BRADFORD DISTRICT & CRAVEN CCG BD&C CCG Governing Body - Public Tuesday 11 May 2021 13:15 – 15:50 To be held via Zoom – details to be circulated separately

AGENDA

ATTENDEES TO NOTE: the meeting may be audio-recorded to assist with minute-taking. Whether a meeting is being recorded will be confirmed at the start of the meeting by the Chair. All recordings will be destroyed after approval of the minutes to which they relate.

Page Item Lead Purpose Time Mins No 1. Welcome & Apologies James Thomas Information - note 13:15 2 Verbal Report 2. Declarations of Interest James Thomas Action - as 13:17 1 Verbal required Report

3. Questions from the public James Thomas Action - discuss 13:18 2 Verbal Report 4. Minutes of the previous meeting James Thomas Decision - approve 13:20 5 held 9 March 2021 and action log 7-18

5. Chief Officer & Clinical Chair’s Helen Hirst Information - note 13:25 15 19-28 Report James Thomas 6. Finance and operational plan 2021/22 i) Planning Guidance Helen Hirst Information & 13:40 10 29-31 Assurance ii) Budget Robert Maden Decision – approve 13:50 10 32-50 iii) System performance, recovery Louise Clarke Information & 14:00 15 51-58 and access Assurance 7. Performance Reports

i) Finance Update Robert Maden Information & 14:15 10 59-69 ii) Patient Safety and Quality Michelle Turner Assurance 14:25 15 70-87 Improvement Report 8. Integrated Care Partnership Vicki Wallace Information & 14:40 20 88-91 development Assurance

9. Sign up to updated Strategic Vicki Wallace Decision – approve 15:00 15 92-138 Partnering Agreement

Comfort Break 15:15 5

10. Individual Funding Request Panel Pam Essler Information & 15:20 15 139-146 Annual Report 2020-2021 Assurance 11. High Level Risk Report Stacey Fleming Assurance 15:35 5 147-164

1 12. Exception reports from Committee Bryan Millar Information & 15:40 5 Verbal Chairs David Richardson Assurance Report Neil Fell Ruby Bhatti

Items to receive and note

Page Item Lead Purpose Time Mins No 13. Primary Care Commissioning Ruby Bhatti Assurance 15:45 3 165-169 Committee minutes: 12 January 2021 14. Finance and Performance Neil Fell Assurance 170-184 Committee minutes: 4 February 2021 & 4 March 2021 15. Quality Committee minutes: 4 David Richardson Assurance 185-196 February 2021 & 4 March 2021 16. Exclusion of the public - it is James Thomas Decision - approve 15:48 1 Verbal recommended that the following report resolution be passed: "That representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest 17. Date and time of next meeting: 13 James Thomas Assurance 15:49 1 Verbal July 2021, 1.15pm – 4.15pm Report

For any queries regarding this agenda, please contact: Stacey Fleming, Senior Governance and Resilience Manager, [email protected]

We are working to make our meeting papers accessible. If you need these papers in a different format, please contact Stacey Fleming on the above email address.

2 Conflicts of Interests Check List for Meeting Chairs

(Appendix C of the Conflicts of Interest and Business Conduct Policy)

Meeting Chairs have responsibility for ensuring the appropriate management of conflicts of interest during the course of CCG meetings (see below for a definition and examples of ‘interests’). In particular they must ensure:

 They are familiar with the contents of the Registers of Interests as pertinent to their Group or Committee. The CCG’s Registers of Interests can be accessed here: https://www.bradfordcravenccg.nhs.uk/ccg-information/publication-scheme/lists-and-registers/

 They prepare for the meeting mindful of any actual or potential conflicts of interest that may arise relevant to the business of that meeting. Where conflicts of interest are known in advance, the individual concerned must not receive the supporting papers or minutes of the meeting which relate to the matter(s) which give rise to the conflict.

 That declarations of interest are always an item on the agenda.

 That the meeting is quorate and that this is recorded in the minutes.

 That members are asked to declare any interests that are likely to lead to a conflict or potential conflict that could impact (or has the potential to impact) on any items on the agenda. This should be repeated again at individual item(s) where it is considered a conflict is likely to or could potentially arise.

 Any declaration must be made clearly noted in the minutes both at the start of the meeting and at the relevant item. If there is any doubt as to whether or not a conflict of interest could arise, a declaration should be made and noted in the minutes.

The minutes must specify how the Chairs have decided to manage the declared interest. The appropriate course of action will depend on the particular circumstances, but could include one or more of the following:

 Where the Chair has a conflict of interest, deciding that the vice Chair (or another non-conflicted member of the meeting if the vice Chair is also conflicted) should chair all or part of the meeting;  Requiring the individual who has a conflict of interest (including the Chair or vice Chair if necessary) not to attend the meeting;  Ensuring that the individual concerned does not receive the supporting papers or minutes of the meeting which relate to the matter(s) which give rise to the conflict;  Requiring the individual to leave the discussion when the relevant matter(s) are being discussed and when any decisions are being taken in relation to those matter(s). In private meetings, this could include requiring the individual to leave the room and in public meetings to either leave the room or join the audience in the public gallery;  Allowing the individual to participate in some or all of the discussion when the relevant matter(s) are being discussed but requiring them to leave the meeting when any decisions are being taken in relation to those matter(s). This may be appropriate where, for example, the conflicted individual has important relevant knowledge and experience of the matter(s) under discussion, which it would be of benefit for the meeting to hear, but this will depend on the nature and extent of the interest which has been declared;  Noting the interest and ensuring that all attendees are aware of the nature and extent of the interest, but allowing the individual to remain and participate in both the discussion and in any decisions. This is only likely to be the appropriate course of action where it is decided that the interest which has been declared is either immaterial or not relevant to the matter(s) under discussion. The conflicts of interest case studies include examples of material and immaterial conflicts of interest.

In making this decision the Chairs will need to consider the following points:

3 - the nature and materiality of the decision - the nature and materiality of the declared interest(s) - the availability of relevant expertise - as a general rule (and subject to the judgement of the Chairs), if an interest involves a financial interest or a significant non-financial interest, the individual should be asked to leave the meeting for the whole item

 Any declaration arising during the course of a meeting / individual item must be minuted and action how to handle it agreed by the Chair and recorded in the minutes It is imperative that CCGs ensure complete transparency in their decision making processes through robust record-keeping. If any conflicts of interest are declared or otherwise arise in a meeting, the Chair must ensure the following information is recorded in the minutes:

 Who has the interest  The nature of the interest and why it gives rise to a conflict, including the magnitude of any interest  The items on the agenda to which the interest relates  How the conflict was agreed to be managed, and  Evidence that the conflict was managed as intended (for example recording the points during the meeting when particular individuals left or returned to the meeting).

 Quoracy of the meeting or for individual items must be checked if an interest is declared. If the meeting is no longer quorate (in full or for particular items) or there is insufficient relevant expertise to inform decision-making once those with conflicts of interests are excluded, the Chairs must agree how this should be managed, i.e. defer the item / meeting or refer any decisions for particular items(s) to another Committee for consideration and formal approval.

 Refer to Standard Financial Instructions for Delegated Limits

Definition of Conflicts of Interest (Section 5 of the CCG Conflicts of Interest Policy)

Conflicts of interest may arise where personal interests or loyalties conflict with those of the CCG. Such conflicts may create problems such as inhibiting free discussions which could result in decisions or actions that are not in the best interests of the CCG, patients or the public and risk creating the impression that the CCG has acted improperly.

NHS England defines a conflict of interest as occurring:

“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 own involvement in another role or relationship.

In some circumstances, it could be reasonably considered that a conflict of interest exists even when there is no actual conflict” (i.e. a perceived conflict).

The latest version of this guidance is Managing Conflicts of Interest: Revised Statutory Guidance for CCGs, June 2017. This guidance supersedes the previous version (June 2016) and has been fully aligned with the new cross-system guidance on Managing Conflicts of Interest in the NHS which was published in February 2017.

NHS England identifies four categories of conflicts of interest:

1. Financial interests: This is where an individual may get direct financial benefits from the consequences of a commissioning decision. This could, for example, include being:

4  A director, including a non-executive director or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with a health or social care organisation.  A shareholder (or similar ownership interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do business with a health or social care organisation.  A management consultant for a provider

This could also include an individual (or their practices, in the case of GPs) being:

 In secondary employment (see Section 7.2)  In receipt of secondary income from a provider.  In receipt of a grant from a provider.  In receipt of payments (for example, Honoria, one-off payments, day allowances or travel or subsistence) from a provider.  In receipt of funding from the pharmaceutical or med-tech industry as part of a joint working arrangement.  In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and  Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider).

2. Non-financial professional interests: This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is:

 An advocate for a particular group of patients;  A GP with a special interest(s);  A member of a particular specialist professional body (although routine GP membership of the Royal College of General Practitioners, British Medical Association or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);  An advisor for the Care Quality Commission (CQC) or the National Institute for Health and Care Excellence (NICE);  A medical researcher.

3. Non-financial personal interests: This is where an individual may benefit personally in ways which are not directly linked to their professional career or do not give rise to direct financial benefit. This could include, for example, where the individual is:

 A voluntary sector champion for a provider;  A volunteer for a provider;  A member of a voluntary sector board or has any other position of authority with a voluntary sector organisation.  A member of a lobby or pressure group with an interest in health.

4. Indirect interests: This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision, for example:

 Spouse / partner  Close relatives e.g. parent, grandparent, child, grandchild or sibling;  Close friend;  Business partner. A declaration for a “business partner” in a GP partnership should include all relevant collective interests of the partnership and all interests of their fellow GP partners (this could be done by cross-referring to the separate declarations made by those GP partners).

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Whether an interest held by another person gives rise to a conflict of interest will depend upon the nature of the relationship between that person and the individual and the role of the individual within the CCGs.

It is not possible to define all instances in which an interest may be a real or perceived conflict.

If in doubt it is better to assume the existence of a conflict of interest and declare it, rather than ignore it.

6 DRAFT Minutes of the Governing Body PUBLIC Tuesday 9 March 2021, 13:15 – 15:15 Meeting held via Zoom Present: Ruby Bhatti Lay Member for Primary Care Commissioning & Communities Louise Clarke Strategic Clinical Director of Strategy and Planning Angie Clegg Registered Nurse Neil Fell Lay Member for Finance & Performance Helen Hirst Chief Officer Robert Maden Chief Finance Officer Bryan Millar Lay Member for Audit & Governance David Richardson Lay Member for Quality James Thomas Clinical Chair ( Chair) Michelle Turner Strategic Director of Quality and Nursing John Young Secondary Care Consultant

In Attendance: Liz Allen Strategic Director of Organisation Effectiveness Diane Daly General Manager, Autism Service (Item 8) Bev Denton Governance & Corporate Manager (observing) Pam Essler Lay Chair of the Individual Funding Request Panel Stacey Fleming Governance & Corporate Manager (Minutes) Ali Jan Haider Strategic Director of Keeping Well at Home Gill Paxton Associate Director of Quality and Nursing (observing) Ruth Shaw Senior Head of Strategy, Change and Delivery (for Item 8) Vicki Wallace Interim Strategic Director, Transformation and Change

Apologies: None

Members of the public: 0

1 Welcome and Apologies

James Thomas, Chair welcomed everyone to the meeting of the Governing Body of Bradford District & Craven Clinical Commissioning Group (BD&C CCG).

No apologies had been received. The meeting was noted to be quorate.

2 Declarations of Interest

No declarations of interest were made against any agenda items. The register of interests records can be found at: https://www.bradfordcravenccg.nhs.uk/ccg-information/publication-scheme/lists-and-registers/

3 Questions received from the public

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No questions had been received from the public ahead of the meeting.

4 Minutes of the previous meeting held 12 January 2021 and action log

The minutes of the previous meeting held on 12 January 2021 were agreed to be a true and accurate record. There were no matters arising.

The action log was reviewed and the action for an update to be provided on children’s autism services was noted to be complete as an item had been added to the agenda for this meeting. The item could be removed from the action log.

RESOLVED: The Governing Body:

 Approved the minutes of the public meeting of the Governing Body held on 12 January 2021.

5 Clinical Chair and Chief Officer’s Report

Helen Hirst, Chief Officer, presented the item, which provided an update to the Governing Body about key issues, meetings and partnership activities affecting the CCG together with updates on national guidance and, where relevant, local impact of this guidance.

Helen provided an update on the discussions being held around the programme of work that was underway for the development of the Integrated Care System (ICS). It was anticipated that a shadow form of the new way of working would be implemented from the autumn. Rob Webster, the current ICS leader, had written to all system partners about the establishment of the ICS and the establishment of Integrated Care Partnerships (ICP) at place. This information, along with some frequently asked questions, would be shared with staff and members of the Governing Body.

An update was provided on the ongoing work to develop the headline arrangements and operating model for the ICP in our place, including consideration of future governance arrangements and ways to further strengthen partnership arrangements that had already been established.

It was noted that the white paper that had been published by the government on the proposed legislative reform sets out that the functions currently allocated to the CCG will transfer legally to the ICS and suggests CCG staff will transfer to the ICS. However, it was envisaged that the majority of staff would continue to work in Bradford district and Craven as they do now.

A transition and development programme board would be established and it was noted that Helen would be a member as place based lead for Bradford district and Craven and James Thomas would be a member as Chair of the Clinical Forum.

It was noted that an ICP development workshop would be held on 19 March 2021 and invitations had been circulated for this.

Following the update on ICS development, Helen then provided an update on the CCG and wider system response to the Covid-19 pandemic. Infection rates and the number of hospital admissions were noted to have reduced considerably. Vicki Wallace provided an update on the successful rollout of the vaccination programme in the area, noting that over 200,000 vaccinations had been provided since the programme began and that people were beginning to be invited for their second doses. Initiatives such as pop up clinics were being utilised to increase vaccine uptake in communities where so far this had been lower than in other areas.

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An update was provided on the preparatory work that was underway ahead of the Easter period in light of the lockdown restrictions beginning to ease with consideration being given to surge and escalation.

Neil Fell made highlighted a reference within the report about the Bradford Economic Recovery Plan and requested that the plan be shared with the Governing Body. Helen updated on discussions held at the Wellbeing Board around economic recovery and the Health and Social Care Economic Partnership (HSCEP)where the need for people to work in local services (such as those provided by the NHS) and the need for local people to gain employment and develop their skills had been recognised. The plan also reflected on the significant impact of Covid-19 on the area and its population.

ACTION: The Bradford Economic Recovery Plan to be shared with Governing Body members.

There were no questions on the reports from the Senior Leadership Team included in the update.

RESOLVED: The Governing Body:

 Noted the information and assurance provided by the Clinical Chair & Chief Officer’s report.

6 ICS Next Steps

The update on ICS next steps was provided under item 5 Clinical Chair and Chief Officer’s Report.

7 Review of the Strategic Partnering Agreement

Vicki Wallace, Interim Strategic Director, Transformation and Change presented the item.

It was noted that a review of the Strategic Partnering Agreement (SPA) had been undertaken to ensure that it continued to reflect the ways of working across the system following since it was developed in 2019. The SPA articulates the approach to governance and shared decision making across the Bradford district and Craven place.

Vicki advised those present that work had begun on the review of the SPA prior to the publication of the white paper in November 2020. Since its publication, the white paper had changed the focus of the review.

Key people had been interviewed across the partnership to understand what was working well and what could be changed. This input had helped shape and update the SPA so it was more reflective of the current ways of working whilst also looking to the future. Key areas covered under the SPA were finance, governance and health inequalities. Ways of working had been accelerated in response to the Covid-19 pandemic.

The updated SPA would be presented to the Governing Body again in May 2021 for sign off.

ACTION: Sign off of updated SPA to be added to forward planner for May 2021.

The updated SPA would contain a schedule setting out the key areas that would allow the BD&C system to work as an ICP in shadow form from October 2021. This would include governance structures, services, schemes of delegation, shared functions, workforce, quality principles and financial flows.

As part of the next steps towards readiness for the ICP, work was also ongoing reviewing the strategy & vision and organisational development.

Bryan Millar made a request that lay and professional members of the Governing Body continue to be regularly appraised of developments relating to the new governance arrangements of the ICP whilst

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9 remaining involved in the current arrangements of the existing organisation until April 2022. Vicki advised that the governance arrangements were still being worked through for the ICP but input would be sought from all partners across the system regarding the formation of new ways of working and governance.

John Young expressed admiration for the approach set out in the SPA and queried if shared contracts and budgets were envisaged as part of the system moving forwards. Vicki advised that discussions were ongoing as to how ambitious the new ways of working would be under the ICP and consideration was being given as to how best the workforce and resources could be utilised. Louise Clarke added that this was a conversation that everyone in the system was part of and it was important to consider the wider ICS footprint across West Yorkshire whilst also recognising this as an opportunity to be innovative in our approach.

Neil Fell reflected on the hard work already carried out through the Act as One approach and development of the CCG strategy and it was hoped that this would form a firm foundation for the development of the ICP.

Michelle Turner reflected on discussions held at a recent Quality Committee that were supportive of the direction of travel but also highlighted the need to influence the quality improvement principles noted in Vicki’s report as this would allow the lay and professional input into the ICP development.

Ali Jan Haider reflected on the current work that was happening around integrated commissioning which reflected the principles highlighted in the SPA and noted areas where discussions were being held with the aim of building a joint approach.

RESOLVED: The Governing Body:

 Received the update on the review of the Strategic Partnering Agreement and next steps.

8 Update on Children’s Autism Services

Ali Jan Haider, Strategic Director of Keeping Well at Home, Diane Daley, General Manager for Autism Services and Ruth Shaw, Strategic Head Strategy Change and Delivery, presented the item which provided an update on work that has been undertaken across Bradford district and Craven to address the long wait that children and young people are experiencing to access the neurodiversity assessment pathway and set out the next steps to improve timely access.

A summary of progress to-date was provided and Ali Jan reflected on the development of partnership working and engagement with service users which had influenced the co-design of pathways and resources. It was noted that a patient tracking list had been implemented to monitor data from different providers to trace referrals to the pathway in a timely and accurate way. Ali Jan highlighted the use of external providers during Covid-19 to secure continuity of care and maintain the level of assessments being carried out.

An update on current finances, capacity & demand was provided with a significant increase in demand on the service being reported. An update was provided on the funding that had been implemented to address the backlog for the waiting list and the level of anticipated future demand was noted. Ali Jan noted the development of a business case that will be presented to the Mental Health, Learning Disability and Autism Partnership Board to help the system meet national guidelines.

The priority areas for 2021/22 were noted and it was anticipated that assurance would continue to be provided at the CCG’s Quality Committee (QC) through regular updates. Work would continue through the System Quality Committee (SQC) to further the joined up approach to children’s autism already in place. Ali Jan provided an update on interventions that were being explored in educational settings to enable support work with children to take place. Work would continue to develop and refine the patient tracking list.

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Pam Essler queried the work that was being carried out to address inequalities and the potential factors that may impact on families accessing services. Ali Jan noted the system approach in trying to address inequalities, such as working with communities and schools. Work was ongoing to understand the data captured on the patient tracking list to address areas of inequalities.

Angie Clegg raised a concern about the lack of clarity around the trajectories on how the waiting list would be tackled and associated timescales. Ali Jan provided more detail on the business case that was being developed which included further information on initiatives that were being explored to tackle the waiting list. Michelle Turner noted the need to maintain a focus on the service at both QC and SQC. Funding to address the waiting list and to meet the demand on a yearly basis was also noted as a key factor.

Robert Maden sought clarification regarding the amount of additional recurrent and non-recurrent funding required to address the backlog and to keep up to demand. It was anticipated that currently, a further £2million was required, however further work was needed to understand the impact that the actions set out in the paper would have to reduce this figure and to bring the waiting list in line with national guidelines.

RESOLVED: The Governing Body:

 Received and noted the update on Children’s Autism Services.  Supported the development of the business case that will be presented to the Mental Health, Learning Disability and Autism Partnership Board.

9 Finance

9.1Finance Update

Robert Maden, Chief Finance Officer (CFO), presented the item.

It was noted that previous reports had flagged up a residual finance risk, however Robert reported that after allowing for forecast budget underspends, the full year additional savings target of £2.8m is fully covered leaving no residual financial risk. Reductions in block contracts with the local NHS Trusts and Bradford District Care Trust had been agreed.

For the last six months of the financial year (October 2020 to March 2021), the CCG has received a fixed funding envelope which it is expected to manage costs within, except for specific items where additional cost reimbursement will be available. Defined block value contracts for providers have been determined however there still remained some risk to be managed relating to prescribing costs and Continuing Healthcare. Work continues with the social care team at Bradford Metropolitan District Council (BMDC) to monitor referrals and flexibility has been built into the forecast to accommodate any future movement. On that basis, Robert reported that the main risks for 2020/21 had been managed.

Robert reported that reimbursement for Hospital Discharge Scheme costs for October and November has been received, but Hospital Discharge Scheme claims for December and January are outstanding as are claims for independent sector activity from October to January. There is a risk that full reimbursement may not be received, but as no queries have been raised with the CCG regarding the claims, the financial position continues to assume full cost reimbursement.

It was noted that on the basis of the forecast operation budget performance, the CCG expects to meet its statutory function target. Robert advised that this also applied to the Bradford place position with each organisation forecast to achieve its plan. From an ICS perspective, the forecast position was favourable to plan.

RESOLVED: The Governing Body:

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 Noted the year to date financial position as at the 31 January 2021 and the forecast financial position to March 2021  Noted that there is no remaining residual financial risk in the reported financial position.

9.2 Operational Planning 2021/22

Robert Maden provided the update on operational planning for 2021/22, advising those present that it was forecast to be another split year. It was anticipated that arrangements for Q1 would see a roll forward of the current arrangements and then different arrangements would then be put in place for Q2- Q4. No detailed planning guidance from NHS England & Improvement (NHSE&I) had been received so far. Resource availability in both planning periods is expected to include funding for Mental Health Forward View and new GP Contract commitments.

It was anticipated that nationally, ICS funding envelopes and organisation level budgets would be recalculated. Robert provided an update on the approach taken for Q1 for West Yorkshire and Harrogate, noting that it had been agreed that resource for each organisation would be rolled forward into Q1 and compared to the nationally calculated system envelope, with a discussion to take place about any difference.

It was expected that a full operational and financial plan for Q2 – Q4 2021/22 would be implemented, with resources expected to be in line with the previous Long Terms Plan (LTP) financial settlement. Financial plans would be developed collaboratively, in line with the principles set out in the SPA, which was in line with the approach taken prior to operational planning being paused in 2020/21 to enable the response to Covid-19. The collaborative approach to planning would be carried through to longer term planning for the ICS and ICP.

Plan submission dates are expected to be the end of April for Q1 plans and the end of June for Q2-Q4 plans. CCG Finance and Performance Committee (FPC) and Governing Body approval dates will be confirmed once further guidance is issued by NHSE&I.

RESOLVED: The Governing Body:

 Noted the update on the operational and financial planning process for 2021/22.

10 Patient Safety and Quality Improvement report

Michelle Turner, Strategic Director for Quality and Nursing, presented the item which provided an update on key issues regarding living with Covid-19, the roll out of the vaccine, system resilience, the care of vulnerable children and progress by the system quality committee.

Michelle highlighted the ongoing efforts to support the care sector, such as the continuation of the super rota and other resources to support the physical and mental wellbeing of people in care homes through lockdown.

An update was provided on the stroke service and Michelle noted that the projected SSNAP rating (Sentinel Stroke National Audit Programme) is a C/B overall. Oversight of the service will be maintained via the Healthy Hearts Programme. Contributing factors to the change in score were waiting times, staffing in particularly in relation to timely scanning and speech & language therapy.

It was noted that the ECIST (Emergency Care Improvement Support Team) have been providing support to aid effective discharges and consider steps to improve patient flow at Airedale NHS Foundation Trust.

An update was provided on primary care and it was noted that Care Quality Commission (CQC) inspections remain suspended during Covid-19, however Michelle noted that to ensure continued safety and assurance throughout the pandemic, the CQC introduced an interim Emergency Support Framework (ESF). The ESF had now been replaced by a Transitional Regulatory Approach (TRA) which is also

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12 referred to as Transitional Monitoring Approach (TMA). A number of TMAs were noted to have taken place in practices across Bradford district and Craven.

Michelle noted the different areas included under the slide regarding vulnerable children – such as children looked after, children and young people mental health, children’s autism and complex children – and reflected on discussions that had taken place at QC and SQC. It was noted that a task and finish group had been established to consider ways to approach the different areas of concern and create some ‘traction’ in addressing these areas. Michelle advised on the recent Directorate for Education Review visit (early March 2021) and confirmed that all health partners were in attendance to demonstrate the progress made on key outcomes for vulnerable children.

Further updates were provided on recent meetings of the SQC, including discussions around planning and prioritisation and the impact of Covid-19 on the system-wide workforce.

RESOLVED: The Governing Body:

 Noted the information and assurance provided by the report, including key actions taken by the CCG to manage quality and safety issues and risks arising from Covid-19.

11 Safeguarding Annual Report 2019/20

Michelle Turner, Strategic Director for Quality and Nursing, presented the Safeguarding Children and Adults Annual Report 2019/20.

The report had been discussed in detail at a recent meeting of the QC held in February 2021 where the positive impact of additional investment in roles within the team had been noted.

RESOLVED: The Governing Body:

 Noted the report which was received and accepted at Quality Committee on 4 February 2021 with no amendments required.

12 Commissioning Assurance Framework

Stacey Fleming, Senior Governance and Resilience Manager, presented the item.

The Governing Body Assurance Framework (GBAF) of the three predecessor organisations had been used as the basis for the new Commissioning Assurance Framework (CAF) of the CCG. The framework identifies the principal risks to delivery of the CCG’s contribution to the Bradford District and Craven vision and strategic ambitions from a commissioning perspective. The strategic objectives and risks had been refreshed where possible and new risks had been added where required.

The name change from to ‘Commissioning Assurance Framework’ signals the move to a broader use of this strategic risk tool, with the aim of promoting wider use with members of the senior leadership team, associate clinical directors and the associate leadership team as well as the Governing Body.

Following receiving feedback at development sessions, the CAF will be presented to the Governing Body on a bi-meeting basis and will come to the meetings held in July 2021, November 2021 and March 2022.

High level changes were noted as follows:  one new risk (5.1) which relates to ICP readiness from 1 October 2021 (shadow form) and 1 April 2022 (in place)

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 an adapted risk regarding our people in transition (6.1) which now reflects the transition of CCG and other associated staff to the ICS, under the 11 February 2021 white paper ICS legislative changes  the strategic risk (7.2) is recommended to close, this is due in large part to the place based development of our Act As One way of working, which negates the need to describe the way we allocate resources separately.

RESOLVED: The Governing Body:  reviewed and approved the CAF / strategic risk log, as a fair and accurate reflection of the CCG’s current strategic risk position and agreed that 7.2 strategic risk can be closed  were assured that future Governing Body meetings will be provided with the CAF on a bi- meeting basis in July 2021, November 2021 and March 2022  were assured that the CAF use will be broader and will include consideration by: the senior leadership team, the associate clinical directors and the associate leadership team.

13 Review of Policies

Stacey Fleming, Senior Governance and Resilience Manager, presented the item.

The Policy on Receipt of Gifts, Hospitality & Sponsorship and the Conflicts of Interest & Business Conduct Policy were reviewed by the Audit & Governance Committee on 1 March 2021. The key proposed amendments were noted as follows:

Policy on Receipt of Gifts, Hospitality & Sponsorship Amendment to new CCG and accessibility standards compliance, approved by the Audit & Governance Committee

Conflicts of Interest & Business Conduct Policy Changes for the new CCG and accessibility standards compliance Version submitted to Governing Body for approval

RESOLVED: Following the recommendation of the Audit & Governance Committee, the Governing Body:

 reviewed and approved the updates to the following policies  noted the approval by the Audit & Governance Committee of the Policy on Receipt of Gifts, Hospitality & Sponsorship  approved the Conflicts of Interest & Business Conduct Policy.

14 High Level Risk Report

Stacey Fleming, Senior Governance and Resilience Manager, presented the high level risk report, which provided the Governing Body with details of risks with scores of 15 or above, new risks and risks closed during the current risk review cycle (Cycle 5 covering months January – February 2021).

During Cycle 5, two new risks had been added to the corporate risk register relating to unidentified carers and designated doctor provision for children looked after. These had risk scores of 20 (‘critical’ risk) and 12 (‘high level’ risk) respectively.

As well as the risk relating to unidentified carers, there was one other ‘critical’ risk on the corporate risk register relating to the Covid-19 pandemic which had a score of 25.

It was noted that there were currently 12 ‘serious’ level risks open on the risk register and further detail relating to these was provided within the report. Page 8 of 11

14

One risk relating to compliance with website and apps accessibility regulations had increased in score from a 4 to a 5. Two risks relating to member engagement in a larger CCG and post pandemic and IG processes and handling of personal data had decreased in score this cycle, both scoring six.

It was reported that currently there was a total of 15 open risks on the Covid-19 risk log, including one new risk relating delayed continuing healthcare reviews, appeals and retrospective reviews which scored nine (‘high level’ risk).

One risk relating to demand for mental health services had increased in score this cycle to 25 (‘critical’ level risk. There were three other ‘critical’ level risks open on the Covid-19 risk register relating to outcomes for the population being negatively impacted due to the lack of clear prioritisation of restarting services (scoring 20), increased health inequalities due to socio-economic and ethnicity factors (scoring 20) and Covid-19 impact on care homes (scoring 20).

Three risks relating to end of life experience, Covid-19 vaccinations and financial sustainability of the care home market were reported to be at the ‘serious’ level.

It was noted from Cycle 6 onwards, the two risk registers would be harmonised and all risks would be reported through the corporate risk register on a bi-monthly basis.

RESOLVED: The Governing Body:

 Received and noted the Risk Register Report and High Level Risk Register Log as at the end of Cycle 5 2020/21.

15 Exception Reports from Committee Chairs

Verbal updates were provided by Committee Chairs in order to share key messages with those present. Minutes of the most recent committee meetings had also been shared as part of meeting papers and would be noted under the ‘items to receive and note’ section of the agenda.

Audit and Governance Committee Bryan Millar, Chair of Audit & Governance (A&G) Committee, reflected on the good work undertaken by Audit Yorkshire in the lead up to the development of the new CCG and recognised the meaningful contribution they may be able to offer as we transition towards the ICS.

Bryan updated on the recent meeting of the A&G Committee held on 1 March 2021, in particular drawing attention to a report on Continuing Healthcare following an internal audit where ‘limited assurance’ had been given. Following the findings of the report, work had been done to address the issues identified in the report and as a result, the interface between organisations had been much improved.

Bryan reflected on the work of the A&G Committee during the transition to the new CCG and noted the willingness and expertise of members of the committee to support arrangements during this transitional year.

Finance and Performance Committee Neil Fell, Chair of the Finance and Performance Committee (FPC), thanked Robert for his comprehensive update around the financial position.

Neil updated that discussions had focused on the temporary financial and operation regimes in place and the complexities around contracting arrangements and the need to meet reset trajectories.

A specific issue had been highlighted relating to availability of monitoring information regarding BDCT contract activity.

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The work to clear the backlog of Continuing Healthcare referrals had been discussed. The timetable and arrangements for approval for Q1 and Q2-Q4 planning for 2021/22 was also noted.

Quality Committee David Richardson, Chair of the Quality Committee (QC), provided an update on the recent review of committee effectiveness that had been undertaken by the members of the QC. Following the review, it had been agreed that on a bi-meeting basis, more detailed discussions would be held to gain better quality assurance regarding deep dives into specific services or issues.

It was noted that Sasha Bhat had given a presentation to the QC on mental health services for children and young people and significant progress against recommendations noted in the Ofsted review had been reported.

An update had been provided regarding a new clinical model that was to be implemented in April 2021 regarding health assessments for children looked after in order to reduce the backlog.

Primary Care Commissioning Committee (PCCC) Ruby Bhatti, Chair of the PCCC, provided an update on the recent meeting where it was noted that the safehaven contract had been extended to September 2021.

The terms of reference of the PCCC had been reviewed and a review of committee effectiveness had also taken place.

Ruby advised that further discussions had been planned around assurance on decision making.

RESOLVED: The Governing Body:

 Received and noted the verbal updates from Committee Chairs.

16 Primary Care Commissioning Committee Minutes

The minutes of the Primary Care Commissioning held on 10 November 2020 were presented to the Governing Body for information and assurance.

RESOLVED: The Governing Body received and noted the minutes of the Primary Care Commissioning Committee held on 10 November 2020.

17 Finance, Contracting and Performance Committee Minutes

The minutes of the Finance, Contracting and Performance Committee held on 3 December 2020 and 7 January 2021 were presented to the Governing Body for information and assurance.

RESOLVED: The Governing Body received and noted the minutes of the Finance, Contracting and Performance Committee held on 3 December 2020 and 7 January 2021.

18 Quality Committee Minutes

The minutes of the Quality Committee held on 3 December 2020 and 7 January 2021 were presented to the Governing Body for information and assurance.

RESOLVED: The Governing Body received and noted the minutes of the Quality Committee held on 3 December 2020 and 7 January 2021.

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19 Audit & Governance Committee Minutes

The minutes of the Audit & Governance Committee held on 2 November 2020 were presented to the Governing Body for information and assurance.

RESOLVED: The Governing Body received and noted the minutes of the Audit & Governance Committee held on 2 November 2020.

20 Date and Time of Next Meeting

The date and time of the next meeting is Tuesday11 May 2021, 1.15pm – 4.15pm. VENUE: To be confirmed but likely to be a Zoom meeting held in public.

21 Exclusion of the Public

It was recommended that the following resolution be passed: “That representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest”.

RESOLVED: The Governing Body passed the resolution to exclude representatives of the press and other members of the public for the remainder of the meeting.

Page 11 of 11

17 Presented to the meeting held 11 May 2021

Governing Body: 2021/22 Action Log

Ref. Meeting Agenda Item Action Required Responsibility Due Date Comment

(2020/21) 5. Clinical Chair and The Bradford Economic Recovery Plan to Complete: Information circfualted via email 9.03.2021 Ali Jan Haider Mar-21 3 Chief Officer's Report be shared with Governing Body members. following meeting. 7. Review of the (2020/21) Sign off of updated SPA to be added to Complete: Added to forward planner for May 9.03.2021 Strategic Partnering Stacey Fleming May-21 4 forward planner for May 2021. 2021 meeting Agreement

18 1 NHS Bradford District and Craven CCG This document provides a summary and/or key discussion points and recommendations relevant to the subject of an item for consideration at the specified CCG meeting for the purpose of assurance, information, decision or action.

Agenda item 5

Name of meeting Governing Body Meeting date 11 May 2021 Helen Hirst, Chief Officer Title of report Chief Officer/Clinical Chair report Report author(s) James Thomas, Clinical Chair Lead(s) / SRO Helen Hirst Report lead(s) Helen Hirst James Thomas James Thomas

Paper summary and/or key discussion points This paper provides a brief update of the key issues, meetings and partnership activities affecting the CCG together with updates on national guidance and, where relevant, local impact of this guidance.

Appendix 1 provides a summary of the Senior Leadership Team meeting discussions and decisions.

Outline how this will help us to achieve our vision through our strategic ambitions:  Our population – improving health and equity for local people, and/or  Our partnerships – as the vehicle for enabling people to take more responsibility for their health, and/or  Our people – a skilled, motivated workforce with a culture of continuous improvement, and/or  Our leadership – assuring sustainability of our health and care system.

This report is relevant to all strategic objectives.

Purpose assurance information decision action

approve / recommend / review / consider / support / ratify comment / discuss Recommendation(s)

1. The Governing Body is asked to note the information and assurance provided by the report.

Appendices (or other supporting papers)

1. Summary of Senior Leadership Team meeting discussions and decisions.

19 Page 1 of 5 1. West Yorkshire & Harrogate Health and Care Partnership (WY&H HCP)

The March meeting of the Health and Care Partnership Board, was held in public:  Received an update on the focus and priorities of the WY&H Partnership work over the past three months;  Listened to the experience of an ICS staff member about her experience of having cancer and the care she received from services during the pandemic;  Received an update on the WY&H Anti-racism Movement; Received an update on the West Yorkshire Devolution plan;  Discussed planning priorities for 2021/22.

In April members of the System Leadership Executive Group:  Were updated on the current COVID-19 position;  Discussed the Operational Planning / guidance and financial framework for 2021/22;  Discussed the proposed workstreams for the WY&H Future Design and Transition group; this included; supporting a number of proposed clinical leadership principles and the next steps to progress them; and receiving an update on the HR framework development;  Discussed the appointment of the WY&H Integrated Care System Chair(s);  Received an update the Partnership response to learning disability deaths and COVID-19;  Received an update on the Partnership approach to personalised care in system recovery and committed to embedding the personalised care agenda within the future design of the WY&H Partnership arrangements.

The Joint Committee of CCGs: In March the Committee:  Received a presentation on the future of commissioning. This was in the context of the Commissioning Futures Programme, the Integration and Innovation White Paper and the future of population planning at place. They discussed the next steps and the role of the committee going forward;  Received an update of the main achievements of the Local Maternity System (LMS) in response to Better Births, the NHS Long Term Plan and Ockenden Report;  Received a presentation on strengthening the commissioning of the VCSE sector by reducing inequality of access, reducing unnecessary variation at place and building on existing best practice and supported the development of a set of shared principles for commissioning and working with the VCSE across all places and at system level.

In April the committee:  Approved the oversight framework for Assessment and Treatment Units (ATUs) for people with a learning disability; endorsed the proposals to further develop the collaborative commissioning model and agree a financial investment mechanism for year 2 onwards and supported the staged implementation of the new model with effect from Quarter 2 onwards.  Approved the extension of the WYH Healthy Hearts project by a further 12 months until 31 March.  Agreed the Diabetes Treatment Guidance for adoption across WY&H.  Discussed the implications for CCGs and planned future employment arrangements in relation to the White paper.

Helen and James also sit on the ICS design and transition group chaired by Rob Webster. This group meets fortnightly and oversees a number of workstreams including HR, ICP development, finance required as part of the ICS establishment work.

2. Business Continuity and resilience update

This section of the chief officer and clinical chair report outlines the current COVID situation in Bradford district and Craven. Updates on the CCG’s arrangements for the management of surge and escalation pressures across the system, responding to the post-EU exit period and addressing internal CCG matters are also referenced.

20 Page 2 of 5 2.1 Overview of local COVID-19 figures

The CCG produces a weekly COVID-19 dashboard that is shared with health and care partners across the system to enable identification of service pressures and the impact upon recovery. The City of Bradford Metropolitan District Council (CBMDC) Public Health team also produces a twice-weekly report with details of numbers of cases, hospitalisations and outbreaks. A verbal, contemporaneous summary of the current COVID-19 position can be provided in the Governing Body meeting to include; incidence, positivity rate, number of hospitalisations and number of deaths. 2.2 COVID-19 vaccination programme roll-out

The COVID-19 vaccination programme continues to roll out at pace. There are 17 vaccination sites across our footprint, including three hospital sites, 10 primary care network (PCN) sites, two community pharmacy sites and two community vaccination hubs. Our district met the target of offering a vaccine to all residents in JCVI cohorts 1-9 by the 15th March 2021. All sites commenced vaccinating 2nd vaccines at 11 weeks post first vaccine unless the person meets the green book criteria for an earlier 2nd vaccination (some specific clinical criteria).

Airedale hospital site will convert to a community vaccination site in early May and we have asked for expressions of interest for more community pharmacy sites in specific areas to ensure that we have enough capacity and a good geographic coverage of vaccination sites.

Two PCN sites and two hospital sites will cease vaccinating once they have completed the 2nd vaccines for the cohorts 1-9 that they vaccinated with a first vaccine. On April 12th 2021 all the remaining sites commenced vaccination of people in cohort 10 (aged 45-49 years in line with the national arrangements) whilst continuing to re-call anyone in cohort 1-9 who had not attended for vaccination when offered previously.

A verbal update of current numbers and cohorts vaccinated can be provided in the Governing Body meeting. 2.3 Health and care silver meeting

The Bradford district and Craven health and care silver command meetings continue to take place and are split into two sections:

 surge and escalation pressures  COVID-19 and post-EU exit Tactical actions are developed in response to the system service delivery requirements applicable to surge and escalation pressures, in relation to COVID-19 and the post-EU exit period. This includes ensuring that we have a co-ordinated system response to individual sector challenges as organisations respond to varying activity, staffing and other pressures. Given the changing nature of these issues, a verbal update of key matters can be provided within the Governing Body meeting. 2.4 Post-EU exit period

The CCG is no longer being asked to routinely provide situational reports (sit-rep) to NHS England applicable to the CCG as commissioner and on behalf of the small non-statutory providers, community interest companies (CICs), independent sector (IS) and primary care providers that the CCG commissions healthcare services from.

The CCG is still required to report any post-EU exit related issues by exception which may impact business critical services for any of the following areas: supply of medicines, medical devices, consumables, goods and services; supply of blood products, transplant organs and tissues; workforce; estates and facilities; clinical trials; data sharing, processing and access; reciprocal healthcare and cost recovery; partner organisations that are essential to delivery of healthcare. The CCG continues to meet informally with CBMDC to ensure that any required responses in the post-EU exit period are co-ordinated.

On 20 April 2021, NHS England published a letter to provide an update on the EU exit response. The letter covers the six month delay to the implementation of EU: UK border controls and also data, reciprocal care and cost recovery. The full letter is available at https://www.england.nhs.uk/wp- content/uploads/2021/04/BE509-eu-exit-nhs-update-letter.pdf

21 Page 3 of 5 2.5 CCG silver command meeting The CCG silver command monthly meeting is the forum for taking tactical decisions relevant to the organisation. As with the other elements of this report, any key issues for assurance to the Governing Body can be provided in the meeting.

3. Bradford District and Craven Partnerships

3.1 Wellbeing Board (Previously Health & Wellbeing Board)

At the Wellbeing development session in April a facilitated workshop was held on the development of the District plan. There was no meeting held in March.

3.2 Integrated Partnership Board (ICP) Executive (Previously Health and Care Executive Board) In February members received an update from the three Health Care Partnerships and the two System Committees. A discussion was held around vulnerable children where it was agreed that Therese Patten CEO of Bradford District Care Foundation Trust would be the Childrens Champion for our partnership. An update of the Better Care Fund was provided and there was a discussion on ICP development. Chris Hopson CEO, from NHS Providers joined the meeting to listen to the journey of our system and how we are progressing.

In March members discussed the Bradford Institute for health Research report: ‘From inequality to opportunity, a plan for regrowth’ (Born in Bradford). The ICP Board supported the work set out in the plan being taken forward.

The latest meeting, in April was taken up with the Q4/year end ICS review with just the ICP development programme being approved in the business part of the meeting.

3.3 Strategic Coordinating Group/Outbreak Control Board The Strategic Coordinating Group continues to meet fortnightly; the Outbreak Control Board meets weekly and receives updates on infection, testing and vaccinations and then determines what strategic and operational actions are required.

4. Operational Planning Guidance 2021/22

This was published on 25 March 2021 and is included in a separate paper.

5. The National Quality Board (NQB) The National Quality Board (NQB) has issued a Position Statement for those working in health and care systems. Endorsed by Lord Darzi, the Position Statement emphasises the importance of prioritizing the delivery of high-quality care at this crucial time of transition and sets out some core principles and consistent operational requirements for quality oversight in systems.

The Position Statement (Managing Risks and Improving Quality through Integrated Care Systems) sets out the NQB’s refreshed Shared Commitment to Quality to provide a common definition and vision of quality for those working in health and care systems. The refreshed version has been co-produced with systems and people with lived experience. It uses the existing Danzi-based definition of high quality care as being safe, effective and providing a positive experience with a greater emphasis on population health and health inequalities.

West Yorkshire is sited as a system case study along with other case studies in www.england.nhs.uk/ourwork/part-rel/nqb/.

The Position Statement describes the key requirements for quality oversight in ICS and some key principles.

During 2021-22 systems are expected to set up a System Quality Group (refreshed version of the West Yorkshire Quality Oversight Group). The effectiveness of these arrangements will signal system readiness and maturity.

22 Page 4 of 5 The NQB will release further information during 2021-22 namely a quality toolkit and policy work to clarify quality oversight arrangements at place and system level and clarification of roles and responsibilities at place, system and regional level.

6. Summary of Senior Leadership Team Discussions Please see attached a summary of the SLT meetings during the last two months at appendix 1

7. National Updates

7.1 Coronavirus (COVID‑19) On April 12 England moved into phase 2 on lifting coronavirus restrictions, phase 3 is expected to commence on May 17th.

For up to date guidance on all aspects of Covid-19 please visit the government website https://www.gov.uk/coronavirus

For local advice please visit the website below https://www.bradford.gov.uk/health/health-advice-and-support/coronavirus-covid-19-advice/

Your COVID recovery website has been launched to support those recovering from COVID-19 The NHS has launched a new website, ‘Your COVID Recovery’, which is aimed at supporting people who are recovering from COVID-19. It is targeted at people who have survived the virus but have persistent concerns related to areas such as breathing or mental health

For more information and to get support, visit. https://www.yourcovidrecovery.nhs.uk/

23 Page 5 of 5 Appendix 1

SLT updates for Governing Body: February 2021 – April 2021

17 February 2021 Sharing successes – Finance hub The team described that despite the additional pressures due to the pandemic they have managed to maintain their internal control against many competing priorities and timescales. They successfully moved from 3 CCGs to 1 CCG, and also worked through a significant amount of new guidance in relation to Covid-19. The past year has seen the team form stronger links across the system with provider colleagues and the ICS, which has provided peer support and promoted sharing best practice. The team have also worked closely with the care home sector and procurement teams. This has put the team in a good position as we move towards an Integrated Care Partnership (ICP) and the team aim to continue to build on these relationships going forward.

Sharing successes – Digital hub The pandemic has had a significant impact on this small team. Alongside managing the transition from eMBED to THIS in the initial stages of the pandemic; the team have supported over 3500 staff in the CCG and in practices to work remotely. They have supported the setup of the red hubs, vaccination centres; all this has been balanced and managed in a way that met all the requests for support. The team plan to link with the transformation programme so they have some input on the future strategy and what will be needed for the system.

Monthly report: Finance and digital update It was reported that as a result of local Trust block contracts, community services and running cost underspends, the additional savings target has been met, and therefore the forecast is a break-even position in line with Integrated Care System (ICS) plan, statutory financial targets for CCG and Place. It was noted the work this year has demonstrated how we have worked together as a system to achieve targets. It is important we hold this position and maintain this approach as we move into 2021/22.

It was reported that Wi-Fi testing in practices and at Scorex House was being investigated by an external company and was expected to be completed by the end of April. IT systems performance, the risk remains at red; issues have increased during Covid but are still within plan, there have been some issues with problems not being escalated through the correct channels, work is ongoing to resolve this. Conversations were ongoing around how some of the projects could be accelerated.

System (ICS) and place (ICP) updates It was reported conversations were being held around workforce design and developing an employment model at ICS.

Childrens services monthly report Members received a presentation around the management of children requiring complex care interventions and the potential to move fully to the Doncaster model for funding cases. It was felt the impact of moving to the model was not fully understood and requested that this be explored further. This was discussed in more detail on 31 March where it was felt that more clarity was needed around the due diligence element of the funding arrangements of the Doncaster model, an update is expected in May.

SLT approved the recommendation the Youth in Mind service contract was awarded to Mind in Bradford.

24 February 2021 Sharing successes – Quality hub The team reflected on how they have adapted in the past year. The team tragically lost a colleague to Covid-19 very early on in the pandemic, this gave them real determination to work differently and, to support the Covid-19 response, staff were redeployed to support the system where it has been impacted the most. The clinical staff in particular felt the need to support their frontline colleagues. The team see themselves as ‘fixers’ and have had to prioritise the work they do alongside, Covid, the team has maintained the core business things like safeguarding and domestic violence which

24 have both seen increases in activity. The team believe that all roads lead to quality, every aspect of health and care includes quality, and the team will continue to be constructively challenging and embrace the opportunity of the change we have been given to continue to support recovery from Covid-19, and help transform services.

Monthly report: Quality update Host commissioning arrangements: The CCG need to have something in place by end of March 2021, work is ongoing with Bradford District Care Foundation (BDCFT) Trust to finalise our position. The Safeguarding Children task and finish group was noted to be going well, Therese Patten (BDCFT) has volunteered to be the CEO Childrens champion. It was reported the backlog of Continuing Health Care (CHC) cases were not expected to be completed by the end of March.

System (ICS) and place (ICP) updates Ongoing conversations are continuing with our place CEOs around the design of our future ICP operating model. The West Yorkshire CCGs were planning to develop some single communications across the CCGs, sharing some basic information of how things will work for staff. Clinical leadership in the ICS was also being discussed and led by James Thomas..

CCG corporate risk register Members reviewed the risk register prior to presentation to the Governing Body. Staff fatigue and the ability to respond to the backlog of activity/increased waiting lists was highlighted.

Covid risks and issues log The log was reviewed and changes highlighted.

Annual review of SLT Terms of Reference (ToR) The updated ToR were approved

Annual review of committee effectiveness The audit and governance committee chair previously agreed that a ‘light touch’ approach could be taken to the 2020/21 committee effectiveness review, which should focus on general discussions rather than completion of questionnaires. A discussion took place in which members of SLT agreed that the meeting was managed effectively.

3 March 2021 Sharing successes: SCD - transformation and change The team shared their reflections, successes, and challenges. In the past 12 months they have worked through the formation of a new CCG, moved to hubs and matrix working and responded to the Covid response. This is a support and enabler team, they work closely with the partnership, contributing/developing, and nurturing so Bradford district and Craven can develop what it needs to deliver to provide better outcomes for the population. They have brought lived experiences and have shared their expertise and skills; the team are constantly looking to the future and ‘The next event’ which is the ICP development. The team continue to seek new relationships in the system and beyond, be un-blockers, learn new skills, and provide support and help and encourage partners to be fully engaged in the direction of travel.

Monthly report: Act as One Highlights included:  The work ongoing to improve DNA rates in low and moderate risk diabetic podiatry patients, this includes an exercise to contact people who are hard to reach and communicate better with them.  funding has been secured for the A&E navigator pilot, the project is due to go live in March working with Breaking the Cycle and VCS, this will include looking at a more holistic approach to people attending A&E.  Work is underway to redesign the programmes to strengthen the work and focus to address health inequalities across the system, identifying any gaps; work is ongoing to develop a system pathway for Long Covid and BDCFT plan to provide some enhanced support to programmes to strengthen the mental health presence.

System (ICS) and place (ICP) updates It was reported the Health and Care Executive Board had agreed to the establishment of formal programme arrangements to support the transition to an ICP. The Bradford district and Craven Clinical Forum were discussing what principles for clinical leadership may look like across the ICS and reflected in ICPs. An event is planned for 19 March; the event will provide feedback on the 25 review of the Strategic Partnership Agreement (SPA). The first population health management workshop was held, there was good attendance from across the system; the topic was the remit of the programme and how to embed the population health management approach in the ICP.

NHS staff survey 2020 - summary of results A summary of results was shared with SLT. Overall scores were broadly similar or slightly better than last year. It was felt whilst there were no major issues to cause concern, the scores around health and wellbeing were disappointing given the effort that has been undertaken to engage staff in the last 12 months, it was suggested this may be linked to remote working but agreed it should be explored further.

Plans re: the 'living with pain' service at BTHFT SLT supported a proposal to develop a more resilient community based service as the current service was no longer functional and there was a large waiting list of patients. It was noted the proposal was in line with the Act as One approach and would test the principles for shifting resource.

17 March 2021 Sharing successes: population health and wellbeing The team summarised the work they were doing across the system and place. The team have undertaken a restructure this year. The team have been working to socialise population health management, support the key functions of the CCG, link to the Act as One programmes. They have implemented the successful rollout of the RAIDR tool to practices and held a workshop to commence a population health management Act as One enabling programme in order to create a population health management function in the ICP and align BI functions across the system. The team have also played an important part in producing reports and dashboards which has highlighted how barriers have reduced during the pandemic and providing an opportunity to link into other organisation’s data.

Monthly report: performance The report highlighted that the impact from Covid was still being seen in the acute trusts; this was affecting bed occupancy and flow which was impacting recovery plans and restarting elective work. There were increased referrals for BDCFT mental health services and Inpatient mental health acuity was causing high levels of occupancy in the number of out of area beds commissioned. A discussion took place on the vaccination roll out and how the CCG could encourage hard to reach populations to have the vaccine.

System (ICS) and place (ICP) updates An update was provided on the work to look at the ICS operating model, workforce, clinical leadership, HR transition, and other strands being considered in ICS development. A future design and transition group to bring them together will be convened. A workshop has been planned to look at the principles of the resource shift in Act as One.

Children’s services monthly report It was reported the Childrens Looked after backlog would be cleared by December 2021; the new clinical model will be implemented by the end of April 2021 and will include GPwSIs. Public Health is planning a review of 0-19 health services and school nurses. Work is underway with the local authority to produce joint children’s strategy.

24 March 2021 Sharing successes: Organisation effectiveness hub This team cover a wide range of responsibilities around corporate affairs and assurance, they work hard to provide strong foundations for the CCG and keep it organised. The team connect to individuals, communities, and system partners and respond to people’s needs, both staff and our population. They are instrumental in supporting staff wellbeing, equality, diversity, and inclusion and patient support, alongside having system oversight, managing governance arrangements and ensure business continuity. It has been a collective effort to keep all these functions running smoothly over the past 12 months and the team are proud of what they have achieved in difficult circumstances.

26 Monthly report: finance and digital No significant changes were reported, the CCG forecast is a breakeven position, and expectation that we will meet ICS plan and statutory financial targets for 2020/21.

IT systems performance: Windows 10 upgrade in progress to help mitigate performance issues, expect to be completed by April 2021. It was noted that there may be a risk of delay around testing and the performance of some the applications. It was agreed that an external person should be sourced to review the IT incident action plan to ensure there are no gaps and look at practice/CCG responsibilities

System (ICS) and place (ICP) updates It was reported that a WY&H Future Design and Transition Group had been convened. This includes the five accountable officers and some work stream leads, initially they will look to align the ICP and ICS operating models.

CCG corporate risk register Members reviewed the risk register prior to presentation to the Governing Body. All Covid risks have moved over to the corporate risk register and all risks will be reviewed on a bi-monthly basis.

Mediscan Any Qualified Provider SLT were informed of a decision to suspend referrals to the endoscopy service due to a number of quality, safety and patient experience concerns being raised.

Department for Education (DfE) visit: vulnerable children It was reported that initial informal feedback suggested the visit had gone well and the DfE were pleased with the progress made. It was noted that this progress needs to be sustained going forward.

31 March 2021 Joint placement panel - impact and potential risks of changing models Update as 17 February above.

Monthly report: Quality The CHC backlog is expected to be completed by May 2021. NHSE have offered some staff support. The CCG will have to pick up the cost of cases from March. The CQC have started undertaking reviews again, they will be using a different approach and conducting at place rather than provider.

System (ICS) and place (ICP) updates The Strategic Partnership Agreement is near completion and will be presented at Board meetings throughout April/May to be signed off. A transition programme board is being convened; this will have a formal programme board structure and will look at strategy, delivery, and leadership. The transition programme board will report into the Integrated Care Partnership Board (formerly Health and Care Executive Board) which will oversee delivery.

HR policies and procedures for approval SLT approved the updated Equal opportunities policy and the raising concerns (whistleblowing) policy and procedure. Given the significant time needed to engage with staff and update/develop new policies, a proposal to roll over all current polices (except where there is a legislation change) with a specified extension date was supported. Polices will be reviewed as part of the development of the ICS, staff will be engaged in this through WY wide fora.

Issues re: warfarin supply SLT were asked to approve a change to the anticoagulation service provision at Bradford Royal Infirmary. Given that there were a number of conflicts of interests of the Strategic Clinical Directors it was agreed the item would be referred to the Governing body for a decision.

Additional days leave

27 SLT supported a proposal to give CCG staff an additional days leave to acknowledge their hard work during the past year. This is in line with other local NHS organisations.

7 April 2021 Sharing success: SCD – Keeping Well Each of the seven pods of the Keeping Well hub gave a brief presentation on their experiences during the past 12 months. The seven pods are: Aging Well, Care at Home, Respiratory, CVD and Diabetes; Children and Young people; Mental Health Autism and Urgent Care; Community Partnerships Living Well and Carers; Access and Cancer; Primary Care and Transformation of contracting. The hub described their ultimate aim as ‘the population needing to use as many services in 20 years’, this will because the living well team will have supported and encouraged them to look after their wellbeing. But in the meantime the team will continue to focus and help to deliver what is needed to continue to provide better outcomes for our population. The health and wellbeing thread is visible throughout everything the team does.

Monthly report: Act as One Some of the ways the system is showcasing the work it is doing locally and nationally were shared; this included West Yorkshire and Harrogate Healthy Hearts which was featured on the BBC and in the Times newspaper. The @ActAsOneBDC twitter account has been launched, and details of the Act as One Festival (27th April – 20th May) were shared.

System (ICS) and place (ICP) updates Members received feedback from the West Yorkshire System Leadership Executive Group (SLEG) and Joint Committee of CCGs.

May Governing Body agendas SLT agreed the agendas for the May Governing Body meeting.

Quarterly update – Individual Funding Request (IFR) panel Members received an update which described the processes in place to ensure there is equity for all the population to access the panel; the activity and how the panel had adapted to working remotely during the past year. SLT discussed the future of the panel as we move towards an ICP. SLT approved the updated IFR policy and procedure and the Botulinum Toxin commissioning policy.

28 NHS Bradford District & Craven CCG

Name of Meeting Governing Body Meeting Date 11 May 2021

Title of Report and Operational Planning Guidance Report Author Helen Hirst, Chief Officer Agenda Reference 2021/2022 Governing Body Helen Hirst, Chief Officer Lead Report Lead at Meeting Helen Hirst, Chief Officer Clinical Lead N/A Group(s)/ Committee (s) that have previously N/A Meeting Date N/A considered this paper

Executive Summary

Operational planning guidance for 2021/2022 was issued by NHS England & Improvement on the 25th March 2021. https://www.england.nhs.uk/operational- planning-and-contracting/

The guidance sets out the priorities for the year, acknowledging the impact of Covid in 2020/21 and the continued pressures on the NHS and other partners as Covid restrictions continue to impact on systems and organisations’ ability to recover and restore services, manage the ongoing impact of Covid and continue with the enormity of the vaccination programme.

The guidance recognises that Covid has taken its toll on staff working in health and care and has brought to the fore the huge health inequalities in our system. As well as focusing on these two areas and recovering and restoration of services the guidance sets expectations for the development of health and care Paper Summary / Key systems and collaborative working through the operational and financial planning Discussion Points arrangements.

Priorities:

A. Supporting the health and wellbeing of staff and taking action on recruitment and retention B. Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19 C. Building on what we have learned during the pandemic to transform the delivery of services, accelerate the restoration of elective and cancer care and manage the increasing demand on mental health services D. Expanding primary care capacity to improve access, local health outcomes and address health inequalities E. Transforming community and urgent and emergency care to prevent inappropriate attendance at emergency departments (ED), improve timely admission to hospital for ED patients and reduce length of stay F. Working collaboratively across systems to deliver on these priorities.

29 The Government has agreed an overall financial settlement for the NHS for the first half of the year which provides an additional £6.6bn + £1.5bn for COVID-19 costs above the original mandate.

The financial settlement for months 7-12 will be agreed once there is greater certainty around the circumstances facing the NHS going into the second half of the year.

In addition, £1.5bn funding has been allocated for elective recovery, mental health and workforce development.

ICSs have been asked to develop fully triangulated plans across activity, workforce and money for the first half of the year. For mental health these plans are for 12 months as the funding envelope is for 12 months.

Assurance Information Decision Action

Approve Review Primary Purpose Recommend Consider

Support Comment Ratify Discuss

The Governing Body is asked to:-

Recommendation(s) a) Note the contents of the Operational Planning Guidance for the NHS for 2021/2022.

Group(s)/ Committee (s) that this paper N/A Meeting Date now needs to be submitted to

Supporting Information

Contributes to financial sustainability and improves quality of Strategic Objectives commissioned services. Quality and Safety implications (how will the contents of this paper impact on safety, effectiveness and N/A experience going forwards?; is an equality impact analysis required?) Public / Patient / Other engagement or involvement undertaken or planned (including with the Bradford CCG’s People’s Board or the N/A AWC CCG Hub where applicable) or experience insight used to inform the paper

30

Resources / Finance implications (including staffing These are covered in the report. / workforce considerations)

Legal / Constitutional implications

(a) Does this paper mitigate against or provide assurance on the management of a strategic risk(s) included in the Governing Body Assurance Framework? No.

Link to Corporate Risk (b) Does this paper mitigate against or provide assurance on the Register / Governing Body management of a risk(s) included in the Corporate Risk Register? If yes, please specify which risk(s): Yes (achievement of CCG Assurance Framework financial sustainability).

(c) Does this paper identify any new risks that require inclusion in the GBAF or Corporate Risk Register? No

Potential Conflicts of Interest Not applicable. and Proposed Management

31 NHS Bradford District & Craven CCG

Name of Meeting Governing Body Meeting Date 11 May 2021 Title of Report and CCG Financial Plan for April 2021 Report Author Robert Maden, Chief Agenda Reference to September 2021. Finance Officer Governing Body Robert Maden, CFO Lead Report Lead at Meeting Robert Maden, CFO Clinical Lead N/A Group(s)/ Committee (s) that Finance and Performance have previously Meeting Date 30 April 2021 considered this Committee. paper

Executive Summary

Operational planning guidance for the period April 2021 to September 2021 (H1) was issued and NHS England & Improvement on the 25th March 2021. This confirmed that the financial arrangements that applied for the last six months of the 2020/21 financial year (H2) will also apply to the first six months of 2021/22, referred to as H1.

From a funding perspective, this means that the West Yorkshire & Harrogate ICS (WY&H ICS) fixed funding envelope has been rolled forward with adjustments for: - a basic national tariff uplift; - a national assessment of CCG Programme and delegated primary care co- commissioning growth funding; - the reinstatement of the funding deduction made for local acute independent Paper Summary / Key sector activity; and Discussion Points - funding to meet Mental Health Investment Standard requirements.

As part of the national calculation of the WY&H ICS fixed funding envelope for H1 (2021/22), organisational level budgets were also calculated which ICS’s could choose to use to determine organisation level shares of the funding envelope. To aid stability and to ease the planning burden, organisations in the WY&H ICS agreed to roll-forward their funding levels from H2 (2020/21), with adjustments for the items listed above. The resulting CCG share of the WY&H ICS funding envelope forms the basis of the CCG’s financial plan for H1 (2021/22) as detailed in the slide-pack.

A key focus in the operational planning guidance is the restoration of elective and cancer care and managing the increasing demand on mental health services.

32

To support this, additional funding of £1.5bn (as announced in the last Spending Review) is now being made available through the Elective Recovery Fund (£1bn) and through system level allocations for mental health services (£0.5bn).

For the Elective Recovery Fund, organisational level financial baselines have been set, but performance to access this funding will be assessed at an ICS level. Therefore, financial risk management arrangements are being agreed by the WY&H ICS to maximise the flow of funds to organisations that exceed their Elective Recovery Fund baselines. For the CCG, this baseline relates to independent sector acute activity.

Other funding available to the CCG in addition to the fixed funding envelope comes from the Hospital Discharge scheme which will continue to operate in H1 (2021/22).

Attached is the April 2021 to September 2021 (H2) budget slide-pack for the CCG that was considered and discussed by the Finance & Performance Committee on behalf of the Governing Body. The paper sets out the CCG’s operational budget for the first six months of the 2021/22 financial year and the main financial risks associated with operating under the financial arrangements for H1 (2021/22).

Key points to note regarding the H1 (2021/22) budgets are:

i) A combination of the brought forward underlying position and the local assessment of cost pressures mean that expenditure budgets exceed available resources by £5.5m. This is on the basis that 100% of Elective Recovery Fund income (£2.3m) is received and the minimum required level of cost savings of £1.45m (0.28% of resources) are achieved;

ii) The CCG has a break-even financial target and therefore the financial gap of £5.5m will also need to be resolved in order to meet this target;

iii) Contingency reserves of £2.5m are included in the plan and are expected to be used to cover the savings shortfall against the minimum savings requirement of £1.45m, with the balance being used to manage other activity pressures. Also, a level of non-recurrent budget underspend is expected to arise to help manage any further pressures;

iv) In line with the WY&H ICS financial risk managements principles, organisations within the Bradford Place have collectively agreed to manage expenditure within the resources available to the Bradford Place, in a similar way as for H2 (2020/21) and therefore we expect to be able to manage the financial gap of £5.5m in H1 (2021/22);

v) There remains a further risk relating to full recovery of Elective Recovery Fund income and this will be minimised as far as possible through risk management arrangements operating across WY&H ICS organisations. To the extent that less than 100% of Elective Recovery Fund income is received, this will add to the financial pressure to be managed locally;

vi) Provision has been made to increase investment in mental health services in line with Mental Health Investment Standard requirements;

vii) Running costs remain within the target set by NHS England and Improvement;

33

viii) The budget proposal and associated risk assessment is based on the current COVID situation not deteriorating significantly, but if this were to happen, e.g a third wave, then both non-COVID and COVID related costs are likely to increase to support the continued response to the pandemic.

Financial risk mitigation is a combination of:

- Strict CCG financial management, including the deferral of expenditure where possible; - Collaborative Bradford Place financial risk sharing as in H2 (2020/21; and - Financial risk sharing across the West Yorkshire & Harrogate ICS in line with the financial principles agreed by partner organisations.

These financial risk mitigations will ensure that either the CCG achieves a financial break-even position, or if financial risk in 2021/22 cannot be managed in total across the ICS, then the CCG will take a share of the overall ICS deficit position.

The Finance & Performance Committee recommends that the Governing Body approves the April 2021 to September 2021 Budget on the basis set out in the recommendations below.

Assurance Information Decision Action

Approve Review Primary Purpose Recommend Consider

Support Comment Ratify Discuss

The Governing Body is asked to:-

a) Note the contents of the report and the recommendation from the Finance and Performance Committee that the operational budget for the period April 2021 to September 2021 (H1) is approved;

b) Note the financial risks associated with operating under the financial arrangements for H1 and the combination of mitigations in place to Recommendation(s) manage this risk;

c) Endorse the need to act in line with the financial principles agreed by partner organisations in the ICS to manage the overall ICS financial position, noting the significant reliance on the level of Place mitigation required; and

d) Endorse the need to retain the current expenditure controls and in particular for new commitments to continue to be approved on an exceptions basis and in line with our local ‘Act as One’ arrangements.

Group(s)/ Committee (s) that this paper N/A Meeting Date now needs to be submitted to

34

Supporting Information

Contributes to financial sustainability and improves quality of Strategic Objectives commissioned services. Quality and Safety implications (how will the contents of this paper impact on safety, effectiveness and N/A experience going forwards?; is an equality impact analysis required?) Public / Patient / Other engagement or involvement undertaken or planned (including with the Bradford CCG’s People’s Board or the N/A AWC CCG Hub where applicable) or experience insight used to inform the paper

Resources / Finance implications (including staffing These are covered in the report. / workforce considerations)

Legal / Constitutional implications

(a) Does this paper mitigate against or provide assurance on the management of a strategic risk(s) included in the Governing Body Assurance Framework? No.

Link to Corporate Risk (b) Does this paper mitigate against or provide assurance on the Register / Governing Body management of a risk(s) included in the Corporate Risk Register? If yes, please specify which risk(s): Yes (achievement of CCG Assurance Framework financial sustainability).

(c) Does this paper identify any new risks that require inclusion in the GBAF or Corporate Risk Register? No

Potential Conflicts of Interest Not applicable. and Proposed Management

35 FINANCIAL PLAN, H1 2021/22 GOVERNING BODY 11th MAY 2021

36 Happy, healthy at home in Bradford District and Craven Planning Requirements

• Deliver the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19. • Build on what we have learned during the pandemic to transform the delivery of services, accelerate the restoration of elective and cancer care and manage the increasing demand on mental health services. • Expand primary care capacity to improve access, health outcomes and address health inequalities. • Transform community and urgent & emergency care to prevent inappropriate emergency department attendance, improve timely admission from ED and reduce length of stay. • Rollout the 2 hour crisis community response at home (additional transformational funding for this. • Work collaboratively across systems to deliver these priorities.

37 Happy, healthy at home in Bradford District and Craven Financial Plan - Funding Basis for H1 2021/22

 As agreed at the WY&H ICS Finance Forum, organisation level funding envelopes have been rolled forward from H2 2020/21 with adjustments for: - CCG Programme Growth; - Reinstatement of acute independent sector contract funding deduction; - MHIS adjustment to normalise for 6 months; - Further Specialised Commissioning Transfers; - Primary Medical Care Growth Uplift as per published allocations; - Further funding to meet 2021/22 MHIS requirements.  No uplift to running cost allocations.

 Additional funding for elective recovery and mental health recovery (national £1bn and £0.5bn).  Hospital Discharge Scheme (Discharge to Assess) funding continues in H1.  No access to historic surpluses.

38 Happy, healthy at home in Bradford District and Craven Financial Plan - Additional Funding for H1

 Elective Recovery Fund – CCG baseline = value of activity over 2019/20 baseline for IS activity; – Baseline increases from 70% of the 2019/20 baseline value in April to 85% from July onwards; – No downside adjustment; – £1bn available nationally; and – Measured at an ICS level.

 Hospital Discharge Scheme (Discharge to Assess) - First 6 weeks of care package reimbursed for Q1; - First 4 weeks of care packages reimbursed for Q2.

 Mental Health Recovery - Share of national £0.5bn expected and used to bring forward Mental Health View investments. (Not in Plan as allocation not confirmed).  Community Services - Additional funding expected for 2 hour community crisis response at home service. (Not in Plan as allocation not confirmed).

39 Happy, healthy at home in Bradford District and Craven H1 Expenditure Budgets - Approach

 Expenditure budgets are based on: - Roll-forward of NHS Trust block contract values + 0.5% uplift as per planning guidance; - Local contracts for all acute IS activity, including providers previously covered by national arrangements; - National Tariff uplift of 0.2% (excludes A4C pay award uplift); - Local inflation / growth uplifts as per Table on next slide; - Increased investment in line with MHIS requirements; - Removal of non-recurrent savings and costs; - Establishment of contingency reserves at 0.5% of resources; and - Savings target of 0.28% of resources as per planning guidance.

 Expenditure budgets are gross of additional funding from the Elective Recovery Fund and the Hospital Discharge Scheme.

40 Happy, healthy at home in Bradford District and Craven H1 Expenditure Budgets - Uplifts

The Table shows the national cost uplifts that drive the overall CCG programme uplift of 0.9% compared against our local assessment of inflation and growth pressures that have been included in the H1 budgets.

Growth assumptions 2021/22 CCG Plan Guidance NHS block 0.50% 0.50% IS Inflation 0.20% 0.20% Prescribing uplift reflects local growth Prescribing Cost inflation 0.00% 3.50% seen over 2020/21.

Prescribing Growth 0.68% 0.60% Continuing care uplift reflects an overall Primary Care 4.50% 4.47% fee increase of 4.5% and activity growth of 1.5%. CHC 1.56% 6.00%

FNC 3.40% 3.48% A4C pay award based on a 2% national settlement (not finalised yet). Some BCF 5.30% 5.30% additional resource may be received for Other programme 1.09% 1.09% this, but not for the running cost element. Community 0.67% 0.67%

Pay - Non A4C 0.00% 1.00% Pay - A4C 0 2.00%

41 Happy, healthy at home in Bradford District and Craven Overall Plan Movements – Underlying Position

UNDERLYING POSITION The H2 underlying deficit Cost / has increased from the £'000 Resource Expenditure (Benefit) opening deficit of £2.8m to Forecast Outturn, H2 2020/21 503,017 503,017 0 £4m due mainly to higher Less Outside of Envelope Funding -9,119 -9,119 0 recurrent costs in Net Forecast Outturn, H2 2020/21 493,898 493,898 0 prescribing and mental health. Less Non-Recurrent Allocations, H2 -8,291 -8,291

Net Non-Recurrent Underspends, H2 3,940 The increase in the underlying deficit was H2 Baseline 485,607 489,547 3,940 funded from non-recurrent Remove Service Development Funding -2,419 -2,419 underspends in 2020/21, Part Year Effect of In-Year Developments 66 including £600k of surplus prior year accruals. Underlying Recurrent Deficit, H2 483,188 487,194 4,006

42 Happy, healthy at home in Bradford District and Craven Overall Plan Movements – H1 Plan Position Cost / Resource Expenditure (Benefit) Underlying Recurrent Deficit, H2 483,188 487,194 4,006

Independent Sector Activity Reinstatement 17,162 16,246 Tariff / Cost Inflation 6,993 Growth 2,369 H1 Mental Health Investment Standard 1,765 1,765 H1 Plan shows a deficit of £5.5m H1 Service Developments 2,598 2,608 after additional funding of £2.3m Reduction in COVID costs -333 from the Elective Recovery Fund.

RIC Scheme Slippage 544 Excluding ERF funding, there is a Contingency Reserves (0.5%) 2,522 Plan deficit of £7.8m Savings Requirement (0.28%) -1,454 H1 Growth Funding (0.9%) 3,872 H1 Primary Care Growth Funding 2,861 H1 MHIS Funding Adj. -1,342 H1 Other Funding Adjs. -58 H1 Outside of Envelope Funding 2,891

H1 Plan Position 512,937 518,454 5,517

43 Happy, healthy at home in Bradford District and Craven SUMMARY, H2 2020/21 TO H1 2021/22

SUMMARY PLAN MOVEMENT £'000 H2 Underlying Deficit 4,006 Local Growth Uplifts vs National Uplifts 1,105 Local decision Creation of Contingency Reserve 2,522 0.5% requirement MHIS Funding Reduction 1,342 National adjustment Savings Requirement -1,454 0.28% minimum Development Spend 629 RIC schemes Reduction in COVID Costs -333 H1 Plan Deficit Before ERF 7,817 Elective Recovery Fund offset -2,300 H1 Plan Deficit After ERF 5,517

44 Happy, healthy at home in Bradford District and Craven SUMMARY, H1 FINANCIAL PLAN

H1 FINANCIAL PLAN ICS PLAN SUBMISSION £'000 £'000 RESOURCES ICS FUNDING ENVELOPE 510,046 510,046 ERF & HDS FUNDING 2,891 2,891 TOTAL FUNDING 512,937 512,937

EXPENDITURE BUDGETS GROSS BUDGETS 517,386 517,386 SAVINGS TARGET -1,454 0.28% -6,971 1.36% CONTINGENCY RESERVES 2,522 2,522 TOTAL EXPENDITURE BUDGETS 518,454 512,937

H1 PLAN DEFICIT 5,517 0

45 Happy, healthy at home in Bradford District and Craven H1, 2021/22 BUDGET – Appendix 1

APPENDIX 1b

H1 2021/22 H2, Roll- H2 Recurrent Reinstate H1 2021/22 forward Movement % Change Expenditure Local IS Costs Budget £'000 Expenditure Acute Care 222,121 16,246 238,367 239,653 1,286 0.54%

Urgent Care 18,934 18,934 19,171 237 1.25%

Community Services 38,413 38,413 38,665 252 0.66%

Personalised Commissioning 27,248 27,248 28,799 1,551 5.69%

Mental Health and LD Services 48,808 48,808 53,215 4,407 9.03%

Prescribing 52,959 52,959 55,386 2,427 4.58%

Primary Medical Care 52,019 52,019 54,221 2,202 4.23%

Other Primary Care 2,996 2,996 2,910 -86 -2.87%

Other Commissioning 752 752 933 181 24.07%

Better Care Fund 9,909 9,909 10,434 525 5.30%

Support Functions 4,660 4,660 4,730 70 1.50%

RIC Investments 3,049 3,049 3,821 772 25.32% QIPP Savings Balance 0 0 -6,971

Total Operating Costs 481,868 16,246 498,114 504,967 13,824

Contingency Reserves 0 0 2,522 2,522

Other Reserves 0 0 0 0

Total Reserves 0 0 0 2,522 2,522

Total Healthcare Expenditure 481,868 16,246 498,114 507,489 16,346

CCG Running Costs 5,321 5,321 5,448 127 2.39%

Total Expenditure 487,189 16,246 503,435 512,937 16,473

46 Happy, healthy at home in Bradford District and Craven FINANCIAL RISKS

 MAIN RISKS: 1) Savings shortfall (currently unidentified) £1,454k 2) Activity risk (mainly Continuing Healthcare) £1,068k

Fully offset by use of Contingency Reserves £2,522k - Expect to generate in-year non-recurrent savings to help manage the position; - Will review prescribing and continuing healthcare expenditure for savings opportunities; and - Controls on new expenditure commitments (exceptions basis) to continue.

3) Additional Savings to Achieve a Balanced Position £5,517k

Collective Agreement to Manage Through Place Based Risk Sharing £5,517k (Local Trusts have balanced Plans for H1)

47 Happy, healthy at home in Bradford District and Craven FINANCIAL RISKS cont.

4) Receipt of Full Elective Recovery Funding depends on performance across the ICS which may result in less than 100% of the expected £2,300k funding being received.

Application of WY&H ICS ERF risk sharing principles to maximise recovery for organisations that exceed their ERF baseline.

48 Happy, healthy at home in Bradford District and Craven ICS RISK MANAGEMENT ARRANGEMENTS

The West Yorkshire & Harrogate ICS financial risk sharing principles that were employed in the second half of 2020/21 will be used again for the first half of 2021/22. These are:

 Subsidiarity principle: Organisation / place / WY.

 Reasonable endeavours to manage risk.

 Supportive and constructive peer review.

 Mutual financial support as last resort. System offset (2019/20) Redistribution of system funding (2020/21) Reasonable endeavours to improve positions

 Mutual formal agreement of all NHS parties for H1 2021/22.

49 Happy, healthy at home in Bradford District and Craven GOVERNING BODY CONSIDERATIONS

The Finance and Performance committee recommends that the Governing Body approves the April to September 2021 budget on the following basis:

The Governing Body is asked to:

a) Note the contents of the report and the recommendation from the Finance and Performance Committee that the operational budget for the period April 2021 to September 2021 (H1) is approved;

b) Note the financial risks associated with operating under the financial arrangements for H1 and the combination of mitigations in place to manage this risk;

c) Endorse the need to act in line with the financial principles agreed by partner organisations in the ICS to manage the overall ICS financial position, noting the significant reliance on the level of Place mitigation required;

d) Endorse the need to retain the current expenditure controls and in particular for new commitments to continue to be approved on an exceptions basis and in line with our local ‘Act as One’ arrangements.

50 Happy, healthy at home in Bradford District and Craven NHS Bradford District and Craven CCG This document provides a summary and/or key discussion points and recommendations relevant to the subject of an item for consideration at the specified CCG meeting for the purpose of assurance, information, decision or action.

Agenda item 6.3

Name of meeting Governing Body Meeting date 11 May 2021 Kerry Weir, Associate Director, Population Health and Wellbeing Helen Farmer, Programme System performance, Recovery Title of report Report author(s) Director – Access to Care and Access Louise Clarke, Clinical Director of Strategy and Planning Bradford district & Craven CCG Lead(s) / SRO Louise Clarke Report lead(s) Louise Clarke

Paper summary and/or key discussion points

The priority areas for 2021/22 planning guidance have been published and work is underway to collate our system plan for Bradford district & Craven which will form our part of the ICS response. This paper sets out our current performance position and the work that is being undertaken within the Access programme to support recovery.

Outline how this will help us to achieve our vision through our strategic ambitions:  Our population – improving health and equity for local people, and/or  Our partnerships – as the vehicle for enabling people to take more responsibility for their health, and/or  Our people – a skilled, motivated workforce with a culture of continuous improvement, and/or  Our leadership – assuring sustainability of our health and care system.

The CCG currently maintains oversight for our population’s access, outcomes and experience of care, and for equity of access across the population. This is currently delivered via our provider partners, and is coordinated at a system level through our partnership programmes (including the Access to Care programme) and system committees. Our system will need to realign resource to support service transformation in these programmes and this will bring with it an inevitable challenge that will be addressed via our system leadership and oversight.

Purpose assurance information decision action

approve / recommend / review / consider / support / ratify comment / discuss Recommendation(s)

The Governing Body is asked to: 1. Note the current position and support the work of the Access to Care programme

Appendices (or other supporting papers)

1. System Performance Recovery and Access

51 Page 1 of 8

52 Page 2 of 8 Appendix 1 System performance, recovery and access

2021/22 priorities and operational planning guidance (25th March 2021)

All of our organisations and our programmes will have a role in delivering on the plans for 2021/22. There is a significant role for the Access programme in relation to elective care recovery, cancer recovery, and best use of system resources in urgent care. The priorities set out in the guidance are: A. Supporting the health and wellbeing of staff and taking action on recruitment and retention B. Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19 C. Building on what we have learned during the pandemic to transform the delivery of services, accelerate the restoration of elective and cancer care and manage the increasing demand on mental health services D. Expanding primary care capacity to improve access, local health outcomes and address health inequalities E. Transforming community and urgent and emergency care to prevent inappropriate attendance at emergency departments (ED), improve timely admission to hospital for ED patients and reduce length of stay F. Working collaboratively across systems to deliver on these priorities. Our current system performance

The following presents performance against some of the key national performance indicators that measure access to health services and which NHS Trusts and CCGs have to deliver as part of their operational plans. Hospital services As Covid levels, reduce both Bradford Teaching Hospitals Foundation Trust (BTHFT) and Airedale Hospital Foundation Trust (AHFT) are seeing increasing attendances at A&E. Both Trusts continue to respond to the challenges associated with the management of hot (Covid) and cold pathways and delivery of the 4 hour access standard remains at circa 85%. Specific actions at AHFT include the continuation of the minor injuries unit (MIU) model successfully trialled during the first Covid peak in the area adjacent to the Emergency Department (ED), a review of skill mix/medical workforce model/shift times to meet changes in demand later in the day and evening period and a review of waiting areas has been undertaken and screens purchased to segregate hot/cold and adults/paediatric attendances. These are now in use and working well. There has also been a Trust wide consultation on the new Emergency care standards planned for February and March to understand the impacts on service, people and process to ensure high quality care. BTHFT urgent care transformational plans are continuing with a view to deliver and improve on Same Day Emergency Care (SDEC) and See and Treat (S&T) pathways, which are relieving over-crowding in the waiting areas. The Medical SDEC model has been developed and implemented and plans are in place to develop the Surgical SDEC on ward 2 and 5. This will further reduce the overcrowding in ED. A potential opportunity to co-locate the Urgent Treatment Centre is being discussed as part of Urgent Care Programme. 18 week performance continues to be a challenge as, although outpatient activity continues to increase with a mix of face to face and virtual appointments, elective capacity has been significantly impacted by Covid. As a result 52+ week breaches are increasing and there are 19 patients at BTHFT who have waited >104 weeks.

53 Page 3 of 8 AHFT’s phased recovery plan commenced from 15th March, and aims to incrementally increase theatres through to 12th April, when all theatres will be fully operational. The Trust’s Referral Assessment Service (RAS) continues to operate, with clinical triage in place to reduce face to face demand and offer alternative treatments/options, and teams are undertaking a deep dive in the areas that have seen an increase in overdue follow up activity. BTHFT elective inpatient activity continues to be below planned levels. The third Covid wave reduced elective ordinary spells in January and an electrical fire in early February delayed the ability to increase inpatient activity sessions until March. Scheduling processes remain in place to maximise the lists that are running and the clinical priority for all inpatient waits has been added to the Patient Tracking Lists (PTL) which is supporting the aligning of clinical priority with wait time analysis, with teams working to ensure all priority 2 patients and any outpatient waits over 52 weeks have clear next steps planned. Cancer treatment capacity has been protected through the clinical prioritisation process and both Trusts continue to track progress at patient level in order to ensure the care offer is made as timely as possible and monthly breach reviews continue. Following a significant increase in breast referrals recently at AHFT, the service has continued to improve access times for patients and the 2 week wait (2WW) standard was achieved during February. Whilst BTHFT performance remained above target in February, it is likely to deteriorate in March due to pathway changes within Leeds general Infirmary, moving more patients to straight to test (STT). The initial delays in time to first appointment are being offset by improvements in time to diagnosis. Meeting the 85% performance standard for 62 day cancer treatments continues to be challenging due to the number of people who have already been waiting over 62 days, although as both elective and diagnostic capacity recovers, this number is now reducing. Diagnostic performance continues to improve, with both Trusts making use of Independent Sector capacity. Endoscopy continues to be the biggest challenge. The AHFT Endoscopy department continues to operate a 3 room timetable during weekdays with additional weekend sessions running supported by an external insourced agency alongside AHFT operators and nursing teams. These sessions are included in business planning to continue into 2021/22 to support recovery and improve performance. The BTHFT Endoscopy department is continuing to work with the independent sector, which has supported a significant increase in activity during February which will continue throughout March and into the coming financial year. Community Care Acute trust elective theatre capacity continues to impact upon Bradford District Care Foundation Trust’s (BDCFT’s) community dental service, with a growing number of patients on the services elective waiting list and 87 patients now >52 weeks. The service supports people who have needs that cannot be met by a high street dentist, for example people who are housebound, have anxiety or severe physical disabilities. Following discussion with NHS England, where it was agreed to restrict access to some patient groups for an initial period of 3 months from November 2020, referral restrictions have been lifted from March and some operating theatre sessions are now being offered by both Trusts, but at much lower levels than pre- Covid activity. Many staff from the CCG’s Personalised Commissioning Department (PCD) were relocated to the clinical frontline during the Covid pandemic and this led to a considerable Covid backlog for Continuing Healthcare Assessments (CHC’s) compared to some other CCG’s. Performance is currently behind the trajectory to clear this backlog, with 52 cases remaining. Key issues have been in relation to the ability to recruit additional staff to clear the backlog, alongside sickness and current vacancies within the team (the ‘bring back staff’ mechanism led by NHS England did not work effectively), the clinical complexity of the remaining cases and increasing new cases and the lack of a digital platform which has made the collation of patient information more challenging and slower. The team has employed VAT liaison to assist with supporting the backlog and all cases have now been allocated to a clinical staff member. They have also secured 4 staff from medicine management team to support the delivery of the trajectory, offered additional finance to staff to undertaken assessments outside of traditional working hours and have supported staff to carry forward their annual leave 2021/22. The trajectory is monitored through the CHC joint oversight group to ensure all improvement avenues are explored and the procurement of a digital platform is underway. It is projected that the backlog will be completed in early May 2021

54 Page 4 of 8 Mental Health and Learning Disabilities Provisional Early Intervention in Psychosis (EIP) performance for the 3 month period December to February is 76.4%, remaining above the 60% target. There were 15 incomplete pathways at the end of the reporting period, of which 6 were waiting longer than 2 weeks. Improving Access to Psychological Therapies (IAPT) waiting times performance remains strong, with 6 week and 18 week targets consistently being met and the recovery rate remains above the 50% national target at 61.2% for February. Increased referral rates are putting pressure on mental health services including Child and Adolescent Mental Health Service (CAMHS), Perinatal Mental Health and Children and Young People Eating Disorder services. Inpatient mental health acuity and bed occupancy remains high. Delivery of Learning Disability (LD) Annual Health Checks (AHCs) is an exceptional 82% for 2020/21. Practices have been supported this year by a strong clinical leadership team who have produced a series of Top Tips about undertaking AHC’s virtually during Covid (video or by phone) including developing a SOP for undertaking reviews. In the last 9 months there has been regular communications in the GP bulletin about why AHC’s are needed, monthly data demonstrating progress and praise via Twitter. A monthly zoom call has been open to general practice to engage and to share best practice and the work has been supported by the LMC and the CCG Chair, who wrote out to practices reminding them of the importance of AHCs and the funding attached. Poorly performing practices have been targeted for supportive phone calls to offer support. Delivery of AHCs for people with Severe Mental Illness (SMI), however, remains a challenge. Whilst a similar approach has been adopted as above regarding practice engagement and support, the same supportive letter from the LMC has not been forthcoming. All Practices have been offered training and in the last quarter all practices have had the offer of BDCFT support to do AHCs if they were struggling, but only 3 Practices have taken up this offer (the others said they had plans in place). Unlike LD AHC’s, which were included in NHS England Covid business as usual guidance along with smears, immunisations etc. there has been no national push to increase uptake of SMI AHCs. In addition most SMI AHCs require face to face contact due to the need for BP and blood tests and there has been some understandable reluctance from some SMI patients (LD checks have been easier to do remotely).

55 Page 5 of 8 Access to Care Programme - Recovery

The Access to Care programme has brought system partners together to cover a number of different work streams focused on urgent care, elective care and recovery, and specific areas for service improvement. A priority for Q4 has been to secure capacity within the independent sector (IS) and Q4 2021 saw a significant number of elective procedures and diagnostics (approx. 2000) being undertaken to support the two hospital trusts to reduce their waiting lists. We are currently combining the waiting lists across AFT, BTHFT and the Yorkshire Clinic to ensure that those patients whose care is being transferred to the independent sector are being treated in order of the longest wait, and by their priority status1 This has required the engagement of clinicians to identify those patients suitable for transfer to the IS, commitment to relocate themselves to undertake the required procedures, development of joint protocols to ensure safe transfer of patient information and follow up pathways, and joint communications for patients to ensure they support their care being transferred. Following the success of this, the arrangements are continuing into 2021/22 financial year and alongside this, discussions continue regarding long-term future partnership working across appropriate specialties that would benefit from multi-site provision. The current waiting list position is detailed in Table One below. and one of the key areas of focus for the coming months is not only how we can work quickly to treat people on the waiting list, but also to provide support and advice to people who are waiting for surgery to optimise their health, and to work with communities to identify those people who have not come forward to access elective care during the pandemic.

By provider Numbers waiting*

P2 to be performed within 1 month 2424

P3 to be performed within 3 months 3668

P4 to be performed over 3 months 5199

P5&6 postpone due to covid/non-covid concerns 347

Table 1 – Elective backlog. *Please note this was at a point in time in March and covers CCG patients at ANHSFT, BTHFT and Yorkshire Clinic. Due to requirements on social distancing and self-isolation pre-surgery, there has been an increase in Did Not Attends (DNA) and we have requested both local and regional communications to reassure patients that services are safe but also to highlight the associated cost where appointments are not cancelled in good time. Previously another patient would have been called in to fill a cancelled slot on a list, this cannot happen within the current COVID restrictions and exacerbates the waiting list problem. For context, Table two shows comparator data for an average day in Bradford District and Craven (BD&C) versus a COVID day (average of April 20 to February 2021) to highlight the scale of the challenge not only in day to day terms from a capacity and demand perspective but this highlights the scale of the challenge we are currently facing in recovering services.

Activity Average day COVID day Elective and day case admissions 279 155

1 Priority 2 - Procedures to be performed in < 1 month; Priority 3 - Procedures to be performed in < 3 months Priority 4 - > 3 months Can wait > 3 months; Priority 5 – Patient wishes to postpone due to Covid-19 concerns Priority 6 - Patient wishes to postpone due to non-Covid-19 concerns

56 Page 6 of 8 Emergency admissions 277 214 A&E attendances 487 394 Face to face outpatient attendances 1829 1230 GP referrals to secondary care 479 286 Table 2 – Activity at ANHSFT and BTHFT

How is the Access to Care Programme supporting recovery? In addition to the ongoing work with the IS, there are a series of projects that will focus on not only those people who have been on the waiting list for a long time but also those who haven’t accessed services for a number of reasons. Where there are shared clinical teams between AFT and BTHFT, discussions are underway regarding sharing theatre capacity to ensure long-waiting patients who are willing and able to be treated in a different location. We are also continuing to scope out community based provision for high volume low complexity procedures such as ophthalmology and ENT in conjunction with multiple providers. Work has already commenced in developing community based pain hubs across BD&C utilising the expertise of all providers who currently have some input into caring for people who present with pain, as well as providers in the VCS who can provide additional support such as art therapy and social activities. We are using the evidence from the Muscular-skeletal (MSK) pathfinder projects (funded from WYICS) to help develop these pain hubs providing insight on the input from VCS to people who are experiencing long waits for an MSK procedure.

Work has commenced with Allied Health Professionals (physiotherapists, occupational therapists, dieticians etc.) and pharmacy teams to look at what resources can either be signposted to or developed to support people who are on waiting lists to optimise their health whilst they are waiting. Work commenced pre- COVID with anaesthetics colleagues and primary care to look at pre-operative optimisation and this is an expansion of this initial proposal. The intention is to link this work across the Living Well Programme to ensure access for patients is as memorable and straightforward as possible.

There are a number of people within BD&C who have not contacted health services during the pandemic and we need to do some targeted work with our community partnerships and PCNs to understand what their concerns are in accessing care, and establish a plan to address this. We anticipate there will be issues with confidence and safety, as well as being able to get in touch with services, and perceptions around burdening busy GPs and clinics. Our message has always been #still here to help and we will continue to pursue this via multiple medium. For example, we are looking at improving cancer screening uptake following a recent decline in people attending their appointments. This will be to understand the issues from both a patient but also a workforce and estate perspective to establish where the focus needs to be to help improve the uptake. We have data at PCN and practice level identifying elective/non-elective usage and primary care access alongside ethnicity and deprivation and this is supporting us in developing the next steps in where to approach people to understand their requirements and ensure they can access the right care first time. We will use this data to identify the PCNs and Community Partnerships where we will commence the patient optimisation work and understand barriers to access. Within Access we want to ensure that the voice of communities shapes the resources and services we develop so this is where we are currently developing our engagement plans.

From an internal perspective, both AFT and BTHFT, together with the CCG, continue to develop e-consults for GPs (Advice and Guidance) to use with consultants to try and avoid a patient having to attend the hospital when it isn’t necessary, and maintain continuity of care with the GP. This is particularly important at present when services are re-starting to free up consultant capacity to undertake procedures, but is also an effective communication tool for GPs and Consultants. In addition the trusts are continuing their work on Patient Initiated Follow Up which means that the patient is in control of whether they want to return to the hospital for a follow up appointment regarding their condition. This is in place for 6 months, after this time the patient is discharged from hospital care. The benefit for the patient is they do not have to travel to 57 Page 7 of 8 the hospital for an appointment that is not necessary if they have recovered from their procedure, and for the providers they can free up more capacity for outpatient clinics.

There are various system groups and committees who will maintain oversight of the whole system recovery plans with their different lenses (System Quality, System Finance and Performance, Access programme, Planning Forum, as well as the work of individual programmes). We are currently working through the role of each of these groups and how assurance is gained on behalf of our population in an increasingly collaborative environment. We will use this learning to inform our ICP development.

58 Page 8 of 8 NHS Bradford District and Craven CCG This document provides a summary and/or key discussion points and recommendations relevant to the subject of an item for consideration at the specified CCG meeting for the purpose of assurance, information, decision or action.

Agenda item 7.1

Name of meeting Governing Body Meeting date 11th May 2021 – Title of report CCG Finance Report for the period Report author(s) Diane Lawlor Strategic to the 31st March 2021 Head of Finance Lead(s) / SRO Robert Maden – CFO Report lead(s) Robert Maden - CFO

Paper summary and/or key discussion points

This report provides information on the financial position of the CCG as at the 31st March 2021. For the first six months of the financial year the CCG operated within the temporary CCG finance regime established by NHS England and Improvement (NHSE&I) and reported a break-even financial position to the end of September 2020. For the last six months of the financial year (October 2020 to March 2021), the CCG has received a fixed funding envelope which it is expected to manage costs within, except for specific items where additional cost reimbursement will be available. Therefore, this report concentrates on financial performance for the six month period from October 2020 to March 2021 (M7 to M12).

Appendix 1 contains information on summary budget performance for M7 to M12 and a summary of the full year position that incorporates performance from April to September 2020.

Key Points:

 The full year forecast position for costs within the fixed resource baseline shows an operational budget underspend of £2.8m. This underspend is net of costs for which additional funding can be claimed and remains unchanged from last month. Additional activity pressures in personalised commissioning and mental health placements have arisen in month, but these have been offset by increased underspends in other budget areas, including primary care.

 The baseline savings target of £1.2m has been covered by reductions in premises costs, support functions and prescribing costs.

 Underspends against budgets for which additional funding can be claimed, i.e. the Hospital Discharge Scheme and local Independent Sector activity costs, are offset by a reduction in the value of the reclaim resulting in no impact on the CCG’s financial position.

 Reimbursement for Hospital Discharge Scheme costs and local acute independent sector activity costs has been confirmed and received for the six month period to March 2021 and is reflected in the reported position.

 The position includes net COVID costs £3.19m against a budget of £2.91m with additional costs being incurred on Red Hub sites, PPE and staff overtime.

59 Page 1 of 2

 Full year forecast budget underspends fully offset the additional savings target of £2.8m resulting in a break-even position for the six months to March 2021 and also for the 2020/21 financial year.

 On the basis of the forecast operational budget performance and subject to the audit of the Accounts, the CCG expects to meet its break-even financial target and its statutory financial targets for 2020/21.

Outline how this will help us to achieve our vision through our strategic ambitions:  Our population – improving health and equity for local people, and/or  Our partnerships – as the vehicle for enabling people to take more responsibility for their health, and/or  Our people – a skilled, motivated workforce with a culture of continuous improvement, and/or  Our leadership – assuring sustainability of our health and care system.

Contributes to financial sustainability and improves quality of commissioned services.

Purpose assurance Information Decision action

approve / recommend / review / consider / support / ratify comment / discuss Recommendation(s)

The Governing Body is asked to:

1. Note the financial position for the six month period to the 31st March 2021 and the overall financial position for the 2020/21 financial year; and

2. Note that subject to the audit of the Accounts for 2020/21, the CCG expects to meet its in-year breakeven target and its statutory financial targets.

Appendices (or other supporting papers)

1. Summary CCG Financial Performance

60 Page 2 of 2 BRADFORD DISTRICT AND CRAVEN CCG

FINANCE REPORT FOR THE PERIOD TO 31 MARCH 2021 (MONTH 12)

1. Introduction.

1.1 This report provides information on the financial position of the CCG as at the 31st March 2021.

1.2 For the first six months of the financial year the CCG operated within the temporary CCG finance regime established by NHS England and Improvement (NHSE&I) and reported a break- even financial position to the end of September 2020.

1.3 For the last six months of the financial year (October 2020 to March 2021), the CCG has received a fixed funding envelope which it is expected to manage costs within, except for specific items where additional cost reimbursement will be available. Therefore, this report concentrates on financial performance for the six month period from October 2020 to March 2021.

1.4 Financial performance for this period continues to be based on the application of the COVID-19 contracting and payment arrangements for services commissioned from NHS and non-NHS Providers. Under these arrangements, block contract values have been determined for our main NHS Trusts and budgets have been set in-line with these.

For other services, where activity information is available, this has been used to support the assessment of financial performance. The main budget areas concerned are Primary Care Prescribing and Continuing Healthcare where activity information was available as follows:

- Prescribing February activity - Continuing Healthcare February activity.

Where no activity information is available and the service has continued, performance is shown in-line with budget.

The additional costs related to responding to the pandemic are included in the relevant budget line and highlighted on the budget report as COVID-19 costs.

1.5 Full year forecast financial performance is reported in Appendix 1 which aggregates the first six months and last six months of the financial year.

1.6 Key points for performance in the period October 2020 to March 2021 are highlighted for the Governing Body.

2. Resource Allocation Adjustments.

2.1 For October to March 2021, the CCG has received an allocation of £484,284k which represents the CCG’s share of the West Yorkshire ICS funding envelope. This includes an allocation for additional COVID-19 related costs.

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2.2 Further allocations have been received in the months October to March as follows:

October - March April - September Full Year

Opening RRLA Closing Closing Closing allocation (non recurrent) allocation allocation allocation April 329,395 329,395 May -59 -59 June 1,830 1,830 July 160,976 160,976 August -2,086 -2,515 September 0 0 October 484,284 615 484,899 1,941 487,269 November 3,418 3,418 -912 2,506 December 3,301 3,301 0 3,301 January 1,752 1,752 0 1,752 February 528 528 0 528 March -139 -139 0 -139 Actioned to date 484,284 9,475 493,759 491,085 984,844

Non-recurrent resource allocation adjustments of -£139k were received in March for:  -£26k funding for children and young people respite provision (transferred to Leeds CCG);  -£240k reduced funding for targeted lung health checks;  £23k remote monitoring software licences;  £35k LD complex care funding (bid 42);  £16k data quality investments (AHFT);  £53k GPIT GPFV infrastructure and resilience.

These resource allocation changes have been reflected in budgets as appropriate.

2.3 The income budget for items reimbursed outside of the fixed funding envelope has remained unchanged and comprises:

£'000 Hospital Discharge Programme -7,174 HDP (staff costs to clear backlog) 0 to a maximum of £554k Flu Vaccinations (additional costs) 0 to a maximum of £140k COVID-19 Vaccination Programme 0 Primary Care Additional Roles -1,982 40% of maximum allocation of £4,925k Local Independent Sector Activity -2,872 -12,028

Actual amounts received are based on final March costs and reimbursement of £9,525k has been confirmed by NHSE for October to March relating to the Hospital Discharge Scheme, flu vaccinations, Covid19 vaccinations and local acute independent sector activity costs.

62 Reimbursement is by way of a resource allocation adjustment, but no adjustment to income budgets has been made for this. Instead, expenditure and income will continue to be shown gross to maintain reporting against plan values.

3. Financial Performance at Month 12 – Key Points.

3.1 Overall Position.

October 2020 - March 2021 Year to Date March of which is Over / COVID19 Mvt from last Budget (Under) Costs month Commissioning Budget 502,747 -4,871 8,033 347 Running Costs 5,866 -458 165 60 Additional Savings Target -2,826 2,826 0 0 Residual Financial Risk 0 0 0 0 Gross Expenditure 505,787 -2,503 8,198 407

Funding to reclaim -12,028 2,503 -5,010 -407 Net Expenditure 493,759 0 3,188 0

Net Summary: Net Commissioning Budget 490,719 -2,368 3,023 -60 Running Costs 5,866 -458 165 60 Additional Savings Target -2,826 2,826 0 0 Residual Financial Risk 0 0 0 0 Net Expenditure 493,759 0 3,188 0

 The position for commissioning costs within the fixed resource baseline shows an operational budget underspend of £2.37m. This is net of costs for which additional funding can be claimed. After taking running costs into account, there is an operational budget underspend of £2.83m.

 The baseline savings target of £1.2m is covered by premises cost and support function savings, and a reduction in forecast prescribing costs.

 Underspends against budgets for which additional funding can be claimed, i.e. the Hospital Discharge Scheme and local Independent Sector activity costs, are offset by a reduction in the value of the reclaim resulting in no impact on the CCG’s financial position.

 The position includes a net COVID-19 costs of £3.19m (October to March budget of £2.91m).

 After allowing for forecast budget underspends and the full release of reserves to offset the increase in personalised commissioning and mental health placement costs, the full year additional savings target of £2.8m remains fully covered leaving no residual financial risk and a balanced financial position.

63 3.2 COVID19 Costs

COVID19 costs against budget are detailed in the following Table. There has been a rise in costs since last month resulting in an increase in the overspend of £156k. The overspend reflects overtime costs as CCG staff continue to be deployed to support the on-going pandemic response, continuing primary care Red Hub and Super Rota service costs and additional PPE purchases, although these are offset partially by lower levels of ambulance activity. The increase this month is due to increased Red Hub site costs and additional PPE expenditure.

October 2020 - March 2021 Year to Date March Over / Mvt from Budget (Under) last month Patient Transport Services 520 -145 0 Telehealth 291 0 0 Mental Health Digital Plan 15 -15 0 Mental Health Cygnet Hospital 7 0 Primary Care Red Hubs 156 143 32 Primary Care Super Rota 173 21 -5 Primary Care Staff Transport 35 -1 4 Primary Care GP Expenses 59 14 0 GP Second Wave Resilience 1,575 0 0 PPE 0 111 111 Admin Support Costs 90 139 14 2,914 274 156

3.3 The main factors affecting financial performance and expenditure for the period October 2020 to March 2021 include:

 Acute Care – net underspend after the reclaim of additional independent sector activity costs of £1,692k mainly due to NHS Trust block contract reductions. This is a net reduction in underspend of £93k since last month reflecting an increase in Neuro Rehab placements.

 Community Services – net underspend of £104k reflecting the reduction in the block contract with Bradford District Care Trust and underspends against patient transport and interpreting service budget, offset by an increase in Community Equipment service costs.

 Personalised Commissioning – underspend before additional cost reclaims of £2,158k covers both normal CHC costs and Hospital Discharge Scheme costs. The underspend represents a £484k overspend on normal CHC and funded nursing care costs and a £2,642k underspend against the Hospital Discharge Scheme budget. This underspend will be offset by a reduced cost claim leaving a net full year forecast overspend of £484k. This is an increase of £479k since last month and reflects final charges after reconciliation of the COVID19 patient cohort.

 Mental Health – net overspend of £922k, an increase of £737k since last month reflecting additional investment in adult autism assessments, increased out of area care packages, catch up on backlog SMI physical health checks and additional costs for children’s complex care packages.

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 Prescribing – overspend of £273k based on actual cost information for the period to February 2021. This shows a 3.72% increase in costs compared to the same period last year (a lower number of items but higher prices). The full year expenditure forecast includes an estimate for March 2021 costs with actual costs expected to be confirmed by the end of May.

 Primary Medical Care - budgets are underspent by £330k before additional cost reclaims. This is due to an underspend against the gross Additional Roles Reimbursement Scheme budget, reduced levels of locum cost claims and the release of list size reserve offset by overspends on flu vaccination prescribing fee costs, premises costs and other smaller budget overspends. The ARRS forecast has increased this month following additional claims from PCNs and there has been a corresponding increase in the reclaim value to reflect this.

 Other Primary Care - budgets are underspent by £89k before additional cost reclaims mainly due to lower than anticipated GP LES activity to the end of March 2021. The additional costs of the flu vaccination programme are reclaimed in full from NHSE.

Other Commissioning – underspend of £1,193k is reported against budget before additional cost reclaims, a reduction of £544k since last month. After allowing for the reclaim of staff costs relating to the Hospital Discharge Scheme assessment backlog and COVID vaccination costs the under spend becomes £1,652k. This is mainly due to a reduction in corporate function premises costs, the release of support function and investment reserves and the release of surplus 2019/20 accruals.

 Running Costs - underspend of £458k against budget relating to staff vacancies and reduced non- pay corporate costs partly offset by the additional costs of COVID19 attributable to supporting remote working.

Appendix 1 shows a summarised budget position and a detailed break-down of each area for the period October 2020 to March 2021. It also shows a summarised position for the full financial year.

4. Performance Against Savings Target

There has been no change concerning the achievement of the 1% savings target of £1.2m which has been achieved in full from primary care rates rebates (£260k) and support cost function savings (£140k) and prescribing costs. The additional savings target of £2.8m relating to the national change in budget setting methodology for local independent sector services in the second half of the financial year has now been fully offset by operational budget underspends which are shown in the reported financial position.

65 5. Financial Risk and Risk Mitigation.

All financial risks have been recognised and covered in the final position.

On the basis of the forecast operational budget performance and subject to the audit of the Accounts, the CCG expects to meet its break-even financial target and its statutory financial targets for 2020/21.

6. Recommendations.

The Governing Body is asked to:

a) Note the financial position for the six month period to the 31st March 2021 and the overall financial position for the 2020/21 financial year; and

b) Note that subject to the audit of the Accounts for 2020/21, the CCG expects to meet its in- year breakeven target and its statutory financial targets for 2020/21.

66 APPENDIX 1 CCG Financial Performance (October 2020 to March 2021)

October 2020 - March 2021 Year to Date March of which is Mvt from Over / COVID19 last Budget (Under) Costs month £'000 £'000 £'000

Acute Care 221,639 -1,432 0 -93 Urgent Care 18,996 -62 0 0 Community Services 38,487 -104 666 60 Personalised Commissioning 34,187 -2,158 4,532 901 Mental Health and LD Services 51,887 922 7 737 Prescribing 52,731 273 0 -272 Primary Medical Care 55,948 -792 1,575 -330 Other Primary Care 6,887 -89 619 -100 Other Commissioning 19,293 -1,193 634 -544 RIC Investments 2,692 -236 0 -12 QIPP Savings Balance -2,826 2,826 0 0 Residual Financial Risk 0 0 0 0

Total Operating Costs 499,921 -2,045 8,033 347

Contingency Reserves 0 0 0 Other Reserves 0 0 0 0

Total Reserves 0 0 0 0

Total Healthcare Expenditure 499,921 -2,045 8,033 347

CCG Running Costs 5,866 -458 165 60

Gross Expenditure 505,787 -2,503 8,198 407

Additional funding to reclaim -12,028 2,503 -5,010 -407

Total Net Financial Position 493,759 0 3,188 0

MEMORANDUM Additional funding to reclaim: Hospital Discharge Programme -7,174 2,642 -4,532 -422 HDP (staff costs to clear backlog) 0 -414 -414 -57 Flu Vaccinations (additional costs) 0 -19 -19 0 COVID-19 Vaccination Programme 0 -45 -45 -6 Primary Care Additional Roles -1,982 599 -108 Local Independent Sector Activity -2,872 -260 186 -12,028 2,503 -5,010 -407

67 APPENDIX 1 cont. – CCG Financial Performance (April 2020 to March 2021)

Full Year April 2020 - March 2021

April - October - September March Full Year of which is Over / COVID19 Budget Budget Budget (Under) Costs £'000 £'000 £'000 £'000

Acute Care 222,680 221,637 444,317 -1,432 0 Urgent Care 18,862 18,996 37,858 -62 0 Community Services 37,745 38,487 76,232 -104 1,364 Personalised Commissioning 33,024 34,187 67,211 -2,158 10,377 Mental Health and LD Services 46,284 51,887 98,171 922 94 Prescribing 51,434 52,732 104,166 273 0 Primary Medical Care 52,993 55,948 108,941 -792 2,228 Other Primary Care 6,036 6,887 12,923 -89 2,105 Other Commissioning 15,858 19,293 35,151 -1,193 1,153 RIC Investments 1,130 2,693 3,823 -236 0 QIPP Savings Balance 0 -2,826 -2,826 2,826 0 Residual Financial Risk 0 0 0 0 0

Total Operating Costs 486,046 499,921 985,967 -2,045 17,321

Contingency Reserves 0 0 0 0 0 Other Reserves 0 0 0 0 0

Total Reserves 0 0 0 0 0

Total Healthcare Expenditure 486,046 499,921 985,967 -2,045 17,321

CCG Running Costs 5,039 5,866 10,905 -458 375

Gross Expenditure 491,085 505,787 996,872 -2,503 17,696

Additional funding to reclaim 0 -12,028 -12,028 2,503 -5,010

Total Net Financial Position 491,085 493,759 984,844 0 12,686

MEMORANDUM Additional funding to reclaim: Hospital Discharge Programme -7,174 -7,174 2,642 -4,532 HDP (staff costs to clear backlog) 0 0 -414 -414 Flu Vaccinations (additional costs) 0 0 -19 -19 COVID-19 Vaccination Programme 0 0 -45 -45 Primary Care Additional Roles -1,982 -1,982 599 Local Independent Sector Activity -2,872 -2,872 -260 0 -12,028 -12,028 2,503 -5,010

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69 NHS Bradford District and Craven CCG This document provides a summary and/or key discussion points and recommendations relevant to the subject of an item for consideration at the specified CCG meeting for the purpose of assurance, information, decision or action.

Agenda item 7.2

Name of meeting Governing Body Meeting date 11 May 2021 Gill Paxton Associate Director of Quality and Nursing Title of report Patient Safety and Quality Report author(s) Improvement report Michelle Turner Strategic Director of Quality and Nursing SRO Michelle Turner Michelle Turner Lead(s) / SRO Dr James Thomas, Clinical Chair Report lead(s) Dr David Tatham ,Clinical Lead

Paper summary and/or key discussion points

This report provides an overview and key messages of the following:

 Living with Covid-19 and system resilience  System health provider quality outcomes - provider specific  Medicines Optimisation - key areas of focus– including Covid-19 vaccinations,  Personalised Commissioning  Research and Development  Safeguarding Adults and Children  Care of Vulnerable Children including Special Educational Needs Disability  Host Commissioner responsibilities for people with Learning Disabilities and Autism in inpatient settings  Learning Disability Mortality Review Programme  System Quality Committee – including maternity, Mediscan, West Yorkshire Quality Board, principles for the system programmes

Each month the CCG’s senior leadership team has also received a more detailed overview of the emerging issues and the steps taken to mitigate. These have been reviewed by the CCG’s Quality Committee along with the CCG’s corporate risk register which includes risks arising from Covid-19).

Key issues regarding living with Covid-19, the roll out of the vaccine, system resilience, the care of vulnerable children and progress by the system quality committee are noted

Outline how this will help us to achieve our vision through our strategic ambitions:  Our population – improving health and equity for local people, and/or  Our partnerships – as the vehicle for enabling people to take more responsibility for their health, and/or  Our people – a skilled, motivated workforce with a culture of continuous improvement, and/or  Our leadership – assuring sustainability of our health and care system.

The quality and safety of services is core to the CCG’s strategy. Patient feedback is included within the paper and a more detailed overview will be considered at the CCG’s Quality Committee. Equality Impact Assessments have been conducted throughout the period and the outcomes have informed the CCG’s approach to risk assessment and to mitigation.

70 Page 1 of 2 Purpose assurance information decision action

approve / recommend / review / consider / support / ratify comment / discuss Recommendation(s)

The Governing Body is asked to:  Note the information and assurance provided by the report, including key actions taken by the CCG to manage quality and safety issues and risks arising from COVID-19 and non-covid-19 issues.  Note the substantial progress made by ‘health’ in address some of the concerns raised about the care of vulnerable children  Note the increasing emphasis on ‘place’/’system and collaboration to address challenges and poor outcomes together rather than on an individual basis with each provider.

Appendices (or other supporting papers)

1. Governing Body Quality Report (May 2021)

71 Page 2 of 2 Governing Body Medicines Covid-19 Quality and Safety Related IssuesSafeguarding and MayRisks 2021 Optimisation

Michelle Turner Patient Quality safety Improvement

Research & Personalised development Commissioning

72 Living with Covid-19 and System resilience Across Bradford District and Craven; • Infection rates are 51.5 per 100,000 in Bradford Local Authority, and 22.8 per 100,00 in the Craven district. Rates show a significant reduction over the preceding 3 months for all cohorts (especially those cohorts offered vaccinations). Despite these reduced rates Bradford remains one of the highest in the country . • Pressures on bed occupancy remains stable, with high demand for mental health beds • The Covid-19 death rate in ‘Place’ is below the Yorkshire average. COVID-19 vaccines • Roll out of the vaccine continues at pace, 54% of the population have had their 1st dose, 15% have had both doses. • Greater than 90% coverage for the over 80s, 75-79yrs, 70-74yrs & 65-69yrs New variants • Estimated 99.4% of Bradford District COVID cases are due to the UK Variant of Concern (VOC- 202012/0). • Recent cluster of VUI-21FEB-03 (Variant Under Investigation) within the District. Airedale NHS Foundation Trust is to be a Community Vaccination Centre; work is ongoing with Primary Care Networks (PCNs) to agree on plans to continue vaccinations after cohort 9 (i.e. people under age 50). Three PCNs, working in two vaccination centres will not continue providing vaccinations past cohorts 1-9 but two PCNs have expressed an interest in adopting the National Booking System (NBS)

73 Living with Covid-19 and System resilience • The development of the Inequalities Mitigating Delivery Plan includes innovative ways of reaching ‘yet to reach’ communities e.g., the homeless, and some focused interventions in line with the approach to Ramadan. Increased communication and engagement is taking place with communities where there is vaccine hesitancy/ low ‘take up’ with an increased focus on vaccinating homeless people. • System pressures continue to be monitored by the weekly system winter + health and care silver call Care Homes • 7 care homes in Bradford are within the 0-28 day cycle after Covid-19 outbreaks, 1 care home and 1 supported living service in Craven within the 15-28 day cycle. • The GP Super Rota hours will focus on discharge assessments from 04/21. Urgent clinical needs for Care Homes are supported via Telemedicine/Goldline • System agreement has been reached to fund the Telemedicine Service for all 126 Care Homes until 31/9/21 with oversight of the identification of the most cost effective remote digital support offer. • The 4 Designated Covid-19 beds in North Yorkshire County Council have closed and will return to be used as Learning Disability respite beds. • The 20 Designated Covid-19 nursing beds in Bradford will become ‘Discharge to Assess’ beds. No further placements are being made into these beds and plans are in place to discharge people from these beds. These beds will then return to standard nursing home beds. • The 5 Local Authority units in Bradford are still able to be flexed to operate as Covid-19 designated units if needed. 74 Quality and Safety COVID Related Headlines 28 April 2021

Overview of system provider quality outcomes (BTHFT/ANHSFT/BDCT/Primary Care)  18 week performance continues to be a challenge as, although outpatient activity continues, elective capacity has been significantly impacted by Covid-19. As a result 52+ week breaches are increasing and there are 19 patients at BTHFT who have waited >104 weeks. Strategic discussions re restart and recovery planned to include quality commenced in April 2021. This will identify any new quality and safety challenges and ensure appropriate measures in place to address them which includes opportunities for quality improvement and innovation.  Diagnostic performance continues to improve, with both Trusts making use of Independent Sector capacity during Covid-19 ensuring timely diagnosis and improved experience for local people.  Cancer services continue to be maintained with a reduction in those who have waited over 62 days  Increased referral rates are putting pressure on mental health services including Child and Adolescent Mental Health Service (CAMHS), Perinatal Mental Health and Children and Young People Eating Disorder services and inpatient mental health acuity and be occupancy remains high  Delivery of Learning Disability (LD) Annual Health Checks (AHCs) is currently forecast to be above our recovery plan at 72% for 2020/21. Delivery of AHCs for people with Severe Mental Illness (SMI), however, remains a challenge.  BTHFT saw A&E attendances increase in line with pre Covid-19 levels, whilst ANHSFT saw attendances decrease slightly during February, with acuity and conversion to admission rates in line with patterns seen at this stage of the year. System conversations planned for urgent care programme and System discharge conversations75 continue via health and care silver. Overview of system provider quality outcomes - (and Care homes) Bradford District Care Foundation Trust • Increased referral rates are putting pressure on mental health services including Child and Adolescent Mental Health Service (CAMHS), Perinatal Mental Health and Children and Young People Eating Disorder services and inpatient mental health acuity and bed occupancy remains high Airedale NHS Foundation Trust • There has been an increase in verbal and racial abuse directed at staff, usually from relatives. This is being explored within the Trust with supportive interventions in place. There have been 5 Serious Incidents reported on STEIS by the 3 main providers. An independent review has been commissioned to review some incidents within the maternity service. A system Quality Summit was also recently held to review some incidents involving people with mental health problems.

Care Home Quality Surveillance • There are currently 6 care homes rated as outstanding and 91 care homes rated as good by the CQC. • A further increase in homes that require improvement and 6 care homes placed in special measures due to an inadequate rating. System support is provided by enhanced surveillance. • 1 domiciliary care provider is rated as outstanding and 61 providers have been rated as good. 9 providers rated as requires improvement and 0 providers with an inadequate rating • Provider led Sector Quality Workshops took place 21st April with a focus on CQC readiness and the new model of inspection.

76 Overview of Primary Care (GP) providers  Temporary suspension of the Contract and Quality Assurance process until April 2021  To ensure assurance throughout the pandemic, the Care Quality Commission (CQC) introduced an Emergency Support Framework (ESF). The ESF has now been replaced with the Transitional Regulatory Approach, also known as Transitional Monitoring Approach (TMA);  CQC Practice Ratings: As inspections are remained suspended up until April 2021 there are no changes to practice ratings; Bradford District and Craven CCG currently have 67 practices CQC rated as ‘Good’; 3 ‘Outstanding’ and 1 ‘Requires Improvement.’ Farrow Medical Practice remains under enhanced surveillance; a visit is planned for May 2021  From April 2021 inspections will resume focusing on high/medium risk, practices that are rated as requires improvement with a breach, and providers who have never been inspected or where no rated inspection has taken place.  Practices that are rated inadequate overall, in special measures or are newly registered services will receive comprehensive inspections  For practices rated requires improvement overall, an extended version of the existing focused inspection methodology will cover three key questions; safe, effective and well-led, also any other areas identified as a concern. This will be used to update ratings. 77 Overview of Medicines Optimisation • There has been a fluctuating Covid-19 vaccine supply that has led to prioritisation of second vaccines • Mutual aid support is being provided to vaccination sites by Link Pharmacists. • Integrating NHS Pharmacy and Medicines Optimisation (IPMO) proposal – system conservations have commenced re greater alignment which includes the two Area Prescribing Committees (APC) is continuing. • Further discussion is ongoing with Psychiatry UK, to enable clients who have opted for this any qualified provider (AQP) to have safe prescription management. • Post Infection Reviews (PIR) to be reconsidered in general practice and across the PCNs to ensure effective investigation, learning and improvement actions are extrapolated • Warfarin monitoring – there have been supply issues, a system proposal is being developed to ensure continuity and ensure patient safety. • QIPP planning for 21-22 has commenced across the wider system to enable the alignment of priorities • System plans are being developed to ensure the Flu vaccination programme maximises the learning from both previous flu programmes and the Covid-19 vaccination roll out with conversations taking place within both system respiratory programme and the Health Protection Assurance Group. Single oversight for the 2021/2 arrangements needs to be confirmed

78 Overview of personalised Commissioning Continuing Healthcare (CHC)

• The Covid-19 backlog of cases was unfortunately not completed as per trajectory by April 2021. The CCG is working with NHSE to have this completed by 6th June 2021 and the revised trajectory remains on track with weekly position statements provided for the CCG/NHSE. Strategies are in place to ensure there are no clinical safety risks. • The NHSE Continuing Healthcare Assurance Tool (CHAT) has been completed and is considered to be on track (green) with regards to process. • Tableau is the NHSE data resource. Comparison of the CHC performance against other aligned CCG’s shows that there are further opportunities to utilise the functionality of Tableau that in collaboration with the Local Authority, to streamline processes and ensure service improvement. • New Governance structures are in place, co-chaired with system partners, to ensure effective quality oversight across the wider system. • West Yorkshire Integrated Care System (WYICS) partners have been supporting a review of Bradford District and Craven CCG documented processes to ensure alignment, and shared learning. • VAT Liaison Company have been commissioned to undertake clients care package reviews, to assist the management of the Covid backlog. • Following a pause due to Covid the Appeals work has now recommenced • Children’s Continuing Care and Joint Placement Panel – further work is ongoing with WYICS system partners to explore potential streamlining of processes

79 Overview of Research and Development (hosted service WYICS)

 Work is ongoing to support and inform NHS England Nationally in the design of Research and development’s placement within ICS structures.  Lowering Antimicrobial Prescribing (LAMP) report 15 continues to inform the Antimicrobial resistance (AMR) response across the region and is integral to the AMR strategy.  Funding received from the Clinical Research Network to take forward the collaborations developed in 3 places, in Bradford work is with both hospitals, the care trust and the GP federations to develop a research registry where patients can register their interest to participate, planned launch in on Clinical Trials Day in May.  The Novavax vaccine trial; continuing follow up for those involved  The Astrazeneca monoclonal antibody trial; continuing the follow up of participants  There are plans to restart a number of projects that were paused at the start of the pandemic.  The Genes and Health study is recruiting  An End of life care study working with Leeds University has commenced

80 Overview of Safeguarding Adults and Children

• The CCG Safeguarding team continue to develop system wide processes for effective commissioning, contracting and tendering both at ‘Place’ and within the emerging ICS . • ACovid-19 regional safeguarding Quality assurance and standards Safety document Related is being consultedIssues on andwith provider safeguardingRisks leads. • There has been a need identified for workforce development and succession planning for both safeguarding adults and children Place and on a WYICS level. • A significant number of statutory reviews are ongoing or due to commence (Domestic Homicide Reviews and Safeguarding Adult Reviews). • With the new Mental Capacity Act (MCA) and Liberty Protection Safeguards (LPS) emergent, a system wide approach has been orchestrated, with the CCG lead driving the agenda forward in collaboration with Provider MCA leads. • A system wide offer of regular Mental Capacity Act Masterclasses has been made facilitated by the CCG.

Serious Case Reviews - children • 2 Serious Case Reviews/ Child Safeguarding Practice Reviews are nearly complete – the best scoping platforms are being explored to ensure seamless multi-agency work to deliver shared actions

81 Vulnerable Children

Highlights for System Quality Committee, Children’s Improvement Board, CCG quality Committee 1. Children Looked After (CLA) new clinical model implemented April 2021, 4/5 GP with specialist interest recruited, revised trajectory within normal limits ( backlog 140 initial health assessments) and will be cleared by September 2021. Concerns re consent. 2. Review of CLA CQC action plan 2018 planned for April 2021 – SQC oversight 3. SQC reviewed system designated and named doctor model for CLA April 2021. 4. Childrens/Young People/Mental health – dashboard agreed and performance data shared with BMDC monthly. Differences of opinion re some detail to be resolved May 2021. There has been a reduction in waits of children on the Acute Pathway . Additional investment to accelerate the implementation of the One Trusted Pathway has been secured. Rapid Improvement week (outcomes and experience of children) Q2 2021. 5. Children’s Autism –Mental health/LD/Autism programme board to facilitate a focused conversation to progress all Age Autism and address key children issues by April 2021. 6. Review of Complex Children – CCG to review risks of moving to Doncaster Model May 19th 2021. No disputes. 7. 0-19 health services – interim wrap around model in place to support school nursing,

more sustainable model to be discussed with82 CCG and BMDC responsible officers, 4/52 audit of health visiting input into safeguarding to be completed by May 2021 Vulnerable Children - SEND

Highlights for System Quality Committee, Children’s Improvement Board, CCG Quality Committee 1. SEND (special educational needs disability) • Educational health care plans – Health Quality Assurance Group established, impact of Quality Assurance framework and audit tool to be reviewed in Q3 2021. • Leadership – highlight report in place April 2021, clinical lead x 2 recruited to commence May 2021, • CYP health and wellbeing - Data Dashboard in place to provide date and intelligence for SEND in place – working with provider services to establish routine data flows and narrative – June 2021. • Ownership and plans for all risks – health risks reviewed on a monthly basis. Ownership of outstanding risks to be clarified with BMDC at SEND Partnership. 2. Strategy and delivery • Joint Children’s Strategy and plans - Plan for joint working arrangements including Vision, Outcomes required, Principles, Priorities, Communication and Project Governance to be outlined by end April 2021 (Mark D /Ali-Jan H/Sarah Muckle) • Recommend best place for strategic and operational oversight of Vulnerable Children -

May 2021 83 Host Commissioner responsibilities for people with Learning Disabilities and Autism in inpatient settings by April 2021

• There is a long term objective for a service design enabling WY ICS oversight for Host commissioner responsibilities referred to as the “West Yorkshire Approach”, together with partnership working to ensure each ‘Place’ follows a consistent methodology. Networking with other ICS’s is underway to review models already in place e.g. Lancaster. • In the medium term, discussions with BDCFT are ongoing to explore options for Delegated Host Commissioner Responsibilities to ‘Place provider’. Option 1 –full model, Option 2 - Hybrid model using their expertise and a buddying system. • In the short term, interim quality oversight arrangements at CCG level have been implemented to ensure statutory duties are discharged whilst working through the options to land the appropriate model for Bradford and Craven. It is envisaged that these arrangements could be transferred to Place and/or ICS once the model is established to ensure continuity and consistency of oversight arrangements.

84 Quality and Safety COVID Related Headlines 28 April 2021

LeDER ( Learning disability mortality review programme - hosted Service for WY ICS Total West Yorkshire Phase 2 position - 19 April 2021 • 95 reviews reported in Phase 2, 17 have exceptions, 49 have been completed (63% of those which have no exception), 29 still in progress Bradford & Craven CCG Phase 2 position • 31 cases have been reported in Phase 2 • 11 reviews are ongoing of which 3 are CDOP, 2 are coronal / have other exceptions, 4 are in the QA process, 2 are now moving into stage 3 due to database change • 20 have been completed since 1st January 2021 • 2 deaths have been notified in March 21 and will become phase 3 Bradford is also reviewing a further 10 cases for other CCG's as part of the West Yorkshire hosting service. In preparation for the new software, no new reviews can be allocated after 28th February. Reviews are expected to then be released from 1st June 2021 on the new system as phase 3. Nationally – each ICS needs to nominate an SRO for LeDER by June 2021 . WY ICS hosted service gained permission from NHSE/I to put a model in place that builds on current arrangements and is line with the WYICS ICS and ‘placed’ based thinking. 85 System Quality Committee - Update April 2021 (health and care)

SQC 2020 -2021 key areas of focus System Quality Committee • User Story – provided a reflection of a NYCC service user and their families experience of cross organisational care provision & the impacts of geographical isolation experienced in some rural areas of North Yorkshire • Draft Proposals for West Yorkshire ICS Quality Board were shared and feedback requested, • The committee suggested a review of themes and trends relating to Serious Incidents and the consistency of governance and reporting • An update on issues raised regarding the Mediscan service provision including elements of patient safety within the pathway and Infection Prevention and Control (IPC). • Overview of maternity services - Work is ongoing with the Local maternity system (LMS) to ensure system processes are aligned and duplication avoided. A new quality surveillance tool has been developed by the LMS to support the requirements outlined in the national planning guidance. The Act As One Better Births programme continues to ensure services are collaborative and developments shared effectively System Ethics committee • Support has been given to providers with ethical framework tools around care and treatment. • There has also been some work with proforma’s/risk assessments for staff who are declining Covid - 19 vaccination. This allows a supportive conversation to help them make informed decisions and has been instrumental in supporting clinical managers86 in the workplace. How can the SQC add value to the system programmes?

Draft principles for the System Programmes to consider - Think health and care 1. Will impact assessments ( privacy and quality ) be maintained throughout the programme life span 2. What contribution is the programme making to help reduce health inequalities. Is there more that can be done? 3. Does the programme promote quality and safety and mitigate any risks created? 4. Does the programme have appropriate metrics to determine the impact on quality and safety? 5. Does the programme introduce best practice and how far is it evidence based? 6. What role is there for citizens and patient voices in the programme and how do you know that you are improving their experiences? 7. Does the programme encourage training and development of the work force? 8. How does the programme know that it is a making demonstrable difference to outcomes – clinical and non clinical? 9. Are there any concerns from a regulatory perspective and how are addressed? 10. How will the programme be evaluated and to what extent will this be independent of programme governance

11. How will the programme impact on and support87 ‘recovery’ and ‘reset’ requirements NHS Bradford District and Craven CCG This document provides a summary and/or key discussion points and recommendations relevant to the subject of an item for consideration at the specified CCG meeting for the purpose of assurance, information, decision or action.

Agenda item 8

NHS Bradford District and Craven Name of meeting Meeting date 11 May 2021 CCG Governing Body Vicki Wallace, Interim strategic director, Title of report Integrated Care Partnership Update Report author(s) transformation and change

Lead(s) / SRO Helen Hirst, Chief Officer Report lead(s) Vicki Wallace

Paper summary and/or key discussion points

 This item gives a high level overview of the plans for the establishment of an Integrated Care Partnership (ICP) in Bradford district and Craven. This is in response to the publication of the white paper Integration and Innovation: working together to improve health and social care for all1.  The white paper sets out the statutory duty to have an Integrated Care System (ICS) and locally we will be part of West Yorkshire ICS. This builds on the partnership we already have in place at West Yorkshire, as through years of closely working together we have established positive and strong relationships with the other four places in West Yorkshire. We operate through a model of subsidiarity, ensuring the importance of place and this will continue through the implementation of the white paper.  We believe that the formalisation of partnership working within the white paper highlights that the ambition and journey Bradford District and Craven has been following for the last ten years has been the right one. The building of a strong place based partnership has been greatly beneficial for our population and our people. Thereby we are commencing the implementation of the white paper from a very strong position which we see as being incredibly positive for our place.  To support the implementation of the white paper and the establishment of an ICP, the Executive Board has evolved to become the ICP Executive Board and a new ICP Establishment and Development Programme has been established to oversee this work.  We want our people to be part of shaping our ICP. This started with the ICP Engage session in March 2021 and will continue with further engagement events moving forward.  There are four key elements to the work the programme board will oversee: vision and strategy; leadership and behaviours; design and delivery; and the CCG transition/close down.  The successful formation of our ICP will need to involve all of our existing partners. Although the establishment of an ICS and ICP includes the transition of the CCG and TUPE of CCG staff, we are fully aware that the CCG is only one organisation within our partnership and to be a highly functioning ICP our entire partnership will need to be involved in the development and agreement of our emergent form and functions. It is anticipated that the continued partnership approach to via the ICP Executive Board and ICP Establishment and Development Programme Board will ensure this. A non-executive and councillor reference group is being established. One of the workstreams is considering how to engage wider citizens in the development of the ICP.

Outline how this will help us to achieve our vision through our strategic ambitions:  Our population – improving health and equity for local people, and/or  Our partnerships – as the vehicle for enabling people to take more responsibility for their health, and/or  Our people – a skilled, motivated workforce with a culture of continuous improvement, and/or  Our leadership – assuring sustainability of our health and care system.

1 https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all/integration-and- innovation-working-together-to-improve-health-and-social-care-for-all-html-version 88 Page 1 of 4 The establishment of an ICP will allow the continuation of a strong place based focus for Bradford district and Craven: ensuring a continued focus on the needs of our population; further embedding how we work as a partnership; empowering and enabling our people to continue to develop and succeed; while ensuring a continued focus of our leadership on our place.

Purpose assurance information decision action

Recommendation(s)

The Governing Body is asked to: 1. Receive the update on the establishment and development of our ICP

Appendices (or other supporting papers)

Appendix A - Update on the establishment and development of Bradford district and Craven Integrated Care Partnership

89 Page 2 of 4 Appendix A – Update on the establishment of Bradford district and Craven Integrated Care Partnership

Introduction

This paper sets out a high level overview of the plans for the establishment of an Integrated Care Partnership (ICP) in Bradford district and Craven. This is in response to the white paper Integration and Innovation: working together to improve health and social care for all2 which sets out two forms of integration: integration within the NHS to make working together an organising principle; and greater collaboration between the NHS and local government. This will lead to the formation of statutory Integrated Care Systems (ICSs) which will be comprised of an ICS Health and Care Partnership and an ICS NHS Body.

Locally, we will have a West Yorkshire ICS with five separate ICPs, mirroring the current CCG footprints. This builds on the partnership we already have in place at West Yorkshire, as through years of closely working together we have established positive and strong relationships with the other four places in West Yorkshire. We operate through a model of subsidiarity, ensuring the importance of place and this will continue through the implementation of the white paper.

The statutory duties and function of the CCG will transfer to the ICS NHS Body. The ICS Health and Care Partnership will determine how these functions are discharged. It is anticipated that many of these functions will be discharged through place based partnerships, to be known as Integrated Care Partnerships (ICPs).

There are two key national deadlines as part of this transition. The first is October 2021, where it is expected that each ICS and ICP will start to operate in shadow form. The second is April 2022, when the ICS will become a statutory NHS body.

Partnership working

Within Bradford district and Craven we will have an ICP which will be created from our partnership of NHS bodies, Councils, Voluntary Sector and independent care providers who collaborate to improve the health and wellbeing of our population and ensure equality of outcomes. This partnership will be informed by the experiences and insights from our communities and grounded in the expertise of our clinical and professional leaders. The ICP will be operated through a model of distributed leadership in communities, organisations and place partnerships.

We believe that the formalisation of partnership working set out within the white paper highlights that the ambition and journey Bradford District and Craven has been following for the last ten years has been the right one. The building of a strong place based partnership has been greatly beneficial for our population and our people. Thereby we are commencing the implementation of the white paper from a very strong position which we see as being incredibly positive for our place.

We have been building our partnership over the last ten years as we believe it: delivers better outcomes for our people; is more efficient; enables us to develop care co-ordination for our people; delivers whole population strategies; and creates a much more positive working environment for our staff. We have seen it as the right thing to do and that the formalisation of this way of working through the white paper supports our aims and ambitions. We have made great progress in developing our partnership, seeing ourselves as frontrunners nationally in regards to our partnership working. Work to date on the development of our partnership includes: the

2 https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all/integration-and- innovation-working-together-to-improve-health-and-social-care-for-all-html-version 90 Page 3 of 4 appointment of senior system leaders; the development and agreement of our Strategic Partnering Agreement, which sets out how we work together as a partnership; establishment of community partnerships to better involve our citizens voices in our place arrangements; the establishment of system committees; the establishment of system transformation programmes; and the launch and adoption of Act As One as our way of working as a partnership, supported by resource allocation.

Development of Bradford district and Craven ICP

Although we are starting from a very strong position we recognise there is still work to be done to formally transition into what is set out within the white paper. Therefore to support the development and transition to an ICP, the Executive Board has evolved into the ICP Executive Board which will be responsible and held to account for the formation of our ICP. The governance arrangements for our ICP are still to be worked through and will be informed by our place based aspirations but will also need to ensure they are coherent with the governance arrangements currently being developed for the ICS. To enable this we are working closely with the ICS establishment arrangements.

The ICP Executive Board agreed that to have an appropriate and robust process in place, a formal programme approach should be taken in regards to these changes. Therefore a new ICP Establishment and Development Programme has been formed to oversee this work. There are four key elements to the work the programme will oversee:

1. vision and strategy; 2. leadership and behaviours; 3. design and delivery; 4. and CCG transition/close down.

These will comprise of a number of separate workstreams who will have a named responsible lead. Each workstream will have a clear ‘job card’, measures, resource implications and timeline for delivery. They will each report into the Programme Board which will oversee the whole. This work will be progressed through existing groups where they are in place and there will be a clear plan for staff and citizen engagement. This engagement has already commenced with the ICP Engage event in March 2021 and will continue with further engagement events over the next year as it is important for our people to shape our newly emerging ICP. This includes a number of staff engagement sessions being run as part of the Act As One Festival (27th April – 20th May 2021).

The successful formation of our ICP will need to involve all of our existing partners. Although the establishment of an ICS and ICP includes the transition of the CCG and TUPE of CCG staff, we are fully aware that the CCG is only one organisation within our partnership and to be a highly functioning ICP our entire partnership will need to be involved in the development and agreement of our emergent form and functions. It is anticipated that the continued partnership approach to via the ICP Executive Board and ICP Establishment and Development Programme Board will ensure this.

Bradford district and Craven is starting from a very strong place in regards to the development of an ICP. We have worked in partnership across our place for many years as we recognised that it delivers better outcomes for people, is more efficient, and enables effective whole population strategies. We believe that the changes set out within the white paper with further enable this way of working.

91 Page 4 of 4 BRADFORD DISTRICT AND CRAVEN STRATEGIC PARTNERING AGREEMENT V3

NHS Bradford District and Craven CCG This document provides a summary and/or key discussion points and recommendations relevant to the subject of an item for consideration at the specified CCG meeting for the purpose of assurance, information, decision or action.

Agenda item 9

NHS Bradford District and Craven Name of meeting Meeting date 11 May 2021 CCG Governing Body Vicki Wallace, Interim – Title of report Strategic Partnering Agreement Report author(s) strategic director, sign off transformation and change

Lead(s) / SRO Vicki Wallace Report lead(s) Vicki Wallace

Paper summary and/or key discussion points

 The Strategic Partnering Agreement (SPA) has been in place since 2019 and it was acknowledged that a review was needed to ensure this document continued to reflect our ways of working across our system.  This work was undertaken by the SPA Design Group which reflects the BD&C partnership.  The work has been completed and Appendix A sets out the key changes made from the original 2019 document.  The revised SPA is attached at Appendix B.  The Governing Body is being asked to approve the revised SPA for sign off. If agreed, Helen Hirst will sign on behalf of the CCG.  The SPA is just one element to the new governance arrangements that will need to be in place moving forward to allow us to operate locally as an ICP.

Outline how this will help us to achieve our vision through our strategic ambitions:  Our population – improving health and equity for local people, and/or  Our partnerships – as the vehicle for enabling people to take more responsibility for their health, and/or  Our people – a skilled, motivated workforce with a culture of continuous improvement, and/or  Our leadership – assuring sustainability of our health and care system.

The review of the SPA will help us to achieve our strategic ambitions for each element of our PPPL. The current and future work will allow the continuation of a strong place based focus for Bradford District and Craven: ensuring a continued focus on the needs of our population; further embedding how we work as a partnership; empowering and enabling our people to continue to develop and succeed; while ensuring a continued focus of our leadership on our place.

Purpose assurance information decision action

Recommendation(s)

92 BRADFORD DISTRICT AND CRAVEN STRATEGIC PARTNERING AGREEMENT V3

The Governing Body is asked to: 1. Receive and approve the revised Strategic Partnering Agreement

Appendices (or other supporting papers)

 Appendix A – Summary of the key changes in the Strategic Partnering Agreement  Appendix B – The Strategic Partnering Agreement

93 BRADFORD DISTRICT AND CRAVEN STRATEGIC PARTNERING AGREEMENT V3 Appendix A

94 BRADFORD DISTRICT AND CRAVEN STRATEGIC PARTNERING AGREEMENT V3

Appendix B

DATE 2021

1. NHS BRADFORD DISTRICT AND CRAVEN CLINICAL COMMISSIONING GROUP 2. AIREDALE NHS FOUNDATION TRUST 3. BRADFORD DISTRICT CARE NHS FOUNDATION TRUST 4. BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST 5. CITY OF BRADFORD METROPOLITAN DISTRICT COUNCIL 6. BRADFORD CARE ALLIANCE COMMUNITY INTEREST COMPANY 7. BRADFORD VCS ALLIANCE LIMITED 8. LOCAL CARE DIRECT 9. MODALITY PARTNERSHIP 10. WHARFEDALE, AIREDALE AND CRAVEN ALLIANCE 11. BRADFORD CARE ASSOCIATION LIMITED 12. AFFINITY CARE

STRATEGIC PARTNERING AGREEMENT

FOR THE TRANSFORMATION AND BETTER INTEGRATION OF HEALTH AND CARE SERVICES FOR THE POPULATION OF BRADFORD DISTRICT AND CRAVEN

No Date Version Number Author 3 10 March 2021 3-1 HD

HD – update following 160321 SPA design 3 17 March 2021 3-2 group meeting

3 29 March 2021 3-3 HD – further updates

HD – updating SQC ToR and adding workforce 3 31 March 2021 3-4 principles; proof read and adding Affinity Care details.

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Contents

1. DEFINITIONS AND INTERPRETATION ...... 9 2. STATUS AND PURPOSE OF THIS AGREEMENT ...... 9 3. ACTIONS TAKEN PRIOR TO AND POST THE COMMENCEMENT DATE ...... 10 4. DURATION AND REVIEW ...... 10 SECTION A: VISION, OBJECTIVES AND PRINCIPLES ...... 10 5. BRADFORD DISTRICT AND CRAVEN ICP VISION ...... 10 6. BRADFORD DISTRICT AND CRAVEN ICP OBJECTIVES ...... 11 7. THE PRINCIPLES ...... 11 SECTION B: DELIVERY OF THE VISION AND OBJECTIVES ...... 12 8. PROBLEM RESOLUTION AND ESCALATION ...... 12 9. OBLIGATIONS AND ROLES OF THE PARTIES ...... 13 SECTION C: GOVERNANCE ARRANGEMENTS ...... 15 10. GOVERNANCE ...... 15 11. RESERVED POWERS ...... 16 12. INFORMATION SHARING AND CONFLICTS OF INTEREST ...... 17 SECTION D: FINANCIAL AND WORKFORCE FRAMEWORK, LIABILITY, ADMISSION AND EXCLUSION ...... 17 13. FINANCIAL PRINCIPLES ...... 17 14. WORKFORCE PRINCIPLES ...... 18 15. EXCLUSION AND TERMINATION ...... 18 16. INTRODUCING NEW PARTIES ...... 18 17. LIABILITY ...... 19 18. DISPUTE RESOLUTION PROCEDURE ...... 19 SECTION E: FUTURE DEVELOPMENT OF THE INTEGRATED CARE PARTNERSHIP FOR BRADFORD DISTRICT & CRAVEN ...... 19 SECTION F: GENERAL PROVISIONS ...... 19 19. VARIATIONS ...... 19 20. ASSIGNMENT AND NOVATION ...... 19 21. CONFIDENTIAL INFORMATION ...... 19 22. FREEDOM OF INFORMATION ...... 20 23. INTELLECTUAL PROPERTY...... 20 24. NOTICES ...... 20 25. SEVERANCE ...... 21

96 BRADFORD DISTRICT AND CRAVEN STRATEGIC PARTNERING AGREEMENT V3 26. WAIVER ...... 21 27. NO PARTNERSHIP ...... 21 28. COUNTERPARTS ...... 21 29. THIRD PARTY RIGHTS...... 21 30. ENTIRE AGREEMENT ...... 22 31. GOVERNING LAW AND JURISDICTION ...... 22 SCHEDULE 1 ...... 25 Definitions and Interpretation ...... 25 SCHEDULE 2...... 29 Governance ...... 29 SCHEDULE 3 ...... 30 Services ...... 30 SCHEDULE 4 ...... 31 Dispute Resolution Procedure ...... 31 SCHEDULE 5...... 33 Change Procedure ...... 33 SCHEDULE 6...... 35 Financial and Risk Management Principles ...... 35 SCHEDULE 7...... 41 Workforce Principles ...... 41 SCHEDULE 8 ...... 42 SPA Work Plan ...... 42 SCHEDULE 9 ...... 45 System Protocols ...... 45

97 BRADFORD DISTRICT AND CRAVEN STRATEGIC PARTNERING AGREEMENT V3

Date: 2021

This Strategic Partnering Agreement (SPA) is made between: 1. NHS BRADFORD DISTRICT AND CRAVEN CLINICAL COMMISSIONING GROUP of Scorex House (West), 1 Bolton Road, Bradford BD1 4AS (“CCG”); 2. AIREDALE NHS FOUNDATION TRUST of Airedale General Hospital, Skipton Road, Steeton, Keighley BD20 6TD; 3. BRADFORD DISTRICT CARE NHS FOUNDATION TRUST of New Mill, Victoria Road, Saltaire, West Yorkshire, BD18 3LD; 4. BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST of Duckworth Ln, Bradford BD9 6RJ; 5. CITY OF BRADFORD METROPOLITAN DISTRICT COUNCIL of Bradford City Park, City Hall, Centenary Square, Bradford BD1 1HY (“Council”); 6. BRADFORD CARE ALLIANCE COMMUNITY INTEREST COMPANY (Registered Company number 10083487) of The Ridge Medical Centre, Cousen Road, Bradford, BD7 3JX; 7. BRADFORD VCS ALLIANCE LIMITED (Registered Company number 10597133) whose registered office is Perkin House, Grattan Road, Bradford. BD1 2LU; 8. LOCAL CARE DIRECT (Registered Company number IP29766R) of Sheridan Teal House, Unit 2 Longbow Close, Pennine Business Park, Bradley, Huddersfield HD2 1GQ; 9. MODALITY PARTNERSHIP of Orsborn House, 55 Terrace Road, Handsworth, Birmingham B19 1BP; 10. WHARFEDALE, AIREDALE AND CRAVEN ALLIANCE of Springs Lane, Ilkley LS29 8TH; 11. BRADFORD CARE ASSOCIATION LIMITED (Registered Company number 11911880) of 68 Kirkgate, Shipley, England, BD18 3EL; and 12. AFFINITY CARE of The Westcliffe Building, Westcliffe Road, Shipley BD18 3EE, together referred to in this SPA as the “Parties” and each individually a “Party”.

The CCG and the Council (where acting as a commissioner and not a provider of social care and/or public health services) are together referred to in this SPA as the “Commissioners".

The other Parties, excluding the Commissioners but including the Council (where acting as a provider of social care and/or public health services), are together referred to in this SPA as the “Providers”.

RECITALS 1. The NHS Long Term Plan (LTP) published in January 2019 aimed to accelerate the redesign of patient care to future-proof the NHS for the decade ahead including the move to a new service model in which patients get more options, better support, and properly joined-up care at the right time in the optimal care setting. It also placed a focus on taking action to strengthen the NHS contribution to prevention and health inequalities.

2. The white paper published by the Department of Health and Social Care in February 20211 (the

1 Integration and Innovation: working together to improve health and social care for all (Integration and Innovation: working together to improve health and social care for all (publishing.service.gov.uk)

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White Paper) builds on the LTP vision and sets out the key components of an integrated care system (ICS), which are proposed to be set out in a new Health and Care Bill. One of these components is “strong and effective place-based partnerships” in local places between the NHS, local government and key local partners, interfacing with a statutory ICS for West Yorkshire & Harrogate and provider collaboratives. Subject to the required parliamentary process in respect of the Health and Care Bill, it is expected that the CCG will be dissolved and its functions transferred to the ICS in April 2022, with a mechanism to allow Integrated Care Partnerships at place level to exercise some functions, reflecting the subsidiarity principle.

3. The Parties have operated under a strategic partnering agreement since 2019 through which they have developed an effective framework for a place-based partnership for Bradford District & Craven through their ‘Act as One’ approach. This framework has been tested in extreme circumstances through the Covid-19 pandemic. The Parties recognise that from April 2021 until April 2022 (in line with the White Paper proposals) they will need to undertake a programme of work through the governance arrangements set out in this Agreement to further develop their partnering arrangements to become an effective Integrated Care Partnership (ICP) from April 2022.

4. As at the Commencement Date, the Covid-19 pandemic is continuing, and the Parties acknowledge that they will need to continue to support each other and work in partnership through this Agreement to address the significant health and wellbeing challenges, including health inequalities, facing the people of Bradford District & Craven.

5. This SPA sets out the operating framework (as at April 2021), values, principles and shared ambition of the Parties in supporting work towards the transformation of health and care and better health and wellbeing outcomes for the people who live in Bradford District and Craven through the ICP model. It sets out a programme of work (the SPA Work Plan) to be undertaken by the Parties in order to develop the arrangements under this Agreement ready for shadow operation by October 2021.

6. The Commissioners are the statutory bodies responsible for planning, organising and buying social care, NHS-funded healthcare, support and community services for people who live in Bradford District and Craven. The Providers are providers of social care, NHS funded healthcare, support and community services to the population across Bradford District and Craven.

7. The Council has a role within this SPA as both a commissioner of public health and social care services but also as a provider of social care services either through direct delivery or through various subcontracts. In its role as commissioner of social care services the Council shall be a Commissioner and in its role as provider of social care services it shall be a Provider. The Council recognises the need to ensure that any potential internal or external conflicts of interest are appropriately identified and managed.

8. Specific new services and initiatives may be added by agreement and inserted into this SPA as required to further the collaborative work of the Parties.

9. This SPA has been drafted to work alongside:

(a) the Services Contracts between the Commissioners and the Providers for the delivery of the Services; (b) the Section 75 Agreement entered into by the Commissioners on 1 April 2020 as a “Framework

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Partnership Agreement relating to the Commissioning of Health and Social Care services” under which they commission the services listed in the schedules to that agreement; and

10. This SPA replaces the previous Strategic Partnering Agreement entered into by certain of the Parties dated May 2019 which is terminated with effect from the Commencement Date. IT IS AGREED AS FOLLOWS: 1. DEFINITIONS AND INTERPRETATION

1.1 In this SPA, capitalised words and expressions shall have the meanings given to them in Schedule 1.

1.2 In this SPA, unless the context requires otherwise, the following rules of construction shall apply:

1.2.1 a person includes a natural person, corporate or unincorporated body (whether or not having separate legal personality);

1.2.2 a reference to a “Provider” or “Commissioner” includes its personal representatives, successors or permitted assigns;

1.2.3 a reference to a statute or statutory provision is a reference to such statute or provision as amended or re-enacted. A reference to a statute or statutory provision includes any subordinate legislation made under that statute or statutory provision, as amended or re- enacted;

1.2.4 any phrase introduced by the terms “including”, “include”, “in particular” or any similar expression shall be construed as illustrative and shall not limit the sense of the words preceding those terms;

1.2.5 documents in “agreed form” are documents in the form agreed by the Providers and initialled by them for identification and attached to this SPA; and

1.2.6 a reference to writing or written includes faxes and e-mails. 2. STATUS AND PURPOSE OF THIS AGREEMENT

2.1 The Parties have together formed a strategic partnership on the terms set out in this SPA in order to develop an operating framework for an Integrated Care Partnership to deliver better health outcomes for the population of Bradford District and Craven.

2.2 This SPA sets out the key terms that the Parties have agreed in how the Commissioners and Providers will work together in a collaborative and integrated way on a Best for Bradford District and Craven basis to develop and implement an ICP model for Bradford District and Craven. The Services Contracts set out how the Parties provide Services to Bradford District and Craven. This SPA is not intended to conflict with or take precedence over the terms of the Services Contracts unless expressly agreed by the Parties to the respective Services Contract.

2.3 The Parties agree that, notwithstanding the good faith consideration that each Party has afforded the terms set out in this SPA and save as provided in Clause 2.4 below, this SPA shall not be legally binding. The Parties enter into this SPA intending to honour all their obligations. Certain aspects of this SPA are not relevant to particular types of organisation due to their differing legal and statutory status. These are indicated in the table at Annex 1 to this SPA as may be amended from time to time. 100 Page 9 of 47 BRADFORD DISTRICT AND CRAVEN STRATEGIC PARTNERING AGREEMENT V3

2.4 Clauses 12 (Information Sharing and Conflicts of Interest), 17 (Liability), 20 (Assignment and Novation), 21 (Confidential Information), 22 (Freedom of Information), 23 (Intellectual Property), 28 (Counterparts) and 31 (Governing Law and Jurisdiction) shall come into force from the date hereof and shall give rise to legally binding commitments between the Parties.

2.5 Each of the Providers either have entered or will enter into individual Services Contracts (or where appropriate combined Services Contracts) with one or more of the Commissioners for Services. The Commissioners may also enter certain contracts with each other such as agreements for the pooling of funds or resources between the Commissioners. This SPA will be referred to in, supplement and work alongside these arrangements as the overarching operating framework across Bradford District and Craven. 3. ACTIONS TAKEN PRIOR TO AND POST THE COMMENCEMENT DATE

3.1 Each Party shall provide to each of the other Parties on or prior to the Commencement Date confirmation that it has approved entry into this SPA. 4. DURATION AND REVIEW

4.1 This SPA shall take effect on the Commencement Date and will continue in full force and effect and will expire on 31 March 2023 (the “Initial Term”), unless and until terminated in accordance with the terms of this SPA.

4.2 The Parties may by agreement in writing extend the Initial Term of the SPA by a further additional period of up to three (3) years (the “Extended Term”).

4.3 The Parties will review progress made against the SPA Work Plan and the terms of this Agreement at six monthly intervals from the Commencement Date or as otherwise agreed between the Parties and may agree to vary the Agreement to reflect developments as appropriate in accordance with Clause 19 (Variations).

SECTION A: VISION, OBJECTIVES AND PRINCIPLES

Whilst the terms of clauses 5, 6 and 7 are not legally binding the Parties all enter into this SPA intending to honour their obligations within them and to work towards the delivery of the vision and the objectives.

5. BRADFORD DISTRICT AND CRAVEN ICP VISION

5.1 The Parties have agreed to work towards a common vision that:

5.1.1 People will be healthier, happier, and have equitable access to high quality care.

5.1.2 People will be in control of their health and wellbeing, and will be supported to stay healthy, well and independent through their whole life. Communities and the health and care system will coproduce health and wellbeing, and will focus on prevention and early intervention.

5.1.3 Reducing the widening health inequalities in Bradford District and Craven is a priority. We will tackle inequality in access and quality of healthcare, and we will contribute to addressing the wider causes of inequality by playing a full part in social and economic development and environmental sustainability.

5.1.4 When people need access to care and support it will be available to them through a proactive and joined up health, social care and wellbeing service designed around their 101 Page 10 of 47 BRADFORD DISTRICT AND CRAVEN STRATEGIC PARTNERING AGREEMENT V3

needs. Access to services will include digital options and will be provided as close to where they live as possible.

In short … Happy, Healthy at Home 6. BRADFORD DISTRICT AND CRAVEN ICP OBJECTIVES

6.1 The Parties wish to deliver improved population health through integrated health, care and support. The Parties have agreed a collective way of working – “Act as One” – which they will use to achieve the following Objectives:

6.1.1 deliver the Bradford District and Craven Integrated Care Partnership Plan, and contribute to the delivery of the West Yorkshire Integrated Care System Plan;

6.1.2 coordinate the local contribution to health, social and economic development to prevent future risks to health and wellbeing;

6.1.3 share collective responsibility for the management of our collective resources, purposefully deployed to secure better outcomes for our population; including incrementally increasing the proportion of our resource used on prevention;

6.1.4 develop population health management capabilities to:

(a) identify, understand and take into account the wider determinants of people’s health and wellbeing;

(b) proactively improve primary and secondary prevention and better target interventions;

(c) reduce health inequalities;

(d) use evidence of people’s experiences of services and outcomes gathered through involvement and authentic public engagement strategies to inform the co-production of simple, modern, joined-up health and care services; and

(e) deliver personalised care; and deliver health and care services that are developed in partnership with the communities they seek to serve; and

6.1.5 recognise, support and develop the collective health and care workforce as a key asset in achieving the vision and objectives.

6.2 The Parties will work together and “Act as One”, making collective decisions on a Best for Bradford District and Craven basis to achieve these Objectives, and in doing so will ensure that the impact of changes in one part of the health and care system on other parts are understood and taken into account. 7. THE PRINCIPLES

7.1 These Principles underpin the delivery of the Parties’ obligations under this SPA and set out key factors for a successful relationship between the Parties.

7.2 The Parties acknowledge and confirm that the successful delivery of the operating framework for the ICP will depend on their ability to effectively co-ordinate and combine their expertise and resources in order to deliver an integrated approach to the planning, provision and use of community assets and services across the Commissioners and Providers.

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7.3 The principles are that the Parties will work together in good faith and, unless the provisions in this SPA state otherwise, the Parties will:

7.3.1 act as one team, pursuing one vision; united in our greater purpose to improve population health outcomes; we will be ambitious for the people we serve and the staff we employ;

7.3.2 exercise leadership for the whole of our Integrated Care Partnership, as well as for our individual organisations; behaving in ways which model our shared values;

7.3.3 assume good intentions, and support each other to work collaboratively in the spirit of continuous improvement;

7.3.4 act with honesty and integrity, challenging constructively when we need to, and trusting each other to do the same;

7.3.5 implement shared priorities and decisions, holding each other to account for delivery of improved outcomes and reduced inequalities;

7.3.6 listen to people and act on their feedback;

7.3.7 understand that we are stewards of the health and care system on behalf of our citizens, now and for future generations; so we will build constructive relationships with communities for the long term;

7.3.8 do the work once – duplication of systems, processes and work should be avoided as wasteful and potential source of conflict;

7.3.9 undertake shared analysis of problems and issues as the basis of taking action; and

7.3.10 apply subsidiarity principles in all that we do – with work taking place at the appropriate level and as near to local as possible,

(these principles together with the Financial Principles (Schedule 6) and Workforce Principles (Schedule 7) are the “Principles”).

SECTION B: DELIVERY OF THE VISION AND OBJECTIVES

8. PROBLEM RESOLUTION AND ESCALATION

8.1 The Parties agree to adopt a systematic approach to problem resolution that recognises the Vision, Objectives and the Principles of the SPA set out in clauses 5, 6 and 7 above.

8.2 If a problem, issue, concern or complaint comes to the attention of a Party which relates to the Principles or any matter in this SPA and is appropriate for resolution between the Commissioners and the Providers under this SPA such Party shall notify the other Parties and the Parties each acknowledge and confirm that they shall then seek to resolve the issue by a process of discussion.

8.3 If any Party considers an issue identified in accordance with Clause 8.2 to amount to a Dispute requiring resolution in accordance with Clause 18 (Dispute Resolution Procedure) and such issue cannot be resolved within a reasonable period of time, the matter shall be escalated to the Programme Board appropriate to the Services in question or if there is no relevant Programme Board to the relevant Health and Care Partnership (or the ICP Board if the Dispute affects more

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than one of the Health & Care Partnerships), which shall decide on the appropriate course of action to take.

8.4 Subject to Clause 18 (Dispute Resolution Procedure), if the matter referred to in Clause 8.3 above cannot be resolved by the Programme Board appropriate to the Service, within 15 Operational Days, the matter may be escalated to the relevant Health and Care Partnership (or the ICP Board if the Dispute affects more than one of the Health and Care Partnerships) for resolution. 9. OBLIGATIONS AND ROLES OF THE PARTIES

General obligations of the Parties and mutual accountability

9.1 Each of the Parties will co-operate in good faith with the others to facilitate the proper performance of this SPA and in particular will:

9.1.1 use all reasonable endeavours to avoid unnecessary disputes and claims against any other Party;

9.1.2 not interfere with the rights of any other Party and its servants, agents, representatives, contractors or sub-contractors (of any tier) on its behalf in performing its obligations under this SPA nor in any other way hinder or prevent such other Party or its servants, agents, representatives, or sub-contractors (of any tier) on its behalf from performing those obligations; and

9.1.3 subject to Clause 9.3, assist the other Parties (and their servants, agents, representatives, or sub-contractors (of any tier)) in performing those obligations so far as is reasonably practicable; and

9.1.4 not wilfully impede the other Parties in the performance of their obligations under this SPA (having regard always to the interactive nature of the activities of the Parties and the Services or any other of the Parties’ statutory functions).

9.2 Each Party severally undertakes that it shall:

9.2.1 work collaboratively with the other Parties in accordance with the Principles;

9.2.2 focus on the delivery of key actions that have been agreed across the Parties in the ICP Board and HCPs and agreement on areas where they require support from the wider group of Parties to ensure the effective management of financial and delivery risk; and

9.2.3 co-operate with the other Parties in providing a system wide approach and response to national regulatory bodies (including NHS England & Improvement and the CQC) and the Integrated Care System for West Yorkshire and Harrogate from the Bradford District and Craven system through the Health and Care Partnerships and the ICP Board on regulatory issues which impact upon the Services or the ability of the Parties to deliver the Vision and Objectives.

9.3 Nothing in this Clause 9.1 shall:

9.3.1 interfere with the Health and Wellbeing Board’s statutory role as the vehicle for joint local system leadership for health and care or other statutory roles of the Parties;

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9.3.2 interfere with the right of each Party to arrange its affairs in whatever manner it considers fit in order to perform its obligations under this SPA in the manner in which it considers to be the most effective and efficient; or

9.3.3 oblige any Party to incur any additional cost or expense or suffer any loss in excess of that required by its proper performance of its obligations under this SPA.

Commissioners’ obligations and role

9.4 The Commissioners will:

9.4.1 help to establish and manage an environment that encourages collaboration between the Providers where permissible;

9.4.2 provide clarity on the resources available for Bradford District and Craven from their organisations clearly articulating health and care outcomes, performance standards, scope of services and technical requirements for the Providers;

9.4.3 support the Providers in developing links to other relevant services;

9.4.4 provide skilled resources for commissioning of the Services (i.e. including relevant know- how);

9.4.5 comply with all of their statutory duties; and

9.4.6 seek to commission the Services in an integrated, effective and streamlined way leading performance development and culture change and encompassing:

(i) operational performance;

(ii) quality and outcomes through population health management; and

(iii) service transformation.

9.5 The Providers will:

9.5.1 act collaboratively and in good faith with each other in accordance with Guidance, National Standards and the Law to ensure the performance of the Services in having at all times regard to the welfare of service users; and

9.5.2 co-operate fully and liaise appropriately with each other in order to ensure a co-ordinated approach to promoting the quality of care across the Services and so as to achieve continuity in the provision of the Services that avoids inconvenience to, or risk to the health and safety of employees of the Providers or service users; and

9.5.3 through high performance, unlock and generate enhanced innovation and better outcomes and value for Bradford District and Craven.

9.6 Each Provider acknowledges and confirms that:

9.6.1 it remains responsible for performing its obligations and functions for delivery of the Services to the Commissioners in accordance with its Services Contracts; and

9.6.2 it will be separately and solely liable to the Commissioners for the provision of the elements of the Services where these come under its own Services Contracts.

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10. GOVERNANCE

10.1 The governance structure for this SPA in Bradford District and Craven will consist of:

10.1.1 the ICP Board;

10.1.2 the Airedale Wharfedale and Craven Health and Care Partnership Board; the Bradford and District Health and Care Partnership Board; and the Mental Health, Learning Disabilities and Neurodiversity Health and Care Partnership Board (together the “Health and Care Partnerships”);

10.1.3 the Programme Boards; and

10.1.4 the System Committees.

ICP Board

10.2 The ICP Board is the group responsible for setting the strategy for the health and care system in Bradford District and Craven, in line with the strategy of the Health and Wellbeing Boards. The ICP Board leads the Parties’ collaborative approach to the Services, the development of the ICP and working in accordance with the Principles across the Bradford District and Craven system. The ICP Board will report to the Health and Wellbeing Boards for Bradford District and Craven as well as the Overview and Scrutiny Committees of the Council. It will hold the Health and Care Partnerships and System Committees to account. It will have other responsibilities as defined in its terms of reference set out in Part 1 of Schedule 2 (ICP Board – Terms of Reference).

10.3 The ICP Board shall not be a committee of any Party or any combination of Parties and will operate as a collaborative forum.

Health and Care Partnerships

10.4 The Health and Care Partnerships will be responsible for managing the Parties’ input into the Services and the delivery of the Objectives, and shall play key roles in linking the ICP with neighbourhood levels in Bradford District & Craven. The Health and Care Partnerships shall not be a committee of any Party or any combination of Parties and will operate as a collaborative forum.

10.5 The terms of reference for the Health and Care Partnerships shall be as set out in Part 2 of Schedule 2 (Health and Care Partnerships – Terms of Reference).

System Committees

10.6 The System Committees are established by the ICP Board and are responsible for developing a system-wide approach in their respective areas of focus. The System Committees will provide advice and assurance to the ICP Board in their areas of focus and play a key role in driving improvement across the ICP. The System Committees report to the ICP Board and include the System Finance & Performance Committee and System Quality Committee, the terms of reference for which are set out in Part 3 of Schedule 2 (System Committees – Terms of Reference).

Programme Boards

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10.7 The Programme Boards are the groups responsible for managing the collaborative operation of the Parties and the delivery of the Services. The Programme Boards will act in accordance with their terms of reference that are to be agreed on a programme-by-programme basis in respect of each Programme to be adopted under the SPA and must:

10.7.1 recommend to the ICP Board and the Health and Care Partnerships for their approval or rejection as to how the Services should be delivered in a more integrated way for Bradford District and Craven (subject always to the terms of the Services Contracts and the formal decisions of the relevant Parties); and

10.7.2 provide clinical and professional leadership with regard to the Services.

10.8 The Parties must each ensure that the relevant representatives (or their appointed deputy) attend all of the meetings of the governance groups set out in Clause 10.1 above respectively and participate fully and exercise their voting rights on a Best for Bradford District and Craven basis and in accordance with the Vision, Objectives and Principles.

Community Partnerships

10.9 Community Partnerships are the basis upon which the Parties coordinate, plan and deliver at neighbourhood level. The Parties will continue to develop ways of devolving decision making as close to communities as possible. Each Community Partnership has a Primary Care Network within it. The Parties acknowledge and agree that Primary Care Networks are an integral part of the Bradford District and Craven Community Partnerships, not an alternative to them. 11. RESERVED POWERS

11.1 The Parties agree and acknowledge that nothing in this SPA shall operate as to require them to make any decision or act in anyway which shall place any Party in breach of:

11.1.1 Law;

11.1.2 any Services Contract;

11.1.3 any specific Department of Health and Social Care policies;

11.1.4 in the case of the Council, the Council constitution;

11.1.5 in the case of the CCG, the CCG constitution;

11.1.6 any requirement upon the Commissioners to undertake and have regard to the results of public consultation; or

11.1.7 in the case of a Provider, its constitution, any terms of its provider licence from NHS Improvement, its registration with the CQC or to breach any legislative requirements including the NHS Act 2006 (as amended); or

11.1.8 any term of a non-NHS party’s legal constitution or other legally binding agreement or governance document of which specific written notice has been given to the Parties prior to the date of this SPA,

and neither the ICP Board or Health and Care Partnerships will make a final recommendation which requires any Party to act as such.

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11.2 Annex 2 contains a summary of the relevant statutory roles of the Parties which could be impacted by the operation of this SPA. 12. INFORMATION SHARING AND CONFLICTS OF INTEREST

12.1 Subject to compliance with Law (including without limitation Competition Law) and contractual obligations of confidentiality in order to meet the Vision, Objectives and Principles the Parties agree to share all information relevant to the provision of the Services in an honest, open and timely manner.

12.2 The Parties will:

12.2.1 disclose to each other the full particulars of any real or apparent conflict of interest which arises or may arise in connection with this SPA or the performance of the Services, immediately upon becoming aware of the conflict of interest whether that conflict concerns the Party or any person employed or retained by them for or in connection with the performance of the Services;

12.2.2 not allow themselves to be placed in a position of conflict of interest or duty in regard to any of their rights or obligations under this SPA (without the prior consent of the other Parties) before they participate in any decision in respect of that matter; and

12.2.3 use best endeavours to ensure that their representatives on the governance groupings for the operating framework also comply with the requirements of this Clause 12 when acting in connection with this SPA or the performance of the Services.

12.3 If there is:

12.3.1 any uncertainty or a lack of consensus between the Parties regarding the existence of a conflict of interest under Clause 12.2.1 or 12.2.2; or

12.3.2 any query or Dispute as to whether any Party is put in a position (or will be) of conflict under Clause 12.2.2,

which cannot be resolved with recourse to the protocol referred to in Clause 12.4, any Party may refer the matter for resolution under Clause 18 (Dispute Resolution Procedure).

12.4 The Parties have agreed, and will each comply with, a protocol for managing conflicts of interest as set out in Schedule 9 (System Protocols). The Parties will finalise a protocol for managing the sharing of information in accordance with Competition Law and data protection requirements during the Initial Term. SECTION D: FINANCIAL AND WORKFORCE FRAMEWORK, LIABILITY, ADMISSION AND EXCLUSION

13. FINANCIAL PRINCIPLES

13.1 The Parties will act in accordance with the Financial Principles set out in Schedule 6 to this SPA to facilitate greater transparency and collaborative working to achieve the changes required to deliver financial sustainability for Bradford District and Craven.

13.2 Whilst the Parties will be paid in accordance with the mechanism set out in the Services Contracts in respect of their Services they also acknowledge that they are ready to work together, manage risk

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together, and support each other when required to deliver the changes required to achieve financial sustainability and live within the resources of Bradford District and Craven. 14. WORKFORCE PRINCIPLES

14.1 The Parties will act in accordance with the Workforce Principles set out in Schedule 7 to this SPA to maximise the collective resources of the Parties to achieve the changes required to deliver the Vision and Objectives for Bradford District and Craven.

15. EXCLUSION AND TERMINATION

15.1 Parties may be excluded on notice from this SPA and participation in the Health and Care Partnerships and ICP Board in the event of:

15.1.1 the termination of their Services Contract; or

15.1.2 an event of Insolvency affecting them.

15.2 Without affecting any other right or remedy available to it, any Party may exit this SPA on giving not less than 6 months' written notice to the ICP Board.

15.3 Any Party may also be excluded from the SPA and participation in the Health and Care Partnerships, the ICP Board and System Committees if the Party in question has materially breached the terms of this Agreement by a resolution passed at a meeting of the ICP Board of not less than 75% of the Parties voting at that meeting. The Party which is the subject of the resolution to remove it from SPA shall be entitled to make representations to the other Parties at the ICP Board meeting at which the resolution is being proposed prior to any vote being taken on such resolution.

Consequences of termination / exclusion / withdrawal

15.4 Where a Party is excluded from this SPA, or withdraws from it, the Parties agree to work together in good faith to agree necessary changes so that the SPA continues to operate effectively on a Best for Bradford District and Craven basis. Any departing Party (whether exiting or excluded) shall procure that all data and other material belonging to any other Party under this SPA shall be delivered back to the relevant Party, deleted or destroyed as soon as reasonably practicable and confirm to the remaining Parties when this has been completed. The departing Party shall also on exit grant a new licence to the remaining Parties to continue to use any of its existing or new Intellectual Property under the terms of Clause 23 to the extent that it remains required for the sole purpose of the fulfilment of the remaining Parties obligations under this SPA.

16. INTRODUCING NEW PARTIES

16.1 Subject to complying with applicable Law, if appropriate to achieve the Objectives, the Parties at the ICP Board may agree to include additional parties who meet the admission criteria to this SPA as set out at Clause 16.2. If the ICP Board agrees on such a course, the new parties will become parties to this SPA on such terms as the current Parties shall jointly agree subject to referral to the Dispute Resolution Procedure in the event of any disagreement.

16.2 The admission criteria for a party to be considered for admission and participation under this SPA by the ICP Board shall be that they hold a contract for services to the population of Bradford District

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and Craven of a scale that the Parties consider enables them to assist in the delivery of the Vision and Objectives across the population.

16.3 The Parties intend that any organisation who is a party to this SPA (including themselves) shall commit to the Vision, Principles and the Objectives and ownership of the system success/failure as set out in this SPA. 17. LIABILITY

The Parties’ respective responsibilities and liabilities in the event that things go wrong with the Services will be allocated under their respective Services Contracts and not this SPA. 18. DISPUTE RESOLUTION PROCEDURE

Subject to compliance with Clause 8, any Dispute will be resolved in accordance with the Dispute Resolution Procedure set out at Schedule 4.

SECTION E: FUTURE DEVELOPMENT OF THE INTEGRATED CARE PARTNERSHIP FOR BRADFORD DISTRICT & CRAVEN

The Parties have agreed to work together to further develop, and implement, the SPA Work Plan, the initial draft of which is set out in Schedule 8 (SPA Work Plan). The areas for development set out in the SPA Work Plan have been identified by the Parties as priorities for 2021/22 in order to ensure that the ICP is thriving and ready to transition to the new model of health and care planning and delivery for Bradford District & Craven in shadow form by October 2021, and fully functioning by April 2022. The SPA Work Plan will form part of a wider programme of work to be undertaken to develop the ICP during 2021/22. The Parties will keep the SPA Work Plan under review through the governance structures set out in this Agreement and may agree to amend the SPA Work Plan as required during the Initial Term in accordance with Clause 19 (Variations), in line with policy direction and legislative developments.

SECTION F: GENERAL PROVISIONS

19. VARIATIONS

19.1 The provisions of Schedule 5 (Change Procedure) will apply.

19.2 Save as set out in Clause 20, any amendment, waiver or variation of this SPA will not be binding unless set out in writing, expressed to amend, waiver or vary this SPA and signed by or on behalf of each of the Parties. 20. ASSIGNMENT AND NOVATION

Unless the Parties agree otherwise in writing, the Services Contracts are personal to those Parties that have entered into those Services Contracts and none of the Parties will novate, assign, delegate, sub-contract, transfer, charge or otherwise dispose of all or any of their rights and responsibilities under any Services Contract or this SPA. 21. CONFIDENTIAL INFORMATION

21.1 Each Party shall keep in strict confidence all Confidential Information it receives from another Party to this SPA except to the extent that such Confidential Information is required by Law to be disclosed, is already in the public domain, or comes into the public domain otherwise than through

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an unauthorised disclosure by a Party to this SPA. Each Party shall use any Confidential Information received from another Party solely for the purpose of complying with its obligations under this SPA and the Vision and Objectives in accordance with the Principles and for no other purpose. No Party shall use any Confidential Information received under this SPA for any other purpose including use for their own commercial gain in services outside of the Services or to inform any competitive bid for any elements of the Services without the express written permission of the disclosing Party.

21.2 To the extent that any Confidential Information is covered or protected by legal privilege, then disclosing such Confidential Information to any Party or otherwise permitting disclosure of such Confidential Information does not constitute a waiver of privilege or of any other rights that a Party may have in respect of such Confidential Information.

21.3 The Parties agree to procure, as far as is reasonably practicable, that the terms of this Clause 21 are observed by any of their respective successors, assigns or transferees of respective businesses or interests or any part thereof as if they had been party to this SPA and this Clause will survive the expiry or the termination of this SPA for a period of 5 years.

21.4 Nothing in this Clause 21 will affect any of the Parties’ regulatory or statutory obligations, including but not limited to Competition Law.

22. FREEDOM OF INFORMATION

22.1 If any Party receives a request for information relating to this SPA or the Services under the Freedom of Information Act 2000 or the Environmental Information Regulations 2004, it shall (within not more than seven (7) days from receipt of the request) consult with the other Parties before responding to such request and, in particular, shall have due regard to any claim by any other Party to this SPA that the exemptions relating to commercial confidence and/or confidentiality apply to the information sought. 23. INTELLECTUAL PROPERTY

23.1 In order to meet the Vision and the Objectives each Party grants each of the other Parties a fully paid up non-exclusive licence to use its existing Intellectual Property related to the Services but only insofar as it is reasonably required for the sole purpose of the fulfilment of that Party’s obligations under this SPA.

New Intellectual Property

23.2 If any Party creates any new Intellectual Property through the development of the Services between the Parties, the Party which creates the new Intellectual Property will grant to the other Parties a fully paid up non-exclusive licence to use the new Intellectual Property for the sole purpose of the fulfilment of that Party’s obligations under this SPA.

24. NOTICES

24.1 Any notice or other communication given to a Party under or in connection with this SPA shall be in writing, addressed to that Party at its principal place of business or such other address as that Party may have specified to the other Party in writing in accordance with this Clause, and shall be

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delivered personally, or sent by pre-paid first class post, recorded delivery, commercial courier or email.

24.2 A notice or other communication shall be deemed to have been received: if delivered personally, when left at the address referred to in Clause 24.1; if sent by pre-paid first class post or recorded delivery, at 9.00 am on the second Operational Day after posting; if delivered by commercial courier, on the date and at the time that the courier’s delivery receipt is signed; or, if sent by email, one (1) Operational Day after transmission. 25. SEVERANCE

25.1 If any court or competent authority finds that any provision of the SPA (or part of any provision) is invalid, illegal or unenforceable, that provision or part-provision shall, to the extent required, be deemed to be deleted, and the validity and enforceability of the other provisions of the SPA shall not be affected.

25.2 If any invalid, unenforceable or illegal provision of the SPA would be valid, enforceable and legal if some part of it were deleted, the provision shall apply with the minimum modification necessary to make it legal, valid and enforceable.

26. WAIVER

A waiver of any right or remedy under the SPA is only effective if given in writing and shall not be deemed a waiver of any subsequent breach or default. No failure or delay by a Party to exercise any right or remedy provided under the SPA or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy. 27. NO PARTNERSHIP

Nothing in this SPA is intended to, or shall be deemed to, establish any partnership between any of the Parties, constitute any Party the agent of another Party, nor authorise any Party to make or enter into any commitments for or on behalf of any other Party except as expressly provided in this SPA. 28. COUNTERPARTS

This SPA may be executed in any number of counterparts, each of which when executed and delivered shall constitute an original of this SPA, but all the counterparts shall together constitute the same agreement. The expression “counterpart” shall include any executed copy of this SPA transmitted by fax or scanned into printable PDF, JPEG, or other agreed digital format and transmitted as an e-mail attachment. No counterpart shall be effective until each party has executed at least one counterpart. 29. THIRD PARTY RIGHTS

A person who is not a party to this SPA shall not have any rights under or in connection with it.

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This SPA and the Services Contracts constitute the entire agreement between the Parties and supersedes all prior discussions, correspondence, negotiations, arrangements, representations, understandings or agreements between them, whether written or oral, relating to its subject matter. 31. GOVERNING LAW AND JURISDICTION

This SPA, and any dispute or claim arising out of or in connection with it or its subject matter or formation (including non-contractual disputes or claims), shall be governed by, and construed in accordance with, English law, and where applicable, the Parties irrevocably submit to the exclusive jurisdiction of the courts of England and Wales.

This SPA for Bradford District and Craven has been entered into on the date stated at the beginning of it.

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Signed by ...... for and on behalf of NHS BRADFORD DISTRICT AND CRAVEN CLINICAL

COMMISSIONING GROUP

Signed by for and on behalf of BRADFORD CARE ALLIANCE COMMUNITY INTEREST ...... COMPANY

Signed by ...... for and on behalf of BRADFORD DISTRICT CARE NHS FOUNDATION TRUST

Signed by ...... for and on behalf of AIREDALE NHS FOUNDATION TRUST

Signed by ...... for and on behalf of BRADFORD TEACHING HOSPITALS NHS FOUNDATION

TRUST

Signed by for and on behalf of CITY OF BRADFORD METROPOLITAN DISTRICT ...... COUNCIL

Signed by ...... for and on behalf of BRADFORD VCS ALLIANCE LIMITED

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Signed by ...... for and on behalf of LOCAL CARE DIRECT

Signed by ...... for and on behalf of MODALITY PARTNERSHIP

Signed by ...... for and on behalf of WHARFEDALE, AIREDALE AND CRAVEN ALLIANCE

Signed by ...... for and on behalf of BRADFORD CARE ASSOCIATION LIMITED

Signed by MATTHEW FAY ...... for and on behalf of AFFINITY CARE

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Definitions and Interpretation

1 The following words and phrases have the following meanings:

Best for Bradford District and best for the achievement of the Vision and Craven Objectives for Bradford District and Craven on the basis of the Principles Bradford District and Craven the geographical population group covered by the CCG Change any alteration of or variation to this SPA or any Services Contract including a Mandatory Change as set out in Schedule 5 (Change Procedure) Competition Law the Competition Act 1998 and the Enterprise Act 2002, as amended by the Enterprise and Regulatory Reform Act 2013 and as applied to the healthcare sector by Monitor in accordance with the Health and Social Care Act 2012. Confidential Information all information which is secret or otherwise not publicly available (in both cases in its entirety or in part) including commercial, financial, marketing or technical information, know-how, trade secrets or business methods, in all cases whether disclosed orally or in writing before or after the date of this SPA Dispute any dispute arising between two or more of the Parties in connection with this SPA or their respective rights and obligations under it Dispute Resolution Procedure the procedure set out in Schedule 4 for the resolution of disputes which are not capable of resolution under Clause 18 Guidance has the meaning set out in the NHS Standard Contract Health and Care Partnership or has the meaning set out in Clause 10.1.2 HCP ICP Board the ICP Board as set out in Clause 10 Initial Term the initial term of this SPA as set out in Clause 4.1 Intellectual Property patents, rights to inventions, copyright and related rights, trade marks, business names and domain names, goodwill, rights in designs, rights in computer software, database rights, rights to use and all other intellectual property rights, in each case whether registered or unregistered and including all applications and rights to apply for and be granted, renewals or extensions of, and rights to claim priority from, such rights and all similar or equivalent rights or forms of protection which subsist or will subsist now or in the future in any part of the world

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Insolvency any of the following events or circumstances (as may be applicable to each Party): a) where a Party suspends, or threatens to suspend, payment of its debts (whether principal or interest) or is deemed to be unable to pay its debts within the meaning of Section 123(1) of the Insolvency Act 1986; b) where a Party calls a meeting, gives a notice, passes a resolution or files a petition, or an order is made, in connection with the winding up of that Party (save for the sole purpose of a solvent voluntary reconstruction or amalgamation); c) where a Party has an application to appoint an administrator made or a notice of intention to appoint an administrator filed or an administrator is appointed in respect of it or all or any part of its assets; d) where a Party has a receiver or administrative receiver appointed over all or any part of its assets or a person becomes entitled to appoint a receiver or administrative receiver over such assets; e) where a Party takes any steps in connection with proposing a company voluntary arrangement or a company voluntary arrangement is passed in relation to it, or it commences negotiations with all or any of its creditors with a view to rescheduling any of its debts; or f) where a Party has any steps taken by a secured lender to obtain possession of the property on which it has security or otherwise to enforce its security; or g) where a Party has any distress, execution or sequestration or other such process levied or enforced on any of its assets which is not discharged within 14 Operational Days of it being levied; h) where a Party has any proceeding taken, with respect to it in any jurisdiction to which it is subject, or any event happens in such jurisdiction that has an effect equivalent or similar to any of the events listed above; and/or i) where a Party substantially or materially ceases to operate, is dissolved, or is de-authorised as an NHS trust or NHS foundation trust; j) where a Party is clinically and/or financially unsustainable as a result of any clinical or financial intervention or sanction by the regulator responsible for the independent

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regulation of NHS trusts OR NHS foundation trusts or the Secretary of State and which has a material adverse effect on the delivery of the Services; k) a trust special administrator is appointed over a Party under the National Health Service Act 2006 or a future analogous event occurs; or l) if a Party suffers any event analogous to the events set out in a) to k) of this definition in any jurisdiction in which it is incorporated or resident; Law a) any applicable statute or proclamation or any delegated or subordinate legislation or regulation; b) any applicable judgment of a relevant court of law which is a binding precedent in England and Wales; c) Guidance (as defined in the NHS Standard Contract); d) National Standards (as defined in the NHS Standard Contract); and e) any applicable code Mandatory Change any Change in the scope of the Services which the Commissioners are required to implement by reason of a change in Law or applicable health or social care guidance, direction, standard or requirement to which the Commissioners have a duty to implement or follow National Standards has the meaning set out in the NHS Standard Contract NHS Standard Contract the NHS Standard Contract as published by NHS England from time to time Objectives the objectives of the Parties set out in Clause 6 Operational Days a day other than a Saturday, Sunday or bank holiday in England Principles has the meaning set out in Clause 7.3 Programme Boards means the programme boards made up of Provider and Commissioner representatives, more particularly described at Clause 10 Section 75 Agreement means the agreement entered into by the Commissioners on 1 April 2020 as a “Framework Partnership Agreement relating to the Commissioning of Health and Social Care services” and any subsequent agreement entered into by the Commissioners under section 75 of the National Health Service Act 2006 to commission elements of the Services Services the services commissioned to be provided by the Providers by the Commissioners for Bradford District 118 Page 27 of 47 BRADFORD DISTRICT AND CRAVEN STRATEGIC PARTNERING AGREEMENT V3

and Craven as set out in Schedule 3 (Services) Services Contract a contract entered into by one of the Commissioners and a Provider for the provision of elements of the Services as set out in Schedule 3, and references to a Services Contract include all or any one of those contracts as the context requires SPA this agreement incorporating the Schedules SPA Work Plan the SPA work plan set out in Schedule 8 System Committees the system committees reporting into the ICP Board, including the System Finance & Performance Committee and the System Quality Committee Vision the vision of the Parties for the ICP as set out in Clause 5.1 Workforce Principles the workforce principles set out in Schedule 7 (Workforce Principles).

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SCHEDULE 2

Governance

Part 1: ICP Board Terms of Reference

ICP Board TORs v0.2.docx

Part 2: (i) Airedale Wharfedale and Craven Health and Care Partnership Board Terms of Reference; (ii) Bradford and District Health and Care Partnership Board Terms of Reference; and (iii) Mental Health, Learning Disability and Neurodiversity Health and Care Partnership Board Terms of Reference

HCPB TORs Feb 2021.docx

Part 3: Bradford District and Craven System Committees – System Finance & Performance Committee and System Quality Committee Terms of Reference

System Finance & System Quality Performance ToRs 290321.docxCommittee ToR updated 300321.docx

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Services

The Services that will be within the scope of the SPA will be:

(1) all of the health and care services commissioned by the CCG; and

(2) adult social care, children’s social care and public health services commissioned by the Council.

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Dispute Resolution Procedure

1 Avoiding and Solving Disputes

1.1 The Parties commit to working cooperatively to identify and resolve issues to the Parties mutual satisfaction to avoid all forms of dispute or conflict in performing their obligations under this SPA. Accordingly, the Parties will look to collaborate and resolve differences under Clause 8 of the SPA prior to commencing this procedure.

1.2 The Parties believe that by focusing on their agreed Vision, Objectives and Principles they are reinforcing their commitment to avoiding disputes and conflicts arising out of or in connection with the provision of the Services to Bradford District and Craven.

1.3 The Parties shall promptly notify each other of any dispute or claim or any potential dispute or claim in relation to this SPA or the operation of the Services (each a 'Dispute') when it arises.

1.4 In the first instance, the Programme Board(s) relevant to the particular Service area in dispute shall seek to resolve any Dispute to the mutual satisfaction of the Parties. If the Dispute cannot be resolved by the Programme Boards within 10 Operational Days of the Dispute being referred to it, the Dispute shall be referred to the relevant Health and Care Partnership Board (or if the dispute covers all the CCG’s populations to the ICP Board) for resolution.

1.5 The Health and Care Partnership Board (or ICP Board where relevant) shall deal proactively with any Dispute on a Best for Bradford District and Craven basis in accordance with this SPA so as to seek to reach a unanimous decision. If the Health and Care Partnership Board (or ICP Board where relevant) reaches a decision that resolves, or otherwise concludes a Dispute, it will advise the Parties of its decision by written notice. The Parties agree that they will look to implement any unanimous decision of the Health and Care Partnership Board (or ICP Board where relevant) in good faith subject always to Clauses 9.3 and 11 of the SPA.

1.6 The Parties agree that the Health and Care Partnership Board (or ICP Board where relevant), on a Best for Bradford District and Craven basis, may determine whatever action it believes is necessary including the following:

(a) If a Health and Care Partnership Board cannot resolve a Dispute, it may refer the dispute to the ICP Board to assist with resolving the Dispute; and

(b) The ICP Board shall:

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(i) be provided with any information it requests about the Dispute;

(ii) assist the Health and Care Partnership Board to work towards a consensus decision in respect of the Dispute;

(iii) regulate its own procedure and, subject to the terms of this SPA, the procedure of the Health and Care Partnership Board at such discussions;

(iv) determine the number of facilitated discussions, provided that there will be not less than three and not more than six facilitated discussions, which must take place within 20 Operational Days of the referral; and

(v) have any costs and disbursements met by the Parties equally.

(c) If the ICP Board cannot resolve the Dispute, the Dispute must be considered afresh in accordance with this Schedule 4 and only after such further consideration again fails to resolve the Dispute, the ICP Board may decide to:

(i) terminate this SPA; or

(ii) agree that the Dispute need not be resolved.

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Change Procedure

1 Change

1.1 This Schedule 5 shall not apply to individual and minor changes to the Services that shall be identified and approved by the Programme Boards in accordance with the agreed terms of reference.

1.2 Save as otherwise specifically provided in this SPA, no Change will be binding on the Parties unless the requirements of this Change Procedure have been satisfied.

1.3 Any Party will be entitled to propose a Change at any time by issuing a notice of the change in the form set out in this Schedule 5 (“Notice of Change”) to the relevant Health and Care Partnership Board (or ICP Board where relevant to two or more Health and Care Partnership Boards).

1.4 The Commissioners, when proposing a Change, will specify whether or not the proposed Change is a Mandatory Change. If the proposed Change is a Mandatory Change then it will be dealt with in accordance with paragraph 2 (Mandatory Change) below.

1.5 Any of the Parties may, at any time prior to the signature of a Change Approval Form in the agreed form by all Parties, withdraw a Notice of Change it served.

1.6 Each Notice of Change will provide in respect of the proposed Change information including, but not limited to:

(a) details of the proposed Change in sufficient detail to allow evaluation of the proposed Change;

(b) the reason for the proposed Change; and

(c) the critical dates, if any, for the implementation of the proposed Change.

1.7 The Health and Care Partnership Board (or ICP Board where relevant) will review the Notice of Change as soon as reasonably practicable after receipt and consider, on a Best for Bradford District and Craven basis, whether or not and to what extent a Change should be implemented.

1.8 The Health and Care Partnership Board (or ICP Board where relevant) will then notify the Programme Boards whether or not the proposed Change has been approved. The Programme Boards will be bound by the decision of the Health and Care Partnership Board (or ICP Board where relevant), in relation to the proposed Change and it will take the appropriate action to implement the Health and Care Partnership Board (or ICP Board where relevant) decision.

2 Mandatory Changes

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2.1 The Commissioners will be entitled in their sole discretion to declare in the Notice of Change that a proposed Change is a Mandatory Change and the date from which the Mandatory Change will be effective.

2.2 Any Mandatory Change and the date from which the Commissioner states that the Mandatory Change is to be effective will be deemed to be approved by the Health and Care Partnership Board (or ICP Board where relevant), and the Programme Boards will give directions as to the implementation of such Mandatory Change in accordance with the relevant Notice of Change.

2.3 The Mandatory Change will be documented in accordance with paragraph 4 (Formalities) of this Schedule 5.

2.4 Subject always to paragraphs 2.1 to 2.3, the Programme Boards may agree to conduct an evaluation report in respect of a Mandatory Change.

3 Effect of Change on Costs

3.1 The Parties must all mitigate the effect, if any, which any Change will have on the costs which each of the Parties will incur in performing their respective obligations under this SPA or any Services Contract.

3.2 In the event of any Change which is made to reflect any change in Law, which is implemented at any time after the date of this SPA, then to the extent that there is any increase or decrease in the costs incurred by each Provider as a result of such change in Law, the Programme Boards shall consider and agree how such cost increase or decrease is best managed by the Parties and which Parties should bear the burden or receive the benefit of such changed costs. Where the increase or decrease may have a significant impact on financial plans or activity then the issue may be escalated to the Health and Care Partnership Board (or ICP Board where relevant), to consider and resolve.

4 Formalities

4.1 A Change Approval Form, in a form approved by the ICP Board, will be raised by the Commissioner in relation to all Mandatory Changes and all Changes which are approved by the Health and Care Partnership Board (or ICP Board where relevant), and will stipulate the date from which it will, or in the case of a Change which is not a Mandatory Change, it is proposed that the Change will, be effective and will be signed by the Parties.

4.2 On receipt of the completed Change Approval Form, the Commissioner will raise and issue a formal amendment to any Services Contract affected.

4.3 The Parties will each take all necessary steps to implement any alterations to or variations of any Services Contract or any Change made in accordance with this Schedule 5.

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Financial and Risk Management Principles

1. As overriding financial principles the Parties will:

a) aim to live within their means, i.e. work in the model to the level of resources which are available to their organisation to provide the Services;

b) develop and shape the strategic capital and estates plans across Bradford District and Craven together, looking to maximise all possible funding sources and ensuring that these plans support the delivery of the Vision and Objectives; and

c) work together to ensure that they have the best possible information, data, and intelligence with which to inform the decisions that they take.

2. Key assumptions

a) The Parties agree that:

• There will be a rigorous Quality Impact and Equality Impact Assessment process for both transformational and in-year changes in order to support financial decisions being made under the SPA on a Best for Bradford District and Craven basis.

• Future financial investment into Bradford District and Craven should be determined as a result of partnership oversight and agreement on commissioning intentions and should fit with the place based clinical, quality and safety priorities. The Parties’ investment decisions should also start to address heath inequalities and be factored into the Bradford District and Craven priorities each year (following the process for investments decisions beyond baseline budgets set out in financial governance (section 7 below)).

b) There will not be a detailed risk/reward mechanism in this SPA initially but the Parties will work together in good faith to develop a risk reward mechanism in line with the risk/reward mechanism principles set out in section 3 below.

c) The risk/reward mechanism will be further developed by the Parties based on their shared desire for payment and incentives to fairly reward effort and to drive the behaviours that the system requires in order to achieve the Objectives.

3. Risk/reward mechanism

a) The principles agreed between the Parties which will underpin the development of the Risk/Reward Mechanism are that:

• transactional costs between the Parties should be minimised;

• there will be cost transparency between the Parties (subject to compliance with Competition Law (where applicable), the need to ensure non-disclosure of commercially sensitive information and having regard to the information sharing protocol);

• definitions of costs will be agreed by all Parties in advance;

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• value for money must be demonstrated across Bradford District and Craven; and

• no Party shall derive unreasonable advantage or suffer unreasonable disadvantage.

b) The Parties acknowledge that some place based programmes (or their constituent projects) will have the potential to disproportionately benefit some participating Parties at the expense of others. A Strategic Outline Case will be prepared to set out the potential impact of the implementation of a programme or project and will describe the ‘risk and gain share’ model between the relevant Parties affected by the programme or project, in preparation for selection of the preferred option in the subsequent Outline Business Case. This risk and gain share model will need to be tailored to each programme or project and will be designed based on the following principles (reflecting that organisations are working on a Best for Bradford District and Craven basis:

 Any losses made by a Party, as a direct result of the implementation of a programme or project will be reimbursed by the other affected members.

 The costs of implementing a programme or project will be met by the participating Parties in the proportions set out in the Full Business Case (FBC).

 The net financial benefits of the programme or project will be allocated to participating Parties on a “fair shares” basis with the precise method being tailored to the programme or project. The method will be set out in the respective FBC.

 An example of how the risk/reward mechanism would work is set out below:

EXAMPLE OF RISK/REWARD MECHANISM

Organisation(s) across Bradford District and Craven (OC) (could be providers or commissioners) are exploring a new service opportunity with a different potential mix of provision across providers.

The currently spend is £1M on the service, which it feels, could be done differently, generating better outcomes for the population of Bradford/improved quality and a better return on investment with potential savings of £600K.

The scoping work to develop a business case has indicated that the new approach to provision with changes to the providers of the service (B) could provide the new pathway with a stepped investment of £400K.

However, the existing providers (A) could not reduce all the costs as some of the workforce and facilities are inter linked with other existing services, which it will still provide. The variable savings that have been identified from an objective assessment are £500K. This would therefore result in potential cost pressures of £500K should the contract income for A be impacted by the reduction of their contract(s) by £1M.

Working with our principle that no organisation should be worse off from a change in service redesign, then the overall net benefit to OC should be the £100K after the cost pressures to provider A of £500 is taken off the overall gross benefit (potential savings) of £600K.

Total Benefit to system (OC) £600K

Cost Pressure for Provider A (£500k)

Net benefit identified £100K

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In developing the scoping work of the project at the start to incentivise all Parties, the net contribution was agreed to be shared equally across all the Parties involved.

This would result in a share of the net residual benefit £100K being split 3 ways with contractual changes reflecting this net impact. For simplicity shared contribution works out at £33.3K each.

Contractual Financial Changes

 Organisations in OC would reduce contractual value by £33.3K.  Provider A would reduce its contract value down by £466.7K (£500K less £33.3K shared Contribution)  Provider(s) B would be given a new/varied contract with £433.3K (£400K invest plus shared contribution £33.3K)

4. Managing Risks associated with Fixed Income Allocations

a) To support all Bradford District and Craven Providers working within fixed income envelopes under their Service Contracts the Parties will develop principles to manage the risks across the Parties and build on the agreed principle that no one provider should left holding all the risk. b) A series of activity thresholds for triggering escalation back to the Access to healthcare programme will be built into the Fixed Income envelopes for managing demand of referrals above the agreed threshold levels. c) The expectation is that the Access to healthcare programme will agree a set of procedures with GPs and Hospital based clinicians for managing demand.

5. NHS Finance principles a) In respect of the management and allocation of NHS finances the Parties agree that:  There is a need to agree and utilise one set of activity and finance data for the purposes of planning, managing transformational changes, and agreeing any related risk reward mechanisms;

 They will commit to managing NHS expenditure in Bradford District and Craven in aggregate across the system, including joint management of stranded costs (focussing on costs and expenditure, not tariff or funding);

 The implications of any changes which result in a net NHS deficit will be considered a failure of all the NHS Parties under the SPA. If longer term planning timeframes are established and cash positions allow, a short term system deficit may be considered by the Parties if initial investment is required by the system to recover greater return in future years (any such approach would be dependent on the ICS and place system financial framework being able to accommodate such an approach – e.g. by a surplus offsetting the deficit in another place);

 The financial focus for decision making by the NHS Parties will be to balance service delivery, quality and safety, and actual cost/expenditure rather than tariff or funding with an acceptance from all NHS Parties that there is a need to end payment by results; and

 A transition mechanism process will be agreed by the NHS Parties to support the impact of transformative service changes. This may include approaches to managing and mitigating losses and gains, double running costs, and unintended financial consequences. Annex 1 to this Schedule 6 sets out the proposed financial framework for future investment decisions which incorporates an integrated approach to development of services and ensuring that material decisions on future investment are made within the available resources for Bradford District and Craven.

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6. Planning Principles

a) The Parties will ensure that opening baseline allocations at Bradford District and Craven level ensure organisational sustainability whilst ensuring future investment from Growth, Development and Transformational funding is developed in an open and integrated way. The Parties agree that the future investment decision making process for Bradford District and Craven should explore options and develop plans for the most effective use of available resources in an integrated way across the Parties.

b) A flow diagram of how the decision making process for financial decisions will work is shown at Annex 2.

c) The baseline/underlying financial position for Bradford District and Craven needs to be clearly understood by the Parties to determine the viability of additional investment into services developments that increase the run rate. If funding is available to Bradford District and Craven above the baseline, the place based clinical and quality priorities that increase the run rate will be considered for investment (subject to the approval of an appropriate case for change/business case with clearly articulated benefits and measurable KPIs).

7. Financial Governance

a) The Parties acknowledge that whilst it is expected that each individual organisations will have their own governance procedures if they are to work collectively as a place they need to ensure that there is a framework that enables assurance on the delivery of Bradford District and Craven system plans and priorities.

b) Annex 1 sets out the financial governance framework for developing the plans and the process for recommendations through the System Finance & Performance Committee in conjunction with the System Quality Committee to the ICP Board for approval of investment plans.

c) The Parties will where agreed give delegated responsibility to lead Directors from their organisation who will form the membership of the System Finance & Performance Committee and be responsible in giving assurance on recommendations to the ICP Boards for future developments that align with the Bradford District and Craven place based priorities.

8. Agreed Clinical & Quality Priorities

a) Bradford District and Craven ICP will agree its main priorities in each year to form the “Act of One Transformational programmes” which are the focus of the activity of the place.

b) The decision making process will also be done in conjunction with the System Quality Committee to ensure investment decisions are also evaluated to understand the impact on quality standards.

(See also the terms of reference for the role of the System Finance & Performance Committee and also terms of reference for the System Quality Committee at Schedule 2 Part 3).

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Annex 1 – Financial Governance Framework

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Annex 2 – Decision Flow Matrix

Organisation has an issue (Development/Pressures)

Can this be resolved within Organisational Baseline Resource and fits with priorities

Organisation with related parties develops Organisations can agree use of existing outline proposal and assess whether it resources with updates of any contract meets System priorities changes required to System F&PC as memo item.

Scoping work is developed with associated partners

Does a Programme exist to deal with issue/development?

If see as a Priority and not linked with an Business Case developed in associated Programme, initial review Associated Programme through the ICP Board or HCPB to ensuring it fits with Priorities determine approach to be taken. defined

progress

ICP Board

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SCHEDULE 7

Workforce Principles

The workforce principles agreed by the Parties are:

Our shared workforce values are:  Mutual respect, trust and understanding  Willingness to learn together  Commitment to work together  People in control of their own lives  Everybody matters  Openness to share ID Workforce Principles A Ensure we keep the person at the centre of everything we do; striving to ensure no decision is taken in isolation of the wider system and taking collective ownership of the key workforce challenges within the system as they present. B Embed an ethos of ‘Act as One’ and working for our Integrated Care Partnership (ICP) rather than an organisation; demonstrating our values in our everyday actions and behaviours through the development of a shared set of core competencies. C Put difficult workforce issues on the table, with a high support and high challenge coaching approach; surfacing the early warning signs of things not working by encouraging a learning culture. D Work with colleagues in our ICS, ICP and on a sector footprint to strategically plan our workforce; aiming to secure the best people by being inclusive, striving to ensure our workforce is representative of the communities we serve and by working in ways to make employment across our ICP attractive to all. E Optimise the knowledge, experience, skills and strengths of our shared workforce by developing our people together and maximising our collective resources (e.g., apprenticeship levy) wherever possible F Proactively support the career progression of BAME and other underrepresented colleagues through the development of local mentoring schemes, talent management and succession planning pipelines G Involve the right people, at the right time to enable workforce transformation; enabling movement around the system to provide the right care and experience for our local people H Develop our workforce in response to current and emerging local population needs; including equipping people for working across new and emerging care pathways and for the digital revolution I Create formal and informal opportunities for our leaders to develop together as system leaders using evidence-based approaches and our ‘Act as One principles J Take collective responsibility for proactively supporting the health and wellbeing of our workforce; retaining staff by being good employers and offering flexible working and career opportunities across the system K Work collectively to develop agreements to retain talent within the system; retraining people and supporting them to transition to new roles, in particular during times of organisational change (whilst recognising and working within employers’ statutory responsibilities)

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SPA Work Plan

This SPA Work Plan sets out the Parties’ agreed areas of focus for the further development of the SPA from April – September 2021 and will form part of a wider programme of work to develop the Integrated Care Partnership arrangements during this period.

Areas for development will include:

Area for development Proposed focus

1 Governance Structures Development of the current governance groups across Bradford District and Craven to include:

1) the possible introduction of Statutory Joint Committee structures 2) further use of Section 75 Agreements with the Local Authority for joint commissioning and also for joint provision 3) consideration of how to extend the ability for the parties to take decisions / allocate resources through decisions in the group meetings 4) consideration of how the funding and staff for the infrastructure and maintenance of the ICP functions would work 5) review of the membership of the various groups and status of the respective members (influenced by what is set in the legislation) 6) consider necessary revisions to existing governance structures to reflect the new roles and requirements under the proposed legislation. For example:

o will the SJC replace ICP Board o where will clinical leadership feature (clinical forum, CAB, alternative)) o how will the Health and Wellbeing Board operate within the governance structure o how will ICP representation at ICS level be determined o how will non-executives/ lay members be represented in the ICP structures o how will the ICP governance connect into organisational governance and ICS governance structures

7) Oversight arrangements – consider how this could operate for the ICP whether via the Health and Wellbeing Board or other arrangements 8) Dispute resolution at ICP level and how and when you would refer this to ICS or to other bodies for resolution 2 Scheme of delegation As part of the governance structures for the interim period and into 2022 consider the current scheme of delegation to the representatives in the SPA groups (including finance and HCPBs and even at a

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Area for development Proposed focus

programme level) and whether this needs to be clarified and extended to deliver the desired development of joint decision making.

3 Services Consider what is to be included under the SPA and to be the focus of the work across the Parties (this will be linked to the SPA membership and what is ultimately set out in the legislation). Identify priority areas for testing of the approach in this period that will be able to demonstrate results prior to April 2022 where possible.

This could also include an update of the list of budgets in scope for the SPA. It would be linked with any pooled or aligned funds between the CCG and LA.

4 Workforce / HR Considering development of a more integrated workforce model with clear principles for the ICP to govern a more robust structure around the workforce in the SPA to facilitate co-working, sharing of resource, multi-disciplinary teams, efficiencies in back office HR etc.

5 Shared functions across Identifying functions which could be more integrated, shared and the ICP managed by the ICP across place (e.g. BI, safeguarding, quality)

6 Financial flows Consider how the financial flow and allocation mechanism will work across the ICP and how representations will be made to the ICS on finance.

Clear financial principles have been developed and will need to be tested against the initial priority areas where possible and link into the governance and delegation work described above.

7 Contracting Develop a clear contracting model from the ICP to provider parties. Link this to the development of the finance, governance and delegation processes at ICP and discussions with the ICS in terms of the proposed model of delegation.

Anticipating that the ICS will have some form of delegation agreement (or ICP Population Health Contract) with the ICP at place and that there will need to be continuing arrangements from the ICP host to the providers themselves.

Identify the elements which will be picked up at ICS level and work through how the ICP based arrangements should operate from April 2022.

8 Quality principles Consider the quality principles for the ICP and bring the process for consideration of quality into line with finance for a linked process when making/taking decisions.

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Area for development Proposed focus

9 Exclusion/inclusion of Consideration of the stakeholders at the ICP – and into the provider members of ICP alliance approach.

Are there different stakeholders who should be involved and consider which level they could engage with the ICP and SPA? For example there could be an associate tier of membership for organisations with limited engagement with the ICP.

Review the current SPA mechanism and consider if needs repurposing for the future intent of the ICP.

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System Protocols

CoI Protocol.doc

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Applicability of Strategic Partnering Agreement elements to the Parties

SPA Part CCG NHS Providers Council Other Providers2 Part A: Clauses x x x x 5-7 Vision, Objectives and Principles Part B: Clauses x x x x 8,9 Problem Resolution and Escalation, Obligations and Roles of the Parties Part C: x x x x Clauses 10-12 Governance Arrangements

Part D: x x x x Clauses 13-18 Financial and Workforce Framework, Liability, Admission and Exclusion Part E: x x x x Future Development of the ICP

Part F: x x x x Clauses 19 – 31 General Provisions

2 Other Providers are significant providers of services in Bradford District and Craven. They are categorised as ‘Other Providers’ because of their corporate status as non-statutory public bodies here.

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Statutory roles

Annex 2 SPA.docx

138 Page 47 of 47 NHS Bradford District and Craven CCG This document provides a summary and/or key discussion points and recommendations relevant to the subject of an item for consideration at the specified CCG meeting for the purpose of assurance, information, decision or action.

Agenda item 10

Name of meeting Governing Body Meeting date 11 May 2021 Clare Smart, Associate Individual Funding Request Title of report Report author director, strategy, change annual report and updates and delivery Lead(s) / SRO Liz Allen, Strategic director, Report lead Pam Essler, Lay chair IFR organisation effectiveness panel

Paper summary and/or key discussion points

This Associate Clinical Director IFR has completed his first annual report to provide assurance to the Governing Body that the CCG is fulfilling its statutory duties. The Panel has recently received a rating of ‘strong assurance’ from Internal Audit and has completed all minor recommendation made to the panel.

Outline how this will help us to achieve our vision through our strategic ambitions:  Our population – improving health and equity for local people, and/or  Our partnerships – as the vehicle for enabling people to take more responsibility for their health, and/or  Our people – a skilled, motivated workforce with a culture of continuous improvement, and/or  Our leadership – assuring sustainability of our health and care system.

The IFR Panel procedure and process is how the CCG responds to the legal duties set out in the secretary of state for health and social care’s directions to CCGs and trusts, the NHS constitution and a range of guidance. Most health care interventions are commissioned as part of the NHS standard contract or contracts with provider partners. However, it is likely that during the year, there will be requests for interventions not covered by the commissioner’s policies. The commissioner, therefore, needs to be able to make decisions about these requests that are fair and consistent. NHS Bradford district and Craven use the processes set out in the IFR policy and procedure document to manage such requests, ensuring an equitable approach to requests. The Associate Clinical Director IFR, Dr Colin Renwick, takes the role of triage, gathering information, and presenting cases to the IFR Panel. The panel aims for reasonableness in its decision-making within an ethical framework. The diligence required of this role support fairness, equity and compassion in the decision-making of the panel.

Purpose assurance information decision action

approve / recommend / review / consider / support / ratify comment / discuss Recommendation(s)

The Governing Body is asked : 1. To receive the annual report of the Associate Clinical Director IFR

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140 Page 2 of 2

NHS Bradford District and Craven CCG

Individual Funding Request Panel Annual Report 2020-2021 : Report to SLT

Contents

Contents ...... 1

Background ...... 2

IFR team and panel...... 2

IFR pathway and process ...... 3

Our successes in 2020-21...... 3

Summary of 2020-21 case load ...... 3

Breakdown of requests into top ten clinical groups (%approved)...... 4

Important issues to highlight to SLT ...... 4

1. Neurodiversity ...... 4

2. Glucose monitoring devices...... 5

3. Chronic Fatigue Syndrome (CFS)...... 5

4. High cost placements ……………………………………………………………………… .5

5. Future challenges ...... 5

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Background

Clinical Commissioning Groups are responsible for local commissioning decisions, and have a duty under the NHS Constitution to provide the best value for taxpayers money and the most effective, fair and sustainable use of finite resources.

One of the key values that underpin the NHS Constitution is that patients have the right to expect local decisions on funding of drugs and other treatments to be made by local Clinical Commissioning Groups (CCGs) rationally following proper consideration of the evidence.

As part of this, CCGs must have a system in place to enable exceptional case reviews. There can be no exhaustive definition of the conditions which are likely to come within the definition of a clinically exceptional individual case. The word “exception” means “a person, thing or case to which the general rule is not applicable”

However, to meet the definition of ‘exceptional clinical circumstances’ there must be some unusual or unique clinical factor about the patient that suggests that they are:

 Significantly different clinically to the group of patients with the condition in question and at the same stage of progression of the condition. (i.e. compared with the same age, sex, disease specific cohort of patients); and

 Likely to gain significantly more clinical benefit from the intervention than might be expected from the average patients with the same clinical condition. An example will be where a treatment is likely to be more clinically effective as well as cost effective on an individual patient. However, the fact that a treatment is likely to be efficacious for a patient is not, in itself, a basis for an exceptionality.

If a patient's clinical condition matches the 'accepted indications' for a treatment that is not funded, their circumstances are not, by definition, exceptional.

It should be noted that social value judgments are rarely relevant to the consideration of exceptional status.

IFR team and panel

The IFR team is made up of:

 IFR manager (and deputy)  Associate clinical director for IFR  Senior commissioning manager  Senior medicines optimisation representative.

This is supplemented by the IFR Panel which meets on a monthly basis and in addition to the above members and attendees, consists of:

 Lay chair  Strategic clinical director  Strategic director  GP member  Senior public health representative (non- voting)

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IFR pathway and process

IFR applications are received by the IFR manager via a dedicated and secure (nhs.net) email account and occasionally in paper form. These are allocated a unique case number, recorded on a database and forwarded to the associate clinical director for IFR for triage. Prior to the need to work from home this was performed in Scorex House but an efficient remote process has been established in the last year.

The outcome of triage can be:

 Approval of the request if it meets existing commissioning policy.  Rejection of the request if not routinely commissioned and no evidence of exceptionality provided.  Allocation of the case for consideration at an IFR Panel meeting.  Request for further information from the referring clinician before deciding on the above.  Referral of the request to other individuals in, or commissioned by, the CCG (e.g. mental health or neurorehabilitation).

Following triage and any decision, the clinician making the request is kept informed of its progress and stage in the process by letter. It is the policy of the CCG, for reasons of equity, that the IFR team only communicate directly with the responsible clinician and not patients or their representative.

Our successes in 2020-21

 Managing remote working and communication to ensure sustainable and effective service.  Participation in internal audit report with strong assurance of our systems and processes. In particular the auditor commented that the panel minutes were the best that she had seen.  Production of “Top Tips” document for GPs.  Successful panel Zoom meetings which run smoothly and effectively.  Oversight of complex neurorehabilitation cases in increased numbers and with increased complexity.  We have embedded NHS England’s “Evidence Based Interventions Policy” guidance within our whole process from initial triage to panel decision.  We have not been involved in any complaints or had any decisions subject to appeal.

Summary of 2020-21 case load

Total cases received 226

Number referred by GP 136 (60%)

Number approved 84

Considered at Panel 56

Approved in Panel 16

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Breakdown of requests into top ten clinical groups (%approved)

Female Breast Surgery 25 (36%)

Neurodiversity 19 (52%)

Chronic Fatigue syndrome 19 (100% referred on)

Benign skin lesions/cosmetic 18 (66%)

Neurorehabilitation 15 (85%)

Open MRI requests 14 (86%)

Glucose monitoring devices 12 (67%)

High Cost Drugs 11 (91%)

Equipment (e.g. post-surgical seating) 7 (100%)

Male Breast reduction 6 (0%)

The IFR team provide oversight to the placement, funding and progress of patients with complex neurorehabilitation needs mainly from acquired brain injury both from traumatic and medical causes. Over this year we have noted an increase in the number of these cases . Historically we would typically have 3-4 cases in such units but are currently managing approximately twice this number. The rehabilitation is usually approved in 12 week blocks, reviewed towards the end of each period and commonly the patient would spend 24-36 weeks undergoing rehabilitation. We understand that these are expensive placements and do take time to consider cost effectiveness, capacity to benefit and hold the units and social service departments to account in planning discharge. I would like to add my thanks to our neuropsychology colleagues in BTHFT who provide expert and independent assessment and recommendations to support our decisions.

We have, additionally, been asked to consider funding for complex psychiatric cases particularly where intensive monitoring (sometimes 2:1 staffing) and secure unit placements are required.

We also provide clinical advice and support to the patient support team (complaints team) in the CCG.

Important issues to highlight to SLT

1. Neurodiversity

The SLT has been updated during the year about issues concerning patients’ “right to choose” their mental health provider and how this has changed the way the IFR Panel considers requests for referral to out of area providers. Regulations state that patients must be offered choice, in these circumstances, where the provider is eligible to receive a referral through having a contract with any other CCG in England, or with NHSE for the provision of that service. The issue became apparent when we received requests for adult attention deficit hyperactivity disorder (ADHD) assessment referral with a national company that provides on line assessments. Legal advice was sought along with confirmation of this company’s contractual status with other CCGs and such requests are now being routinely approved. The IFR team has noted a slight increase in the numbers of these requests.

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More recently, we have received correspondence (an “open letter”) from an organisation based in Calderdale advising of the same right to choose for assessment for autism spectrum disorder (ASD).

It has been difficult to establish whether, and how many, providers are available in the marketplace for such choice as there does not appear to be any central record that would help CCGs and referrers in establishing eligibility. The IFR team will continue to keep an overview of numbers, but it is possible, and likely, that eventually referrals will be made without seeking prior approval as the regulations state that the IFR process should not need to be involved in this right to choose. 2. Glucose monitoring devices

The report details a significant number of requests for provision of new real time glucose monitoring devices. It has been noted that most of these requests come from one acute trust, and one clinician in particular. The IFR team have recently been contacted to ask if we were able to account for this difference. We have responded that our assumption is that one trust absorbs the cost of such devices within its block contract with the CCG and therefore does not submit them as IFRs, although the figures may also be partially explained by differences in clinical practice. 3. Chronic Fatigue Syndrome (CFS)

Requests for referral to specialist services for management of CFS have increased recently; indeed 11 of these have been requested in 2021. Only one has specifically identified as being associated with a prior confirmed Covid illness, although others may be related to an asymptomatic infection or the changes in activities that lockdowns have necessitated. It is possible that we will receive increasing numbers of such requests related to “long Covid” and I will be alert to this as referral to dedicated clinics for this illness may be more appropriate than the current pathway that includes initial assessment by the primary care wellbeing service. 4. High Cost Placements

The Panel takes on the role of assessing and deciding on requests for high cost placements including for admission to the National Inpatient Centre for Psychological Medicine in Leeds. These placements would be for conditions such as chronic fatigue syndrome and medically unexplained symptoms, and are a financial challenge to the CCG both in terms of daily cost but also length of stay which might typically be for 3-6 months. Patients are likely to be severely unwell and disabled by their condition and to have suffered with it for several years. We have developed a process where we require locally commissioned services to have been tried and exhausted, particularly our local and novel Primary Care Wellbeing Service, and at times this has generated some dissatisfaction from referring clinicians. The NICPM is commissioned by Leeds CCG and half of the beds are for Leeds residents but the remainder are available for patients nationally. The Panel are uncertain of the evidence base for the long term clinical benefit for such placements, the Centre only citing psychometric improvement and physical ability improvements at discharge. We are approaching the Lead Clinician for clarification. 5. Future challenges  Inequity. It is apparent to all panel members that less requests are received for people in our more deprived communities probably as a result of lower expectations and advocacy.

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 Uncertainty about how the integrated care system will interplay with the IFR process as commissioning becomes more standardises across our system. Will there still be a place for a local IFR process?

Colin Renwick Associate Clinical Director for IFR March 2021

6 146 Agenda item 11

Name of meeting Governing Body Meeting date 11 May 2021 Risk Register Report: Cycle 6 Title of report Report author(s) Bev Denton, Corporate 2020-21 (March - April) Governance Manager Stacey Fleming, Senior Lead(s) / SRO Helen Hirst, Chief Officer Report lead(s) Governance and Resilience Manager

Paper summary and/or key discussion points

The purpose of the paper is to provide the Governing Body with details of ‘high level risks’ (those scoring 15 or more), new risks identified and risks closed during the current risk review cycle.

Corporate risk register (updated bi-monthly)

 There are four risks at the ‘critical’ level (scoring 20 or 25). Risk 1613 relates to the demand for mental health services, risk 1495 relates to the COVID 19 Pandemic, risk 943 relates to the COVID impact on care homes and risk 1582 relates to increased health inequalities due to socio-economic and ethnicity factors  There are 17 risks classed as ‘serious’ (scoring 15 or 16).  One risk has increased in score. Risk 1579, the impact of backlog of CHC referrals has increased from an overall score of 9 (Impact x3, Likelihood x3) to 16 (Impact x4, Likelihood x4).  One risk has decreased in score, relating to unidentified carers. Previously scoring 20 the score has been reduced to 15 (Impact 5 x Likelihood 3).  One risk has been marked for closure during the cycle. Risk 1590 relating to outcome for population negatively impacted has been closed as it is no longer relevant to the CCG.

Outline how this will help us to achieve our vision through our strategic ambitions:  Our population – improving health and equity for local people, and/or  Our partnerships – as the vehicle for enabling people to take more responsibility for their health, and/or  Our people – a skilled, motivated workforce with a culture of continuous improvement, and/or  Our leadership – assuring sustainability of our health and care system.

A robust risk management framework is essential to supporting the delivery of the CCG strategy. The CCG’s new assurance framework is in the early stages of development. This will set out the higher- level and longer-term risks to achievement of the CCG strategy. The assurance framework is underpinned by the corporate and Covid-19 risk registers which set out the CCG’s more operational risks and their management. See the Covid-19 and corporate risk logs.

Purpose assurance information decision action

approve / recommend / review / consider / support / ratify comment / discuss Recommendation(s)

The governing body is asked to receive and note the risk report and high level risk log. Page 1 of 2 147

Appendices (or other supporting papers) Appendix 1: Risk report including scoring matrices and risk overview diagram Appendix 2: Corporate risk register; high level risk log

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Risk Register Report: Cycle 6 2020-21 (March 2021 – April 2021)

1.0 Purpose of the Report

1.1 To provide the Governing Body with details as at the end of Risk Cycle 6 2020-21, of:

 ‘high level risks’ (those scoring 15 or more)  new risks added to the risk register during the current risk cycle  risks closed during the current risk cycle.

2.0 Risk Review and Reporting Process

2.1 There are normally six risk review cycles per annum. The process for the review and reporting of the CCGs’ corporate risk register is as follows:

 Review of individual risks by Risk Owners  Review of individual risks by allocated Senior Managers  Review of all risks by the Senior Leadership Team (SLT)  Review of all risks by either the Finance and Performance Committee (FPC) or Quality Committee (QC)  Further report to SLT prior to Governing Body reporting by exception.  Reporting of risks scoring 15 or more, plus new and closed risks, to the Governing Body.

2.2 In addition, the corporate risk register is a standing item on the agenda of standard Audit and Governance committee meetings in order to provide assurance on the risk management process.

3.0 Corporate Risk Cycle 6 March - April 2021

3.1 Please see Appendix 2 for the CCG risk overview diagram.

3.2 Numbers of risks and average risk scores are shown in the table below:

1

149 Numbers of risks and average risk scores

Total number of open risks 48 Number of open risks aligned to Finance and Performance Committee (FPC) 20

Number of open risks aligned to Quality Committee (QC) 25 Number of open risks aligned to both Finance and Performance and Quality committee 3

CCG average risk score 13

FPC average risk score 10.90

QC average risk score 14.16

3.3 Two new risks were added to the risk register in the current risk cycle, details of which can be found in the table below:

Details of new risks

Risk scores are calculated by multiplying the impact by the likelihood.

Risk reference Risk summary Current risk score number 1735 PC/VDI Desktop Resources: in mid February the CCG was Overall score is 15 alerted via a call with TPP that a new release of functionality Impact score is 5 in SystmOne was imminent. The release was to include the Likelihood score is 3 record of all COVID Tests done (both positive and negative results) and this functionality would consume a significant amount computing power, mainly memory (RAM) resources. This applies equally to both the PC and Local Server environment in Craven (5 Practices) as it does in the remaining 66 Practices in BD&C CCG.

Given the current constraints of the Windows 7 Operating System (this can only make available and consume a maximum of 4GB) there is a risk that following release of this functionality overall IT system performance would deteriorate significantly and in turn would introduce Clinical and Operational Risk.

It may result in a reduction in the number of people who could be seen in General Practice, place additional stress on the GP workforce and in turn create pressures elsewhere in the place and potentially wider system. Patient experience could be equally impacted.

1739 There is a risk of burnout amongst the NHS workforce as the Overall score is 15 system continues to manage the significant acute and now Impact score is 5 longer-term demands of COVID-19, in addition to dealing with Likelihood score is 3 the backlog of elective care that necessarily accrued during the pandemic, which could impact negatively on staff wellbeing and on the provision of care to the population.

2

150 3.4 There are four risks currently classed as ‘critical’ (scoring 20 to 25) open on the risk register, details of which can be found below:

Details of critical risks

Risk scores are calculated by multiplying the impact by the likelihood. Risk Risk summary Current risk score reference number  DEMAND FOR MENTAL HEALTH SERVICES 1613 Overall score is 25  Risk that demand for mental health services outweighs capacity and / or require a different focus going forwards due Impact score is 5 to increased need arising from the pandemic, including the impact on key workers (for example PTSD). Likelihood score is 5  The impact is inability of local people to access appropriate mental support in a timely way which would reduce their health and wellbeing.

 COVID-19 PANDEMIC 1495 Overal score is 25  There is a risk that the COVID-19 pandemic will result in Impact score is 5 substantial fatal outcomes in high-risk groups and economic and societal disruption. The demand for health services may Likelihood score is 5 outstrip resources available.

943 COVID IMPACT ON CARE HOMES Overall score is 20

There is an increased risk that quality of health care in care Impact score is 4 homes is reduced due to COVID- 19 and response required to prevent and manage infections Likelihood score is 5

1582 INCREASED HEALTH INEQUALITIES DUE TO SOCIO- Overall score is 20 ECONOMIC & ETHNICITY FACTORS Impact score is 5 There is a risk of increased health inequalities due to socio- economic and ethnicity factors during the pandemic Likelihood score is 4 (evidence to date is that the pandemic is impacting on deprived and BAME groups more than average). The impact is failure to meet statutory duties relating to reduction of health inequalities / disproportionate suffering for certain groups.

3.5 ‘Serious’ risks are those scoring 15 or 16. The current number of ‘serious’ risks is 17 in total. Risks 1735 and 1739 are new risks and have been reported in sections 3.3 in this report. Two risks will be reported in private and the remaining ‘serious’ risks are noted below:

3

151 Details of serious risks Risk scores are calculated by multiplying the impact by the likelihood.

Risk Risk summary Current risk Previous Cycle 6 update reference score risk score number

1694 Underlying financial position Overall score Risk has The financial plan for the risk is 16 been static in first six months of 2021/22 (FPC) score for two shows an underlying Impact is 4 cycles. deficit of £5.5m and whilst the funding position for Likelihood is the second half of 4 2021/22 is unclear, it is likely that we will still have an underlying deficit to address. Bradford Place financial plans will be reviewed over the coming months to clarify the financial position that we expect to take forward into the second half of the financial year, together with a range of mitigating actions to manage this risk. Risk remains high as we 1579 Impact of Backlog of CHC Overall score Risk has await a post holiday referrals is 16 been static in period analysis of (QC) score for 11 pandemic increase in R Impact is 4 cycles. rate. Likelihood 4 . 1574 End of Life Experience Overall score Risk has Risk remains high as we is 16 been static in await a post holiday (QC) score for 11 period analysis of Impact is 4 cycles. pandemic increase in R

rate. Likelihood is 4

1135 Adult Autism and/or ADHD Overall score Risk has No further update Assessment and Diagnosis is 16 been static (QC) for 11 cycles. Impact is 4

Likelihood is 4 The specialist CLA health 1134 Health outcomes for Overall score Risk has team, in provider services, children looked after. is 16 been static are reviewing working (QC) for 18 cycles. practices and priorities to Impact is 4 maximise resources and Likelihood is provide data for the 4 proposed review. New pathway in development, as described above. 4

152 Risk Risk summary Current risk Previous Cycle 6 update reference score risk score number No further update 1094 Child autism and/or ADHD Overall score Risk has assessment and diagnosis is 16 been static in (QC) score for 20 Impact is 4 cycles.

Likelihood is 4 940 BTHFT maternity services Overall score Static –5 Quality team member and (QC) is 16 cycles CCG Clinical lead have membership on the Impact is 4 Outstanding Maternity Services (OMS) program Likelihood is me (monthly meet, 4 commenced August 2020)

CQC Inspections and ongoing CQC support to the Trust

Process for Unit Suspension Notifications (BTHFT to CCG)

Maternity services are reported quarterly to Yorkshire and Humber maternity dashboard.

Patient safety and quality sub group (PSQSG)- note currently on hold due to COVID

West Yorkshire Quality Surveillance Group (WSQSG) bi-monthly

Newly formed Better Births Programme (July 2020)

Collaboration, working as one; System Quality Committee

1713 COVID Vaccinations Overall score Static – 2 Continues to be a section is 15 cycles of our community who are There is a risk that a large not confident to accept the proportion of our population Impact is 3 vaccine. National and will not receive the covid19 local work underway to vaccination due to a variety Likelihood is target specific of reasons including: 5 communities which will be vaccine availability; enhanced by national workforce to deliver; funding coming via ICS individual beliefs and (£100k at ICS). sharing of misinformation.

5

153 Risk Risk summary Current risk Previous Cycle 6 update reference score risk score number

1594 Care Home Financial 15 Risk has The CCG is liaising with Sustainability. been static in local care home providers score for 11 regarding payments for There is a risk to the cycles. services and an analysis financial sustainability of the Impact 5 of the how the pandemic care home market due to has impacted on their the costs and issues arising capacity and resilience. from the pandemic. Likelihood 3 The impact is reduction in care home capacity / pressure on other parts of the health and care system. • 0-19 Partnership Group 1404 0-19 Services impact on Overall score Risk has in place to oversee the CCG commissioned is 15 been static in implementation process (QC) services score for 9 and meeting months Impact is 3 cycles. • CCG representatives on the group: Anne Connolly Likelihood is 5 and Jude MacDonald provide clinical input; Ali Jan Haider and Ruth Hayward provide managerial input. • 0-19 Service Risk Register in place and monitored by the Partnership Group

Performance against System F&P Committee 1098 constitutional standards Overall score Static – 6 meets monthly and is 15 cycles planning now undertaken (FPC) on a system footprint. Impact is 3 System performance and Likelihood is recovery dashboards in 5 place

964 Vulnerability to cyber attack Overall score Risk has Risk not reviewed is 15 been static in (FPC) score for 6 Impact is 3 cycles Likelihood is 5

3.6 One risk (risk 1579) relating to CHC referral has increased in score during the current risk cycle, details of which can be found in Section 3.5

3.7 One risk (risk 1726) has decreased in score during the current risk cycle, details of which can be found in section 3.5

3.8 One risk has been marked for closure during the current review cycle and this is detailed below:

6

154 Details of closed risks Risk scores are calculated by multiplying the impact by the likelihood.

Risk Risk summary Current risk Cycle 6 update reference score number This risk has been closed as it is no longer 1590 Outcome for population Overall score relevant to the CCG. 27.01.21: COVID negatively impacted is 20 activity increasing in secondary care but (QC) urgent services such as cancer referrals Impact is 5 continuing as normal. In terms. Restart Likelihood is prioritisation managed via access program 4 (system group). No current issues with PPE via national portal. No change to risk.

4.0 Recommendations

The Governing Body is asked to receive and note the High Level Risk Report and Risk Log. Appendices

Appendix 1: Risk Scoring Matrices (from the Integrated Risk Management Framework) Appendix 2: Risk Overview Diagram Appendix 3: High Level Risk Log

7

155 Appendix 1: Risk Scoring Matrices and Risk Grading

Impact 4 Insignificant 5 Minor 6 Moderate 7 Major 8 Catastrophic Impact

Financial £1k - £10k Up to £50k Up to £250k Up to £1M Over £1M

Some minor injuries/ Many minor injuries/ Minor bruises/ Some major injuries/ ill- Multiple Harm discomfort/ ill-health - minor. ill-health – temporarily health - permanently injuries/infections incapacitating. affects wellbeing. incapacitating Unexpected Death <3 days absence RIDDOR reportable.

No significant effect on Noticeable effect on Significant effect on Patient care Clinical care Patient care impossible quality of care provided quality of care provided quality of care provided significantly impaired

Negligible negative Minor negative impact Moderate negative Major negative impact Catastrophic negative impact on access, on access, experience impact on access, on access, experience impact on access, experience and /or and /or outcomes for experience and /or and /or outcomes for experience and /or outcomes for people people with this outcomes for people people with this outcomes for people with this protected protected with this protected protected with this protected characteristic. characteristic. Minor characteristic. characteristic. Major characteristic. Negligible increase in increase in health Moderate increase in increase in health Catastrophic increase in health inequalities by inequalities by health inequalities by inequalities by health inequalities by widening the gap in widening the gap in widening the gap in widening the gap in widening the gap in Quality access, experience and access, experience access, experience and access, experience and access, experience and /or outcomes between and /or outcomes /or outcomes between /or outcomes between /or outcomes between people with this between people with people with this people with this people with this protected characteristic this protected protected characteristic protected characteristic protected characteristic and the general characteristic and the and the general and the general and the general population. general population. population. Potential to population. population. Potential to result in result in moderate Potential to lead to Potential to result in minimal injury requiring Potential to result in injury requiring major injury leading to incident leading to no/minimal intervention minor injury or illness, professional long-term death, multiple or treatment, peripheral requiring minor intervention. incapacity/disability permanent injuries or

8

156 4 Insignificant 5 Minor 6 Moderate 7 Major 8 Catastrophic Impact element of treatment intervention and overall irreversible health suboptimal and/or treatment suboptimal" effects, an event which informal impacts on a large complaint/inquiry number of patients, totally unacceptable level or effectiveness of treatment, gross failure of experience and does not meet required standards

National Performance National Performance Internal Standards not Repeated failure to Performance not achievable not achievable achievable meet internal standards (Intermittent) (Continuous)

Audit non- Breach of procedure/ Government Enforcing action conformance/advice Directive from Improvement Notice. Prohibition Notice. Investigation. from enforcers. enforcers.

Likelihood

Level Descriptor Description

1 Rare The event may occur only in exceptional circumstances

2 Unlikely The event could occur at some time

3 Possible The event should occur at some time.

4 Likely The event will probably occur in most circumstances.

5 Almost Certain The event is expected to occur.

9

157 Score and risk level

Score Risk Level

1-3 Low risk

4-6 Moderate risk

8-12 High risk

15-16 Serious risk

20-25 Critical risk

10

158

Appendix 2: Risk Overview Diagram

11

159 Corporate Risk Log for Governing Body as at 28.04.21at asBody Governing for Log Risk Corporate 1590 1495 1613 Risk ID

09/06/2020 03/03/2020 19/06/2020 Date Created

QC QC QC Risk Type

Our Population Our Population Our Population Risk Category 20 25 25 (I5xL4) (I5xL5) (I5xL5) Risk Rating

10 12 10 (I5xL2) (I3xL4) (I5xL2) Target Risk Rating

Dave Tatham Laura Siddall Sasha Bhat Risk Owner

Dave Tatham Liz Allen Alijan Haider Senior Manager delivering reducing as objectives CCG such inequalities. health on need The isaccesswho impact patients servicesto access areto / unable not them closure - some elective of services wave during 2 access equipment to limiting- sickness, testing, PPE as and such availability bed supplies,factors staff staff enable this) to information lack to of services clearlack - of non-urgent re-starting(partly due prioritisation urgent of and are to: negatively due impacted There population our for is outcomes riska that OUTCOMES FOR POPULATION NEGATIVELY IMPACTED services resources outstrip available. may health for societal The demand economic disruption. and and high-risk groups There is will the COVID-19 in riskpandemic a outcomes that fatal result in substantial COVID-19 PANDEMIC timely which way reduce wellbeing.would their and health in a The isimpact local inability of access support people mental to appropriate key workers including on the impact (for example PTSD). increased to goingdue forwards need focus arising different the pandemic, from services health mental for / or require and outweighs demand capacity Risk a that DEMAND FOR MENTALSERVICES HEALTH Principal Risk re-start work-stream to mobilise re-start to work-stream May. 15th Executive System re-started from Board meeting1st Re-start BD&C of met weekly- 06.05.20 meetings the timefor being. Still 2 weekdoing urgent referrals current lower expected).(but volume than isrelevant placecohorts of taking Vaccination - in line timescales. with national with established. BMDCseniorBoard Led leadersby Control system and membership. Outbreak - on careLateral- flow and staff. testing health established for care and partners Weeklyhealth - Craven district videoconferences Bradford and for Regional- teleconference calls the NHS emergencyfor once week.a planners Craven. district structure Full across - in placeBradford and gold, silver in and the CCG command bronze and vital capacity providing in Mind Bradford from resource support - Additional and ~ process be Redeployment this need activated in to place should escalated. ~ Weekly calls in place with ensure providers to risks mitigatedare and/or managed, picked up, in timelya manner happen to the above enabled has funding ~ Additional is continued. ensure support ~ Worked ensure with to partners weto delivercan communications of devices means with those no to allenabled services and digitial ~remote deliver have Suported and to to working solutions their services ~ New care models of being in triedcrisis, out CAMHS urgent, and CMHT trust) and (community organisations MOU~ allow have betweenresources Providerto capacity swift of forum redeployment and resource pusblished and material and developed ~ Communiactions established work overseeing plan group have finish ~ and and Task care available to homes. ~support of Lots lines established. support trauma ~ NHS National staff funding of out run now BDCFT this has - by operated staff ~ Bereavementline Psychological servicesfor support and line public, for training front setstaff for up inequalities factors ~ revise need Recognitionto of needs, strategies health including changes to and in lightpandemic of Key Controls summarised as 'wash hands, cover face, space'. make hands, 'wash as summarised guidance - the relevant law by abide and/or not see increase an in ratesinfection if the public does restrictions lockdown could The - easingnational of transmission of component Public- compliance with social isdistancing key a arrangements requiredchanging. areand constantly emergingnew actions variants and 19 that means the prevalence COVID-of of nature changing Rapidly - calls.fortnightly and data monthly through monitoring On-going locally be needs identified.to grief loss support Covid continue and to Funding COVID and COVIDrestarting servicesand the newavailable whilst capacity managing and waiting list and numbers understand Workto ongoing happen. allow to this prioritisation to conversation and Need re-start governance arrangements system to Key Control Gaps 160 * Other services demand. manageable report high, but related general to winter pressures remains high. activity reduce, isto activity continuing although care silver COVID meeting that Feb 25 2021, on and the health reported at have ANHSFT and BTHFT - week.the previous 14.1% on aged 60+ those casesyears areamong but down Cases perpeople (all 100k ages) are 374.5, stable at week.previous rate The ispositivity 8.9%. stable at the is14.6% on hospital down to admitted patients of district, in Feb 22 2021, Bradford the number As of - UPDATE FOR SLT (2 March 2021): * Assurance Controls Identified Identified SLT 06/05/20 ReviewedSLT 10.06.2020: RO score- is.remain appropriate to who the same. to as Query Followingreducing to SLT scoreSLTconsideration issuesnoted 24.06.2020, 08/07/2020: with but data 31.07.2020. at as provided SLT: No update be people seenlistto one as in clinicaland managed clinicala priority and review all waiting a of people on list. services isestateensure reduction to that of the utilisation are safe. covid Drive the elective ensure to that waiting lists are increasing made has elective services, particularly aerosol generating challengingdiagnostics proceduresa and has as Activity isSLT 26.08.2020: increasing service across many areas. A relatively slow decline across activity all in Covid sectors target trajectoriesactivity maintain the ability submissions to of in areas impact the planning which may COVID of As positive 21.10.20 numbers cases are increasingthere is in again the community increased in activity all service in specificundertaken areas. 1. theirthe levels in sectors peak Some some plans, activated cases at on contingency impacted activity have this has of COVID25.11.20 across activity all sectors increased has significantly, acute COVIDwere arethey inpatients higher than now No23.12.20 update risk. change to terms. accessvia Restart prioritisation managed (system program group). No current issues Noportal. with PPE national via COVID27.01.21: increasingactivity care urgent services in secondary but cancer as such referrals In normal. as continuing CCG by produced care Dailydashboard - and system health Council Public team. Health Bradford by produced Twice-weekly- dashboard arrangements. NHSE on to the CCG returns Assurance - by Daily - NHSE. SITREPs to acute trusts by Local been - established in arrangements line have guidance. with national Identified SLT 22/04 Agreedrisk 05/05: Daily remains same that levelhuddle at or escalating if necessary – this is cross sector group. addressing these resolution by work issuesto Weoperational and weeklya have meeting understand risksaddress to and will health mental on impact be moreCovid a longer term issue. We are still seeing increase an Area. in of people Out psychosis. early of messagesidentification develop to support to communications and communities Childrens address crisis to set group up arefinish pressure working the system. and and Wewith on task a have we see update, areto SLT As an continuing risea SLT 08/07/2020: which in crisisispresentation placingpsychosis and place. taken follow after this has to update - July of set the 22nd for Workshop SLT 22.07.2020: 31.07.2020 at as provided SLT: No update This SLT risk26.08.2020: COVIDremains by high been given impacted economic have the socialcircumstances and that The risk remains high the full as pictureneeds emerges. of see starting to now significantly thesebut increase.dropped crisis acute and on service Demand SLT 23.09.2020: remains high. Access early low to help levelreferraland support had area placements which Riskremain high.score Keyfield been updated. Controls reducedI5xL3 has =to 15 service of maintain work Loss out Griefwork,to access;continue on-going visibilitymonitor to and to and continuing funds 9/11/2020 - Winter pressures support will provide additional resource, needs have been prioritised, seeking additional grief for loss service. and funding additional 26/11/2020 - Risk score increased to I5xL4=20 following discussion at SLT confirmationand that there is no further emerging yet.as . nothing sources but funding agreed at have look coverto to local needs. adequate Command Gold not Yorkshire support 16/12/2020 - Risk remains high. Funding now exhausted for local service waitingand list for support developing. West increasing the last cycle.at 20 to will wellbeingthe mental on be the pandemic population significant.our The of Hence,impact of 27.01.2021: the risk pressures service but on demand continue. manage current how changes isservicesto deliveredstaffing and particularly children. for and to We adjustments made have The increases08.02.2021 crisis in referrals AED via and non-elective admissions serviceand seen has significant a increase risk. resourcewith non-recurrent capacity WY adding from ICS. However, the pressures workforceisstill capacity a and continu * existing vaccines are in ratereducing the newfor variants. the death effectivehow Research- and the new variants on is being undertaken requirement self to isolate (if test positive) decline people Potential to for - testingthe in Covid orderavoid to very mild or have symptoms. asymptomatic arepeople arewho of COVID-19 positive but numbers Unknown - high compliance how is with Unknown social- measures.distancing * Assurance Gaps

NA GBAF Ref No(s)

Closed - Risk no longer relevant to the CCG Static - 6 cycle(s) Static - 1 cycle(s) Risk Status 1579 1694 943 1582 Risk ID

08/06/2020 25/11/2020 17/01/2017 09/06/2020 Date Created

QC FPC QC QC Risk Type

Our Partnerships Our Leadership Our Population Our Population Risk Category 16 16 20 (I4xL4) (I4xL4) (I5xL4) 20 Risk Rating

6 12 2 (I3xL2) (I3xL4) (I1xL2) 10 Target Risk Rating

Nadine Cullimore Robert Maden Bev Gallagher Polly Masson Risk Owner

Michelle Turner Robert Maden Michelle Turner Sohail Abbas Senior Manager The impact The isimpact team, pressure increase CHC risk. on reputational in complaints, process the CHC re-starts. newreferrals significant a CHC of backlog to team pressure due the CHC once on and There is families relationships with riska negativelocal on impact and of authorities IMPACT OF BACKLOG REFERRALSOF CHC activities the pandemic. of by caused disruption deliver resultthe inability a as to the to £13.8m of of savings the original planned There is is will the CCG riskdue deficit that financial underlying 2021/22 into an take UNDERLYING FINANCIAL POSITION RISK. resilience and the sustainability the care• of Support sector . well-being workforce; residents and our health the mental, physical and of • Support • levelsMinimise mortality and infection across care homes; There is need a to: destabilise to potential wider resilience.system the sector of the stability and on impacted which mortality have placements and including increasing result covid-19 in a as reductions sector managing voids of of * These difficulties arethe rising to exacerbated due further the costs reported by * pace with Maintaining guidance changes to access digital shared a to record. sharing across and the system information up joined lack of and * Communication the pandemic; during support care providing of and * Mental wellbeing the demands to due care of staff home staff & across carehealth parents on impact self-isolation –also schools and and isolation workforce issues include and to retention,recruitment *skill Staff and mix, staff re (rehab ablement); and - * Increasing care complexity of residents COVID home include to post infections visiting, healthcare servicesactivitiesaccess/provision of and residents;for life of betweenbalance * in termsbetweenquality Tension and control of infection PPE,regular training and testing; * measures control include Requirement to increased for and prevention infection list):exhaustive includean (not the pandemic Care been challengesexacerbated by homes have that user harm. the increased care riskand serviceof of provided the quality adverse on impact in an resultinfections. This manage may response required COVID-and prevent and to 19 Therecare health isof increasedin care an quality isrisk homes reducedthat to due COVID IMPACT ON CARE HOMES certain for suffering groups. inequalities / disproportionate The isduties relatinghealth impact of failure reduction meet to to statutory average). BAME more groups than deprived and is(evidence the pandemic the pandemic during impacting ison factors date to that There is ethnicity riska increased of inequalities and socio-economic health to due INCREASED INEQUALITIES HEALTH DUE TO SOCIO-ECONOMIC & ETHNICITY FACTORS Principal Risk restarts (date still clear). not PC in with discussion of local Head regardingauthorities processassessments once CHC prioritisation of will system our on C19 Cases as marked be assessed proceduresonce C19 firstare CHC for lifted. A. areteam The consideringmanagement this work how will possible.as quickly as be managed be can progressedschemessavings of when that it Identification - isso. do possible to and 2021/22; for Place- approach integrated planning based m. Well being resources with shared care staff home affected. wherel. residentsIPC outbreak 30% withCQC of homes an targeted those commenced inspections for concern of homes easilyhow people accesscan the service. for inspections on-site Targeted and IPC planned inspections leadershipservices safety, monitoring and to on focuses that approach transitional of launch k. CQC where the sector share staff to possible schemeresourceaid is a the care mutual staff to being and progressedhomes supply with guidance for j. Workforce schemes the NHS Bring (BBS) in place and withBack Staff the localscheme authority to meetings (Craven) command membership at meetingskey work streams. Care NYand Group membership, Board command Independent inclusion of the Care included in decisioni. Association through Bradford making Engagement - Stakeholder bulletins, care communications referenceCare@Home home and forums group, & NYCC Engagement BMDC via provider provider zone and Communications h. Comprehensive learning shared best practice,and inform improvement to quality support and Guidance g. Business Continuity reviewsmedication specialist and EOL support need.proplr with escalating/enhanced for COVID, This includes virtual ward rounds structured digital enhanced via Care (i.e. offer telemedicine (March care21) for super rota residents home with f. Increased access remoteto clinical care reduce to with risks infection escalatingFor patients of needs outbreaks from winterfor e.resilience support training,(IPC)provides advice and Group learning sustainability and all COVID related areas care guidance to ongoing sector and for BMDC of COVID- d. establishment support Team provide 19 to challenges capacity and process, demand rates, infection Care on operational, mortality, Homes challenges address support to action and targeted and monitoring daily support to c. Comprehensive intelligence dashboard and monitoring and settings ensure arrangements to dischargesafe access NHS and from freeportal to PPE the national from carefor providers, Fund includes Control providers the Infection across the of key areas extension and social local care for and actions authorities, NHS organisations sectorand winterfor 2020-2021 Social the social carefor b, Adult care winter support which key elementsplan sets national out of oversight strategica)system SilverCare@Home and Command group caseloads Two projects ledBDCFT (proactive by admiral carenursing team) are livebuilding and team now and careprimary people projects, CLICShealth, mental workforceand development. RIC programme is VCS withlead slowlyprojects,particularon emphasis homeless gaining momentum high risks groups. work.with practices work to related/ comms Recent vulnerable patients offering support to additional the RIC by monies are great doing central within funded locality.connectors Bradford The community immediateSome mitigations are the work we inequalitiesare health as doing network across WY and revise need Recognitionto of needs. strategies health changes to and in lightpandemic of Key Controls towards an agreed an plan. towards action where homes working needed supporting and arepartners CQC. The Local and Authorities the by care been inadequate rated as have homes concerns –safety Two and quality to due intervention and * require homes Some support enhanced & carehealth parents- staff on impact and students *of self-isolation - Schools workforce on the impact wholetesting home and through staff * increasing Workforce and fatigue in infections care there are areengageproviders who to difficult with. * BCA coverageinclude all not does providers and localour system; of the control of out testing programme, whichrelation the national isto process failure * and in riskcapacity On-going of governance within the system; change *whilst pace of Maintaining ensuring good requirements Programme/superother Care@Home IPCrota, and the support partners system to and CCG for funding and * Resourcestaffing in gap termsboth of MDT, therapies); wave the second (i.e.needed for and OOH disbanded have COVIDduring and via redeployed staff services of were number a *of that Gaps established options; up/alternative care24 i.e. isstep these what to back the contingency rota/telemedicine/dischargeSuper assess/my to mitigating ongoing i.e. factors of * Sustainability guidance; and pathways governance for ongoing and system rolesresponsibilities* and Clarity around within the Bhat) communities. (Sasha for support inequalities health mental at looking and specifica have The team Mental health workstream DistrictBradford deprived area Keighley on with particular focus organisations and local VCS amongst funding grant inequality VCS alliance raise event to is an awarenessholding for be reviewed RICthe next at steering group. willchildren and related) the moment at arehold on and (mainly BTHFT maternity involve Projects that PHE work ischair Williams.and ledToni by will work and I Bradford HI report network that to Bird, registrar public health a is leadingthe on PHE. at Pippa and in Bradford public health by started There vulnerable people is support also work to agreed. this will when plan restoration be the CHC placed into referrals LA's PCD are into which consideringboth and for A case been drafted has prioritisation tool with regardeligibility. CHC to time after the crisis enable decision quick to making remainRemote in assessments placemay some for 2021/22. framework for financial Clarity - on and developed; PlacePrioritisation- Bradford be framework for to Key Control Gaps 161 backlog trajectory and urgent clinical trajectory and backlog work meet to the CHC staff shuffles team management occur far, however to the as start these may new for projections referrals day 28 are being met so incurringwithout dispute. a also in place Generalfor Nurses complete to DSTs ProjectLA's CHC manager. Bradford Agreements are which PCDdevelopment will with jointly coordinate resultedsome training and of in the identification meeting LD with Leads the Localhas Authority initialTrack priorteam Christmas. An the Fast to to cases. was This expectedslump following support our casebacklog which the CHC areload trajectory on LD 29/01/2021 The team are 3 cases below the developing. and relationships with Local our areauthorities positive and the team into complaints the rate of Oversight Therethe CHC Group. areincreases no in these issues.demonstrate This is at being monitored newreferrals. CHC Risk been ratingincreased has to increasing awarean of beingbacklog created our for SLT wereare also and aware this yesterday made of nurse resource this work beinginto the maximum. at cases the expected of despitecompletion behind with 7 cases today) running (asbreached again of work backlog this has the C-19 trajectory for 25/02/2021 Whilst the team did catch up with the schemessavings 2021/22. of for Confirmation - 2021/22. for the plan of membersthe development on Body Governing reporting SLT to and and of Involvement - . arrangements governance practices, and management medication relatetrends care and to records, PPE, recruitment in special and measures. themes inadequate rated as 5 homes rated RI homes 23 and CareQuality Home etc.):(designated provision some continuity, provide March to of 31st beyond needed re D2A approach Designated per Beds day: 9 consideration hours - to down stepped - 33 caseload 9: Rota Super Craven: 3/3/2021 Care home COVID Outbreaks Bradford:33 deliveryare determinerequired to if adjustments service on covid of impact We monitor to continue phase. evaluation and weas monitoring 21/22, into move membership for review to February and format Steering will group session in development a hold languages]. these in key community we are versions creatingworkingof on additional comms. [Note future for platform a page,provide to been created,brochure) have together with web interest. national Three key assets (videos and 4 RICsuccessfullyFeb with regional on launch and willin so February, be held in March. Steering session was development postponed group share learning.to inequalitieshealth and reducingwider to on contribute conversation system Feb & 19 so CareHealth on Partnership Board RIC the Bradford to leads presented their approach them. wider awarenessthe services access of to how and materials willevents and ensure to be developed their localtargeted cohorts. engagementIn addition, all reach needed services to that the support have project specific on focusing requirements ensure to engagement work is and now Comms 02.03.21: Assurance Controls the backlog and overall current and the backlog case work 21/08/2020 Still await NHSE(I) guidance, action plan is being drafted to monitor PCD activities around the management of process increaseto efficiency across & CCG processes.LA CHC the process. TFG are The through CHC revisingcaseloads moving keep currentto both tasks carry to out the department caseloads (C19 & backlog New both referrals) identified managing CHC specificwithin have prioritisation daily and staff by recruitment will subsequent cases. backlog and C19 allocation stall of PCDcompletion in this delay arefunding that been received monies has of acknowledged far. so NHSE have amount of confirmation yet as no and allocation national resource CCG's. staff for However been this agreedwill has NHSE additional for by Funding SLT 23.09.2020: be received via the PCD through clinical priority table will are the team how prioritising in order be demonstrate workflows formed comingto CHC the total retrospective work weuntil a recruited clinical have and been Act raised This One as additional has the CHC Group at staff. backlog, newcompletecase CHC some reviewswork and however, there is very limited complete and to appeals capacity NHSE's BBSfrom Team. the CHC present At requested the PCDsupport with work are NHSE through to and managing recruit to resource clinicalbank staff We using the joint the staff also confirmed commencethe 05.10.2020 staff. have from resource,SLT Staff 21.10.20 which agreedincludes been BDMC identified now SLT.via and has Recruitment processes will referral iscaseload effectively also being withmanaged all cases beingfar so completed within timescales. with arefigures mark the backlog well doing and in keeping within the projected weekly targets completion. the newfor current for work vacancies the backlog arefor Applications However, 28.10.2020 poor. regardless, way we hit the half have representative individual/their progress. on with the communication maintains the nurse effectivelyinvolved are the assessment during period managed and KPI. 28day The the CHC Clinical clinicalmaintain to ensure Leads will to capacity any breach days 28 casesrisks monitor that Track Team whichFast will the Community ultimately effect 6 nurse the teams in order support redeployed Band a to have March The 2020. team of the end work SLT backlog by The target 23.12.20 remains team complete C-19 on to the CHC this. LD manage with to team the Local Authority occur within LD lackthe LDa of to Nursedue caseload resource. A meeting discuss revised to workingis of ways planned eligibilitytarget CHC for breach day the 28 clinical may who breachesdecisions.individual arerisks day 28 any likelyfor to manage and monitor to complete the predictedto cases the backlog The 27.01.21: continues trajectory and team above year,the financial together of this with risk. mitigatingrangemanage half a the second to of actions will plans financial we be into reviewedthat expectforward take clarify to to position the financial over the coming months is unclear,2021/22 of it is half the second for likely we that will Place stilldeficitunderlying address. Bradford an to have position whilst the funding deficitand underlying £5.5m an of shows 2021/22 of the first for six The plan months financial effectivelyused in 2020/21. approach Integrated planning Other workforce:sickness Digital levelscurrently. Staff managing Care but isHub threat a posting low to due occupancy considering furlough Workforce- varied - picture sickness/isolation with experiencingwhilst to some homes due others staffing short providers available for funding LA - sustainability Average- 79% occupancy • Wethere will that also anticipate require in providers be that the coming further improvements weeks BMDC/CCG. surveillanceby enhanced supported with AllCQC. been threeinadequate placed rated as in homes have special homes measures, are in embargo place on and see starting to •increase require an As reported 3 last rated RImonth with that homes in 21 improvements homes and CareQuality Home receivedfeedback care from providers positive residents and some vaccinated already and • PCN Each vaccinate Care Vaccinations staff to Home how is planning in the care TBCrather than home staff by home at this in place. put considerproviders to BCA to collectivea support to enable response lateralto flow be tests completed to which resourcinglogistics be IPC/ need considered to dist * N/A * * Assurance Gaps

NA NA GBAF Ref No(s)

Increasing Static - 2 cycle(s) Static - 3 cycle(s) Static - 11 cycle(s) Risk Status 1094 1134 1135 1574 Risk ID

14/09/2017 03/01/2018 03/01/2018 08/06/2020 Date Created

QC QC QC QC Risk Type

Our Population Our Population Our Population Our Population Risk Category 16 16 16 16 (I4xL4) (I4xL4) (I4xL4) (I4xL4) Risk Rating

6 2 9 9 (I3xL2) (I1xL2) (I3xL3) (I3xL3) Target Risk Rating

Ruth Shaw Ruth Shaw Karren Jolaoso Alijan Haider Risk Owner

Alijan Haider Michelle Turner Alijan Haider Alijan Haider Senior Manager diagnostic support. support. diagnostic post- identified formal appropriately delaying any 3 months, by appointment first for standard with resultsthe NICE in (non-mandatory) non-compliance This support. immediate waitingpost-diagnostic assessment, and for diagnosis serviceThere duty childrenfor offer is deterioration risk in a further the statutory of DIAGNOSIS. ADHD ASSESSMENT CHILDand AUTISM and/or will this risk. updates on further be provided commenced and now CLA has in care CLA.opportunities arrangements for The reviewCCG-led services health of to assessments resulting health timescalesmissed in potential statutory for failure meet to due to organisations, health to damage (CLA),reputational and After Children There Looked of isoutcomes the health riska negative on impact of OUTCOMES HEALTH OF CHILDREN LOOKED AFTER processthe diagnostic are of completion lengthening. and referrals.for the demand address to The capacity waiting times initialfor assessment the limited to due support immediate post-diagnostic assessment, and diagnosis There is deterioration risk in a further the service of waiting adults for for offer DIAGNOSISADULT ADHD ASSESSMENT and AUTISM and/or grief. to adding experiencethe risk family The of isimpact and negativeand patient causing upset current COVID-19 restrictions. (i.e.choose would they bedside, at religiousfamily ceremonies etc) the to due theirThere families and is experience patients willriska the death that have that not END OF LIFE EXPERIENCE Principal Risk CYP Autism ProjectCYP Autism Board. Performance Committee. Finance and System SLT. CCG Regularat updates development. under The - first meeting the review terms03/07/18 reference of Update of been held and has group are rise to continues children after in paediatricians.of Bradford looked The number and nursing team the steering been agreed the specialistImmediategroup. have maximiseactions of to the capacity The - TOR18 Sept the reviewfor are agreed.now areColleagues membersthe local from of authority The - review19 Jan services health of After is Children for Looked progressing is development. under duplication and A newreducing / Children'saimed at cross-health Socialmissed appointments Care pathway been requested. CLA has reviewA CCG-led to provision health of risk and situation this, are of awarethe current of sub-group the health Careand Strategy Group, Multi-agency Through SLTCCG Performancesystem Finance and and Committee. allowing withmembers allayed by family are who contact palliativedigital by media. been the ward visitorshave relatedallow on to BTHFT's decision any to the conerns that not of Some - available support the public on to Comms - this in them managing GPs support to to gone out has Comms - / familiespossible as patients much as with virtual contact providers supporting - cremation arrangements. and funeral with public around communicate BMDC- to continue cremations. ~ their BMDCchanged cremation celebranthas processesa or religiousthat so attend official now can new public. visitingon rulesand ~ been circulated Communications have staff to Key Controls near near future itthe review isidentified and hoped will in start the leadA CCG - reviewer 07/03/18 Update been now has The - review 04/04/18 started. now Update has currentlydevelopment under termsreference been held,of has and group are The - first meeting the review03/07/18 of Update medicals. completingadoption initial assessments and health guidance target in respect timescales of for rise we fail in and areto meeting continuing statutory to CLA continues of The - number 28/08/19 Update: herhow clinical will input be reallocated. retirement the Designated of Doctors,one and of the of the impact There about is uncertainty CLA in the districtof The number is increasing forward. moving reviewmedical and assessments health adoption the timeliness on impact initial assessment,of health medicals..will capacity in reduction previous Any adoption urgent initial assessments and health meet the COVID-19 guidance in respect access of to with the service to agree providers to approach our medicals. We adoption are assessments and working initial assessments, undertake reviewhealth health would who redeployed staff have they advised All SLT 31/03 at to as threeUpdate providers initially where there is greater risk. serviceprioritythe other a against not pressures the service routes are but used contractual Formal is people. support to then first and staff this isline being and communities front rolledto out minority specifically and faith support for and training developed have team The health - mental practicable be can addressed. issues, any wherelocalconcerns from people that so messagesregarding also listens out COVID-19 to and messages pushes J's positive (Fiona team) that Saeed Khan by been formed has group A whatsapp - religious of involvement groups. and comms experience, is death into looking that sub-group a Walsh Matt are of ~Jeffrey,part Sue and Jones Fiona timeliness forward. assessments moving autism will capacity in reduction previous the Any on impact organisations. COVID-19 responses within their support to deployed BDCFT. We are clinical aware are that being staff serviceCOVID-19 on across AFT, and BTHFT provision We of the impact are currently workingunderstand to COVID-19. post been allutilised has the currently identified funding will they the service provide front to continue up until been funded As the providers have appropriate. and service are available where face face options to non The three their provide external to providers continue project meetingsteam across partners. monthly reportingthe Comprehensive placetakes through Key Control Gaps 162 CYP Autism ProjectCYP Autism reporting. Committee. Performance Finance and the System Minutes of SLT.the CCG Minutes of services the timefor being in lightCOVID of impact Weekly- March 2020 reporting Children's SLT to on responsibilities.parenting their of corporate part as safeguarding, holder for the councillor BMDC is who of and the portfolio requirements. This is with shared the Chief Executive reporting national of part as local authority, the by basis monthly a assessments ison monitored health with date statutory to CLA up of The number Chair's briefing.and BMDC at Overview Health Scrutiny Attendance and Committee. Performance Finance and the system Minutes of submitted. SLTthe CCG where Minutes of regularare updates * Assurance Controls Progress report. is Bodiesthe Governing reported to update are membersthe project board. staff of CCG progress. The SLTCCG of is informed kept address, to whereversupport assessments.possible, of the backlog review been implemented. agreed assessments has health This coversand agreement urgent continued requests to and medicals and IHAs, adoption provide to plan delivery trajectory to JQC. compliance continuity A business requested as by the (AFT,teams of finance willBDCFT,the available finances of BTHFT).the update This on in delay impact confirmation IHAs. arrangements for colleaguesCCG casethe funding areinitialwithon an awaiting provider focus responses from 04/05/2020 Finance contractingand colleagues continue to review refineand the financial elements of the CLA business progress will be reviewed steps agreed.next and crossa winsmeeting systems quick Septemberaddress 24 and for at is and planned identify to provider organisations with shared partners. across the begun Work and has been developed CLA the reviewhas for report of provision health of within the contained the recommendations of implementation support to paediatric plan The capacity. action additional 4wteWe across by 2019/20. during discussions with the system CLA viewnursing capacity a continue identifying to 4 role Band a increase for to within CLA the BTHFT capacity nursing team. funding BDCFTincrease to are proposing their JCC in Following- Aprilto the presentation the strategicidentified 28/06/19 non-recurrent Update: have team partnerships Interimdevelopment. been identified. Designatedhas Dr support A training employment. ispackage of currentlycontracts in agreedBDCFT the GPs have offer honorary this to model and which will 1 April GPsby areWe2021. who of be operational interestedidentified in cohort place a have in and supporting seniorA systems the clinical oversee been 2021: established to leadershipof has Jan group the implementation model describedas in Newdevelopment, above. pathway review. the proposed for data provide and The specialist team, in CLA health provider services, are reviewing working practicespriorities and maximise to resources clear to the waiting£80-100,000 list. (Karren Leach) 17/02/20 Flagged up the issue again at SLT, Submitted additional activity to DoF identifiedand the need to assign approx 28/10/20 paper to SLT updating concerning picture Karren) Jolaoso, will e-consult (28/08/2020- the demand. stem pathways, help some to of GP referrals people wellalteredas of diagnosis per in the service. month, assessment and the ongoing as GP assist referral with service meet averageto the on the capacity 10 outstretches manager. The servicethe demand and limited has funding referralFrom capacity. and / triage thereappointments rate. isconversion service40-50% Draft a spec being worked on limitation in scheduled because of months 6/12 be up-to made. This take can issue isrequiredaccurate to diagnosis time an the length diagnosis. a for This of for issub-assessments of related the no to 28/08/20 All referrals into the service are being triaged by the service. There is no-one waiting to access the service, the circumstances. exceptional individual the IFR face via route a work isCliniciansprocessreferralshave those to suspended. for continue considered urgent or for No service- change to 2020 August restrictions present,at the service face to but completeswork is as do much as to safe agreedSLT 29.04.2020: reduce to the risk (previously L5 x I4 = 20). Agreedrisk 05.05.2020: Daily remains in. same that huddle level.at added controls Additional palliative care pathway. consider review To SLT closurewhole to for 10.06.2020: to agreedrisk - but remain to riskopen expand that wording and COVID-19. to due restrictions apply that givenhealth/safety other the social and distancing The familiesrisk experience stillSLT willand 08/07/2020: the death patients choose have remainswould that they not COVID-19. to due Risk remain restrictionsto active.apply that givenhealth/safety other choose the social and distancing families experience Therewilland SLT 22.07.2020: the death patients the risk are changes have to would that they no not 31.07.2020. at as provided SLT: No update measures. safety related and health social of This restrictionsthe impact SLTremain risk to 26.08.2020: to high due resulta of referralsof completed activity. and refine comprehensive a oversight allow the PTLhave to to us continues waiting lists will Work organisations. the currentto be held host by (to September fit in with 2020 existingthe new year) school although from doors’ ‘front the new pathway of introduction work towards necessary, deliver to face face assessments.to The services to continue the ability, where virtual assessments and of implementation are currently and exploringthe pandemic the serviceof throughout face face elementsto non provide Serviceto continued providers have The - waiting 2020 listrise. August to continues per This willorganisation. than be discussed with NHSE roles doctor place’ a at named level and doctor the designated rather resourcethe system at look agree to to made implementmodel a to delivery in the October SQC to 2020. moreA decision sustainable was make the model to present version to the next of been asked has group finish CIB with and along revisedSept. a The task the 29th trajectory for perspective.admin A single integrated narrative will be the prepared for BDCT will and backlog review its current resource nursing and a from the current support work more to doing BTHFT joint and ANHSFT about assessments.. completethe health Decisionssome of were also made seenalready has more80 children face face and to to remotely and it how uses its current resource enable moreto children be seento place whichCOVIDduring took lockdown) e.g. reprioritised has BTHFT IHAs F2F long waits the non IHAs (includingof for of the completion their together,service impact, and by log the back address providers to been already undertaken have term that the short actions understand A meeting seniorto leadersof system leads 24/09/20 was held on and Finance Committee. and Systems the July discussed at reviewto refine be it advise to caseisthe business and and planned colleaguescontracting Finance and some continue need point. IHAs at cases of backlog in a pre-proceedings have will who they advised have medicals.deliver reviewsSocial health careadoption colleaguesand social the timelinessto will capacity carehealth both and and on impact we are service support changes to aware that delivery across both urgent requests for any to respond to COVID-19 serviceand throughout servicedeliver to health our continued a Although providers have Uncertainty re clinic service and capacity commissioned. provider services from data Current lack of (Karren Leach) isas trust impacting limitedtime a for spent service, when incorrect) internal (GPsreferrers and theirimprove documentation the care from Care Trust. This will be included in the contract. Referrers need to 25/02/20 Service Specification now completed sharedand with the Neurodiversity Mental LDhealth, HCPB. and the newly of developed part as neurodiversity at looking group sub 27/01/2021 We continue to work with the provider thereand is to be a 29/12/20 no change in concerning situation. ADHD and Autism across both cases,only ongoing 95 40/50 for of commissioned Service spec still trajectory March 2021 of the end being developed, by months 14 to 12 diagnosis, now resultingIncreased in demand longer time assessment and frame for 28/10/20 agreement. the contractual update to the waiting on 19 list. We will be also developing servicea specification be working with BDCFTreview to C- assess progress of the impact and processsocialCOVIDdiagnostic of enforced by distancing 19. We will The - service 2020 the August been on closedthe impact has to due * Assurance Gaps

2.2 1.1 2.2; 1.1 NA GBAF Ref No(s)

Static - 20 cycle(s) Static - 19 cycle(s) Static - 11 cycle(s) Static - 11 cycle(s) Risk Status 1594 1713 1726 1735 1739 940 Risk ID

09/06/2020 24/12/2020 02/02/2021 05/03/2021 26/03/2021 17/01/2017 Date Created

FPC Both FPC and QC QC Both FPC and QC QC QC Risk Type

Our Population Our Population Our People Our Population Our People Our Population Risk Category 15 15 15 15 16 (I5xL3) (I3xL5) 15 (I5xL3) (I5xL3) (I4xL4) Risk Rating

8 9 10 5 6 9 (I4xL2) (I3xL3) (I5xL2) (I5xL1) (I3xL2) (I3xL3) Target Risk Rating

Alijan Haider Vicki Wallace Anna Smith Simon Wilson Dave Tatham Kate Varley Risk Owner

Alijan Haider Vicki Wallace Alijan Haider Robert Maden Dave Tatham Michelle Turner Senior Manager and care and system. The is impact the health in reduction care / of pressure capacity parts other home on issues arisingand the pandemic. from There the carecosts to of due market is home riska sustainability the financial to CARE HOME FINANCIAL SUSTAINABILITY deliver; misinformation. beliefssharing of individual and including:reasons vaccine variety a of workforceavailability; to due to vaccination will receiveThere not population our is largeof a riskthe covid19 a that proportion COVID VACCINATIONS increasedafter. look the carer they acute carethe person both needs and for resulting and health support, in physical worse assessment and and mental offered carersThere is identified are unpaid carers as risk a arenot that therefore and not impacted. equally elsewhere wider potentially in the place system. and Patient experience be could Practice, create stress in the GPturn place workforce on pressuresadditional and be seen could people who result Itin of General may in in reduction the number a Clinical Risk.introduce Operational would in turn and and overall deteriorateIT would performance system this functionality significantly of 4GB) of there ismaximum a following consume risk a release that available and make the Windows 7 Operating (thisGiven of the currentSystem only can constraints CCG. (5 in Craven Practices)environment itas in does the remaining Practices66 in BD&C (RAM)memory Localresources. Serverthe PC and This both applies to equally power, mainly computing significant a amount consume would this functionality include the record negativeall results) of COVIDpositive and and (both Tests done newwas a imminent. in release SystmOne The releasethat functionality of was to PC/VDI Resources: Desktop was the CCG in alertedmid February calla via with TPP care the population. to of wellbeing the provision on staff negativelywhichimpact pandemic, on could and dealingelectiveto with of the backlog carenecessarily that accrued the during COVID-19, in of addition longer-termnow demands the significant acute and manage the NHS to workforce continues the system as amongst There is riska burnout of concerns over compliance with WHO surgical checklist. report highlightedCQC 2020 these events isremains outstanding. embedded Third retained Neverswab event (December learning form that 2019) assurance LMS level report consistently BTHFT (historically currently) and the highest still an ratebirth on accessPrimary Care records online information. cannot maternity clinical of each other-risk delaying to in 'speak' the obtaining/sharing not do Medway Two clinical (EPR, in systems operation Services- Maternity for Medway EPR and remained the same ‘requiresas improvement’ ‘good’. as Overallthe caring rating domain and the maternity improvement’ remained ‘requiresas effective domains in and 2018).improvement’ The safety the Well- (previously ‘requiresand was ‘inadequate’ rated as led domain was ‘requiresrated as – Responsive domain (previously in ‘good’ improvement’ 2018) rated overall ‘requirementsas the domains improvement’. in Ratings 2 of went down services The Maternity: maternity outcome inspection (published) CQC 2020 was obesity. inequalities,diabetes health and higher has LMS)Bradford levels (and the country of areasother to of In comparison harm. patient avoidable of the potential serious incidents and willbabies and women receive care result this may in increased unsatisfactory QUALITYBTHFT AND OF SAFETY MATERNITY SERVICES- there isrisk potential a that Principal Risk Further conversations taking placetaking regarding Further conversations pay. rates of principle's funding the Section linked agreement.75 to re ongoing costs and void Conversations response. up joined and consistent we BDMC isby and work closely assumed sustainability market of ensure with to them a Co-ordination Raising issues NHSE via regional SROcolleagues callsCovid and issues. escalate to relating supply associated issues Continue vaccine nationally to and availability which meets weekly. resources are maximised: meeting withweekly a COVIDCDs on of part basis; vaccine steering group Regular meetings in place with all ensure across partners to the system workforce, vaccine and arrangements in placeGovernance across system messages out. get to channels right Using messagescommunication variety a of are with populations. shared our leaders ensurefaith to the and teams, community local communications and Working with national spare vaccines wasted. 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Matt escalated NHSE The has Regionalthis CCG to Primary Care Director separately Clinicalthe National and working. of care secondary deliver interfacingto across and primary and technology) more efficientenhanced ways workingnew enhance (enabled of embraceways work by to and transformational system recovery and wellbeing, staff realistic on communicating settingfocus system and of expectations and Organisational Collaboration, working SystemCommitteeone; as Quality Newly Better formed Births Programme (July 2020) West YorkshireSurveillance (WSQSG)Quality Group bi-monthly COVID to due currentlyhold (PSQSG)- note group on sub quality and Patient safety servicesMaternity dashboard. maternity areHumber Yorkshire reported to quarterly and Process(BTHFTNotifications CCG) to Unit for Suspension the Trust to support CQC ongoing and Inspections CQC (OMS) meet,2020) meprogram commenced August (monthly ServicesMaternity ClinicalCCG memberthe Outstanding team and membership on Quality lead have Key Controls and manage relationships with manage the same. and work to continues the CCG that It is important equally manner. in controlled a upgrades changes and orderplan to limitations in potential their userunderstand to base Clinical their suppliersSystem of engage need to with Despite it highlights above, the controls NHSX to and No in gaps control measures outcome strategy and establish OMS maternity to requires improvement audits maternity withnational Compliance local and inspection, learningembedded) CQC not complete,as marked 2020 plan action improvement (2018 plans action improvement Maternity benchmark against other CCGs other against benchmark fees CHC Clarification working- to on ongoing deliver the vaccines. to services staff pressure of availability which puts on delivery allon There of be NHS focus a to continues issues departments. other to in timelya are they as way call centres the which pass helplinesinfluence. help The able arenational to not directionwhich weon no national under have supplies associated are all and The vaccine supply misinformation circulation of help combat Needto teams national issues supply national act on Needto teams national JVCIvaccinating 10 group agree PCNs Needto teams on position national in place not in Bradford support carer (2) implemented assessment and statutory and practices carers identify stillto S1 fully on not Current likelihood remains 4 (1)as local priority for carer's assessment. statutory for refer to include prompt not template does SystmOne reached allhave practice staff. not template may SystmOne for Communications Key Control Gaps 163 To be To confirmed * (under 50s) 10 group to as update awaitingso JVCI national 1-9 groups PCNs deliver currentlyto only contracted vaccines to three our for wave 3 sites.information this rollyet have waves weso of not out, do 1 March, theredetail sitesonly for went who in first 3 delivery dose availability. 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ICSat via (£100k coming whichfunding will national by be enhanced target localto specificwork underway communities accept to the vaccine. and National confident not arewho community our be sectiona to of Continues clinicalon system. carers extracts of with SystmOne numbers recorded managed. appropriately strategies risks be can be and can shared areHere maintained. service longer changes termand Clinicalrelationships with NHSX and Suppliers System vehicle appropriate ensure to an CCG provides Service Informatics Digitalthe CCG and Team, Reference working Group, with The Health Digital maturing The established and already priorities identified in the Ockenden Report the urgent clinicalagainst action there response and Progress reportsubmitted Ockenden Trust - against linksBetter to Births program monitoring and regulatory support CQC report urgent clinical priorities identified in the Ockenden compliance Trust LMSwith oversightthe of motoring Committee Quality Serious Incidents escalatedthe CCG and Exceptions to progress and access measures, regularon outcomes to updates OMSBTHFT timely provides membership CCG of Plan group Action Improvement the Maternity OMS reports alongside directly board the BTHFT to 26.08.2020) ServicesMaternity Outstanding BTHFT OMS (lauched programmes throughout Work approach one as workingleadershipSystem together and Assurance Controls 20.05.2020 - Added to log. to Added - 20.05.2020 materialises in fewthe next weeks. SLT : 10.06.2020 riskNational / issue costs, given fill inability to void etc.beds A lot will demand how on depend care of homes. COVID sustainability the financial on are The in withkeepinglocal discussion the care closea authority of SLT the impact and 08/07/2020: homes on watch Risk SLT remain 22.07.2020: to active. concerns address whereshare and practicablecare re:capacity. COVID and home care of impact on sustainability home This SLT (DOF) risk regular26.08.2020: Robert Ibeen Maden holding continues; have and meetings with the care to homes SLT risk- 30.09.20 remains the same level.at SLT Risk- 25.11.20 remains active. update no - SLT23.12.20 resilience. their and on capacity impacted has pandemic The 27.01.21: isCCG liaising with local the the how care of services for analysis providers regarding home an payments and N/A new24.12.20 risk added Discussion re 28/01/2021 likelihood.Update Agreed 3. likelihood4 to change VW/SDfrom N/A27.01.21: new24.12.20. risk added Risk altered SLT discussed as at 1.03.21 Updated New Geriatric Comprehensive template for carers Assessment (CGA) include to template linkunpaid to template reviewedSystmOne Decemberreferral includeand to socialLTC Safeguarding 2020 to follow up, prescribers. the widerand Programme. project.secured The has CCG the resourcesProgramme seasoned a Manager the Plan workingof sideCCG assure both to There is weeklya Digital meeting THIS which betweenProgrammeincludes the Windows and the CCG 'Transformation' 10 accelerate or the overallto shift delivery may slightly certain that the left. to tasks resource additional (£suggestedNHSX or eitherhave people) that available to be made could April ensure of is21 end hit Windows Plans migration for 10 areare wellconsideredalready and generally advanced robust. care secondary deliver interfacingto across and primary more efficientworking. of ways and technology) workingnew enhanced enhance (enabled of embraceways work by to and transformational system wellbeing, staff realistic on communicating settingrecoveryfocus system and of and expectations and Organisational committee quality to BTHFT Planned quality CCG to CTG related of SIs in reduction the number CTG training (since in package place, subsequent 2018) are Maternal outcomes otherwise stillwith the exception of good births. work collaboratively to BetterSystems OMS CCG membership and Births opportunity Programme an provide Positive Assurance * newsFake is still groups being ciruclated anti-vax by 50,000. more than people carersas 19,280 isSystmOne. The true number on estimated as In OctoberGP practicesidentified2020 Craven district in Bradford and this detail however. is the plan expected provide The iteration next of to understood. fully therefore the risk,and sickness be in the event of / diversion, not can detail clearly not does The plan the resources required each task for be To confirmed with communities our and hospitals between in the hospital, both both standards improve work collaboratively to to opportunity an membership provides programme ( internalthe Trusts operational with recent CCG 08/07/2020 the systems newly formed Better Births Programme and improvement’. Overall rating remainedthe maternity the same ‘requiresas remained ‘requiresas effective domains and The improvement’, safety in 2018).improvement’ Well- (previously ‘requires was ‘inadequate’ rated as led domain was ‘requiresrated as Responsive domain outcome improvement CQC visible use who SystmOne GP's to or departments BTHFT other clinicalInteroperability of current issystem systems- Medway not areinvestigations embedded the first retained Seriousof swabs the actions Incident that Third retained Neverswab event (December 2019)limited assurance Never Events complianceNon with WHO Surgical Checklist theme Report a in & CQC Assurance Gaps

NA 2.1 1.1; 6.1; 6.2; 6.3 GBAF Ref No(s)

Static - 11 cycle(s) Static - 2 cycle(s) Decreasing New - Open New - Open Static - 5 cycle(s) Risk Status 964 1098 1404 Risk ID

26/01/2017 19/09/2017 25/09/2019 Date Created

FPC FPC QC Risk Type

Our Leadership Our Population Our Population Risk Category 15 15 15 (I5xL3) (I3xL5) (I3xL5) Risk Rating

3 4 9 (I3xL1) (I2xL2) (I3xL3) Target Risk Rating

Simon Wilson Kerry Weir Ruth Shaw Risk Owner

Robert Maden Robert Maden Alijan Haider Senior Manager reliance IT on / remote working. April SLT 8th agreed2020 raise to score impact in light 5 the pandemic during to of network or network in the corporate Scorexhome House. / mobile deviceisdirect theselaptop a either that apps from the users to connected re-iteratedstrongly be within used VMwareto are they not resulting in access to remote working (e.g.business CCG for MS Teams)Zoom, with cleara message being level vulnerability. However / of therehome isincrease support an to in using apps – necessarily withinternationally shared THIS) healthcarenot – institutions our but on increasedattacks in attempted about team Fraud Interpol the Counter via increases potentially pandemic during (recent Riskcyber-attack of from comms resources. diversion of and lost data operations, viruses containing / ransomware. business resultto This could in disruption genuine click emails/viruses/hacking bait being received in the organisations seemingly and sophisticated There to due is cyber-attack riska to vulnerability of CYBER ATTACK care.reduced patient alongside impact reputational and financial achievement.face both The may CCGs premium quality Assessment Framework ratings and and Improvement annual assessments including performance the national CCG of number a upon impact will standards Therethe key constitutional against performance is poor riska that PERFORMANCE AGAINST CONSTITUTIONAL STANDARDS significantly reduced budget), resulting in services.pressure health other on servicesoral health visitor, nursing and school CBMDC (commissioned by with a There services commissioned CCG is on riska impact redesigned to of due health SERVICES: 0-19 IMPACT ON COMMISSIONEDCCG SERVICES Principal Risk Cyber Attacks, the effect and details of how to deal and report them. deal and to how details of the effect and Cyber Attacks, examples of contain incidents reports reported in of Cyber Securitythe press. and Communications materialsemail receive of to in reminders the form communication continue All about staff ad-hoc compliant. are not that managers receive ESR via staff and training for monitored notification statutory & basis. with Compliance mandatory annual DSPT an training completeon to theirAll mandatory staff firewalls maintained. THIS willand all ensure updated been applied, software securityvirus definitions that have patches will annually. be undertaken high risk withFeb 2020, no This findings. Network network undertaken the CCG testing of penetration are met. all standards – is assurance Service with Informatics The high.2020 Health Work ensurewill to throughout continue standards mandatory with / 106 103 SecurityAprilcompliant Data & 2020 Protection submitted; Toolkit in place recovery dashboards and performance System 04/01/21 System F&P Committee meets monthly planningand now undertaken on a system footprint. provider performance. of monitoring On-going safeguarding. vulnerable families, including: the most and for some face new-borns face to support continue should nursing serviceselement school face visiting face an work to health but of and stopped services We community that 31/03/20 guidance for are advised Update COVID-19 aware national that •Service 0-19 Risk Register the Partnership Group by monitored in place and managerial provide input. Hayward Ruth Haider and clinical provide AliMacDonald Jude Jan input; and • Connolly CCG representativesAnne the group: on in place oversee meeting•Partnership Group to process 0-19 months the implementation and Key Controls is moderate to ishigh). to moderate Moderate (likelihood impact is low and moderate to The overall IT Cyber Security Threat Level remains be arranged in to 2021. Body Cyber Awareness sessionGoverning with SLT and performance delivery for improved plans of to-date with up- NHSI. provide consistently Providersnot do provider targets individual agreed to applicable due leversNormal contractual financial currentlyare not development. • Matrix working between BDCFT CBMDCstill and in BDCFT in Yearthe contract. support 2 VCS of to the be from commissioned to capacity • Additional influencedirect) (not only can partners and • The neitherCCG this or service provides manages Key Control Gaps 164 above. All by Cyber ITmonitored Incidents reported and Committee. Gov & included in reportsAudit to SLTreported to and ALT with Compliance and DSPTby training monitored JQC at performance provider quality of Monitoring JFPC at monthly performance constitutional CCG of Monitoring providers. via groups performance via Monitoring fora key to report updates and • Regular data of analysis (verbal) Partnership • Group Report to Update Mobilisation • Strategic Body Governing Partnership Report to Assurance Controls Both Data Centre Data FirewallsBoth (patched). date to areup current, and in warranty Team rePeriodic / reminders being Cyber Aware. Communications via updates are all sent to staff since (non Aprilpresentbe March taken to - to 2021). action 2020 on advise and meetings Management Account Cyber Security escalate instances of breachesmonthly via the CCG to and any THIS capture detected). receipt particular (no pattern emailsindividuals virus of / of malware containing number a to the via been made have multiple within in attempts the CCG last No3 years reported cyber-attacks although effects of 2020/21 of end 08/09/20 - Draft recovery plans have been submitted but are unlikely to deliver required levels of performance before the • BDCFTreceivedAssurance are that progressingthe agreed Partnership via Group of contract. the implementation Positive Assurance and real and life examples. threats common examples provide of being of vigilantimportance and all users. serveThis would the regulara as reminder about all to staff material distribute to / to education it use communication as could that THIS narrative report from monthly formal a from benefit would CCG standards delivery constitutional of 04/01/21 - Coronavirus continues to impact on access to services and standards delivery constitutional of 02/11/20 - Coronavirus continues to impact on access to services and standards delivery constitutional of 08/09/20 - Coronavirus continues to impact on access to services and standards delivery constitutional of 13/07/20 - Coronavirus continue to impact on access to services and 18/05/20 - Coronavirus continue to impact on access to services standards constitutional 17/03/20 - Coronavirus likely to impact deliveryupon of all addressed alongside the implementation process. the redesignservices concerns the 0-19 ensureraised of that about are 18/05/2020 The CCG is working closely with a multi-agency team to leaflets their familiesfor of COVID-19 part as response. Public colleagues Health series a supported develop to information of vulnerable children. the most some of for We have support of planning service and been integralthe identification have this work through to occurred.have specialThe commissioned CCG needs nursing school families in their where homes or to suspected isinfection an known work services. isteam visit also available to children The Covid-19 and social statutory to or areup early stepped help appropriate support receive they the lead agency or by that managed being appropriately risk childrenvulnerabilitiesensure identify is that with additional and to been childrendeveloped has social care approach partnership a referrals of Developed in in the reduction number response to to (ICV19) Integrated Outreach team. Covid-19 an children through vulnerable most implement our response for our and develop to teams 04/05/2020 The 0-19 team have been working with CBMDC Early Help (waiting times, etc.) currently reporting Partnership Group to • data performance Lack of demand. the agreed meet of to contract the adequacy • to as assurance Lack of Assurance Gaps

3.1; 6.3 1.1 1.2 3.1 3.2 GBAF Ref No(s)

Static - 6 cycle(s) Static - 6 cycle(s) Static - 9 cycle(s) Risk Status Minutes of the Primary Care Commissioning Committee

Tuesday 12th January 2021, 10:00 – 11:45

Zoom meeting

Present Representing Ruby Bhatti (Chair) Lay Member for Primary Care Commissioning CCG Dr Louise Clarke (non-voting) Strategic Clinical Director of Strategy and Planning (GP) CCG Neil Fell Lay Member for Finance & Performance CCG Ali Jan Haider Strategic Dire ctor of Keeping Well at Home CCG Robert Maden Chief Finance Officer CCG Bryan Millar Lay Member for Audit & Governance CCG David Richardson Lay Member for Quality CCG Peter Brunskill Secondary Care Consultant CCG

In attendance Neil Coulter Senior Primary Care Manager NHSE Ashley Green CEO Healthwatch NY Helen Rushworth Manager Healthwatch Bradford Dr Steve Patterson YORLMC Ltd Chair (GP) LMC Dr Val Wilson YORLMC Ltd Liaison LMC Karen Stothers Senior Head of Strategy, Change and Delivery CCG John Hartley Senior Head of Quality Improvement (representing CCG Michelle Turner) Debbie Oxley Head of Strategy Change and Delivery CCG Sarah Dick Head of Corporate Governance CCG Bev Denton Corporate Governance Manager (minutes) CCG

Apologies Helen Hirst, Chief Officer, CCG - member Dr James Thomas, Clinical Chair, CCG (GP) – non-voting member Michelle Turner, Strategic Director of Quality and Nursing, CCG - member Louise Wallace, Director of Public Health, North Yorkshire Council - attendee Sarah Muckle, Director of Public Health, Bradford Metropolitan Council (BMDC) - attendee

Members of the public: 1

1. Welcome and Apologies

Ruby Bhatti, Chair of the Primary Care Commissioning Committee (PCCC), welcomed everyone to the meeting of the NHS Bradford District and Craven (BDC) PCCC, noted apologies and set out etiquette for meeting held by Zoom. The meeting was noted as quorate.

2. Declarations of Interest

No declarations of interest were raised at this point in the agenda. There was further discussion about declarations of interest at Item 5 of the agenda.

3. Minutes of the meeting held on 10th November 2020, and actions arising

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The minutes of the meeting held on 10th November 2020 were agreed to be a correct record by the members of the Bradford District and Craven (BD&C) CCG PCCC.

RESOLVED: The Primary Care Commissioning Committee approved the minutes of the 10th November 2020.

4. Action Log

An update was provided for the following actions from the November meeting:

 Update to contract QA process. Neil confirmed this action was complete. Feedback had been provided to Michelle Turner and Neil had confirmed support to the proposed B&C approach whilst noting there may be moves towards an ICS level approach going forwards.  GMS and PMS Harmonisation in AWC. Ali Jan Haider updated that following a meeting in December no decision has been reached and a further meeting is to be arranged.  Draft principles for income protection for GPs – action complete.

All actions on the log from the last meeting were noted as complete, with GMS / PMS harmonisation to be carried forward to a future meeting.

RESOLVED: The Primary Care Commissioning Committee noted the responses on the Action Log from the last meeting.

5. Primary Medical Care: Service Provision during Covid 19

Karen Stothers noted this paper include decisions relating to second wave primary care funding and highlighted the need for GP interests to be declared.

The following declarations of interest were noted for GP members and attendees of the committee:

1. Dr Steve Patterson, LMC representative – financial interest as a partner in Baildon Medical Practice and as Clinical Director for the Bingley Bubble Primary Care Network 2. Dr Val Wilson, LMC representative – assumed financial interest as a locum employed by CCG member practices 3. Dr Louise Clarke, non-voting PCCC member – financial interest as a salaried GP employed by Bevan Healthcare (community interest company)

It was noted that to comply with CCG statutory guidance on conflicts of interest management, it is necessary to declare any actual or potential interests at the start of each meeting and again at the relevant agenda item (ONGOING ACTION; all members and attendees).

Bryan Millar (CCG Conflicts of Interest Guardian) confirmed that the GPs could participate in the agenda item with the exception of the aspects relating to the funding decisions.

Karen Stothers presented a paper on the series of guidance documents for general practice. The paper gave an overview of ring-fenced second wave funding for general practice and included the general practice income protection agreement across West Yorkshire, which had now been agreed with the LMC and sent out to CCG practices The paper also provided details of the agreement to release additional roles reimbursement (ARRS) funding based on the unallocated budget position. Also included in the paper was an overview of the COVID Vaccination programme and the latest COVID outbreak, T & T practice position and the current practice site closure summary.

The first section of the paper related to second wave funding (The General Practice Covid Capacity Expansion Fund) and details the seven priorities aligned to this funding. Guidance states that if the CCG wanted to do anything different with the funding it needed to be agreed with LMC. In relation to supporting the establishment of the simple COVID oximetry@home model the CCG wanted to work Page 2 of 5

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with Airedale hub to top-slice £50k to enable this to happen; this was agreed with LMC. The remainder will be allocated to general practice in January.

Bryan Millar asked for clarification of the quoted financial figures. Karen confirmed that the £6.41 million is across all West Yorkshire and that £1,574k is for Bradford CCG. Action: Karen Stothers to amend paper to reflect the financial allocation.

The second section in relation to income protection and Karen updated that further correspondence have been received to encourage GPs to ensure services are delivered against COVID practice. The key point is that general practice should use their own professional/clinical judgements in prioritising services based on clinical need. Karen highlighted that on 7th January a letter was received from the centre stating that CCGs should ensure that work delivered by practices was in response to COVID vaccination programme.

Neil Fell asked if there has been a decision to devolve the Additional Roles Reimbursement (ARR) budget to PCN and asked if this is to be spent in the same way as the first round or if this is subject to restrictions. Karen confirmed any unallocated money should be used to pay for overtime for existing roles in response to delivery of the vaccine. For examples practices opening on Saturday.

Neil also asked if the £25.16 vaccination fee comes from the £1.575k and how does the process change covering two doses and the new regulation about the spacing of doses. Karen confirmed that the enhanced service process has changed and that a practice will receive a payment on each vaccination dose given. Neil commented that due to the 12 week gap, those patients that received the vaccine in January, the second dose will be in the new financial year. This was confirmed.

Karen discussed the repurposed local enhanced services and LES agreement repurpose to ensure funded capacity for COVID vaccination. .

Karen highlighted the success of the vaccination progamme. To date the CCG had 10 PCN designated approved sites. Vaccine delivery started on 15 December with all sites receiving initial vaccines. We now have access to two approved vaccines. Sites now have AstraZeneca vaccine which allows more flexibility around moving and storage.

Karen briefed the PCCC on practice staff testing positive for Covid, this is monitored locally under a Standing Operating Procedure agreed by the Local Authority. The number of reported cases within general practice is reducing with the local outbreaks position in currently stands at 1 a week. Previously we were seeing were 3 incidents a day.

An updated list of practice closures has been provided to the Committee. Ruby Bhatti highlighted that the paper sought support of decisions already made, these related to second wave primary care funding proposals (recommendation 2) and a decision to re-purpose Local Enhanced Services (recommendation3). She noted that these decisions were in response to national directives and due to timing pressures the decisions had already been taken; the Committee was therefore asked to ratify the decision.

Ruby noted that the PCCC’s terms of reference included arrangements for undertaking urgent decisions which had not been followed in relation to these decisions and that she had not been aware of them at the time. She stressed that going forwards all urgent decisions required to be taken outside of regular PCCC meetings must be taken as set out in the PCCC’s terms of reference (Chair’s action in consultation with the Chief Officer or a Strategic Director member of the committee or via email decision by the full committee; in all cases urgent decisions must be ratified in pubic at the next meeting of the PCCC.

RESOLVED: the Primary Care Commissioning Committee:

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1. Noted the overview of the second wave funding for general practice and the general practice income protection agreement and principles agreed across West Yorkshire. 2. Ratified the decision to devolve funding to PCN’s for the unallocated ARR’s budget 3. Ratified the decision to repurpose the CCG Local Enhanced Services contract with practices to make funded capacity available for the COVID-19 vaccination. 4. Note the requirements of the NHSE COVID -19 Vaccination programme and progress to date 5. Noted the latest practice COVID outbreak and test and trace position 6. Noted the update on the local testing site and the roll out of asymptomatic testing for practice staff.

6. Contract requirements paused as a response to Covid -19

Debbie Oxley provided an update on the contract and quality assurance process, CQC approach to regulating general practice, an update on the primary cash dashboard and a summary of discussion and outcomes of the Contract Assurance Group on 8th December 2020.

The Committee took the paper as read and Debbie highlighted that the CQC are continuing to evolve their process along with the pandemic and will continue to inspect if there are any patient safety issues identify.

To note that Ashwell Medical Centre was due a Transitional Monitoring Approach (TMA) in January due to staffing and this has been postponed and a future date is to be confirmed.

Local Care Direct had agreed a contract extension in relation to Safe Haven Service, to June 2021 (not 2020 as stated in the paper). Tender documents have been issued with a deadline of 29th January, looking to commence a contract on 1 July 2021.

RESOLVED: The Primary Care Commissioning Committee noted the paper.

7. Contract requirements paused as a result of COVID 19

Karen Stothers introduced this new paper to the Committee. It is envisaged that this will be regular paper during the pandemic. The paper provided a summary of contracting requirements which have been paused as a response to COVID. The paper also includes estimated restart dates. If any dates change the Committee will be updated.

RESOLVED: The Primary Care Commissioning Committee noted the paper

8. General Practice Forward View Funding

The following declarations of interest were noted for GP members and attendees of the committee:

1. Dr Steve Patterson, LMC representative – financial interest as a partner in Baildon Medical Practice and as clinical director for the Bingley Bubble Primary Care Network 2. Dr Val Wilson, LMC representative – assumed financial interest as a locum employed by CCG member practices 3. Dr Louise Clarke, non-voting PCCC member – financial interest as a salaried GP employed by Bevan Healthcare (community interest company)

It had been agreed under Item 5 that the GPs with an interest would be excluded from contributing to discussion relating to funding decisions, item 8 also includes funding decisions so the same declarations of interested were applied.

Karen introduced the paper in relation to the General Practice Forward View that was published in

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April 2016. This committed an extra £2.4 billion a year to support general practice services by 2020- 21.Such funding has been managed by The West Yorkshire and Harrogate, Health and Care Partnership and overseen by the WY Primary Care Leads Group. Due to the pandemic, this group is not meeting routinely and therefore the funding has been allocated to local CCG’s on a fair share basis. The PCCC is considered the most appropriate forum within the CCG for making decisions around ring-fenced funding for general practice support initiatives.

Karen reported that there 4 separate funding lines, two of which are aligned to existing projects. The retained/returning GP scheme, a national push to bring retired GP’s back to the NHS to support the NHS response to Covid 19. The on-line consultations, an existing contract is in place with EConsults ltd, to deliver this service. The contract terms allow an extension of a further year; this funding is to support this contract extension.

The remaining funding lines, Practice Resilience and Training, the CCG is in discussion with the LMC with a proposal that this funding is used to enable a mentorship programme for practice staff and a Practice Manager resilience programme.

Neil Fell question – as this is noted as 2021 funding is this accurate as we are in January do we need to make provision to accrue. Karen confirmed it is ring-fenced and that if the CCG are not in a position to spend this allocation by the end of March 2021, then this funding would be accrued.

Robert Maden confirmed this was within year end flexibilities.

Recommendations

1. The Committee noted the funding streams 2. The Committee approved the release of practice resilience funding to PCNs 3. The Committee approved working with the LMC on the roll out of the mentorship scheme 4. The Committee approved the alignment of funding 5. The Committee approved the extension of the E Consults contract.

9. Questions from the Public on Agenda Items

HealthWatch commented on the mixed reactions to on line consultations with some individuals having difficulty and asked how we taking views of those who can’t access. Karen commented that e consults was an additional tool to support the offer of access for patients.

Ruby Bhatti commented that those who have English as a second language also have difficulties.

10. Key Messages for Governing Body

No messages identified. Sarah Dick agreed to prepare a highlight report for the Chair’s review. (ACTION SD)

11. Date and Time of Next Meeting

The next meeting of the Bradford District and Craven CCG PCCC will take place on Tuesday 9th March 10:30am to 12:45. Venue to be confirmed but likely to be a Zoom meeting held in public.

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169 NHS Bradford District & Craven CCG

Minutes of the Finance and Performance Committee Meeting Thursday 4th February 2021, 12.00 – 14.00 Zoom Meeting

Present: Neil Fell (Chair) Lay Member for Finance BD&C CCG & Performance Bryan Millar Lay Member for Audit BD&C CCG & Governance Robert Maden Chief Finance Officer BD&C CCG

Louise Clarke Strategic Clinical Director BD&C CCG (Items 1 – 9) Strategy & Planning

In Attendance Chris Balson Senior Head of Strategy Change BD&C CCG Delivery Amy Paffett Strategic Head of Finance BD&C CCG

Kerry Weir Associate Director, Population Health BD&C CCG Items 1 – 9) & Wellbeing Claire Kilburn Senior Head of Medicines BD&C CCG (for Item 8) Optimisation

Stacey Fleming Senior Governance & Resilience BD&C CCG (for Item 7) Manager

Bev Denton Corporate Governance Manager BD&C CCG (Item 6 onwards) Andrew Creighton Finance & Digital Team Admin. BD&C CCG (minutes)

Apologies Sarah Dick Head of Corporate Governance BD&C CCG Walter O’Neill Strategic Head of Keeping Well BD&C CCG

1. Welcome & Apologies for Absence Apologies were noted as above. 2. Declarations of Interest Louise Clarke declared a potential conflict in regard to item 8, The Primary Care rebate scheme. In discussion it was agreed that there was no direct financial interest to Louise and that any financial benefit from the scheme would be enjoyed by the CCG. Louise’s contribution in regard to potential impact on clinical judgement would be useful and would therefore, be allowed to stay and participate in the discussion but not vote. 3. Minutes of the last meeting The minutes of the Finance and Performance Committee meeting held on the 7th January 2021 were 1

170 agreed to be an accurate record. 4. Action Log Standing Financial instructions (02.04.20): RM reported that there was now a new Contract Finder portal for publishing contract opportunities and managing responses, but otherwise no changes to the thresholds etc. Medequip (07.01.21): Still an ongoing conversation as to whether to continue with the contract. No obligation to formally respond until May, but North Yorkshire CCG is pressing for an earlier response. COVID Risk Log (07.01.21): In Sarah Dick’s absence it was unclear whether the PPE risk level had been lowered.

Updates on other actions are on the agenda for discussion. 5. Performance Report Kerry Weir gave an update. Key points to note: • It was noted that COVID was causing increased demand on A&E, increased admissions, and impacting non-urgent activity, recovery plans, and performance overall. • A significant increase in 52+ week breaches (over 2000 now at BTHFT) • Diagnostic performance had improved. • IAPT performance is meeting its recovery targets. • Outpatient activity is ok (delivery has been made more virtual), though there is a lack of ability to deliver follow-up elective procedures. • COVID cases and admissions now dropping, which should relieve some of the pressure on the acute Trusts • 85% of 80 year olds have been vaccinated, 78% of 75-79 year olds, and currently 30% of the 70-74 cohort. • 75,000 vaccinations delivered since just before Xmas. • As at 2nd February, of about 28,000 staff over the 3 Trusts, c19, 000 had been vaccinated, and 61% of Care Home staff had received vaccinations on site. • It is projected that by the end of March there will be over 104,000 14 Week Waiters across West Yorkshire. It was noted at the meeting that the position is going to be precarious when Covid subsides. • It was noted that although there was now a sense of a plateau in relation to Covid, staff were exhausted and on their knees. Medical Directors need to factor this into their planning, and recognise that to protect staff it will not be possible to simply launch into immediately addressing the unprecedented backlog. There is simply not the pre-Covid capacity to do so. • Due to an increase in numbers for the 2 Week Breast pathways at Airedale, the Trust was looking to put some Breast and also Gynaecological work out to the Yorkshire Clinic.

Recommendations; The Finance and Performance Committee: • Noted the update. 6. Terms of Reference Sarah Dick was not present due to illness, and Stacey Fleming, attending on her behalf, did not feel in a position to provide a full update. • The version of the TOR circulated with the papers for the present meeting was not the latest iteration. • The only discussion was around Paragraph 6 ‘Chair’. On the latest version, the Chair of the Audit and Governance Committee was no longer excluded from being the Chair of this meeting. It was agreed that in the absence of the regular Chair, the members present would elect another (non-conflicted) member of the meeting to chair. • Other changes were non-contentious. • LC noted that the meeting’s relationship with the System F&P had been nicely captured by the amendments. • The proposed amendments to latest version of the TOR were approved.

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171 Recommendations; The Finance and Performance Committee: • Reviewed and agreed its terms of reference for subsequent approval by the governing body • Discussed the effectiveness of the committee and any potential changes that could be made to further strengthen the operation of the committee. 7. Corporate & COVID Risk Register Stacey Fleming gave an update. Key points to note: • No new additions to the Corporate Risk Register or to the Covid Risk Register, however some changes to risk levels (2 decreases, no increases) and risk to whom. • The Covid Vaccination Risk sits with the Quality Committee. • The PPE risk has reduced. It is now also wholly owned by this committee • There was some discussion around the sustainability of the Care Home market (current risk score of 15). The Occupancy Support Scheme has helped, but occupancy levels are down to 70%. The CCG would like to keep homes rated ‘Good’ going, however it is unclear what support the CCG is going to be able to offer – very much a ‘wait and see’ situation.

Recommendations; The Finance and Performance Committee: • Reviewed and approved the FPC risk log and COVID FPC risk log for reporting to governing body, subject to any amendments requested. 8. Primary Care Rebate Schemes (PCRS) for Prescribing Claire Kilburn was in attendance to give an update. • Louise Clarke’s earlier declaration of interest was noted. • It was noted that the financial benefit to the CCG could be as high as £300k. • The Policy had come to the Committee for re-approval. • There was very little change to the existing (3 year old) policy: and the basic process hadn’t changed. • The Committee saw nothing contentious or any cause for concern in the changes, and nothing that would have an influence on prescribing behaviour. • The Policy was approved by the Committee (LC did not vote, declaring an indirect COI as a prescriber)

Recommendations; The Finance and Performance Committee: • Approved the Primary Care Rebate Schemes for Prescribing Policy. 9. Contracting Report Chris Balson gave an update. Key points to note: • It was noted that the monitoring information received had been very limited, due to local providers working under a national framework contract in response to Covid. • There was little change to the underlying positions of the acute Trusts. Activity way down on previous years. • An apparent move in pass-through costs at Bradford from under trade to overtrade can be attributed to pass-through drugs. • It was noted that the Care Trust was not generating much reporting (even internally), and won’t be reporting until March (February data). • Yorkshire Clinic: Since the last committee the CCG have triggered a local surge, and can access 100% of Yorkshire Clinic capacity under the National Contract (surge not yet endorsed by NHSE/I). For the immediate future, the emphasis has now switched from the planned P3/4 activity to P2 as a priority, with P3 only where capacity allows. It was noted that the Yorkshire Clinic was operating almost as a system partner. The Clinic is taking some Breast and Gynaecological work from Airedale. There is still no clarity on how the Independent Sector will be financed in 21/22, so cannot yet plan the volume and type of activity to put through the Yorkshire Clinic in 21/22 3

172 • YAS: There had been some drop in efficiency arising from restructuring around multi- passenger transport due to Covid. • Enable 2: Activity down on previous years. • NHSE/I had issued guidance separating IS contracts into 5 categories. • BTHFT have concerns, and no assurance, around funding their referrals to sub-contracted IS providers after the 31st March. • NF Expressed the opinion that we should be seeking some kind of assurance from BDCFT that they were actually delivering their planned developments.

Recommendations; The Finance and Performance Committee: • Noted the update.

[KW & LC left the meeting} 10. Hospital Discharge Scheme Amy Paffett gave an update.

LA figures for the 2nd part of the scheme – Discharge to Assess – show an implausibly low level of activity in the past few months. The risk for the Forecast Outturn position might be a possible overstatement of expenditure and will be meeting with the LA within the next 2 or 3 weeks to investigate and clarify the position.

The probity of payments, and whether all the appropriate approval processes and checks were in place was being actively addressed by the CHC Act as One Group, which will feed back on assurance and governance through the Audit Committee.

Recommendations; The Finance and Performance Committee: • Noted the update. 11. Finance Report Robert Maden gave an update. Key points to note: • Operational Budget underspend at M9 similar to last month’s • Residual financial risk remains at £2m. Local Trusts were reported to be comfortable with that number and still able to provide support. • Full reimbursement from NHSE for M7 &M8. Expecting M9 to be confirmed shortly. • The Primary Care variance was due to expenditure commitments on the Additional Roles Reimbursement Scheme. (It was noted that the use of the fund was different than had been indicated in a paper that went to PCCC.) No risk involved: increased spend will be matched by increased reclaim) • YAS have reported £2m extra pressure in year. Each ICS partner has agreed to absorb £400k of that. • No other changes to risks, though some concern around CHC. • Re the IS reimbursement risk, AP reported that the templates for M10 do allow adjustments to be made. • NF noted that North Bradford PCN had the greatest (6%) reduction in item growth, but the biggest increase in price growth (11.3%). RM noted that the range of variation across PCNs is surprising and at this stage is presented for information. Work to understand the why there is such variation across PCNs will be picked up once CCG resources can be released from supporting the pandemic response.

Recommendations; The Finance and Performance Committee: • Noted the year to date financial position to the 31st December 2020 and the forecast financial position to March 2021; and

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173 • Noted the level of residual financial risk and how this is expected to be addressed. 12. Issues to highlight to SLT & GB None specified. There will be no Governing Body before the next F&P meeting, and therefore nothing to escalate. 13. Any Other Business There were no items. 14. Date & time of next meeting The next meeting will be held on Thursday 4th March 2021, 11am - 1pm, via Zoom.

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174 NHS Bradford District & Craven CCG

Minutes of the Finance and Performance Committee Meeting Thursday 4th March 2021, 11.00am – 1pm, via Zoom

Present: Neil Fell (Chair) Lay Member for Finance BD&C CCG & Performance Bryan Millar Lay Member for Audit BD&C CCG & Governance Robert Maden Chief Finance Officer BD&C CCG Louise Clarke Strategic Clinical Director BD&C CCG Strategy & Planning

In Attendance Chris Balson Senior Head of Strategy BD&C CCG Change Delivery Stacey Fleming Senior Governance & BD&C CCG (for agenda item 9 only) Resilience Manager

Walter O’Neill Strategic Head of Keeping BD&C CCG Well Amy Paffett Strategic Head of Finance BD&C CCG Kerry Weir Associate Director, BD&C CCG Population Health & Wellbeing Sharon Wood (minutes) PA to Chief Finance BD&C CCG Officer

Apologies Sarah Dick Head of Corporate BD&C CCG Governance

1. Apologies Apologies were noted as above. 2. Declarations of Interest There were no declarations of interest. The register of interests records all interests declared and is available at: www.bradforddistrictandcravenccg. 3. Minutes of the Meeting held on 4th February 2021. The minutes of the Finance and Performance Committee meeting held on the 4th February 2021 were agreed to be an accurate record. 4. Action Log ToR - NF to circulate the latest version (& to include SF in the circulation) Neil confirmed the ToR were circulated. Action complete.

RM & NF to liaise around production of a more detailed work plan for 2021/22. Neil confirmed he had a discussion with Robert around a more detailed work plan, highlighting in the performance report many of the things received nationally can only be discussed when available. The areas to include on the work plan were the System Finance & Performance Committee minutes to note, Personalised Commissioning and the CHC issues, Prescribing and Primary Care.

175 Bryan highlighted the finance regime and this new year will set some timetables for the first Q been reported back and when they move into a second phase for the last 9 months and mapping when the committee note or approve plans could be part of the timetable. Thoughts to consider on timescales for when these additional items are on the agenda.

The Covid Vaccination Risk sits with the Quality Committee. SF to share the Quality Risk Register for assurance that it is current and fit for purpose. – Neil confirmed this is now a shared risk. Action complete.

CK to share a list of the schemes in operation, who they are with, and approximate values at the next meeting. – Claire to share the information at the next meeting.

It was noted that the Care Trust was not generating much reporting (even internally), and won’t be reporting until March (February data). RM to request PICU information from BDCFT. Robert confirmed he has a meeting with Claire Risdon on the 21/22 contract arrangements and will pick up the PICU issue as part of that.

NHSE/I had issued guidance separating IS contracts into 4 categories. CB and RM to discuss how to handle Category E type contracts, which cover AQP/GPSI type services. Chris confirmed he had a discussion with Robert and is in the process of putting together a report. Robert confirmed this was around reinstating existing contract arrangements, which have been confirmed and Chris is setting out what they are doing around that. 5. Performance Report Kerry weir gave an update.

Key points to note are: • Whilst A&E activity remains below pre-Covid levels at both Trusts, acuity has increased, which has impacted upon bed occupancy and flow; • 18-week performance continues to be a challenge as, although outpatient activity continues, elective capacity has been significantly impacted by Covid. As a result 52+ week breaches are increasing; • BTHFT recovery plans have been further delayed due to an electrical fire (05/02/2021) reducing theatre and bed capacity; • Acute trust capacity is also impacting upon Bradford District Care Foundation Trust’s (BDCFT’s) community dental service, with a growing number of patients on the waiting list and 50 patients now >52 weeks; • Diagnostic performance continues to improve, with both Trusts making use of Independent Sector capacity. However, BTHFT performance has been affected by a CT scanner being down for 2 weeks in February, which has caused an increase in the waiting list; • Cancer services continue to be maintained. However, it is currently challenging to achieve the 62 day standard due to the numbers of patients who are already beyond day 62 of their cancer pathway; • Increased referral rates are putting pressure on mental health services including Child and Adolescent Mental Health Service (CAMHS), Perinatal Mental Health and Children and Young People Eating Disorder services; • Inpatient mental health acuity is resulting in high levels of occupancy, associated inpatient staffing pressures and increased use of acute adult and Psychiatric Intensive Care Unit (PICU) beds. There is continued pressure for out of area placements resulting from demand & Covid related bed closures; • The number of daily reported cases of Covid has continued to fall since early January with a subsequent decrease in hospital reported cased since early February. However, pressures on bed occupancy remain high, including mental health beds and Covid continues to account for between 30-40% of staff absence; • Delivery of the Covid vaccination programme continues and as of 26th February, over 176k

176 first vaccinations have been given. This includes over 90% coverage of the over 70 population and as of yesterday have covered 80% of the 65-69 population, just over 60% of carers and 40% of learning difficulties cohort. • All PCN sites remain in operation and are working through the national JVCI groups as per national guidance and 3 vaccine clinics have been undertaken in mosques; and • Capacity across place has been limited at times due to national vaccine supply. Kerry highlighted in terms of elective capacity there is a small amount of elective work that falls within the 18 weeks criteria which the Care Trust do and is commissioned by NHSE Specialist commissioning around dental elective care for the LD cohort. Their capacity and waiting lists and over 52 weeks breaches is very much affected by the capacity in both Trusts as they need surgical space and the use of an anaesthetist and this needs to be considered as part of the prioritisation work. Louise highlighted this is one to put into the access programme as they haven’t got an eye on that cohort and are they prioritising them in the same way and looking at all of the possibilities.

Neil asked if the over 52 week’s waiters would be monitored. Kerry confirmed this will form part of the system planning process, NHSE have delayed all the planning things until the first Q and Andrew Copley is leading a piece of work across the system to do some of that planning in advance. The 102/3 week waiters will also be monitored.

Neil highlighted the care home occupancy continues to go down and is flagged as a risk. Robert highlighted BMDC have put out their revised occupancy support scheme and the CCG were able to contribute to that and hoping that has managed a bit of the impact of that lower occupancy.

Neil highlighted the out of area Mental Health bed use has gone up a lot over the past few weeks, Kerry confirmed this is a knock on effect with the pressures on the whole Mental Health bed base and the increase in acuity.

Recommendations; The Finance and Performance Committee: • Noted the update. 6. Contracting Report Chris Balson gave an update. Bradford and Airedale Hospitals Trust Continued apparent large under trades within acute trust activity (Bradford teaching hospital and Airedale NHS trust) but these do not reflect the cost of COVID delivery. The CCG will roll forward into Q1 in terms of a contract position and are looking at what these may look like going forward into 21/22.

Bradford District Care NHS Foundation Trust All main providers across the Bradford District and Craven system for 2020/21 are working under a national framework contract as direct response to the COVID19.

Yorkshire Clinic The Yorkshire Clinic will be on a framework contract under the CCG from the 1st April for all their acitivity and things will be done as a lift and shift, ie the hospitals will identify patients who are suitable for transfer to the Yorkshire Clinic. The caveat in this is that it will leave a significant number of P2 patients on the books at the hospitals who cannot be seen or treated anywhere other than the hospitals who do not have the capacity or resource to treat them.

Robert confirmed local DoFs agreed to the lift and shift arrangment to the Yorkshire Clinic and collectively will manage the financial implications of that on the patch, whilst the CCG budget for the Yorkshire Clinic will be reinstated in 21/22. There is a risk that the actual activity that goes through will be greater than that because Trusts would also have sub-contracted some activity through the Yorkshire Clinic. They will be holding some resource as well that can help manage

177 and fund that activity. Anything beyond that will come through the waiting list backlog funding that was announced in the spending review. Chris confirmed when the framework was first launched back in October / November there was a very clear push from NHSE/I to clear numbers and because of the prioritisation patients were transferred between sites. The second part of this is that the system are starting to run out of P2s that can be done outside of acute hospitals i.e in the independent sector.

Neil asked Louise if people were happy with this from a clinical perspective, Louise confirmed it is the clinical perspective that is mainly driving it where people can have part of their treatment in the independent sector and then HDU back up that they can’t get through the independent sector. Through the access programme there is some work ongoing with the 2 Trusts looking at what they can do more of. Chris confirmed alongside the contract framework in place with lift and shift there will be small cohorts of sub contract activity that will still move between the sites to ensure that the surgeon needing activity can continue but the P2s left in the hospital cannot be done by the independent sector.

YAS M10 The month actual figures are reported to highlight the shift back to underperformance of Care Calls Answered. All CCG’s Total is shown to highlight the overall YAS activity position as at January 2021.

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• YTD costs to the end of January 20201 were £165K • 89% of all year to date costs relate to Primary Care activity (£147k) which includes a small portion attributed to GPwSI. Total GP bookings to the end of January were 11,788 - an increase by 1,485 from the previous month. • Bevan Healthcare have the highest number of costs/activity ytd (£72k) • In comparison to the same period for 19/20, the number of GP bookings totalled 13,768 at a cost of £486k.

MEDEQUIP (AWC patients only) YTD activity/costs to December charges were £161k. Full year forecast is expected to be £195k resulting in a forecast overtrade of £40k against the contract value (£155k).

In comparison to the same period in 2019/20, the recharge for year to date activity was £158k.

Other Providers/ IS Framework

Optegra YEH were included in the national contract through 20/21 and like YC were given notice that this would terminate at 24th December 2020.

They rejected the offer of the new national contract and so the CCG have negotiated a framework contract that covers the period 24th December to 31st March 2021.

They will need a new Framework contract from the 1st April 2021, or extension of current terms, but as above that can only go a maximum of 6 months.

Westcliffe Health innovations have had a cost recovery model with both BDC and Leeds CCG for 20/21. They now have Framework subcontracts in place with BTHFT for endoscopy and cardiology and are reviewing the option for CCG model. Under consideration, this will not be taken.

WHI will need a framework contract from 1st April to cover endoscopy and cardiology

Discussions have begun on future contracting model around IS provision across WY&H. Anticipated that they will in effect replicate current position’s from 1st April for 6 months under

178 direct award, Q1 is resolved re: planning and financial flows. Take future view during that period on models required and transition to ICS contracts.

Recommendations; The Finance and Performance Committee: • Noted the update. 7. Finance Report Robert Maden gave an update.

Key Points to note:

The main changes are that block contract reductions have been actioned for the 2 acute trusts and the Care Trust as part of the local financial risk management arrangements. Together they are expected to cover the shortfall against the CCG additional savings target. The rationale for the reductions in the acute trust contract values is to recognise the impact of the significant elective under trade which has resulted in some non-pay underspend. In terms of the Care Trust reduction that will relate to planned development slippage where they have not been able to progress some of the things that were funded in the block contract.

The additional cost reimbursement process is taking longer than anticipated in terms of NHSE turning payments around; this is for hospital discharge schemes costs and the local independent sector additional activity costs. The CCG have submitted those claims as part of the normal monthly finance return to NHSE and have received 2 months of hospital discharge scheme reimbursement but nothing for the local independent sector activity. The CCG have now received the M11 resource allocation update which has some allocations for reimbursement of costs plus estimates for February and March. The team is currently reconciling these values. Neil highlighted in terms of the allocation to date does it imply that it is more than the CCG have put in for. Robert confirmed NHSE are processing things in preparation for 20/21 year end so what will be left when you move into early April is the need to action small adjustments when actual outturn has been reported. From a cash perspective, the CCG will be paying for this activity and will get resource and cash limit that goes with it. In terms of the overall position, on the back of the block contract allocations and some favourable movement on other budget lines, the residual financial risk is now zero and we are forecasting a balanced position. One of the items the CCG were not expecting was an allocation for flash glucose monitoring devices. This has gone into the prescribing budget and the underspend has improved by £300,000. Some prescribing contingency continues to be held for additional prescribing costs over the last few months. The additional roles reimbursement scheme has been updated to recognise some of the additional overtime costs that can be included in the reclaim.

Robert highlighted the risks have now been fully mitigated and we expect to meet our financial targets for 2020/21.

Bryan commented that it is good news to have a positive potential outcome and thanked Robert for his work. Bryan was conscious of the budget yesterday (3rd March) as it looks like the NHS is going to get a significant reduction in specific covid related funding as you move into next year and highlighted the more you can protect yourselves against unexpected costs the better. Bryan also highlighted the CCGs reliance on the wider ICS system in terms of the year end and would be a further buffer if required? Robert confirmed each patch is in the same place and there are no wider ICS pressures affecting the CCG. Bryan asked if there was any follow up with the MHIS from the audit committee. Robert confirmed he had a discussion with Rashpal along the lines of confirming that external audit won’t need to challenge the CHC apportionment and going to treat the primary diagnosis as a clinical judgement and doesn’t need to go any further than that. Bryan highlighted 2 out of 3 areas are compliant

179 with Prescribing outstanding. Robert confirmed in terms of Prescribing the CCG is taking the same approach as in 18/19 and will get the same qualification and there are no implications arising from that. Neil highlighted Prescribing, with 4 months of actual spend still to be reported. There is still some uncertainty around that and asked how the process the CCG has put in train to clear the backlog of CHC assessments is progressing. Robert confirmed the CCG have followed up with the council and still waiting for their information to triangulate with CHC teams’ understanding of referrals they have received for assessment. Internally they are happy they have captured everything they just want that additional assurance from the list that the council will provide. Neil highlighted the RIC investment and in terms of the approaching year end what has been done? Robert confirmed in terms of the budget this reflects the final agreed programme, but that the potential slippage of £700k referred to in previous reports was now lower following confirmation of actual scheme commitments.

Recommendations; The Finance and Performance Committee: • Noted the year to date financial position to the 31st January 2021 and the forecast financial position to March 2021; and • Noted that there is no remaining residual financial risk in the reported financial position. 8. Operational and Financial Planning Update for 2021/22. Robert Maden gave an update.

The current financial arrangements operating for the October to March 2021 period will be rolled forward to cover the first quarter of 2021/22 and the operational planning process for 2021/22 covering activity, workforce and finance for the remainder of the financial year has been deferred to Quarter 1 of 2021/22. There will be a financial plan for Quarter 1 (2021/22) and a full operational and financial plan for Quarter 2 to Quarter 4 (2021/22). As in 2020/21, resources will be allocated to the West Yorkshire and Harrogate ICS and a process overseen by the West Yorkshire and Harrogate Finance Forum will determine organisational level resource allocations for both planning periods within 2021/22. Individual organisational plan approval will be required to support the approval of the overall West Yorkshire and Harrogate ICS plan. Resource availability in both planning periods is expected to include funding for Mental Health Forward View and new GP Contract commitments. For Quarter 2 to Quarter 4, resources will also include a share of the Spending Review 2020 settlement of £3bn which is intended to help address elective waiting list pressures, mental health service pressures and to help ease existing pressures (including the loss of productivity in 2020/21). Further guidance is awaited to confirm the detailed roll-forward financial arrangements and operational and financial planning guidance for Quarter 2 to Quarter 4 (2021/22) is expected at the end of April 2021. Plan submission dates are expected to be the end of April for Quarter 1 plans and the end of June for Quarter 2 to Quarter 4 plans. CCG Finance and Performance Committee and Governing Body approval dates will be confirmed once further guidance is issued by NHS England and Improvement.

Locally, whilst each organisation still has to develop and sign off its own plan for 2021/22, the plans will be developed collaboratively in line with the principles set-out in the Strategic Partnering Agreement, the expectation of the ICS and in preparation for moving to a shadow Integrated Care Partnership from the Autumn. The Executive Board is expected to collectively sign-off plans for the Bradford Place.

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Bryan highlighted if they stick with the timetable the CCG should know something this month around the initial roll forward allocations, however, if they don’t the F&P Committee on the 1st April should approve some budget or some assumptions that will form part of their planning at an organisational level for next year. Robert confirmed one particular issue for them in terms of Q1 is what the inflation uplift is going to be? There is a suggestion that for NHS Trust block contract values there will be no inflation uplift, and the CCG are concerned about non NHS Trust contract values and continuing care in particular as the CCG will agree a fee uplift for Care Home placements that largely mirrors the council uplift. Therefore, there is a risk there that they proceed and approve an inflation uplift that is beyond what they are getting in the funding envelope uplift. Bryan asked if the CCG knew what the council uplift will be, Robert confirmed the fee uplift on Care home placements will be 3% for next year. This question has been raised in the national finance webinar and through a number of other forums as it is not sustainable to have a zero uplift for certain non NHS contracts.

Neil highlighted if there is an approved budget in April, there will be a need to have some Q1 process for signing off outside this committee and GB. Robert confirmed the indications were that the Q1 plan should be submitted by the end of April and needs an approval process that sits around that. It is likely that a budget will come to an F&P committee and then GB in May.

Neil highlighted even if the CCG can balance something in Q1, Q2 – Q4 will throw up the QIPP requirements and how will they address that? Robert confirmed it will be a local system approach to whatever the productivity requirement is. There will be an expectation that the additional covid costs start to reduce and normal efficiency schemes will begin to be progressed. The CCG will focus on CHC and Prescribing as the main ones and pick up other things from some of the work around the system programmes.

Recommendations; The Finance and Performance Committee: • Noted the update on the operational and financial planning process for 2021/22 9. COVID Risk Log Stacey Fleming gave an update. This is the last cycle where the COVID risk log will be reviewed on a monthly basis. Following discussion at SLT, reporting of the COVID risk log will be moving to bi-monthly review to align with the reporting of the Corporate risk register from February 2021. Previously, reporting of the COVID risk log has reduced from fortnightly during July and August and weekly during April to June.

As at 25 February 2021, there are a total of 15 open risks on the COVID risk log. Of these

• Eight risks align for assurance purposes with the finance and performance committee. This includes two risks which align with both this committee and the Quality committee: o Risk 1713: risk relating to Covid vaccinations (risk score 15) o Risk 1727: risk relating to delays in CHC reviews (risk score 9)

• One new risk was added this cycle:

• No risks have increased in score since the last report to the committee. • One risk has decreased in score:

• There are four risks at the ‘critical’ level (scoring 20 or 25) on the COVID risk log. All of these are aligned to the quality committee.

• There are three risks at the ‘serious’ level (scoring 15 or 16) on the COVID risk log. One of these aligns to the FPC and one aligns with both FPC&QC:

Recommendations; The Finance and Performance Committee:

181 • Reviewed the FPC COVID risk log. 10. Annual Report - Annual Governance Statements Neil Fell gave an update. The Annual Governance statement forms part of the Annual Report with information relating to the role of the Finance and Performance Committee. Bryan highlighted it reflected the true position the committee are in and was an excellent paper. 11. Issues to highlight to SLT & GB • Finance – good news and on track to meet obligations. • Performance – note that over 52 weeks is increasing but work is ongoing and there are arrangements to try and minimise the impact of covid. • Operational and Financial Planning Update for 2021/22 – this paper is going to GB but will note the uncertainty and the aim to set some budgets that reflects the regime for Q1 and revisit for Q2. 12. Any Other Business There were no items. 13. Date and Time of Next Meeting The next meeting will be held on Thursday 1st April 2021, 10.30am – 12.30pm, via Zoom. Apologies from Louise Clarke.

182 183

184 Bradford District & Craven CCG Draft Minutes Quality Committee Meeting Thursday 4th February 2021 13:30-16:00 hours Zoom Call

Present:- David Richardson (Chair) Lay Member, Quality John Young Secondary Care Consultant Gill Paxton Associate Director of Quality & Nursing Kate Varley Senior Head of Patient Safety Angie Clegg Independent Registered Nurse John Hartley Senior Head of Quality Improvement Dave Tatham Strategic Clinical Director of Keeping Well in Hospital James Thomas Clinical Chair Jackie Haw-Wells Head of Patient Safety & Quality Improvement Bev Gallagher Head of Safety and Quality Improvement Fiona Jeffrey Associate Director of Organisation Effectiveness

Apologies-: Sarah Dick Head of Corporate Governance Victoria Simmons Head of Engagement Michelle Turner Strategic Director of Quality & Nursing Peter Brunskill Secondary Care Consultant Ruby Bhatti Lay Member Primary Care Commissioning Helen Rushworth Manager - Healthwatch

In Attendance:- Elaine Phelps (Minutes) PA to Quality Team Helen Hart (Item (Item 6) Designated Nurse, Safeguarding Adults Tracey Gaston (Item 9) Senior Head of Medicines Optimisation Claire Kilburn (Item 9) Senior Head of Medicines Optimisation Bev Denton (Item 14) Corporate Governance Manager

1. Introductions and Apologies: Apologies received as noted above.

2. Declarations of Interest: There were no declarations of interest.

3. Minutes of the previous Meeting: The minutes of the meeting held on the 3rd December 2020 and 7th January 2021 were accepted as a true record of the meeting.

4. Action Log: All actions within the action log were noted and updated or marked as completed.

5. Matters Arising: There were no matters arising

6. Safeguarding Annual Report - circulated: Helen Hart gave an outline of the Annual Report. The Annual Report demonstrates the activities undertaken by the Safeguarding team during the period 2019-2020, evidenced against the key priorities outlined in the team safeguarding strategy. The report summarises:

185  Significant changes within the team personnel with further recruitment planned in the next reporting period  Additional resource allocation within the team  Increased activity levels across multi-agency partnerships to meet statutory and legislative changes and changed responsibilities  Priorities for the forthcoming year

The focus of the report is on the safeguarding of children and adults at risk, but includes the CCGs contribution to wider safeguarding agendas which can affect anyone – e.g. Domestic Violence, Modern Day Slavery and PREVENT

Areas of planned activity over the next year will include;

 Evaluation of the GP assurance tool.  Completion of the action plan and development of the business case re health services delivery to Children in Care.  Completion of the action plan re CLAS inspection, including recruitment to increase the capacity of the safeguarding team.  Recruitment and appointment to the Specialist Health Practitioner roles, Deputy Designated Nurse: Safeguarding Children  Robust induction process for newly formed team  Optimising the health contribution to the Children’s MASH and CE hub.  Continued review of training needs and delivery in light of the intercollegiate documents and changes to local safeguarding procedures.  Considering of options to strengthen hosting arrangements for guidance to GPs through GP assist.  Further development and strengthening of the team role regionally and within the Integrated Care System.

The Quality Committee is asked to accept the report and note the levels of activity and assurance. This was agreed by the committee.

7. Covid Vaccine NHSE Guidance and SOP Log: (circulated) A Covid vaccine log has been created in order to ensure that there is a suitable record of actions taken in line with all NHS England’s letters and guidance to primary care around the rollout of the vaccination programme within Primary Care Networks. The log is updated frequently to ensure that the CCG are compliant with all requests and requirements to ensure that the vaccine roll-out locally is safe and appropriate. The Quality Committee is asked to note the document for assurance purposes

8. CHC Audit Plan - Revised Section 117 Policy GP gave an update on the revisions to the Section 117 policy reviewed at the last meeting. The policy was then ratified by the meeting.

9. Quality Update KV, JH and BG outlined current activity within the Quality Team. Work is ongoing around DNACPR and the Phase 2 LeDeR work is progressing well. There is currently a backlog of coronial investigations of approx. 18 months, which is affecting the completion of some LeDeR reviews.

It has been agreed that Stroke services will sit within the Healthy Hearts Programme. There has been a decrease in performance in the Stroke Unit mainly due to Covid and winter pressures. Action: BG to give a regular update on Stroke Thrombolysis to QC Action: GP to liaise with MT re a regular update to this meeting from the Healthy Hearts Group.

Progress has been made against the five focus areas of Outstanding Maternity Services (OMS)  The Women’s Journey and Clinical Excellence

186  Investing in our Workforce  A Building Fit for the Future  Moving to Digital  Linking Learning and Quality through our information

However risks to OMS delivery include Covid-19 impact on the service + staffing, Midwifery and support staff shortfalls.

KV highlighted an incident at BTHFT pertaining to tissue, further details not yet available.

BG updated on the Care Sector. Four homes are currently Inadequate and have been placed into special measures. In Craven there have been 5 homes and 1 Extra Care Housing facility with Covid outbreaks within 0-28 day cycle. Bradford Care home infection rates have doubled since Christmas with 31 homes having outbreaks. Large outbreaks are under control and IPC training is continuing. The new variant of Covid-19 is becoming more dominant with a slightly higher death rate

100% of Care homes have been offered Covid 19 vaccine with the exception of those with outbreaks. Nursing bed availability has been confirmed at Hazel Bank Nursing Home and the team are currently trying to secure beds at Troutbeck Nursing Home to support the flow of patients.

JH told the meeting that Cygnet Woodside remains under an Organisational Safeguarding Enquiry primarily due to concerns remaining regarding the sustainability of the actions implemented in response to the recent CQC Inspection

The School Nurse Child protection pathway pilot has been suspended and work to mitigate any risk in the short time frame has been challenging

JH reported that the LAMP report is now with practices and the team are currently working with all places in West Yorkshire to establish new ways of working to deliver research projects, taking the learning from the vaccine trials into other research GP commended the phenomenal amount of work that has been done by the R&D team

CK reported that all PCNs are now operational in regards to the delivery of the Covid vaccines with the sites receiving a mixture of Pfizer and Astra Zeneca vaccine. New Non- PCN sites are planned for Rimmington Pharmacy (city centre), Bradford College and Jacob’s Well. The CCG is also supporting some site visits. A governance log of Primary care guidance and local SOPs is to be created and shared.

The flu dashboard will continue to be produced and circulated, however the focus now needs to be on analysis of this year’s data to provide an insight into areas for improvement for 2021/22 and to inform the Covid vaccination programme

TMG told the meeting that there has been significant improvement on the previous year’s target for flu vaccines with 75% of over 65’s being vaccinated.

KV told the meeting that the CHC backlog and trajectory are on track and backlog cases will be prioritised rather than new referrals. All PCD staff who wished to have the first dose of C- 19 vaccine have received it. The team continue to work effectively through an enormous amount of complex work remotely; staff report being happy and the teams overall sickness rates have reduced.

10. On The Horizon:

187 FJ reported that there have been four complaints received since the last report. 3 relating to CHC and 1 to Mental Health Act. There has also been one complaint received regarding a secondary care provider re all aspects of care and treatment, including clinical protocols and manner of staff. There are a number of issues/concerns arising from Covid within secondary care  Delays in non-urgent surgery/appointments (x2)  Access to maternity services/restriction of partner attending appointments  Discharge of patient Covid positive to care home  Non Covid compliance - face covering, two metre distance rules (x2)

Compliments have been received regarding the patient experience at Skipton and The Ridge

Our two staff networks, BAME staff and Wellbeing and Able staff met to produce a workforce equality action plan for the CCG based on the inequalities that have been identified from staff network members’ lived experience. The aim of the plan is to develop a more inclusive organisational culture where a ‘population health management’ approach to our workforce is taken, recognising that different groups of staff experience inequalities that need to be addressed.

Work is coming to a conclusion on the Bradford district’s Roma strategy and there will soon be recommendations about how to reduce the health inequalities experienced by Bradford’s Roma communities.

As part of the ongoing work to review and restart Grassroots reporting we are working with colleagues in different teams to try using the grassroots system and report back with feedback of their experience. We continue to work with partners to establish routes to bring data collated from providers onto the CCG system - SEND will be an initial focus for this work.

11. Serious Incidents inc. Q3 Report: Serious Incidents - JHW gave an overview of the report. There have been two new incidents reported at ANHSFT during the last month, one of which involves a home birth. HSIB are investigating No new incidents have been reported by BDCFT; however there are 6 incidents beyond deadline one of which is due to a police investigation. BTHFT currently have one new incident this involves a maternity client and is being investigated by HSIB. There are also 4 incidents over deadline. YAS - one incident over deadline and an updated has been requested Yorkshire Clinic has reported 1 new incident due to complications during surgery.

Q3 Report

The report provides an overview of current Serious Incidents relating to NHS Bradford Districts & Craven CCG and is structured as follows:-  Total number of Serious Incidents by provider and their stage in process.  Update on open Serious Incidents by provider.  Serious Incident reports reviewed; grade and audit process of action plans.  Themes and trends identified from the CCGs’ main providers.  A note of action plans reviewed by providers for evidence of implementation each quarter.  Learning from Serious Incidents

The Number of Serious Incidents reported for Quarter 3 (2020/2021) from 1st October 2020 to 31st December 2020 = 28

BTHFT reported the majority of SI’s during this period. The main category being Slips/Trips/Falls. This was closely followed by BDCFT who are continuing to report an increase in apparent suicide and self-harm incidents. This is coupled with a continued increase in the number of alleged abuse incidents from staff to patients during Q3. A detailed analysis and deep dive has been carried out by the Trust and shared with the CCG.

188 ANHSFT have reported the least number of incidents overall, although reporting has increased from the last quarter and of mixed category incidents

There also continues to be a positive reporting culture within the care home and independent sector. It also noted that there were only two pressure ulcers reported by a main provider, this being BTHFT, as hospital acquired.

The Quality team have made some excellent progress during this Quarter in developing the emerging QA model which has been well received by a majority of Providers. This will help with wider system and lean working whilst providing adequate assurance with regards to learning and implementation of necessary changes to practice for the benefit of patient safety and staff. What has also been particularly noticeable this Quarter is the more integrated joint working between the main providers (and the local authority/independent sectors to some degree) where incidents involve mutual patients and integrated care delivery. The CCG has played a big part in helping facilitate this and are able to have a wider system approach and influence which the providers have found extremely beneficial and this will continue. This is another reason why the wider learning forum is instrumental in continuing to develop key working relationships and sharing wider learning across the board.

12. Terms of Reference / Committee Effectiveness The committee’s terms of reference were approved as part of the CCG establishment process and subsequently amended and approved in May 2020 9thvs, to reflect the job share arrangement for the secondary care consultant role. In light of current circumstances it was agreed with the audit and governance committee that a ‘light touch’ approach would be taken to the 2021/22 review which would focus on general discussions rather than completion of questionnaires. The Quality committee is asked to  Discuss the effectiveness of the committee and any potential changes that could be made to further strengthen the operation of the committee  Review and agree its terms of reference for subsequent approval by the governing body

During a discussion it was decided that the ToR are to be reviewed to make clear the statutory business items and the Quality Assurance work.

A standing agenda item is to be added to the QC agenda for items to be escalated to SQC and/or Governing Body

A discussion then followed regarding the content of meetings with the suggestion that each alternate month would focus on the statutory functions in detail and the further 6 meetings should focus on a particular QA area with the statutory function items circulated to members for information. Action: Members to send any thoughts to GP prior to next meeting Action: DR to liaise with PB and RB for their thoughts and send to GP Action: GP to bring back to future meeting

13. Further Meetings - next Year’s QC plan - included in Item 12

14. Risk Register update including Covid Risk Log There are currently 16 open quality risks an increase of 1 on the last cycle. One corporate risk is critical - Covid-19 and demand for health services. There are 5 serious risks including 1 new risk in relation to Designate Doctor provision for Children in Care. No quality risks have been reduces/marked for closure.

Covid Risk Register - There are 8 risks allocated to Quality Committee, 4 critical, 2 serious and none were reduced/increased/closed. One new risk related to Covid vaccinations.

15. Any Other Business There was no further business

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Date and Time of Next Meeting:

Thursday 4th March 2021 at 1.30pm via Zoom

190 Bradford District & Craven CCG Draft Minutes Quality Committee Meeting Thursday 4th March 2021 13:30-16:00 hours Zoom Call

Present:- David Richardson (Chair) Lay Member, Quality Michelle Turner Strategic Director of Quality & Nursing John Young Secondary Care Consultant Kate Varley Senior Head of Patient Safety Angie Clegg Independent Registered Nurse John Hartley Senior Head of Quality Improvement Dave Tatham Strategic Clinical Director of Keeping Well in Hospital James Thomas Clinical Chair Jackie Haw-Wells Head of Patient Safety & Quality Improvement Bev Gallagher Head of Safety and Quality Improvement Fiona Jeffrey Associate Director of Organisation Effectiveness Peter Brunskill Secondary Care Consultant Ruby Bhatti Lay Member Primary Care Commissioning Helen Rushworth Manager - Healthwatch

Apologies-: Gill Paxton Associate Director of Quality & Nursing

In Attendance:- Elaine Phelps (Minutes) PA to Quality Team Sasha Bhat (Item 8) Head of Mental Wellbeing Tracey Gaston (Item 10) Senior Head of Medicines Optimisation Bev Denton (Item 13) Corporate Governance Manager

1. Introductions and Apologies: Apologies received as noted above.

2. Declarations of Interest: There were no declarations of interest.

3. Minutes of the previous Meeting: The minutes of the meeting held on the 3rd February, 2021 were accepted as a true record of the meeting.

4. Action Log: All actions within the action log were noted and updated or marked as completed.

5. Matters Arising: There were no matters arising

6. WY&H ICS developments and CQC MT told the meeting that Helen Hirst was involved in the design group for the New ICS and there are 4 pieces of work as part of the programme. MT is helping ICS lead with what a QA model should look like over the ICS. Other areas are accountability framework, shared commissioning to quality, proposed oversight and NHSE/I MT Attended a workshop about what to do about ICS/Place. There is a challenge locally as to how we discharge our duties this year JT informed the meeting that the Clinical Forum are involved in a piece of work on what good clinical leadership will look like going forward.

191 In terms of leadership the CCG have a number of people involved in ICS It is hoped that a shadow board will be formed by October at Place dependent on legislation JH stated that the CQC proposed strategy consultation ‘safety through learning’ people and communities closes today. If we are going to achieve progress at Place it would be quicker if providers are confident that relationships with the CQC are mature

7. Vulnerable Children MT presented an update on vulnerable children’s work.

Children Looked After The CCG agreed 10k a month of non-recurrent funding + band 4 nurse (recurrent) to support initial health assessments in 2020 and a new Clinical model is to be implemented 1st April 2021 to provide initial health assessments and review health assessments. A revised trajectory shows a current back log (209 for HA, 1180 RHA) will be cleared by April 2022. An interim arrangement has commenced with Kate Ward as Des Dr for CLA to provide strategic leadership and help develop a sustainable system model for Des Doctor +Named Drs for April – to be signed off by SQC and SFC March 2021.

CYP Mental Health The CAMHS strategy was refreshed in 2018 and a system review was completed in 2020. There were some concerns re accurate data set. Key metrics were agreed and the first set of data has been received and is to be reviewed by the system programme 2nd March 2021. There has been a reduction in waits of Children (inc Looked after children ) on Acute Pathway for initial assessments (28 days), with the initial assessment to the first appointment being 4 weeks and 18 weeks to the second appointment.

Children’s Autism CCG has given funding to address the waiting list and to enable local providers to provide additional clinics and explore alternative models with external providers.

Review of Complex Children Panel ( CCG and BMDC) A joint review of current arrangements was completed in January 2021 and presented to CCG/BMDC SMT on 17/2/21, 69 children were seen with no disputes. The CCG are to review the impact of moving to full Doncaster Model to improve the flow of complex children requiring residential care. Subject to a decision on 17th March the team will develop a project plan to move to new arrangements for quarter 1 2021/22 in Thresholds, TOR and definition of therapies.

Health visiting and school nursing review (0-19) A timeframe of 0-19 health visiting and school nursing review is to be agreed by the Director of Public Health. There has been a reduction in the School Nursing service and a 40% increase in demand for safeguarding work – BDCT are using £300k non recurrent monies to recruit additional nurses to develop a team of practitioners who can focus on strategy meetings and social worker enquiries. A Review of the school nursing service has commenced - mapping services across schools, activity, interviews to explore alternative models (+ external best practice), and improve outcomes

Governance A review of the CQC CLAS 2018 Action Plan is to be presented at SQC March 2021, The CCG Designated Clinical Officer reviewed SEND inspections reports to ensure there were no gaps arising for Health.

8. Children & Young Peoples Mental Health Sasha Bhatt updated the meeting on Children & Young Peoples Mental health following an Ofsted report and a short discussion took place. The report highlighted areas relating to children and young people’s mental health including: • Referrals and access • Waiting times and volume

192 • Therapeutic support • Parental support • Co-production

The improvement action plan was aligned to our Future in Mind/Review work and highlighted the key actions to be focussed on for improvement

• Whole system review completed • Waiting time RT1A: 256 days to 38 days • Waiting list initiative: 160 children offered 164 hours of telephone support, 222 hours of counselling support, 29 video assessments • Co designed a single pathway and access (RIC) • Increased representational recruitment (RIC) • Support for Parent and care givers: support, training and peer led • Increased and broadened our counselling offer (8 new) • Tailored campaign and information for Healthy Minds in schools • All our services are digital by default with their support • Recruited six apprentices in partnership • Established two Mental Health Support Team (2020) and a further two fully recruited to (2021). “Trailblazer of trailblazers”. • Partnership with Wolfson (BHIR), CAER, Schools, Opportunity Area • First site in the country to be part of the NHIR evidence study

JY stated that this model was better than the previous system and is very patient/user focussed.

9. Quality Assurance Model KV updated the meeting regarding the System Level QA model that GP is leading on. There is now an agreement in place with all three providers around using the QA model. This involves meeting monthly and looking at how we can be further blended into their existing mechanisms to flatten the governance structure. This is an emerging/transitional model at Place. This will also evolve based on the revised CQC guidance and the changed ways of working to do with our regulatory bodies. MT is involved in discussion around what a QA model will look like at an ICS level.

JY felt this was something interesting thing for QC to look at felt it would be good to have input into shaping it. JY to join group with KV and GP.

10. Quality Update JHW updated on LeDeR. Phase one was completed on 31st December 2020 and are now in phase 2. This involves referrals from 1st July 2020.

The current numbers for West Yorkshire for Phase 2 are: 94 cases have been reported 16 cases have been submitted/closed 78 are in progress - including those agreed exemptions for statutory processes, and those being reviewed by NECS

Bradford & Craven CCG position as at 19th February 2021; Total number of reviews reported in phase 2 is 31 6 have been completed and submitted since 1st January 2021 (7 more are in QA) 25 still in progress including those being reviewed by NECS, and those with agreed exemptions for statutory processes

Maternity Services Response to the Ockenden Report - Both of our providers have responded to the Ockenden report which was submitted to NHSE/I before 15th February deadline. Both providers are part of the ICS safer maternity systems group

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NHS Patient Safety Strategy This has been updated, however whilst the scope of the strategy has not changed what has changed is the learning from Covid, specifically around enhancing the National Patient Safety Strategy to look at health inequality and the diversity of communities.

Care at home BG updated on the Care at Home workstream. All homes have been offered the Covid vaccination for the residents.

ANHSFT have offered the use of dietetic resource to work alongside the Super Rota and provide targeted support, training and interventions for residents living in Care Homes

Designated accommodation a further 10 nursing beds have been commissioned from Troutbeck Ilkley

ReSPECT – Implementation is ongoing and working through challenges by engagement, sharing best practice and great examples of COVID specific ReSPECT forms. Super Rota support to GP practices to ensure that ReSPECT forms are COVID specific.

Outbreaks Bradford has seen a decrease in care home outbreaks and there are currently 24 care homes within the 0-28 day cycle Craven has seen a slight increase in care home outbreaks with 7 homes and 1 ECH currently having an outbreak within the 0-28 day cycle. 3 further homes have single cases within days 2- 15. There are issues around variable standards across the Care Home sector in responding to and managing COVID outbreaks. Targeted interventions and support is offered and co- ordinated through the Care@Home system and multi-agency Out of Hospital MDT. NYCC are collaborating with Bradford to share best practice around virtual Quality assurance and IPC standards – Plan to test out with Bradford LDA providers and homes that require support

Host commissioner responsibilities for people with LDA in inpatient settings Guidance has now been published and there is an expectation that CCGs will implement Host arrangements by 31st March 2021. Currently there are 141 out of area placements to 5 hospitals (LDA and MH) from 34 CCGs. Discussions are taking place with Partners both at Place and ICS to develop a HOST Commissioner model at ICS either through mutual aid agreement or ICS team.

Safeguarding Adults Cygnet Woodside remains under an Organisational Safeguarding Enquiry and has made the decision to deregister as a hospital. Service users are being found alterative placements by the 20th April 2021, the CCG have 3 clients that are involved. Discussion continues in the Local Authority about creating a link safeguarding role to support Cygnet establishments locally. Recruitment of Deputy Designated Nurse: Safeguarding Adults commenced

Safeguarding children SQC have formed a Task & Finish group to focus on – Designated Dr CiC, SNCP pathway, CLAS Action plan. Recruitment to Deputy Designated Nurse Safeguarding Children

R&D LAMP continues with report 14 due in early March, this continues to form part of the AMR response across the region and is integral to the AMR strategy Funding has been received from the CRN to take forward the collaborations developed working in the 3 vaccine trial hubs across West Yorkshire, this partnership working in the 3 hubs will be solidified over the coming months The Novavax vaccine trial; So successful as a region recruiting participants that the study team requested to double the initial recruitment target, The team completed this within the timeframe, the study is now in follow up.

194 The Astrazeneca monoclonal antibody trial; in one of the hubs achieved the first global recruit to the study, the study being open in 7 countries currently, successfully hit the recruitment target and have now moved into follow up Currently planning to restart a number of projects that were all paused at the start of the pandemic. One study successfully restarted is the Genes and Health study

Primary Care The Red home visiting service capacity is being reduced in Bradford as the service is not being utilised. The car will remain for Modality as they have high utilisation, WACA declined the use of a car. There are still some issues relating to the uptake of vaccine from specific communities and targeted work is ongoing with those communities to understand their concerns around the vaccine and myth busting. This includes working with the VCS and local authority

Modality vaccinated in Central Mosque in Keighley on Thursday 11th February which was a great success. PCN 4 and PCN 6 will be vaccinating from Central Mosque in Bradford on Thursday 18th and Thursday 25th February. Learning from these sessions will inform whether we utilise more community venues for pop up vaccination clinics.

Meds Opt COVID-19 Vaccinations: PCN sites continue to run well. Vaccine deliveries still on a ‘push’ system so centres have little control over delivery dates and volumes. The Jacob’s Well site now open and being supported by some members of the Meds Opt team. A new site at Bradford college is due to open soon. Rimmington Pharmacy (city centre) now also open.

Support to CHC Team 4 members of the team supporting are CHC part time until end of March and it has been agreed that the team will continue redeployment to PCN vaccination sites at least until spring/summer

Personalised Commissioning CHC backlog activity is 7 cases behind the trajectory. 83 cases remain on the backlog list and it is expected NHSE will request an action plan for remedy when the Sitrep is posted. In order to complete the caseload by the 31st March 2021, 14 cases per week need to be completed going forward and it is possible this will not be achieved. The CHC new caseload has a backlog of 19 cases as of 16.02.21. Delays have been caused due to a lack of clinical staff given the C-19 backlog remains the teams priority. Individuals in this waiting list are not self-funding and are in receipt of a care package. The new case backlog and appeals backlog have been added to the Risk Register

11. Workforce JHW gave an update on incidents happening across the main providers over the last year compared to the year before. It is felt that there is a general increase in incidents of MH patients in acute settings and managing of them and also alleged abuse incidents and disruptive aggressive incidents. The team went back through the SI database to obtain the data. This has shown that there has been an increase in alleged abuse incidents/ Suicide Self harm and attempted homicide at BDCFT

BTHFT have seen an increase in disruptive/aggressive incidents

The SI’s are the tip of iceberg and there is an increase in violence and aggression from all providers and anecdotally from primary care. NHSE have launched 40 MH hubs for staff

FJ to link with Damien Kay and Dawn Clissett re the Commissioning People plan and bring to future meeting (May) Action: FJ/KV to liaise outside of meeting

195 12. Serious Incidents JHW reported there have been 10 new SIs reported for February. ANHSFT 1 new with 6 beyond deadline these are mostly due to sign off delays/covid response

BDCFT 3 new - 2 community suicides and 1 Community treatment order with 7 beyond deadline some of these are stop the clock due to police involvement

BTHFT 5 new with 4 beyond deadline

YAS 0 new SIs and 1 beyond deadline

Independents 1 new SI with 1 beyond deadline relating to Sheffield Children’s hospital

13. Risk Register This is the last cycle where the COVID risk log will be reviewed on a monthly basis. Following discussion at SLT, reporting of the COVID risk log will be moving to bi-monthly review to align with the reporting of the Corporate risk register from February 2021.

As at 25 February 2021, there are a total of 15 open risks on the COVID risk log. Of these

Nine risks align for assurance purposes with the quality committee. This includes two risks which align with both this committee and the finance and performance committee: • Risk 1713: risk relating to Covid vaccinations (risk score 15) • Risk 1727: risk relating to delays in CHC reviews (risk score 9)

One new risk was added this cycle, no risks have decreased in score, nor have any risks been marked for closure this cycle. One risk has increased in score this cycle. There are four risks at the ‘critical’ level (scoring 20 or 25) on the COVID risk log. All of these are aligned to the quality committee. There are three risks at the ‘serious’ level (scoring 15 or 160 on the COVID risk log. One of these aligns to the quality committee and one aligns with both FPC and QC.

14. Items for Escalation to Governing Body/System Quality Committee Autism Vulnerable children progress Workforce debate Introducing more deep dives to QC meeting

15. DNA CPR BG reported that we has been asked by HOSC in Feb to give clarity on EOL practices and what systems and processes are in place across Bradford district & Craven, They also wanted to understand the rationale for DNACPR and what the impact and implications of this are. This request came from a councillor who had constituents who were concerned when DNACPR was talked about and didn’t know whether they could ask for a DNACPR or not. Work has been done into clarification on EOL care in Bradford.

DT stated that there has been a shift towards ‘respect’ which is more a focus on expressing individuals wishes and allows all wishes to be taken into account.

JT told the meeting that we are looking to appoint an EOL lead with the aim to broaden out access to all programmes

16. Any Other Business There was no further business

Date and Time of Next Meeting:

Thursday 1st April 2021 at 1.30pm via Zoom

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