibilities
Lead CCGs Associate CCGs NHS England Other Key Parties UHSFT Southampton City Isle of Wight CCG Wessex Area Southampton City CCG Fareham and Team Council West Hampshire Gosport CCG CQC CCG South East Hampshire CCG Dorset CCG Solent Southampton City West Hampshire Wessex Area Southampton City (Southampton CCG CCG Team Council contract) CQC Southern Health Southampton City Wessex Area Southampton City NHS Trust CCG Team Council (Southampton West Hampshire CQC Contract) CCG Care UK – Southampton City West Hampshire Wessex Area Southampton City Southampton CCG CCG Team Council Treatment Centre Isle of Wight CCG CQC South Central Fareham and Southampton City Southampton City Ambulance Gosport and South CCG Council Service East Hampshire CQC CCGs Care UK – Minor Southampton City Southampton City Injuries Unit CCG Council CQC Spire Healthcare West Hampshire CQC – Southampton CCG BUPA Healthcare Southampton City Southampton City CCG Council CQC Nursing Homes in Southampton City Southampton City Southampton City CCG Council CQC OOH Southampton City CQC CCG 111 Southampton City CQC CCG In Health Southampton City CQC CCG
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APPENDIX 4 Managing Incidents in General Practice
Guidance on the management of: significant events, never events, serious incidents and patient safety incidents in general practice
V1 – June 2017
Introduction and background This guide aims to support general practice staff in the identification, reporting, investigation and learning from incidents. Significant event review has been a key part of learning and improvement activities in general practice for some time now. Its importance is emphasised in regulatory and individual clinician clinical appraisal requirements, and the analysis of significant events encourages a culture of honesty in the team as well as team-based and individual reflection. Applied effectively, the technique provides many opportunities to improve the safety of patient care. However, there is more to the reporting and management of incidents than significant event analysis alone. The understanding and recognition of serious incidents and never events in general practice is outlined in the NHS England Serious Incident Framework but the use of this framework has been variably applied in GP practices. This guidance will provide practice staff with definitions of the key classifications of incidents and provide practical examples to support the identification of incidents and the harm level.
Definitions and examples
Significant event A significant event (SE) is defined as any episode of care, incident, occurrence or accident, related to clinical or non-clinical care, which has or could have resulted in a positive or negative outcome, or an injury, or near miss to a patient, visitor or member of staff. A significant incident may also be a complaint or piece of patient feedback; it may be related to clinical or non-clinical care or an event resulting from non-compliance with the routine procedures of the practice. The significant event may also result in property or equipment damage, equipment failure, and can include physical aggression or verbal threats to other patients or staff. Any incident can be a significant event; those involving patient safety should be reported as a patient safety incident via the practice’s local incident reporting system (e.g. Quasar) as well as to the National Reporting and Learning Service (NRLS), regardless of the level of harm. It is really important to capture near misses, where no harm has occurred, as understanding near misses can prevent harm to patients in the future. Some incidents are classified as serious incidents (SI) if the level of harm is serious according to the NHS England Serious Incident Framework. Please refer to the remainder of this document for explanations on determining harm. Figure 1 below shows the various types of incidents and where they should be reported.
Figure 1: Types of incidents
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Report and Report to record internally Report to NRLS Report to NRLS For self- record internally and NRLS if appropriate reflection
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Patient Safety Incident A patient safety incident is any unintended or unexpected incident which could have or did lead to harm for one or more patients receiving NHS care. A patient safety incident may also be a serious incident, if it involves serious harm to the patient (s). Screening incidents also include any incident where there is harm or risk of harm because one or more persons eligible for screening are not offered screening. The characteristics of screening programmes mean that safety concerns/ incidents require special attention and management. This is because: • there is potential for safety incidents in screening programmes to affect a large number of individuals: seemingly minor local incidents can have a major service and population impact • poor quality screening can do more harm than good – it can harm individuals and have no benefit to the population • incidents often affect the whole screening pathway not just the local department or provider organisation in which the problem occurred • local incidents can affect public confidence in a screening programme beyond the immediate area involved
The Managing Safety Incidents in NHS Screening Programmes guidance should be followed.
Near misses A near miss is an unplanned event that did not result in injury, illness, or damage, but had the potential to do so. Only a fortunate break in the chain of events prevented an injury, fatality or damage. It may be appropriate for a ‘near miss’ to be a classed as a patient safety incident or serious incident, depending on the potential severity of harm that could be caused should the incident (or a similar incident) occur again. Deciding whether or not a ‘near miss’ should be classified as an incident should be based on an assessment of risk which should consider: • the likelihood of the incident occurring again if current systems/process remain unchanged or • the potential for harm to staff, patients, and the practice should the incident occur again.
Every ‘near miss’ should be reported as where there is a risk of system failure and/or harm, the incident process should be used to understand and mitigate that risk / harm.
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Serious Incidents In broad terms, serious incidents (SIs) are events in health care where the potential for learning is so great, or the consequences to patients, families and carers, staff or organisations are so significant, that they warrant using additional resources to mount a comprehensive response. Serious incidents can extend beyond incidents which affect patients directly and include incidents which may indirectly impact patient safety or an organisation’s ability to deliver ongoing healthcare There is no definitive list of events/incidents that constitute a serious incident, as this can lead to inconsistent or inappropriate management of incidents. Every incident must be considered on a case-by-case basis using the description below. Inevitably, there will be borderline cases that rely on the judgement of the people involved. Where it is not clear whether or not an incident fulfils the definition of a serious incident, GP practices and the Clinical Commissioning Group (CCG) must engage in an open and honest discussions to agree the appropriate and proportionate response.
Examples of incidents in general practice Incidents in general practice can generally be allocated into six groups, these are set out in the table below. The examples included below alongside the definitions provided and the harm ratings are intended to support practices to determine whether the incident is a near misses, a SE or a SI. Please note the examples included in the figure 2 below are not an exhaustive list; they are intended to provide guidance only, to help you determine if an incident requires further investigation under the near miss, SE or SI framework.
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Figure 2: Examples of Incidents which may occur in general practice
Patient Safety Incident
• Delayed or missed diagnosis • Misinterpretation of a handwritten prescription • Medication errors • immunisation incident • Wrong drug prescribed • Delayed or missed diagnosis • Wrong drug dose • unexpected / avoidable death within 48 hours of contact with the practice • Drug interaction • Failure to offer or refer to screening • Inadequate drug monitoring • Delay in performing screening or reporting results • Wrong drug / dose dispensed • Medication errors resulting in severe/catastrophic harm ie admission to acute • Important message not acted on or death • Result miss-filed • Communication failures • Result not acted on • Urgent referral not done • Investigation request not sent • Complications related to procedures undertaken on the premises (e.g. • fridge/cold chain failures affecting vaccines infection resulting from minor surgery, retained instrument etc.) • wrong vaccine/dose administered
Information Health & Adverse Business Continuity Safeguarding Governance Safety Incident Media/Reputational breach • Appointment letter • Accidents • Poor CQC rating • staffing / • Patient expelled from practice sent to wrong on • Poor patient resource issues such • Termination request – Termination of pregnancy?? address premises feedback following as registrar on alone, • Domestic abuse issues • Wrong information (inc. surveys, limited GP • Angry or upset given over sharps/spla complaints, /nurse/admin cover, • Violence /aggression towards staff or patients telephone sh injury, concerns • Disruption of • allegations, or incidents, of physical abuse and sexual assault or abuse; • Equipment failure patient falls • Claim services • Child protection concerns • Computer data etc.) • IT failure / • Accusation of physical misconduct or harm loss • Damage to disruption • Loss of Personal premises Identifiable Data • Wrong address of patient
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Measurement of harm The main methods used to measure harm in primary care include: - incidents reported by staff - review of individual patient records - Structured or planned audits - automated review of electronic records - examination of registries or databases - patient interviews and surveys - staff surveys and interviews - direct observation.
Incidents are firstly assessed on the probability (likelihood of the incident happening) and secondly on what would happen i.e. the consequence or impact. When assessing how likely it is that an incident will occur, the current environment should be taken into account. Consideration must be given to the adequacy and effectiveness of the controls (e.g. policies and procedures; staff training) already in place within the environment, which could address the causes of the incident and therefore the likelihood of the risk being realised. When assessing what the impact of the incident, consideration should be given to what the impact of the incident would be in most circumstances within the environment and what is reasonably foreseeable.
How to score an incident? Consequence score (C): choose the most appropriate domain for the identified incident / risk from the left hand side of the below matrix. Then work along the columns in the same row to assess the severity of the risk on a scale of 1 to 5 to determine the consequence score, which is the number given at the top of the column. Likelihood score (L): what is the likelihood of the consequence occurring? The frequency-based score is appropriate in most circumstances and is easier to identify. It should be used whenever it is possible to identify a frequency.
For grading risk, the scores obtained from the risk matrix are assigned grades as follows 1 - 3 Low risk 4 - 6 Moderate risk 8 - 12 High risk 15 - 25 Extreme risk
Levels of harm & examples in primary care
Term Definition Clinical example
No harm Any patient safety incident that did A GP prescribes the twice the recommended dose not result in harm or injury or that of a new drug, which the local community had the potential to cause harm pharmacist picks up when dispensing the but was prevented, resulting in no prescription. harm (near miss)
Low harm Any patient safety incident that A patient’s home visit is missed; the patient has required extra observation or minor cellulitis of the right leg; this was picked up the treatment following day resulting in the GP deciding to prescribe I.V. rather than oral antibiotics which need to be delivered by community frailty team.
Moderate Any patient safety incident that Continuing treatment with warfarin without harm resulted in a moderate increase in monitoring INR for 6 weeks. The patient had an treatment and which caused upper GI bleed and was admitted to hospital for 5 significant but not permanent harm days for monitoring and follow-up. It was noted on admission that the INR was 7.
Severe Any patient safety incident that A patient who is a heavy smoker with a persistent harm appears to have resulted in cough is noted to have a suspicious lesion on a permanent harm. chest x-ray. The GP messages the practice reception to arrange an urgent appointment with the patient, although there is no answer on the patient’s home telephone as he is on holiday. The message to follow up is missed. Two months later the patient presents with shortness of breath and haemoptysis. He is admitted to hospital via MAU and is diagnosed with lung cancer.
Death Any patient safety incident that A patient is on a repeat prescription for morphine directly resulted in death sulphate 10mg twice a day for chronic pain. The patient requests a prescription and, in error, a prescription is issued for morphine sulphate 100mg twice a day. The medication is dispensed and the patient’s wife, who looks after his medicines, gives her husband 100mg tablets of morphine sulphate. He takes 2 doses over the next day and then his wife is unable to rouse him in the morning. He is admitted to hospital where he has a cardiac arrest and dies.
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Reporting of Incidents The majority of incidents in general practice result in no or low harm levels which will be investigated via significant event analysis at practice level. GP practices are however requested to use the National Reporting and Learning System (NRLS) to report any serious incidents, near misses and where appropriate Information Governance and Health and Safety incidents that has occurred within the practice. Further guidance in reporting significant incidents to CQC can be found on the following link: CQC- Significant event reporting guidance
Incidents that meet the definition for reporting as a serious incident must be raised verbally with the CCG immediately or by the end of the next working day. The CCG in turn will enter these incidents onto STEIS (Strategic Executive Information System). A subsequent confirmation email should be sent to [email protected] by the practice. The CCG will offer support to practices with the coordination of an investigation and also reserves the right to support practices with investigations of incidents where significant harm has, or may have occurred but which does not meet the threshold for a SI. Screening incidents (either suspected or confirmed) must be reported and investigated in accordance with the guidance on Managing Incidents in NHS Screening Programmes. This means they must all be notified within 24 hours to the Screening and Immunisation Team (SIT) embedded within the NHS England Public Health Commissioning Team via [email protected]. For screening incidents, the SIT may advise that Public Health England’s Screening Incident Assessment Framework (SIAF) form should be completed. The SIT will oversee the investigation and will advise on the process to be followed.
Completion of Incident Investigation Investigation of incidents should be undertaken using the established significant event analysis process. The full guidance can be found www.npsa.nhs.uk/nrls/gp A suggested significant event analysis report can be found here:
SEA template.docx
If the practice has determined that an incident is to be reported as an SI a full root cause analysis (RCA) should be conducted. Further information on the completion of a root cause analysis can be found http://www.nrls.npsa.nhs.uk/resources/collections/root-cause- analysis/ The CCG are able to provide support in the coordination of this. Examples of RCA templates are provided below:
RCAtemplate.docx blank RCA.doc
Sharing Learning from Incidents The purpose of reporting and investigating incidents is to ensure learning is identified, recurrence is limited by identification of actions and to ensure that learning is shared with other practices. The CCG can support with the sharing of learning. The Screening and Immunisation Team will ensure that learning from screening safety incidents, ‘potential’ incidents and near misses is disseminated locally and shared with national NHS screening programmes to help prevent incidents elsewhere and to inform guidance and training
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SERIOUS INCIDENT REPORTING PATHWAY
Incident occurs Practice Manager and/or
NRLS champion notified Immediate notification to external
agencies if required (CCG, NHSE, police, safeguarding) Patient and relatives informed that CCG notification immediately or by the incidence is being reported and end of the next working day – CCG to investigated report onto STEIS where required
NRLS champion or practice Staff member commences appropriate Review of RCA by manager to determine level of investigation and associated (senior) partner investigation level and reporting – commence RCA with and NRLS instigate immediate actions support of CCG champion to mitigate potential risks. (consider impact on patient and service)
Keep patient, relatives and external partners informed throughout Formulate an Action Plan and identify lead and time frame
Final analysis of report including Monitor delivery of action plan at Patient and lessons learned discussed at agreed meetings / intervals relatives practice wide meeting and provide informed of RCA to CCG within 2 months outcome
Implement actions CCG will review RCA and update STEIS with investigation outcome
Process complete. Share learning with other partners and practices.
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NHS SOUTHAMPTON CITY CLINICAL COMMISSIONING GROUP CORPORATE PREPAID CARD POLICY
Subject and version number of Corporate Prepaid Card Policy, Version 21 document:
Owner of the policy: Nicky Geh Head of Financial Reporting
Operative date (first created): 1st December 2020
This document applies to: All CCG employed staff
Policy Implications: This policy summarises how to use the prepaid card and what it is for.
Equality Analysis Completed? This document includes a section about Equality Analysis, the aim being to encourage and support policy developers to demonstrate ‘due regard’ to the Equality Act 2010. This will be achieved if all new policies are assessed for equality impact at an early stage, and records kept of the equality analysis process and any actions identified.
Consultation Process Senior Management Team Governing Body
Approved by: Governing Body
Date approved: 27th March 2019
Next review date: December 2020
Dissemination of policy:
Action Date completed Uploaded to website N/A Available on the W drive, insert location Yes Article in staff newsletter
Review Log:
Include details of when the document was last reviewed:
Version Review Date Name of Reviewer Amendment description Number 2 November 2020 Head of Governance Review and revision of card amount
Contents
1. Introduction and purpose
2. Scope and definitions
3. Procedure
4. Limits
5. Transactions
6. Administration
7. Audit
8. Roles and responsibilities
9. Equality analysis
10. Success criteria/Monitioring the effectiveness of the policy
11. Review
CORPORATE PREPAID CARD POLICY
1. INTRODUCTION & PURPOSE
1.1 NHS Southampton City CCG has identified advantages to be gained by using prepaid cards after taking into account all alternatives such as purchasing through the Supplies Department and buying via petty cash.
1.2. The prepaid card is in effect ‘cash’. It is not a “credit” or “purchasing Card”. It is replenished with funds via the internet, once the funds have been spent it cannot be used again until additional funds are added.
1.3. The prepaid card is issued to the Chief Financial Officer.
1.4. The cardholder needs to activate the card, with security information supplied at the time of application.
1.5. Like a credit or debit card a PIN is required to make purchases. The cardholder is responsible for its security.
1.6. The card holder may only use the card for business purposes.
1.7. The effective working of the prepaid card depends on the integrity of the card holder.
1.8. Breaches of CCG policy with regard to the use of prepaid cards will be referred to the Local Counter Fraud Specialist (LCFS) for investigation which could result in the application of a criminal sanction.
1.9. Statements are available to view on line and download, detailing the transactions for the card. Access to the statements is only available via the finance team.
1.10. A copy of this policy and procedure will be issued to all designated purchasing card holders.
1.11. Please note this Policy does not cover the use of Personal Health Budget cards, for these purposes please refer to the Personal Health Budgets Policy.
2. SCOPE & DEFINITIONS
SCOPE
2.1 All CCG staff must be aware of this policy, before they wish to use the prepaid card.
DEFINITIONS
2.2 CFO – Chief Financial Officer CSU – Commissioning Support Unit Prepaid Financial Services Administrator – Head of Financial Reporting Card Administrator – AdminFinance Assistant
3. PROCEDURE
Card Housekeeping
3.1 This procedure attempts to cover the most common issues that arise in connection with the use of the card.
Issue
3.2 There is no limit to the number of cards that can be issued. Each card has separate funds added to it.
3.3 Authorisation for additional cards may only be made by the CFO in writing to the Finance Team. Once received, the request for additional cards will be processed by the Prepaid Financial Services administrator.
3.4 The setting up of additional cards requires two members of the Finance team. Details of all of CCG’s employees that hold prepayment cards are held by the Finance team.
3.5 The CCG’s Cardholder Procedure must be followed in all cases.
3.6 Each prepaid card will be issued by the Head of Financial Reporting. As the prepaid card is issued, each card holder will be required to sign an Employee Agreement (attached at Appendix 1)
Amended Cards
3.7 Any amendments to the prepayment card must be in writing by the Chief Finance Officer to the card administrator.
3.8 Obsolete cards should be cut in half across the magnetic strip and confirmation this has been done to the card administrator following receipt of the new card.
Renewal of Cards
3.9 All cards will bear an expiry / renewal date. Your replacement card will be issued to the card administrator approximately 14 days before the renewal date. The card administrator will contact you to arrange delivery of the new card and destruction of the old.
Security
3.10 The prepaid card must only be used by the designated card holder. The designated card holder must not, under any circumstances, disclose their individual card number or PIN to anyone. It is the card holder’s responsibility to ensure that the card is retained in a secure location at all times.
3.11 The card must be available for audit inspection at all times.
Lost / Stolen Cards
3.12 If the card is lost or stolen, the holder must contact the card administrator immediately.
Job Change / Leaving Employment
3.13 In the event of a job change, the Chief Finance Officer will decide if the card is needed for your continued use. This decision will be communicated to the card administrator in writing.
3.14 Upon leaving employment of the CCG, the card must be returned to the card administrator who will arrange for it to be cancelled and destroyed
Card Holders Liability / Credit Status
3.15 Whilst the prepayment card is printed with an individuals’ name, it is not a credit card and consequently there is no impact on the individuals’ personal credit status.
3.16 However inappropriate use by the cardholder may result in disciplinary action, including termination of employment. Where there is a suspicion or evidence of fraud a referral will be made to the LCFS in line with the CCG’s Counter Fraud Policy, which may result in the application of a criminal sanction.
4.0 LIMITS
4.1 While the card does not have a limitThe card does have a limit and, it can only be used when there are sufficient available funds on it to meet the transaction. If the transaction is in excess of available funds the transaction will be declined.
4.2. The card administrator will arrange for funds to be automatically replenished when the available balance is below the agreed level, as set by the CFO (see attached appendix 1). The card administrator will review the available funds once a week, or as appropriate. The CCG may also ask for the card to be topped up before this limit, if they are aware of a specific need arising.
4.3 The card holder is responsible for informing the card administrator if a high value transaction is anticipated. The card administrator will review the available funds and if appropriate seek approval to top up the funds as required.
4.4 Personal purchases must not be charged to the card. Evidence of inappropriate purchases may result in a referral to the LCFS for further investigation.
5.0 TRANSACTIONS
5.1 The purchasing card can be used at most suppliers. The card cannot be used to obtain cash. This facility has been blocked.
5.2 The CCG has the duty to obtain value for money for all purchases therefore; use of the card should be limited to those transactions where it is not possible or efficient to go through the traditional supplies route.
5.3 Normally it is expected that staff pay for travel tickets in advance and claim the cost back via expenses. However, where it would be unreasonable due to the value involved to expect the member of staff to pay in advance, then the prepaid card can be used if agreed by their manager.
5.4 All goods ordered using the card should be delivered to the CCGs premises.
6.0 ADMINISTRATION
6.1 Each card holder or their nominated lead must complete transaction log (Appendix 2).
6.2 It is important that all receipts are retained and attached to the transaction log. The transaction log must be sent to financial services on the 1st of each month. If the card holder’s transaction log is not received by the deadline the card administrator will contact the card holder to request details are sent immediately.
6.3 Each month, the card administrator will download a statement detailing all transactions carried out on the card. The card administrator will reconcile this to the card holder’s transaction log for the same period.
6.4 Any discrepancies should be referred to the financial controller in writing with copies of relevant paperwork enclosed. Once the transaction log and statement have been agreed, the transaction log and the statement should be signed by the card administrator as evidence that the reconciliation has been carried out and is correct.
6.5 Financial services will arrange for each month’s expenditure to be input into the ledger as per the codes supplied on the transaction log by the 4th working day.
7.0 AUDIT
7.1 Random audits will be conducted for both prepayment card activity and retention of receipts. It is therefore important that documentation is checked and filed promptly.
7.2 Improper use of the prepayment card is not acceptable and will be dealt with accordingly. Evidence or suspicions of fraudulent activity will result in a referral being made to the LCFS in line with the CCG’s Counter Fraud Policy. Counter Fraud investigations may result in the application of a criminal sanction.
8. ROLES & RESPONSIBILITIES
Cardholder
8.1 The cardholder will adhere to this policy. • Inform the CCG finance team of any exceptional high value transactions. • Complete the transaction log. • Ensure all receipts and supporting documents are attached to the transaction log. • Send the transaction log to the CSU Financial Services generic email account by the 1st of each month. Even if there have been no transactions.
Chief Finance Officer
8.2. The Chief Finance Officer has the following responsibilities: • Nominating cardholders and countersigning the cardholder application form • Confirming the prepaid card limit per card holder • Ensuring the cardholder uses the card in accordance with CCG guidance • Monitoring all cardholder transactions
Card Administrator
8.3 The card administrator has the following responsibilities: • Download transactions. • Reconcile to transaction log. • Investigate any discrepancies. • Ensure “top up authorisation” is valid. • Store all transaction logs & supporting documents for inspection by the CCGs auditors. • Top up any prepayment card which drops below the agreed balance level
CSU
8.4 The CSU has the following responsibilities: • Post transactions to the ledger by the 4th working day. • Reconcile the balance on the card to the transaction log.
9. EQUALITY ANALYSIS
The EIA found that there would be no negative impact on people protected under the equality act (2010)
10. SUCCESS CRITERIA / MONITORING THE EFFECTIVENESS OF THE POLICY
The effectiveness of the policy is reviewed as part of the ongoing monitoring of the financial services control account procedure.
11. REVIEW
This document may be reviewed at any time at the request of either staff side or management, but will automatically be reviewed on a bi-annual basis.
Appendix 1 - Prepayment Card - Employee Agreement
I, ______, as an employee of NHS Southampton City CCG, have been issued with a Prepaid card. The value held on this card is ______as agreed by the CFO. As a card holder, I agree to comply with the following terms and condition pertaining to the card. I have received, and understood that I am entrusted with a CCG prepaid card and will be making financial commitments on behalf of the organisation. I understand that the prepaid card is in effect the CCGs money I agree to use this card for appropriate NHS Southampton City CCG business purchases only and agree not to use the card to make personal purchases. I understand that the CCG will audit the use of the card and report any discrepancies found. I also understand that appropriate action will be taken if required, including a referral being made to the Local Counter Fraud Specialist (LCFS) in line with the CCG’s Counter Fraud Policy. Counter Fraud investigations may result in the application of a criminal sanction. I will follow the established procedures for use of the card. Failure to do so may result in either revocation of my use privileges or any other disciplinary actions, including termination of employment and a referral being made to the LCFS for criminal investigation. I agree to return the card immediately upon request or upon termination of employment. If the card is lost or stolen I agree to notify the Financial Controller immediately by telephone and the card administrator as soon as possible thereafter.
Employee’s Signature ______
Print Name ______
Date ______
cc Employee's Personal File Prepaid Card Administrator
Appendix 2 – Transaction Log
3 Analysis Analysis
2 Analysis Analysis 1
Analysis Analysis
Subjective
Cost centre Ledger Code Ledger 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Gross Amount Date to Contact Number £0.00 £0.00
In month top up? top Inmonth Availiable Balance Availiable VAT
£0.00 Totalagreed to statements OpeningBalance Net amount
Southampton City CCG Receipt attached Y/N
Department Date from
Description of goods / services
CARD TRANSACTION LOG Supplier
Date of purchase 5295 6500 0111 5612 APPENDIX A Cardholder signature Printed Name Date Appendix 2 Ref No The expenses claimed above have been actually and necessarily incurred on authorised business. CCG understand I that ifinformation, knowingly I give disciplinary false action may be taken may and I be liable for prosecution. Name Card NumberCard Appendix 3 – Equality Impact Assessment
Equality Impact Assessment
Introduction An Equality Impact Assessment (or EIA) is a tool to help you demonstrate that you have considered the needs of people and communities when devising a policy, planning a project or making a commissioning decision. The process also involves making sure that implementing the policy, project or proposal will not lead to discrimination and addresses health inequalities, both of which the CCG has a legal duty to do.
The idea is not to prove that there is no impact, but to identify where there are impacts and recommend ways of mitigating or reducing the impact on the affected groups. It is also an opportunity to demonstrate any positive impacts that your proposal may have.
Checklist
Before you complete the EIA you will need the following information:
• General details - title of project, responsible Director • Purpose of the policy, project, proposal or decision • The findings from any staff and/ or patient and public involvement undertaken as part of the project • Evidence about how people and communities will be affected by this policy, project or proposal. This information will help you consider both adverse and positive impacts on the following groups (known as protected characteristics):
Age Disability Gender reassignment Marriage and civil partnership Pregnancy and maternity Race Religion or belief Sex Sexual orientation
You may also need to consider the impact of other factors like poverty, whether people affected live in rural areas, and so on.
To complete the EIA and summarise your findings as an Equality Statement, you will work through the following questions: • What are you proposing to do? • Why are you doing it? • Who is intended to benefit from this proposal? • What evidence is available about the needs of the relevant equality groups? • What equality issues or impacts have you identified? • What do you propose to do to manage the impacts? • What potential mitigating actions can you take?
For advice and support contact the Equality and Diversity Lead - [email protected]
Title of policy, project or proposal: Corporate Pre-Paid Card Policy
Name of lead manager: Head of Business
Directorate: NHS Southampton City CCG
What are the intended outcomes of this policy, project or proposal? This policy summarises how to use the prepaid card and what it is for.
Evidence Who will be affected by the policy, project or proposal? Identify whether patients, carers, communities, CCG employees, and/ or NHS staff are affected. Any individual employed by the CCG who is authorised to use the pre-paid card.
Age Consider and detail (including the source of any evidence) the impact on people across the age ranges. The impact of this policy is equal for all individuals regardless of their age. The policy summarises how to use the prepaid card and what it is for. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below.
Disability Consider and detail (including the source of any evidence) the impact on people with different kinds of disability (this might include attitudinal, physical and social barriers). Certain medical conditions are automatically classed as being a disability – for example, cancer, HIV infection, multiple sclerosis. The impact of this policy is equal for all individuals regardless of whether they have a disability or not. The policy summarises how to use the prepaid card and what it is for. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below. Dementia Given the CCGs commitment to commissioning ‘Dementia Friendly’ services, consider and detail any impact on people with dementia. The impact of this policy is equal for all individuals regardless of whether they suffer from dementia or not. The policy summarises how to use the prepaid card and what it is for. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below. Gender reassignment (including transgender) Consider and detail (including the source of any evidence) the impact on transgender people. Issues to consider may include same sex/ mixed sex accommodation, ensuring privacy of personal information, attitude of staff and other patients.
There will be no impact on people depending on gender reassignment. The impact of this policy is equal for all individuals. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below.
Marriage and civil partnership Note: This protected characteristic is only relevant to the need to eliminate discrimination within employment. Where relevant, consider and detail (including the source of any evidence) the impact on people who are married or in a civil partnership (for example, working arrangements, part-time working, infant caring responsibilities).
There will be no impact on individuals depending on marriage and civil partnership status. The impact of this policy is equal for all individuals. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below.
Pregnancy and maternity Consider and detail (including the source of any evidence) the impact on women during pregnancy and for up to 26 weeks after giving birth, including as a result of breastfeeding. There will be no impact on individuals depending on whether they are pregnant and on maternity. The impact of this policy is equal for all individuals. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below.
Race Consider and detail (including the source of any evidence) the impact on groups of people defined by their colour, nationality (including citizenship), ethnic or national origins. Given the demography of west Hampshire this will include Roma gypsies, travellers, people from Eastern Europe, Nepalese and other South East Asian communities. Impact may relate to language barriers, different cultural practices and individual’s experience of health systems in other countries. There will be no impact on individuals depending on their race. The impact of this policy is equal for all individuals. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below.
Religion or belief Consider and detail (including the source of any evidence) the impact on people with different religions, beliefs or no belief. May be particularly relevant when service involves intimate physical examination, belief prohibited medical procedures, dietary requirements and fasting, and practices around birth and death. There will be no impact on individuals depending on their religion or beliefs. The impact of this policy is equal for all individuals. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below.
Sex (gender) Consider and detail (including the source of any evidence) the impact on men and women (this may include different patterns of disease for each gender, different access rates). There will be no impact on individuals depending on their gender. The impact of this policy is equal for all individuals. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below.
Sexual orientation Consider and detail (including the source of any evidence) the impact on people who are attracted towards their own sex, the opposite sex or to both sexes (lesbian, gay, heterosexual and bisexual people). There will be no impact on individuals depending on their sexual orientation. The impact of this policy is equal for all individuals. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below.
Carers Consider and detail (including the source of any evidence) the impact on people with caring responsibilities. This must include people who care for disabled relatives or friends (as they are protected by discrimination by association law), but you should also consider parent/ guardian(s) of children under 18 years. Carers are more likely to have health problems related to stress and muscular-skeletal issues, they may have to work part-time or certain shift-patterns, or face barriers to accessing services.
There will be no impact on individuals depending on whether they are carers or not. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below.
Serving Armed Forces personnel, their families and veterans The needs of these groups should be considered specifically. The CCG has a responsibility to commission all secondary and community services required by Armed Forces’ families where registered with NHS GP Practices, and services for veterans and reservists when not mobilised (this includes bespoke services for veterans, such as mental health services). The impact of this policy is equal for all individuals. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below.
Other identified groups Consider and detail (including the source of any evidence) the impact on any other identified groups. E.g. - Poverty - Resident status (migrants and asylum seekers). - Low income - Areas of deprivation
The impact of this policy is equal for all individuals. For more information on the impact please refer to the sections ‘Positive impacts’ and ‘Negative impacts’ below.
Involvement and consultation For each engagement activity, briefly outline who was involved, how and when they were engaged, and the key outputs How have you involved stakeholders with an interest in protected characteristics in gathering evidence or testing the evidence available? N/A How have you involved/ will you involve stakeholders in testing the policy, project or proposals? N/A
Equality statement Considering the evidence and engagement activity you listed above, please summarise the findings of the impact of your policy, project or proposal. Consider whether the evidence shows potential for differential impact, if so state whether adverse or positive and for which groups.
The policy will have an equal impact on all individuals. Positive impacts Where there is evidence, provide a summary of the positive impact the policy, project or proposal will have for each protected characteristic, and any other relevant group or policy consideration. This should include outlining how equal opportunities will be advanced and good relations fostered between different groups. This policy ensures correct use of the corporate pre-paid card.
Negative impacts Where there is evidence, provide a summary for each protected characteristic and any other relevant group or policy consideration. If the evidence shows that the policy, project or proposal will or may result in discrimination, harassment or victimisation this must be outlined.
There are no direct negative impacts from the policy.
Health inequalities Please outline any health inequalities highlighted by the evidence (for example, differential access to services or worse health outcomes for particular groups or localities). There are no health inequalities associated with this policy.
Southampton City Clinical Commissioning Group Board
Date of meeting 25 November 2020
Agenda Item (number) 10
Freedom of Information Report
Topic Area Quality
Summary of paper and key Detail of FOI’s received within Q2 2020/21 information Key/Contentious issues to None be considered and any principal risk(s) relating to this paper
(Assurance Framework/Strategic Risk Register reference if appropriate) Are there any potential None conflicts of interest that the committee need to be aware of? Please indicate which None meetings this document has already been to, plus outcomes HR Implications (if any) None Financial Implications (if None any) Public involvement – N/A activity taken or planned Equality Impact N/A Assessment required / undertaken Report Author Liz Hutchings (name and job title) Complaints and Patient Experience Manager Board Sponsor Stephanie Ramsey (GP Board member or Director of Quality & Integration Executive Director) Date of paper November 2020
Actions requested The Board are asked to note the FOI report for information. / Recommendations
Freedom of Information
Review of FOI requests received
Quarter 2 2020/21
Requests received NHS Southampton City Clinical Commissioning Group (CCG) received 55 Freedom of Information (FOI) requests during quarter 2 of 2020/21.
Request breakdown by month
July 2020 August 2020 Sept 2020 Total 21 19 15 55
Third Party FOI responses NHS Southampton City CCG has not received any requests in this period from other public authorities for permission to release information that has been requested from them under the Freedom of Information Act that they hold and which however, is owned by NHS Southampton City CCG.
Summary Quarter 2, 2020/21 has seen an increase in FOI requests from the previous quarter. However, quarter one request were lower due to the COVID -19 pandemic.
In comparison to quarter 2 2019/20, quarter 2 2020/21 shows a lower number of FOI requests made, with a reduction of 14 requests.
Compliance Completed data for the period from the 1stJuly 2020 to 30th September 2020 shows full compliance.
Exemption application Completed data for this period, shows the CCG has applied two exemptions during this quarter:
July 2020; One part exemption applied under Section 40, Low volume data.
August 2020; One part exemption applied under Section 21, Information available elsewhere.
Requests for review NHS Southampton City CCG received no requests for a review of a response made under the Freedom of Information Act 2000 during this period.
There have been no complaints made to the Information Commissioner in this period.
Author: Liz Hutchings, Complaints and Patient Experience Manager Date: November 2020
Meeting Minutes
Joint Commissioning Board – Public
The meeting was held on Thursday 18th June 2020, 09:30 - 10:30 Microsoft Teams Meeting
Present: NAME INITIAL TITLE ORG Dr Mark Kelsey MK CCG Chair SCCCG Councillor Lorna Cllr Fielker Cabinet Member – Adult SCC Fielker Social Care Councillor Dave Cllr Cabinet Member - Health SCC Shields Shields and Sustainable Living Matt Stevens MS Lay Member – Patient and SCCCG Public Involvement James Rimmer JR Managing Director SCCCG In attendance: Stephanie Ramsey SR Director of Quality & SCCCG / Integration SCC Donna Chapman DC Associate Director SCCCG Grainne Siggins GS Executive Director SCC Wellbeing (Health & Adults) Sandy Hopkins SH Chief Executive Officer SCC Beccy Willis BW Head of Governance SCCCG Claire Heather CH Senior Democratic Support SCC Officer Angela Murrell AM Senior Administrator SCCCG (minutes)
Apologies: Keith Petty KP Co-ordinating Finance SCC Business Partner Councillor Chris Cllr Leader of the Council SCC Hammond Hammond Maggie MacIsaac MM Chief Executive Officer SCCCG
Action: 1. Welcome and Apologies
Members were welcomed to the meeting.
Apologies were noted and accepted
2. Declarations of Interest
A conflict of interest occurs where an individual’s ability to exercise judgement, or act in a role is, could be, or is seen to be impaired or
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otherwise influenced by his or her involvement in another role or relationship
No declarations were made above those already on the Conflict of Interest register.
3. Minutes of the Previous Meeting/Action Tracker
The minutes from the previous meeting dated 20th February 2020 were agreed as an accurate reflection of the meeting.
Matters Arising There were no matters arising.
Action Tracker The outstanding actions were reviewed MK commented that most of the actions on the action tracker were on hold due to Covid-19 and will relook and reschedule all the actions at a future meeting.
4. Five Year Strategy Priorities – Next steps
SR and DC presented the Five Year Strategy Priorities report to the Board, explaining that this was a roadmap within the City moving forward. The Better Care Steering Board and sub groups related to that have undertaken a review of the Strategy in light of the impact of Covid-19
DC summarised some of the changes and key issues;- • The use of digital and virtual contact • Reduction in the routine work • Strong focus on self-management • Considerable effort and enhancement within the Community and Voluntary sector has taken place
DC highlighted the main concerns across all of the groups: • Emotional and mental health, back log in activity and also new presentations of people with emotional and mental health difficulty. • Loneliness • Widening inequalities • Safeguarding
DC talked through the Start Well priorities and highlighted the following;-
• Short term – increase emotional and mental health offer • Short term – Promote and support re integration to school • Short term – Safeguarding • ICP level – CAMHS Crisis Pathway • ICS level – Suicide prevention plan YP – designed at ICS level but implemented at Place level • Medium term – Extend the locality • Medium term – Review of Disabled Children’s Health and Care
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• Medium term – Implementation of Phoenix • Specialist resource hub for YP with complex SEMH
SR talked through the Live Well priorities and highlighted the following;-
• reduce the impact of the inequalities and deprivation • Mental health and wellbeing • Supporting people to live independently
DC talked through the Age Well priorities and highlighted what has changed due to the impact of Covid-19 and stated what the priorities will be:- • Specific focus on the shielded patient lists • Enhanced Health and Care Home programme • Pathway 3 and discharge to assess • Building on community hub offer • Social inclusion
SR talked through the Die Well programme highlighting the following key points:-
• Training for care homes has taken place • Out of hospital end of life care coordination service • Developing a workforce which is confident and competent to discuss end of life wishes.
MS stated that 1 in 3 that have died from Covid-19 had diabetes and with this in mind should we now have a stronger focus in this area. SR confirmed that in the short term diabetes is a key priority.
The Board support the revised priorities for the Southampton Five Year Health and Care Strategy.
5. Covid-19 Overview of Health and Care Response in Southampton
SR presented the Covid-19 overview of Health and Care Response in Southampton paper highlighting the key areas of focus and changes;-
• Establish a Covid-19 Health Protection Board • All organisations being able to adapt to a local outbreak • A lot of work in the Social Care Market has taken place • Changes in the rehab and reablement service put in place • Financial impact of Covid-19 • Change to the discharge process – new discharge processes in place • CAMHS services adapted
• Adapted how we are monitoring all services • Long term funding of packages
Cllr Fielker commended everyone who has being doing the work in
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response to Covid-19.
MS asked if this way of working regarding the discharge team in place at Sembal House will continue.
DC stated that it is a model that would like to be continued and this is being evaluated and how to sustain the model.
GS commented that a fast discharge process is very important as well as ensuring people have the appropriate rehab and reablement, making sure that the whole journey is being thought about.
The Board noted the report.
6. Better Care Steering Board Minutes
The Board received the Better Care Steering Board (BCSB) meeting minutes from 3rd March 2020 for information.
7. Date of Next Meeting
15th October 2020, 09:30 – 11:30, Microsoft Teams
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These meeting minutes may become available to the public under the Freedom of Information Act 2000.
Retention of Records: These minutes will be confidentially destroyed 2 years after the date of the meeting, in line with CCG policy and guidance from the Department of Health.
Meeting Minutes Finance and Audit Committee
The meeting was held Wednesday 22nd July 2020, 09:30 – 11:30 Microsoft Teams Meeting
Present: NAME INITIAL TITLE ORG Henry Slater (Chair) HS Lay Member, Governance SC CCG Matt Stevens MS Lay Member, Patient and SC CCG Public Involvement Alison Powell AP Associate Lay Member SC CCG
In attendance: James Rimmer JR Managing Director SC CCG Sam Harding SH Engagement Manager Grant Thornton Jackson Murray JM Engagement Lead Grant Thornton Lesley Heasman LH Auditor TIAA Kay Rothwell KR Deputy CFO SC CCG Beccy Willis BW Head of Governance SC CCG Emily Chapman EC Business Manager SC CCG (Minutes)
Apologies: Karen Travers KT Local Counter Fraud CFS Specialist Nick MacBeath NM Head of Internal Audit TIAA
Action: 1. Welcome and Apologies All members were welcomed to the meeting.
All apologies were noted and accepted.
Declaration of Interest 2.
A conflict of interest occurs where an individual’s ability to exercise judgement, or act in a role is, could be, or is seen to be impaired or otherwise influenced by his or her involvement in another role or relationship
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No declarations of interest were made in relation to the agenda.
Minutes of Previous Meeting and Matters Arising 3.
The minutes of the meeting that took place on the 16th June 2020 were reviewed and agreed as an accurate record of the meeting.
Matters arising There were no matters arising.
Covid update re Single Tender Waivers 4. KR presented the paper to the Committee and outlined the highlights.
AP queried as the CCG have been acting on others CCGs behalf, has this created additional admin costs and are Southampton CCG paying for this? KR responded that staff have worked additional hours, particularly to cover the hub which has been set up, each CCG pay for their staff via their Covid fund.
JR raised we are still within a major incident, with unusual costs. All covid expenditure is covered by the treasury. The level of spend is reducing month on month now; however it could easily spike again towards winter.
HS asked if there were any issues with the contracts as they had to be set up quickly. KR responded that they all worked well, we have now reduced hotel provision. The quality team is heavily involved with the work within the care homes and also the hotel provision.
HS asked for assurance on the hotel provision single tender waivers. KR responded that SOEPS advice was sought all the way through, and they assisted with these contracts by putting messages out to the market. No challenge has been received from the market on these contracts.
AP raised as the hotels are open now for normal guests, how is this working with the hotels providing covid provision. KR responded we still have beds within the Holiday Inn within Southampton and Eastleigh. Patients who go to these beds no longer have Covid-19, they have recovered.
Currently there is a one month notice period on the hotel provision, and if SMT decide to reduce provision, this notice period would be implemented.
The Committee noted the update on Single Tender Waivers.
CFO Update – Review of Accounts Format 5. KR provided a verbal update to the committee on finance.
It is expected that the Covid regime could continue through August and
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possibly September. NHS England and the Department of Health are currently working on financial regime for the rest of the year.
We are expecting to receive prospective allocations, assuming Covid continues. In terms of future waves of Covid, there will be a break glass in those arrangements. This is likely to be beginning of September/October, but final confirmation is awaited. The other element is the Mental Health Investment Standard (MHIS), which is a key target for 2021, and we are expected to make investments in line with the Long Term Plan (LTP).
HS asked if we continue to pay UHS its normal amounts, as if they were operating their normal range of work at full capacity. KR responded the CCGs are paying NHS Trusts based on their run rates from 19/20 on a block basis. This would fund their baseline capacity and infrastructure. NHS England/Improvement is funding the Covid costs on top of that.
JR added that UHS will not currently get back to 100% capacity, most hospitals are currently operating between 50-70% capacity. Spend is currently stable and activity is lower than this and the hospital is well staffed.
KR talked through the format of the accounts and drew out the highlights from the papers.
Nationally there is a template from NHS England which cannot be changed; the format would be our view for public consumption. It wouldn’t cause too much additional work to do the new format.
HS raised we need to explain the term N/A as to whether it’s not applicable or not available.
The Committee agreed the revised format proposed.
Future Ways of Working Update 6. JR presented the papers to the Committee. The document received has been through the Future Ways of Work Steering Group which is chaired by Matt Stevens and JR outlined the highlights.
HS asked for assurance that audit is being considered throughout the merger process. JR responded that for each workstream there is a focus on finance, HR, communications, digital, work with the CSU and governance all of which have work stream programmes. Within the finance plan audit is included as a sub-section.
The Committee noted the update.
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Guide for Audit and Risk Committees on Financial Reporting and 7. Management during COVID-19
KR presented the guidance to the Committee.
Hs asked if we are assured we have implemented the guidance. JR responded that we have covered most things within the guidance, and we may wish to review at future Committee.
LH raised there is an audit within the plan which covers finance and home
working, which may pick up on some of the guidance and provide some assurance in the October Committee.
The Committee noted the guidance for information.
JR left the meeting.
Note and Review Changes to the Assurance Framework / Risk 8. Register
The Committee received the risk register and KR outlined the highlights. This was the opening risk register for 20/21 and went to the May public Board. There has been risks added related to Covid-19 and a more detailed update will be received at the July Board next week.
AP raised some risks relate to capacity at UHS which we don’t have direct influence on? KR responded we do work closely with UHS on this particularly around the Covid-19 response.
The Committee noted the risk register for information.
Service Auditor Reports – 2019/20 Report Action Plan 9.
The Committee received the Service Auditor Report 2019/20 action plan and noted it for information. It was noted that the CCG are satisfied with
the CSU response.
Review the Finding of Other Significant Assurance Functions 10.
Nothing to report.
KR to follow up with NHS England if we are getting anymore reviews as a KR CCG.
Clinical Governance Committee Update 11.
The Committee received and noted the quality exception report for information.
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Note Update on Litigation 12.
Nothing to report.
Note Single Tender Actions 13.
Nothing to report.
Annual Review of the Effectiveness of Internal Audit and Counter 14. Fraud
The Committee received the effectiveness review of Internal Audit and Counter Fraud; KR outlined the highlights of the paper.
The Committee thanked IA and CF for the work undertaken throughout the year.
Review of the Effectiveness of the Committee (Self-Assessment) 15.
The Committee received and noted the self-assessment review of effectiveness of the Committee.
Internal Audit Update 16.
The Committee received the following Internal Audit papers:
- Audit Strategy and Annual Internal Audit Plan for 2020/21 - Summary Internal Controls Assurance (SICA) Report
LH raised that TIAA are working with CCGs to undertake the audits on the plan.
External Audit Update 17.
SH presented the annual audit letter to the Committee. This will be published on the CCG website.
The Committee noted the annual audit letter.
Counter Fraud Update 18. The Committee received the following Counter Fraud Papers:
- Fraud, Bribery and Corruption interim report Q1 - Security Management interim report Q1 - Covid-19 Fraud and Security risk assessment - Covid-19 Fraud and Security risks
MS asked if there is a more difficult process with more staff working from home and monitoring access in terms of fraud. KT responded that there is a
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little detail around cyber, but there hasn’t been evidence in hacking or anything like that. KR there is a benefit of using the CSU for IT support as they have expert knowledge in this area.
Date of next meeting 19.
21st October 2020, 09:30 – 11:30, Microsoft Teams meeting.
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These meeting minutes may become available to the public under the Freedom of Information Act 2000.
Retention of Records: These minutes will be confidentially destroyed 2 years after the date of the meeting, in line with CCG policy and guidance from the Department of Health.
Meeting Minutes Primary Medical Care Commissioning Committee – Part 1
The meeting was held on Thursday 27th August 2020, 09:30- 11:00, Microsoft Teams Meeting
Present: NAME INITIAL TITLE ORG Voting Matt Stevens (Chair) MS Lay Member - Patient and Public SC CCG Involvement James Rimmer JR Managing Director SC CCG Kay Rothwell KR Deputy Chief Finance Officer SC CCG Henry Slater HS Lay Member - Governance SC CCG Alison Powell AP Associate Lay member SC CCG
Non-voting Phil Aubrey-Harris PAH Associate Director of Primary Care SC CCG Lesley Gilder LG Patient Representative Healthwatch Dr Mark Kelsey MK Chair SC CCG
In Attendance: Beccy Willis BW Head of Governance SC CCG Tom Sheppard TS Head of Communications SC CCG Emily Chapman EC Business Manager SC CCG (minutes)
Apologies: Stephanie Ramsey SR Director of Quality and Integration SC CCG and Chief Nurse Councillor Lorna Fielker LF Cabinet Member – Adults and SCC Health Peter Horne PH Director of System Delivery SC CCG
1. Welcomes and apologies
It was note that this meeting was being recorded as a public meeting, all members of the meeting consented to the meeting being recorded.
All members were welcomed to the meeting.
Apologies were noted and accepted.
2. Declarations of Interest
A conflict of interest occurs where an individual’s ability to exercise judgement, or act in a role is, could be, or is seen to be impaired or otherwise influenced by his or her involvement in another role or
relationship
HS raised he is a patient at Hill Lane Surgery.
Dr Mark Kelsey raised he is now a salaried GP at Victor Street Surgery. It was agreed if there were any conflicts relating to his role then this would be addressed at the agenda item as appropriate.
No declarations of interest were made in relation to the agenda.
3. Minutes of the Previous Meeting and Matters Arising
The minutes of the Primary Medical Care Commissioning Committee that took place on the 9th June 2020 were agreed as a true, accurate record of the meeting.
Matters arising Living Well Partnership Branch surgery and Primary Care Network (PCN) applications – PAH updated that this was also approved by West Hampshire CCG (WHCC). A condition was set relating to the PCN which WHCCG added which was about the Living Well Partnership (LWP) exit from the Eastleigh Southern Parish PCN and agreement on what payments might be made in lieu of those changes. ACTION: PAH to circulate letter written to LWP for the Committees PAH information.
Action Tracker There were no outstanding actions on the tracker.
4. Primary Medical Care Report for Period 1 May 2020 - 31 July 2020
The Committee received the Primary Medical Care Report for Period 1 May 2020 - 31 July 2020 and PAH outlined the highlights of the report.
Primary Care restoration, recovery and preparedness PAH provided an explanation of what “hot” and “cold” sites deliver to the Committee.
JR gave an update on hospital services. Cancer services have remained open throughout the Covid period. There has been a challenge for non-cancer services and there are considerable backlogs. Work is taking place to start to restore services, and how to reduce waiting lists it was noted this will take a considerable amount of time.
HS asked two questions, one about the nearest test centre for people within Southampton and the other about the impact of the abolishment of Public Health England. JR responded that Covid testing can be accessed online, the website will direct you to the nearest site. There are three options, there is a site in
Portsmouth open 7 days a week, 8am-8pm. There are also 3 mobile testing services in Hampshire and Isle of Wight and they move around daily. The final option is a home testing kit which is sent in the post. All options are working well and test results are being received within 48 hours. With regards to PHE, the local Public Health team are employed by Southampton City Council and the
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abolishment of PHE has no impact on this.
LG asked if there is a standard way of patients being informed of the intermittent closure of surgeries. PAH responded where possible, and working with practices we have worked as hard to engage with patients. TS added that GP practices have been informing patients, due to the circumstances it’s difficult to do in a co- ordinated way however we are monitoring feedback from patients and learning from this. We haven’t received an increase in complaints; however we continue to monitor this. TS added some work will be taking place to look at GP practice websites ensuring that they are up to date.
The Committee noted the update for information.
Variations to Primary Care contracts for the period from 23 March to 31 July 2020
HS asked about Southampton Primary Care Limited (SPCL) and the reliance on
them to deliver services? PAH responded that there is a unanimous view that Southampton did well in the respond to Covid, and it wouldn’t have been possible without SPCL.
The Committee approved the temporary reconfiguration of GP practice services in line with NHS England directions and the temporary restrictions to access for these sites for the period to end August 2020. The Committee requested that PAH work with Peartree practice to explore whether face to face services at
Bitterne Health Centre could be reinstated more quickly than their proposed timescale. ACTION: PAH to follow up with Peartree re temporary restriction of face to PAH face services The Committee noted the variations to date of SPCL contracts to date and likely implications for further developments over coming months. Primary Care Estates and Access review update It was clarified that the majority of the £83k is for the west and central review, and will be taken from this financial year.
The Committee noted the update on the Review and to ratify the total investment of £83k to conclude Phase 1 (East) and undertake Phase 2 (West and Central).
Primary Care Network (PCN) update The Committee noted the PCN update.
5. Delegated Primary Medical Services Finance Report
The Committee received the delegate primary medical services finance report. KR outlined the highlights of the report.
AP raised the variations in locums, sickness and retainers and asked if this was down to Covid? KR responded that this doesn’t include additional costs for
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Covid. Sickness has been high over the last couple of years, the retainer scheme has also seen an increase.
The Committee noted the finance report.
6. National GP Patient Survey and Patient Engagement Update
The Committee received the national GP patient Survey and Patient engagement update. PAH/TS outlined the highlights of the update. It was noted that the survey took place between January and March 2020, so this was pre- Covid.
The Committee discussed the Living Well Partnership results. The CCG are working with LWP on an improvement plan as they are an outlier, not only locally but nationally. Reports on improvements will be frequently bought back to this Committee.
MK raised we need to ensure we work with all practices across the city to ensure that we remain consistent in all areas.
The Committee is focussed on improving quality and outcomes for those practices who are outliers.
The Committee congratulated on those practices that are performing well within the city.
It was noted there will be a quality and performance report at the next Public meeting.
The Committee noted the update.
7. Primary Medical Care Commissioning Committee Terms of Reference
The Committee received the updated Terms of Reference which have been revised to be in line with the Constitution.
The Committee approved the updated Primary Medical Care Commissioning Committee Terms of Reference. These will be ratified at the September Governing Body.
8. Senior Management Team: Primary Care Minutes
The Committee received the following Senior Management Team: Primary Care Minutes for information:
- 2nd July 2020
9. Date and venue of next meeting
28th October 2020, 13:00 – 13:30, Microsoft Teams Meeting
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These meeting minutes may become available to the public under the Freedom of Information Act 2000.
Retention of Records: These minutes will be confidentially destroyed 2 years after the date of the meeting, in line with CCG policy and guidance from the Department of Health.
Meeting Minutes Clinical Governance Committee
The meeting was held on 2nd September 2020, 09:00 – 11:30 Microsoft Teams Meeting
Name Initials Job Title Organisation Ruth Williams RW Clinical Governance Committee Chair SCCCG Matt Stevens MS Lay Member for Patient and Public Involvement SCCCG Stephanie Ramsey SR Director of Quality & Integration/Chief Nurse SCCCG / SCC Sue Kingsbridge SK Primary Care Quality Lead SCCCG Andrea White AW Head of Medicines Management SCCCG Theresa Gallard TG Senior Quality Manager SCCCG / SCC Carol Alstrom CA Associate Director of Quality/Deputy Chief SCCCG / SCC Nurse Katherine Elsmore KE Head of Safeguarding SCCCG / SCC Shelley Lewis SL Deputy Clinical Lead CHC and Complex Care SCCCG Tom Sheppard TS Head of Communications and Engagement SCCCG Beccy Willis BW Head of Governance SCCCG Dr Shiba Qamar SQ GP Board Member SCCCG Lesley Gilder LG Patient Representative Health Watch Apologies Tania Emery TE Clinical Lead – CHC and Complex Care SCCCG Dr Mark Sopher MS Secondary Care Doctor SCCCG Helen Eggleton HE Senior Quality Manager SCCCG / SCC Antony Shannon AS Lead Infection Prevention and Control Nurse SCCCG / SCC Specialist In attendance Emily Chapman EC Business Manager SCCCG (minutes)
1. Welcomes and Apologies
RW welcomed all attendees to the meeting and noted apologies.
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2. Declarations of Interest
RW noted that her contract for clinical work with SHFT has now ended, and is not undertaking any clinical work with them now.
No other declarations of interest were made in relation to any items on this agenda.
3. Minutes of the Previous Meeting
The minutes of the meeting that took place on the 5th August 2020 were agreed as a true, accurate record of the meeting.
Action tracker The action tracker was reviewed and updated.
4. Provider Assurance and Metrics Report/ Shared learning newsletter
The Committee received the provider assurance and metrics report.
UHS MS queried re phlebotomy appointment system and how its working? TG to ACTION follow this up with HE for an answer.
Solent RW queried the school age immunisations and the mitigations relating to this. KE responded that Solent are aware that the take up rate in schools are much higher, no other alternative delivery models have been seen but there will be catch up clinics. RW asked for this to be monitored and included in the solent report.
RW raised the repeated reference to issues with the translation services and asked about the mitigations relating to this. TG to follow this up with HE. ACTION
SHFT TG informed the committee that work is taking place on how we work together with providers to support and assure quality going forward. The CCG have had their first invite to the newly structured quality and safety division meeting at SHFT. TG will be an attendee at this meeting regularly.
SR/CA joined the meeting.
Care UK TG raised as a result of a serious incident work is taking place with UTC on access to information systems. Mountbatten RW raised the risk around staffing within Mountbatten as this is unusual for hospices. CA raised she is a trustee of Mountbatten, it was agreed that this did not present a conflict within this meeting. CA updated that two new posts have been appointed to which are the Deputy Director of Nursing and also a community nurse.
PHL RW raised it will be important to track what’s happening with the implementation of Datix. To understand how PHL are using this for quality Page 2 of 6
improvement
Inhealth RW queried the increase in DNAs and if anything is in place for DNAs? TG responded that this is being looked into. A process was introduced to call patients before appointments to outline what will be expected when attending appointments, particularly around new things in place with regards to the covid response. TG has asked for an update on further assurance around their appointments process, as we have also had sight of some complaints in relation to the process.
Recovery and Restoration. SR raised it may be helpful to have information relating to exception risks and issues, rather than all the work that is taking place.
It was suggested that the issues/risk around restoration and recovery could be included in the main slide deck for each provider.
Primary Care RW raised access within primary care. MS asked where the data is coming from with regards to access to primary care and also what individuals experience is using e-consult. TG raised there haven’t been any issues coming through the patient experience team in relation to e-consult or access. SR asked if an equality impact assessment has been done around access to primary care particularly focussing on inequalities. CA responded ACTION that this needs to be look at further.
ACTION: Primary Care slide to be added into the slide deck to provide ACTION updates
ACTION: SR/CA to consider if primary care access to be included on ACTION the risk register
SL left the meeting.
SK provided an update to the Committee on primary care.
5. CCG responsibilities
Safeguarding Annual Report The Committee received the safeguarding annual report and KE outlined the highlights of the paper. ACTION for review CA raised the independent review in the Local Authority, it was agreed that of report the team would review the addition of this in the report. prior to submissi SR raised adding a priority of working with the Local Authority within the on to report. CCG Board SR also raised we need to make sure the balance of “place” and the ICP is correct within the report.
Training also needs to be highlighted to the Board that we need to improve training figures going forward.
The Committee discussed asylum seekers. Southampton have facilitated accommodation for asylum seekers and this is determined by the Home
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Office. The impact of this is yet to be known. ACTION: an update report on asylum seekers to be brought to a future ACTION Committee.
The Committee noted that Annual report, some minor amendments to be made and then will be shared with the Board. A recommendation to be made to the Board that safeguarding is an important issue when working ACTION towards the ICS.
Safeguarding update – briefing themes/issues The Committee received the safeguarding update; KE outlined the highlights of the report.
RW raised the changes around child protection medicals, and it is important to highlight these changes in the report.
CA raised work is taking place to see if there are any safeguarding deaths related to Covid.
Infection Control The Committee received the Infection Control update and SK outlined the highlights. It was acknowledged that the team have worked very hard over this period and continue to provide advice and information to care homes and nursing homes as well as others.
Medicines Management Annual Report The Committee received the Medicines Management Annual Report for 2019/20, AW outlined the highlights of the report. It was agreed that this was a comprehensive report prior to going to the board RW suggested that ACTION the team added some information on the considerable patient engagement that has taken place this year.
ACTION: This report to be taken to the Board.
Complaint Service – learning & actions update The Committee received the learning and actions update, which leads on from the annual report that was received at the last Committee. TG also noted that an internal audit is currently taking place on the complaints service, and the outcome of this is awaited.
Restoration and Recovery SR shared come slides with the Committee on Restoration and Recovery and outlined the highlights.
RW raised it would be useful to understand how the quality impact assessments (QIA) will be undertaken on some of this work. SR responded there are some QIAs underway already. QIA to be brought to a future ACTION meeting.
Workforce is being discussed, there is some money available for ICPs relating to workforce, and how this is spent is being reviewed.
SL re-joined the meeting.
Standard Operating Procedures (SOP) The Committee received the SOP for virtual CHC assessments. These have been developed as the requirement for CHC assessments to start taking place again. SL talked through the SOPs.
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BW raised a point for clarification linked to the SOP on the virtual assessments about recording. There needs to be additional clarity about ensuring that the assessors only undertake assessments from confidential ACTION places.
MS asked if acknowledgment is needed that appropriate equipment is available to the assessor / client.
KE asked how this compares to other SOP e.g. the Local Authority. SL responded they are aligned. A separate conversation on how this aligned across the Integrated Commissioning Unit (ICU).
SR raised that we will need to review this rapidly once implemented to ensure it is working well.
SR queried how we included people like translators and how this works in this SOP. SL to review this.
RW raised it will be important to have easy read versions. CA added there will also be videos to explain the processes.
It was agreed these changes to be made, and also get communications to overlook them. Once those changes are made the Clinical Governance Committee approved the use of them, recognising they may need changing and updating. An update to be brought to each committee as they change.
6. Information for the exception report
- Safeguarding Annual Report - Medicines Management Annual Report (with the additions of engagement) - Safeguarding risks as we merge with other CCGs - Risks emerging on GP access and how it is monitored - Highlight the approach on CHC SOPs and how it will be monitored
7. Any Other Business
None raised.
Date of next meeting: 7th October 2020, 09:00 – 11:30, Microsoft Teams
Abbreviations AMH Adult Mental Health CHC Continuing Health Care CQC Care Quality Commission CQRM Clinical Quality Review Meeting FFT Friends and Family Test FOI Freedom of Information ICU Integrated Commissioning Unit IG Information Governance IPC Infection Prevention and Control Page 5 of 6
LAC Looked After Children LD Learning Disabilities LSAB Local Safeguarding Adults Board LSCB Local Safeguarding Children’s Board MARP Multi Agency Resource Panel MASH Multi Agency Safeguarding Hub MH Mental Health NHSE/I NHS England/Improvement OPMH Older Persons Mental Health PALS Patient Advice and Liaison Service PCN Primary Care Network PES Patient Experience Service PHL Partnering Health Limited RCA Root Cause Analysis SCAS South Central Ambulance Service NHS Foundation Trust SCC Southampton City Council SCR Serious Case Review SHFT Southern Health NHS Foundation Trust SI Serious Incident SPCL Southampton Primary Care Limited STC Southampton NHS Treatment Centre STWB Steps to Wellbeing UHSFT University Hospital Southampton NHS Foundation Trust UTC Urgent Treatment Centre
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These meeting minutes may become available to the public under the Freedom of Information Act 2000.
Retention of Records: These minutes will be confidentially destroyed 2 years after the date of the meeting, in line with CCG policy and guidance from the Department of Health.
Meeting Minutes
Clinical Executive Group
Wednesday 9th September 2020, 14:00 – 15:30, Microsoft Teams Meeting
Present: NAME INITIAL TITLE ORG Dr Chris Sanford (Chair) CS GP Board Member SC CCG Dr Mark Kelsey MK CCG Chair SC CCG Dr Hana Burgess HB GP Board Member SC CCG Dr Sarah Young SY GP Board Member SC CCG Dr Pritti Aggarwal PA GP Board Member SC CCG Dr Shiba Qamar SQ GP Board Member SC CCG Kay Rothwell KR Deputy Chief Financial Officer SC CCG Peter Horne PH Director of System Delivery SC CCG
In attendance: Donna Chapman DC Associate Director SC CCG Phil Aubrey-Harris PAH Associate Director of Primary Care SC CCG Beccy Willis BW Head of Governance SC CCG Robin Poole RP Public Health SC CCG Emily Chapman (minutes) EC Business Manager SC CCG
Apologies: James Rimmer JR Managing Director SC CCG Stephanie Ramsey SR Director of Quality and Integration SC CCG Debbie Chase DC Interim Director of Public Health SCC
Action: 1. Welcome and Apologies
CS welcomed members to the meeting and apologies were noted and accepted.
2. Declarations of Interest
A conflict of interest occurs where an individual’s ability to exercise judgement, or act in a role is, could be, or is seen to be impaired or otherwise influenced by his or her involvement in
another role or relationship
No other declarations of interest were raised in relation to the agenda.
Minutes from the Previous Meeting and Matters Arising / Action 3. Tracker
The minutes of the meeting that took place on 8th July 2020 were agreed as a true, accurate record of the meeting, with the following amendments:
- Update the chair to be CS, not SY
Matters Arising There were no matters arising.
Action Tracker There were no outstanding actions.
4. D2A Pathway
The Group received the D2A pathway papers, and DC outlined the highlights of the paper.
SY raised MH capacity assessments happening in the community, do we still have resources to do that? Also there is a home that has significant safeguarding issues, are we sure the homes we are using have the right support and have been via the quality team. DC responded the MH capacity will be part of the additional work, we have worked closely with the CHC and Quality Team. DC also responded the quality team are working closely with the home with safeguarding concerns and it is being managed, they are currently not taking any new referrals.
SY asked will these beds just be more bed blockers, is 20 beds enough? DC responded we are exploring move on beds with the market, there is always a risk with bed blocking.
SY asked therapy assessments used to be done in the hospital, are we moving those resources to the community? DC has asked this question, there is a therapy group being set up off the back of the discharge guidance which looks at therapy across acute and community. This is work in progress.
HB queried if there is someone in hospital that self-funds and wants to choose a different home, do we have an issue around patient choice? DC responded that this will be part of the standard discharge pathway. The national letters as part of the guidance state that patients should
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not be in hospital for any longer than needed.
HB asked what happens if the beds are occupied once the funding runs out. DC responded the national funding runs out after 6 weeks; we are working through how we manage the financial risk. After the 7 months we would need to look at the exit plan for those 20 beds.
PH raised that the HIOW winter planning has an end date till the end of Easter (mid-April), we will need to review how things are going around mid-January, and this will not need to come through CEG.
MK asked about the differing costs between the two homes and if this has any impact? DC responded that costs do vary for homes across the city; it is difficult to find homes to work with us in this way. DC added we are having discussions with Hampshire to see if any work can be done collaboratively.
CEG:
- Noted the need for additional capacity to meet the new levels of demand on Pathway 3 since Covid and to deliver the government requirements of a full D2A roll out - Noted the need for additional staffing to ensure that Pathway 3 D2A can operate effectively and patients can move
DC/PH left the meeting.
5. Think 111 First
PAH joined the meeting to present the Think 111 First papers to the group. PAH shared some slides with the group and talked through them.
PA asked when the average day for activity in 111 was calculated. PAH responded this is pre-Covid.
PA asked from a patient experience perspective, is there any way we can cut out duplication. PAH responded through the CAS procurement there is work being done to cut out duplication? We need to ensure CAS works well with primary care.
PA also raised during Covid, primary care has become almost 24/7 with e-consult being available. How will this impact on NHS 111. PAH responded a lot of the practices haven’t used e-consult in a big way, it will need to be reviewed if the availability of e-consult has an impact on ED activity. PAH to look at this further.
SQ asked if 999 calls would be diverted to CAS. PAH responded that
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discussions are in place about this to explore further.
SQ also asked if there was any impact identified in primary care from the 111 Pilot. PAH responded that it is being reviewed.
HB asked what we do about patients who do turn up at ED inappropriately. PAH responded that he would look into this further where other areas have done pilots.
SY raised we need to ensure we consider all groups of people when thinking about digital consultation, such as people who can’t read or write.
6. Restoration and Recovery
This item was deferred.
7. TARGET
The group discussed the TARGET and the upcoming event, also the future of TARGET.
CEG discussed the value of TARGET in Southampton. It was agreed that a paper would be brought to the October CEG about the 21/22 TARGET meetings.
8. Sub-committee minutes
CEG received the following subcommittee minutes for information:
• Senior Management Team – 18th June 2020, 2nd July 2020, 16th July 2020 and 6th August 2020 • Performance Board – 25th June 2020
9. Any Other Business
None raised.
Date of next meeting: 14th October 2020, 14:00 – 17:00, Microsoft Teams Meeting
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These meeting minutes may become available to the public under the Freedom of Information Act 2000.
Retention of Records: These minutes will be confidentially destroyed 2 years after the date of the meeting, in line with CCG policy and guidance from the Department of Health.
Meeting Minutes Clinical Governance Committee
The meeting was held on 7th October 2020, 09:00 – 11:00 Microsoft Teams Meeting
Name Initials Job Title Organisation Ruth Williams RW Clinical Governance Committee Chair SCCCG Stephanie Ramsey SR Director of Quality & Integration/Chief Nurse SCCCG / SCC Helen Eggleton HE Senior Quality Manager SCCCG / SCC Andrea White AW Head of Medicines Management SCCCG Theresa Gallard TG Senior Quality Manager SCCCG / SCC Antony Shannon AS Lead Infection Prevention and Control Nurse SCCCG / SCC Specialist Katherine Elsmore KE Head of Safeguarding SCCCG / SCC Tom Sheppard TS Head of Communications and Engagement SCCCG Dr Shiba Qamar SQ GP Board Member SCCCG Lesley Gilder LG Patient Representative Health Watch Tania Emery TE Clinical Lead – CHC and Complex Care SCCCG Apologies Carol Alstrom CA Associate Director of Quality/Deputy Chief Nurse SCCCG / SCC Sue Kingsbridge SK Primary Care Quality Lead SCCCG Dr Mark Sopher MS Secondary Care Doctor SCCCG Beccy Willis BW Head of Governance SCCCG Matt Stevens MS Lay Member for Patient and Public Involvement SCCCG In attendance Emily Chapman EC Business Manager SCCCG (minutes)
1. Welcomes and Apologies
RW welcomed all attendees to the meeting and noted apologies.
2. Declarations of Interest
No declarations of interest were made in relation to any items on this agenda.
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3. Minutes of the Previous Meeting
The minutes of the meeting that took place on the 2nd September 2020 were agreed as a true, accurate record of the meeting.
Action tracker The action tracker was reviewed and updated.
4. CCG responsibilities
Quality Risk Register The Committee received the risks on the corporate risk register relating to quality, and SR outlined the highlights.
The Committee discussed risk SC002. HE raised concerns about the waiting list initiatives and prioritisation, the Committee needs assurance of what this looks like e.g. is this consistent across the patch? Quality questions have been developed and these will be taken back to the providers to gain assurance. ACTION: HE to include a sentence on waiting lists and prioritisation in HE the risk register
RW queried if there is assurance that providers are following up with patients, and how it’s being done. SR suggested this needs capturing within this risk.
RW queried asked if there is access to school academies within the city with regards to younger peoples Mental Health. SR to follow up on. SR
RW queried discharge processes and how the appropriate conversations are taking place at the beginning of the pathway. SR responded that there are better processes in place now, there is some work taking place on this. discharge processes at UHS have improved.
The Committee discussed Covid-19 and the increase in cases in schools, this will have an impact on key workers having to isolate or stay at home for childcare purposes. This will impact on workforce.
The Committee discussed risk SC014, the score may increase but this will be reviewed as the risk of covid-19 increases again.
Infection Prevention & Control (IPC) The Committee received the IPC update.
SR raised testing and if there are any timescales for improvement. AS responded it is improving as people are accessing testing; however this also presents challenge in capacity. A new lab is currently being set up; this should provide an improvement on the delivery of tests. AS presented the LeDeR update to the Committee. There are 13 reviews currently underway and only 1 without a reviewer assigned.
Safeguarding Update The Committee received the safeguarding update and the NHSE/I Q2 return for information. SQ raised reduced access to primary care and if this could have an impact
Page 2 of 6 on child protection cases? KE responded that a lot of referrals come from the police as opposed to primary care. If children are not seen in person professionals could potentially miss indicators that may raise concerns. There are virtual contacts taking place, however the constraints of this approach is that the contact is with parents as opposed to seeing the child. SQ asked if professionals should be doing anything differently in primary care. KE responded there is national guidance released on virtual assessments which can be shared with primary care.
ACTION: KE to share guidance on virtual assessments with primary KE care
SR highlighted there is an increase in pressures, and work is taking place to look at capacity within the safeguarding team to manage these pressures.
RW acknowledged all the work that has taken place within the complex safeguarding arena.
ACTION: SR/KE to consider safeguarding on the risk register SR/KE
RW raised it is important to look at capacity across the system when joining with the other CCGs. SR to raise this with the Board.
AS left the meeting.
Medicines Management The Committee received the medicines management update.
AW highlighted patients don’t need to be switched to another drug if they are on lithium as a pause has been put on this piece of work.
Continuing Healthcare The Committee received the CHC update which included an updated on the CHC deferred assessment project.
SQ asked about the funding for the assessment project. TE responded for the deferred assessments the indication is that this will be till 31st March 20201. Next month an exception report to be brought to the Committee to show how the assessments are progressing.
SR raised that a group has been established to review impact on medically fit for discharge element. This group is being led by Solent NHS Trust. This will highlight any quality risks and how they are mitigated.
TE left the meeting.
Care Homes SR provided a verbal update on care homes. SR shared the Care Home Oversight Group action plan. There is also a clinical risk and an issue log, work is taking place on producing a dashboard to review care homes across the city. All these documents are monitored via the Care Home Oversight Group. The action plan will be shared with this Committee regularly.
ACTION: Care home action plan with the committee every 2 months SR
Quality & Safeguarding The Committee received the quality and safeguarding update.
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SQ asked about the remaining homes that required NEWS2 training, are the timescales feasible to deliver this training. TG to take this back and follow up.
ACTION: TG to follow up with Lindsay Rugman timescales for NEWS2 TG training
KE raised we need to continue to use the correct processes for referrals through adult social care, this will reduce duplication and workload.
PGD for Flu Vaccinations The Committee approved the PGD for flu vaccinations.
5. Provider Assurance and Metrics Report
The Committee received the provider assurance and metrics report.
UHS RW raised the risks in ophthalmology and asked what the capacity related to. HE responded there was not full assurance on the service. There is a piece of work taking place to look at ophthalmology (being led by West Hampshire CCG). HE raised concern around the waiting list; HE has requested detail on this. If the information is not received then this will be escalated. SR raised capacity in UHS and its part of the recovery and restoration, there is detail around trajectories and funding is being looked at for this.
RW queried the process issue in diagnostic imaging. HE raised that discussions have taken place internally about this. This has highlighted the current system isn’t intuitive enough, this is being worked through at a senior level to resolve this. There is also an issue around the declining of appointments, but this is also being resolved.
Solent RW queried the timescales around safeguarding. HE to follow this up with Solent.
SQ asked if the MSK service will start to have face to face appointments, and also are any patient satisfaction surveys being completed? HE responded there have been virtual assessments on physio, but HE will follow up on this.
ACTION: HE to follow up safeguarding timescales and MSK service HE queries
SHFT TG highlighted they SHFT are closing an OPMH ward (not in Southampton) for refurbishment. The impact of this will be reviewed on other wards.
Care UK TG highlighted that Care UK have rebranded to Practice Plus Group. TS raised that engagement about this was not undertaken with stakeholders.
TG raised there was a SIRI at UTC, there is a delay access to an IT system and this is causing an issue. SR to follow up on with TG.
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SR/KE/TS left the meeting.
Mountbatten No questions or comments raised.
PHL No questions or comments raised.
SCAS No questions or comments raised.
Inhealth No questions or comments raised.
Primary Care RW noted the access issues raised in the engagement paper. RW queried how long it takes to speak to someone on the phone when calling primary care. Rather than the time the call is answered in. AS to follow this up.
ACTION: AS to follow up on telephone answering times in primary AS care
6. Information for the exception report
- Safeguarding/primary care work and capacity in the ICS - ICP in ICS - CHC impact review and mitigating risks across the system - Work of the Care Home Oversight Group - UHS restoration risks.
7. Any Other Business
None raised.
Date of next meeting: 4th November 2020, 09:00 – 11:30, Microsoft Teams
Abbreviations AMH Adult Mental Health CHC Continuing Health Care CQC Care Quality Commission CQRM Clinical Quality Review Meeting FFT Friends and Family Test FOI Freedom of Information ICU Integrated Commissioning Unit IG Information Governance IPC Infection Prevention and Control LAC Looked After Children LD Learning Disabilities LSAB Local Safeguarding Adults Board LSCB Local Safeguarding Children’s Board Page 5 of 6
MARP Multi Agency Resource Panel MASH Multi Agency Safeguarding Hub MH Mental Health NHSE/I NHS England/Improvement OPMH Older Persons Mental Health PALS Patient Advice and Liaison Service PCN Primary Care Network PES Patient Experience Service PHL Partnering Health Limited RCA Root Cause Analysis SCAS South Central Ambulance Service NHS Foundation Trust SCC Southampton City Council SCR Serious Case Review SHFT Southern Health NHS Foundation Trust SI Serious Incident SPCL Southampton Primary Care Limited STC Southampton NHS Treatment Centre STWB Steps to Wellbeing UHSFT University Hospital Southampton NHS Foundation Trust UTC Urgent Treatment Centre
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