Enclosure: H Agenda item: 8iii

GOVERNING BODY MEETING

Title of paper: NHS CCG Quality Strategy and Annual Work Programme 2014/5 Date of meeting: September 24th 2014 Presented by: Nicola Moore & Title: Director of Integrated Governance Dr Ellen Wright Prepared by: Maggie Aiken Title: AD Governance & Quality

Summary of Corporate Objectives Supported by this Report (X) 1. To commission high quality, cost effective services to meet the needs of local x people which improve health outcomes and reduce inequalities developing more integrated services for patients.

2. To ensure that the patients’ and public’s voice is heard so that we improve the x quality of the services that we commission for the diverse needs of our population

3. To develop Greenwich CCG as a clinically driven organisation that can attract and x retain excellent staff, deliver effective governance and its full statutory and financial duties 4. Create & optimise a data rich environment to inform commissioning decisions at x CCG, Transformation Steering Group, Syndicate and practice level

5. To develop a long term approach to improving healthcare for the population of x Greenwich delivered by sustainable providers through partnership working with RBG, local providers, the community and voluntary sector.

The Quality Strategy is an outcome of a Quality Strategy Workshop held on January 10th 2104 with members of the NHS Greenwich CCG Quality Committee. This gave members an opportunity to reflect on achievements made during 2013/14 against the agreed Annual Work Programme and to define our key priorities for 2014/15, as well as consideration of our Post-Francis responsibilities. As a member organisation, we have listened to our member practices on what they think our key Quality priorities should be for 2014/15 and the outcome from this feedback is included. The strategy and work programme has been developed through the Quality Committee and is presented to the Governing Body for approval. Please provide brief executive summary:-

Summary of Impact Assessment and Risk Management Issues (x) (please provide detail in the body of the report) Impact on Risk Assurance Framework (x) Yes No N/A x Impact on Environment (x) Yes No N/A x Legal Implications (x) Yes No N/A x Resource implications (x) Yes No N/A x Equality impact assessment (x) Yes No N/A x Impact on current NHS Outcomes Framework areas (x) Yes No N/A x Patient and Public Involvement (x) Yes No N/A x Communications and Engagement (x) Yes No N/A x Impact on CCG Constitution (x) Yes No N/A x

Brief Summary of Recommendations: The Quality Committee recommends that the Governing Body approve the Quality Strategy and Annual work programme 2014/15.

Page 2 of 2 Quality Strategy

Draft to the Quality Committee: June 5th 2014

Draft V.2. to the Quality Committee: September 4th 2014

Date for Approval: 24th Sept 2014 by the Governing Body

Clinical Lead: Dr Ellen Wright

Director of Integrated Governance: Nicola Moore

Author: Maggie Aiken, AD Governance & Quality

0 | P a g e CONTENTS

1. Introduction 2

2. Background 2

3. Definition of Quality 4

4. National Drivers for Quality 5

5. Where we are now (SWOT ANALYSIS) 10

6. What we need to maintain /improve. 11

7. Listening to Member Practices 12

8. FutureDevelopment:AnnualWorkProgramme14/15 13

Appendix A: Annual Work Programme for the Quality Committee

1 | P a g e 1. Introduction

The first priority of NHS Greenwich Clinical Commissioning Group (GCCG) is to commission services that offer quality for local people – services that are clinically effective, safe, well-led, and responsive to patient’s needs and provide a positive patient experience. This strategy links to the key strategies of NHS Greenwich CCG and in support of the SEL Commissioning Strategy.. The drive to secure positive health outcomes for local people and continuously improve the quality of services is at the heart of the work of the CCG. A key focus for our work will be in supporting NHS Greenwich CCGs strategic objectives, the transformation work taking place at local level and the priorities being addressed within the Alliance Partnership, namely MSK, COPD, Cardiology and Frailty. As a member organisation, we have listened to our member practices on what they think our key Quality priorities should be for 2014/15 and the outcome from this feedback is described below (Section 7. ‘Listening to member practices’). This will be woven into our annual work programme. (Appendix A)

This strategy is an outcome of a Quality Strategy Workshop held on January 10th 2104 with members of the NHS Greenwich CCG Quality Committee. This gave members an opportunity to reflect on achievements made during 2013/14 against the agreed Annual Work Programme and to define our key priorities for 2014/15 as well as consideration of our Post-Francis responsibilities.

We recognise that securing and improving quality cannot be achieved by the CCG in isolation. We recognise that our patients’ journeys cut across primary, secondary and specialist care, health and social care, with services commissioned and delivered by multiple organisations and professions. We are committed to work with our partners in maintaining standards and in continuously improving quality. We will continue to support and collaborate with provider organisations to improve the quality of services provided, whilst holding them to account for standards of service delivery.

2. Background:

Quality in Transition

The key focus during 2013/14 and the first year of NHS Greenwich CCG being established, was to maintain quality during transition. This required close partnership working with the neighbouring CCGs of and .

During 2013 the health landscape in SEL underwent dramatic changes. Following on from the recommendations of the Trust Special Administrator and the disaggregation of South Healthcare NHS Trust (SLHT), Queen Elizabeth Hospital merged with Lewisham NHS Trust. The newly formed Lewisham and Greenwich NHS Trust commenced operation in shadow form from 1st September ’13 until formal handover on 1st October '13.

2 | P a g e NHS Greenwich CCG led some developmental work with Bexley and Lewisham CCGs, facilitated by The Good Governance Institute, to ensure good governance during transition and to establish a new Clinical Quality Review Group that would be fit for purpose for the new infrastructure.

The high-level workshop focussed on:

 maintaining organisational memory and good governance during transition  enabling the current CQRG to capture its legacy and learning  ensure the safe transfer of this knowledge to a new CQRG  ensure identification and mitigation of significant quality and patient safety risks during transition  how best to foster and build the new relationships  defining membership of the new CQRG  Explore and agree best practice for monitoring quality  Review current dashboards/tools to monitor quality ensuring efficiency through non-duplication of effort  Ensure the safe handover and closure from one organisational form to another, the Handover of Legacy; key quality and patient safety issues

The outcome was the establishment of a ‘Clinical Quality Review Group’ for the newly formed Lewisham & Greenwich NHS Trust. An innovation from this work was to introduce a ‘Duty of Candour’ Question to the agenda of the CQRG and this has encouraged a deeper level of openness and transparency. The CQRG has been running since Sept 2013 and has GP Clinical Leads and Governance Leads from each borough as members. (See Appendix A: Terms of Reference for LGT CQRG)

During 2013, NHS Greenwich CCG reviewed the Terms of reference and membership of the Clinical Quality Review Group for Oxleas NHS FT (Community & Mental Health) and also introduced a ‘Duty of Candour’ question to this meeting..

NHS Greenwich Clinical Commissioning Group’s response to the Report of Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report; Feb 2013)

NHS Greenwich CCG carefully considered the report, the recommendations from the report and its overarching response in April 2013. Further influences from the Francis report have come from the Keogh report and the Berwick Report. The Keogh report influenced the design of the local Integrated Quality Dashboard and the Berwick Report supports the CCG organisational culture moving forward as a learning organisation. The Governing body agreed to delegate to the Quality Committee the further refinement and implementation of the action plan, reporting back to the full Governing Body at least twice a year on progress. Endorsed within the overarching approach to the Francis Report was a focus on two key areas:

a) To ensure that all providers of NHS care are appropriately delivering safety standards and

3 | P a g e b) A focus on listening to patients and staff, working inclusively as a member organisation.

NHS Greenwich CCG has worked to a defined Annual Work Programme approved by the Quality Committee during 2013/14. This has been revised for 2014/15.

NHS Greenwich CCG Governing Body has received Quality Reports at all of its Public meetings 2013/14. These have been systematically reported to The Governing Body and includes Quality Commentary from the Clinical Quality Review Groups (CQRGs), the NHS Greenwich CCG Quality Committee, The Quality Surveillance Group, Serious Incidents, Safeguarding, Infection Control & Prevention and progress made on Cost Improvement Programmes (CIPs) and CQUINs. The Quality Report also includes NHS Greenwich CCG Integrated Quality Dashboard which gives an overview of Quality in all acute providers.

3. Definition of Quality

Definition:

Quality means different things to different people and the NHS is the only healthcare system in the world with a single definition of quality. At its simplest, Quality is defined as care that is safe, effective and provides as positive an experience A simple, yet powerful definition was first set out in High Quality Care for All in 2008, following the NHS Next Stage Review led by Lord Darzi. This definition now used in legislation has the patient and the NHS Outcomes Framework at the heart. The Care Quality Commission (CQC)’s new inspection approach goes further to build on the three dimensions of Quality two additional dimensions:  Organisational Culture & Leadership: commissioning high quality care which is well-led;  Responsiveness: commissioning high quality care which is responsive to the needs of patients.

4 | P a g e 4. Drivers for Quality

The NHS Outcomes Framework

- builds on the definition of quality through setting out five overarching outcomes or domains, which captures the breadth of what GCCG is striving to achieve for patients: Domain 1: Preventing people from dying prematurely; Domain 2: Enhancing quality of life for people with long-term conditions; Domain 3: Helping people to recover from episodes of ill health or following injury; Domain 4: Ensuring people have a positive experience of care; Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm.

5 | P a g e The CCG Assurance Framework

NHS (NHSE) holds CCCGs to account for the Quality of services they provide through the CCG assurance framework. The CCG Assurance Framework was first published in Nov 2013. The Francis Report & Winterbourne View followed by the publication of the Keogh review into hospital mortality rates and Berwick review into patient safety have made important contributions to the national debate about the quality of NHS services. The final CCG assurance framework has been written in the context of these reports, reflecting the need for evidence-based enquiry and the fundamental need to better reflect patient and public opinion in assurance conversations and assessment methodologies. The assurance domains are: Domain 1: Are patients receiving clinically commissioned, high quality services? Domain 2: Are patients and the public actively engaged and involved? Domain 3: Are CCG plans delivering better outcomes for patients? Domain 4: Does the CCG have robust governance arrangements? Domain 5: Are CCGs working in partnership with others? Domain 6: Does the CCG have strong and robust leadership

The NHS Operating Framework: ‘Everyone Counts’: Planning for patients 2014/19

Systematically and continuously improving the quality of services across settings of care represents a significant challenge for the CCG and partner agencies. As financial resources are constrained, there is a need to improve quality and outcomes through innovation in service design, efficiency, and a continued focus on prevention of ill-health alongside treatment and care. ‘Everyone Counts: Planning for patients 2014/19 sets out the national framework within which commissioners will need to work with providers and partners in local government to develop strong, robust and ambitious five-year plans to secure the continuity of sustainable high quality care for all. The planning guidance seeks:-

 Strategic plans covering a five year period, with first two years at operating plan level  An outcomes focused approach, with stretching local ambitions expected of commissioners, alongside credible and costed plans to deliver them  Citizen inclusion and empowerment to focus on what patients want and need  More integration between providers and commissioners  More integration with social care – cooperation with Local Authorities on Better Care Fund planning  Plans to be explicit in dealing with the financial gap and risk and mitigation strategies. No change not an option

6 | P a g e The NHS Constitution (2009): established the principles and values of the NHS in England. It sets out the pledges the NHS’ commitment to operate fairly and effectively, the rights to which patients, the public and staff are entitled.

Cost Improvement Programmes: For 2014/15 Lewisham and Greenwich NHS Trust have set an organisational CIP programme. The CIP development process was undertaken by Divisional Clinical Directors and Divisional General Managers presenting outline CIP schemes to the Trusts Executive Management Team in December 2013. As part of this process Quality Impact Assessment were completed on these outline plans. Progress on CIPs are monitored through the Lewisham & Greenwich CQRG.

Quality, Innovation, Productivity and Prevention (QIPP): is a large scale transformational programme for the NHS, involving and engaging staff, clinicians, patients and the voluntary sectors in Greenwich in improving the quality of care delivered whilst making efficiency savings, leading and supporting change and addressing local quality challenges. A QIA process has been approved.

Commissioning for Quality and Innovation Framework (CQUIN): enables commissioners to reward excellence by linking a proportion of healthcare provider’s income to the achievement of local quality improvement goals. Enabling providers to act as a vehicle for improving patient safety, experience and outcomes. CQUINs schemes form part of the contract between GCCG and its main providers of healthcare. These are routinely monitored a sub group of the CQRGs. During 2013/14 CQUINs were developed more strategically with our neighbouring CCGs :

Lewisham & Greenwich Trust CQUINs 14/15 Friends and Family Test Implementation of staff FFT - NHS Trusts Only

NHS Safety Thermometer Improving harm free care

Dementia Improving care for people with dementia

Discharge planning and Improving discharge planning and communication communication

Maternity Services Improving quality and women's experience in Maternity Services

Supporting Integration Effective neighbourhood networks and planning for 7 day working

London Quality Standards Implementation of London Quality Standards in Radiology across both UHL and QEH sites

Patient Experience Improving patient experience supporting the development of the 6c's

7 | P a g e Making Every Contact Count Delivering alcohol brief interventions

CYP Disability Register Implementation of clinical and functional coding in CYP Services

Current Oxleas (Community) CQUINs 14/15:

1. Implementation of staff FFT Friends & Family Test 2. Early implementation 3. Phased expansion NHS Safety Thermometer Improving harm free care

Supporting Care Of People Supporting carers of people with long term with Long term conditions condition. (Carer focus)

Supporting integration: MECC Healthy Lifestyle Promotion Making Every Contact Count (MECC)

Improving Clinical Outcomes To support integration and whole systems working for better patient outcomes

Current Oxleas (Mental Health) CQUINs 2014/15:

Improving the health and care of people with Learning Disabilities

Care planning for people with dementia

CAMHS

Improving access to IAPT services

In year, we are committed to ensure close working and engagement of clinical leads in developing future CQUINs that support key priority areas identified at local level and strategically across the boroughs of Bexley, Greenwich and Lewisham

The London Quality Standards: NHS England London has published new data on the progress of hospitals in meeting standards for acute emergency and maternity services across London and it shows more are delivering high quality acute emergency care for patients across all seven days of the week. The London Quality Standards were all endorsed by the London Clinical Senate and the London Clinical Commissioning Council. London’s Quality Standards set out what good care should look like and they were developed to ensure that all hospital-based acute emergency and maternity services

8 | P a g e provide care that is safe and of consistently high quality for patients across London, seven days a week. When implemented they should improve patient outcomes. London is the first place to develop standards to improve quality. Its approach is being used as a model for other standards that will be rolled out across the country by 2016/17. London’s CCGs are working on five year plans which will describe how every hospital will deliver all the standards.

Healthwatch England: is the independent consumer champion for health and social care in England created to ensure that the voices of the public and those who use services reach the ears of the decision makers. Healthwatch Greenwich plays a key role at local level in ensuring the views of Greenwich’s population and people who use commissioned services are taken into account. In May 2014 NHS Greenwich CCG invited Healthwatch to be a member on to the Quality Committee.

9 | P a g e 5. Where we are now :

NHS Greenwich CCG held a workshop in January 2014 to reflect achievements made during 13/14 as on Quality and to set priorities for 14/15 The following SWOT (Strengths, weaknesses, opportunities and threats) analysis is the product of the Workshop held in Jan 2014. It illustrates progress made and key areas we would wish to improve during 2014/15.

Strengths Weaknesses:  Tenacious in approach  Yr 1. Establishment and refinement of  Need more insight into smaller CQRGs with neighbouring CCGs. providers. Gaps in assurance.  Clinician to clinician meetings  Lack of systematic approach on Quality  Feedback – good structured reporting on input for procurement and service re- Quality and good focus design  Work on developing the Integrated  The Quality Alert system needs Dashboard improvement and monitoring to ensure  Work on Infection Control & Prevention good feedback (e.g. via Compliance management and engaging members on Report) this.  No integrated dashboard from CSU  Quality Alerts as an Early Warning  Data quality and capturing it. System.  Strengthen links between safeguarding  Themed review approach of the Quality and quality at an operational level Committee.  Performance monitoring SCR’s and SI’s.  Good use of soft intelligence.  Strengthen quality assurance of Primary  Established a good reputation on Quality Care & Governance  Better identification of quality  Greenwich as a Leader. improvement v monitoring/triangulation  The prominence of Quality in the CCG  Did not make use of a Board to Board work. opportunity with a focus on Quality.  Shared intelligence group with CQC and NHSE.  Observational visits to QEH A&E and Bevan Unit. Good audit approach.

Opportunities Threats  How do we work with the CSU?  Zero insight into smaller institutions  Further engagement with Oxleas FT (AQPs, Care Homes, Small Providers)  Strengthen Quality Alert System across  Timely data, Data quality. the 3 CCGs.  Failure of CCG to adopt Covalent Quality  Contracting levers and Quality Schedules Alert System (Bexley model)  Working with Healthwatch  Failure to implement Action Plan on  Working with Public Health in MOU. smaller providers  Look at Quality along care pathways  Lack of integrated working with  Focus on Quality at every point of the CHST/Commissioners/Designate commissioning cycle Safeguarding Leads.  Hold CSU to account to deliver the Integrated Quality Dashboard.

10 | P a g e 6. What we need to maintain/ improve:

Maintain:  Keep the structure of the Quality Committee with themed review and time to discuss issues in detail.  Refresh and ensure the use of The Integrated Quality Dashboard (CSU and Oxleas to populate).  Maintain visits as required: utilise teams across the organisation  Work on the Francis recommendations.  Work on Quality Alerts across 3 CCGs.  QIA process for QIPP initiatives  Drive on Infection Control & Prevention at local level.

Improve:  Utilise levers in contracts and local schedules more  Define escalation process from CQRG to Contract Management Board  Engaging leads in the CQUIN process for 14/15  Ensure Annual Board to Board on Quality  Add Monitor and Local Authority representatives to the Shared Intelligence Group as required.  Explore use of cultural barometer (e.g. through the Capital People Programme)  Adopting the London Quality Standards  Influence the Audit Programme with acute providers  Engagement with local clinicians/member practices on Quality issues.  Standing agenda item for Quality Committee: AQPs, Care Homes, small providers.  Work of SI evaluation panel to include Lewisham CCG  Measures of patient experience.  Disseminating local knowledge about quality across the organisation.

11 | P a g e 7. Listening to Member Practices.

A Quality Survey was undertaken by local member practices to which we received a 60% response rate. Local practices prioritised the following as key areas they would like the Quality Team to address during 14/15

 38% of responders wanted to the Quality Team to prioritise the management of Infection Control and prevention (Including C.Difficile in the Community) and ensure local practices adopt best practice.  32% of responders cited Cancer as the main priority area particularly Dermatology referrals, appropriate referrals and up skilling clinicians on diagnosis. (Suggestions received included the design of an urgent cancer referral proforma and establishment of a 2 week community clinic for lesions)  30% of responders wanted the Quality Team to prioritise improving communication for Primary Care with the Acute Providers, in particular in ensuring good discharge summaries.

Fig. 1. Key Quality Priorities Suggested by Member Practices.

Key Quality Priority Areas

Infection Control Cancer Communication with Acutes

Under a category of ‘Other’ – member practices suggestions included:  Rheumatology referrals and up skilling on diagnosis;  prostate cancer ; bowel cancer;  Diabetes  Ensure appropriate number of District Nurses to cover the wide area of service needed.  feedback to practices on the Quality of the 2 week referrals;  improving the efficiency of X Ray reporting service at QEH; easier access to a Consultant Radiologist to discuss queries relating to Radiology Reports.  Ensuring and preserving a high quality GP out of hours service

12 | P a g e During 14/15 NHS Greenwich CCG will build into its work programme for Quality:  Aiding member practices in Infection Control & Prevention.  Aiding member practices in Cancer Management , in particular dermatology  Aiding member practices in improved communications with Acute Providers

8. The Annual Work Programme is illustrated in Appendix A.

This sets out the agenda plan for the year for the Quality Committee and maps areas of work against CCG statutory duties.

13 | P a g e NHS GREENWICH CCG QUALITY COMMITTEE ANNUAL WORK PROGRAMME 2014/15

STAT POWER AREA OF WORK Reporting cycle Lead June 5th Sept 4 Oct 9th Dec 11th Feb 12th STRATEGIC Review of TORs and membership Annual NM/MA Review of Quality Strategy ✓ ✓ Review of work plan Annual NM/MA ✓ ✓ Quality Across the Organisation (Issues arising) at each meeting ALL DIRECTORATES DUTY Equalities & Human Rights bi-annual CB

DUTY RESEARCH & RESEARCH GOVERNANCE Progress on Local Action and Response to the Annual reports to the Francis recommendations Governing Body NM/MA ✓ DUTY SERIOUS INCIDENTS and Never Events Serious Incidents and Never Events at each meeting DG/MA/NM ✓ ✓ ✓ ✓ ✓ Public Health DUTY INFECTION CONTROL & PREVENTION at each meeting RBG ✓ ✓ ✓ ✓ ✓ Public Health Infection Control & Prevention Annual Report Annual RBG ✓ Internal audit recommendations for Quality, Risk & Governance as per timescale for audit ✓ ✓ DUTY RISK MANAGEMENT Emergency Planning & Resilience, BIA Annual NM/AK ✓ Review of Integrated Risk Management Framework Annual NM/MA Quality Risk Report at each meeting NM/MA ✓ ✓ ✓ ✓ ✓ DUTY PROVIDER QUALITY MONITORING CSU/NM/MA Acute Quality Report at each meeting CSU ✓ ✓ ✓ ✓ ✓ CQRG update as per Trust business cycle NM/EW/MA ✓ ✓ ✓ ✓ ✓ Quality Accounts Annual NM/MA ✓ Provider CIPs (Cost Improvement Programmes) ✓ ✓ ✓ ✓ ✓ QIAs via CQRGs minutes CSU/NM/MA Quality of Small Providers Quarterly DG/CSU ✓ ✓ 1 NHS GREENWICH CCG QUALITY COMMITTEE ANNUAL WORK PROGRAMME 2014/15 Annual workshop to NM/MA/DG/GP Dec CQUIN development and review prioritise themes Clin Leads June 5th Sep 4th Oct 9th 11th Feb 12th Quarterly Compliance Report CB ✓ ✓ ✓ ✓ Quality Alerts Quarterly CB Primary Care Complaints as per NHSE reporting cycle NHSE/CB ✓ ✓ ✓ DUTY FREEDOM OF INFORMATION Quarterly CB ✓ ✓ Letters to MPs Quarterly CB DUTY MANDATORY TRAINING UPTAKE Quarterly CB ✓ ✓ ✓ DUTY SAFEGUARDING Safeguarding children Bi monthly LK/PH ✓ ✓ ✓ ✓ Safeguarding adults Bi monthly EH Safeguarding ✓ Safeguarding Annual Report Annual Leads DUTY PATIENT VOICE/PATIENT CHOICE reports from Patient Reference Group (minutes) as per business cycle IG/RR Progress Reports on Projects on patient ✓ ✓ engagement bi-annual IG/RR REPORTS FROM WORKING GROUPS Shared Intelligence Group with ✓ ✓ DUTY CQC/NHSE/CCGs/Monitor Quarterly NM/MA Serious Incident Evaluation Panel Monthly Part 2 DG ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Information Governance Group (minutes) Monthly for info NT/CB HEALTH & SAFETY AND WELL BEING AT WORK DUTY GROUP Quarterly CB ✓ ✓ ✓ ✓ DUTY EMERGENCY PLANNING & RESILIENCE Bi Annual NM/DG ✓ ✓ ✓ Pressure Ulcer Working Group Quarterly KB 2 DUTY CONTROLLED DRUGS ANNUAL REPORT Annual NHSE June 5th Sep 4 7th Oct 9th Dec 11th Feb 12th ✓ ✓ ✓ ✓ ✓ Medicines Management (minutes) as per business c ycle RA/SM ✓ Medicines Management AnnualANNUAL Report WORK Annual PROGRAMME RA/SM 2014/15 ✓ ✓ SEL NHS 111 CLINICAL GOVERNANCE GROUP Bi annual MA/ TB/HS ✓ Quality in OOH services Annual Grabadoc ✓ Quality in UCC Annual Quality Targets Sub Committee as per TORs IG Sub group of members as QIA reviews of Transformation Projects required CH/NM/MA CONTINUED IMPROVEMENTS IN THE QUALITY OF DUTY PRIMARY CARE Bi Annual IG CONTINUED IMPROVEMENTS IN THE QUALITY OF DUTY SERVICES Bi Annual DUTY INNOVATION IN QUALITY: EXAMPLES NH/MA/GP Clin Leads ✓ Capital People Project CB/HB

Governance Commissioned Conferences (e.g. gangs) in year NM/VS ✓ Pioneer in year SST INTEGRATED REPORTING - INTEGRATED ANNUAL ✓ ✓ DUTY REPORT in year NM/VS ✓ Board Development on Risk, Quality , Governance Clinician to Clinician Meetings as required Board to Board Meetings as required THEMED REVIEWS TO BE AGREED Care in Care Homes Winterbourne Safeguarding ✓ ✓ ✓ ✓ A&E at QEH on each agenda IP/NS/NM/MA/EW ✓ ✓ Cancer Care

Joint Child Poverty Strategy with LA via Safeguarding as per safeguarding reporting Safeguarding Leads 3 DUTY NICE compliance (via CQRGs) Minutes to CQRG