NHS Coventry and Warwickshire CCG Governing Body Meeting to be held in Public on Wednesday, 21 July 2021 9.30am – 12.15pm Via Microsoft Teams A G E N D A
Time Item Presenter Enclosure Pack 2 Purpose No (Pack 1) Information 1. Standing Items 1.1 9.30 Welcome and Apologies Received Chair Verbal 1.2 Confirmation of Quoracy Chair Enclosure A Declarations of Interest: Where possible, any conflict of interest 1.3 should be declared to the Chair of the Chair Enclosure B meeting in advance of the meeting. See guide overleaf. Minutes of the meeting held on 19 Chair Approve 1.4 Enclosure C May 2021 1.5 Matters Arising/Action Schedule Chair Enclosure D Review 1.6 9.35 Chair’s Report Chair Enclosure E Information 1.7 9.40 Accountable Officer’s Report Mr Phil Johns Enclosure F Inf ormation 2. Assurance and Governance Report from Audit Committee: 9 June 2.1 9.45 Mr Richard Percival Enclosure G Assurance 2021 NHS Long Term Plan Prevention and Ms Liz Gaulton / 2.2 9.50 Enclo s ure H Assurance Inequalities Update Dr Shade Agboola 2.3 10.00 System Development Plan Ms Rachael Danter Enclo s ure I Information CCG Annual Assessment 2020/21 2.4 10.10 Mrs Anita Wilson Enclosure J Assurance Performance 3. Strategy and Planning Year 1 3.1 10.20 Community Diagnostic Hub Mr Adrian Stokes Enclosure K Approval Business Case 4. Quality 4.1 10.30 Reports from Clinical Quality and
Governance Committee: Enclo s ure L a) 27 May 2021 Mr Zubair Khan Assurance Enclo s ure M b) 24 June 2021 Ms Rebecca 4.2 10.35 Nursing and Quality Report Bartholomew / Enclosure N Assurance Mr Jamie Soden CCG Response to Provider Quality Ms Rebecca 4.3 10.45 Enclo s ure O Information Accounts for 2020- 2021 Bartholomew Learning Disability Mortality Review Ms Rebecca 4.4 10.55 Enclosure P Information Annual Report 2020/21 Bartholomew Time Item Presenter Enclosure Pack 2 Purpose No (Pack 1) Information 4.5 11.05 Learning Disabilities and Autism Transforming Care Programme Mr Jamie Soden Enclosure Q Assurance Partnership Plan 5. Finance and Performance 5.1 11.15 Reports from Finance and Perf ormance Committee: Enclosure R Mr Zubair Khan Assurance a) 2 June 2021 Enclosure S b) 7 July 2021 5.2 11.20 Perf ormance Report Mrs Ali Cartwright Enclo s ure T Assurance 5.3 11.30 2021/22 CCG Month 2 Finance Mr Adrian Stokes Enclosure U Decision Report 6. Primary Care 6.1 11.40 Report from Primary Care Assurance Commissioning Co mmittee: 27 May Mr Ghulam Vohra Enclosure V Corresponding
2021 Minutes 7. For Information Communications and Engagement Mrs Anita Wilson 7.1 11.45 Enclo s ure W Assurance Assurance Report 8. 11.55 Questions from Visitors Chair Verbal 9. 12.05 Any Other Business Chair Verbal
Future Governing Body Meetings held in Public: Date Time Venue 15 Sept 21 9.30am – 12.15pm Via Microsoft Teams
17 Nov 21 9.30am – 12.15pm Via Micro soft Teams
19 Jan 21 9.30am – 12.15pm Via Microsoft Teams
16 Mar 21 9.30am – 12.15pm Via Microsoft Teams
Declarations of Interest Under the Health and Social Care Act 2012, there is a legal obligation to manage conflicts of interest appropriately. Where possible, any conflict of interest should be declared to the Chair of the meeting as soon as it is identified in advance of the meeting. Where this is not possible, it is ess ential that at the beginning of the meeting a declaration is made if anyone has any conflict of interest to declare in relation to the business to be transacted at the meeting. An interest relevant to the business of the meeting should be declared whether or not the interest has previously been declared.
Type of Description Interest Financial This is where an individual may get direct financial benefits from the consequences of a Interests commissioning decision. This could include being:
• A director, including a non-executive director, or senior employee in a private company or public limited company or other org anisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations; • A shareholder (of more than 5% of the issued shares), partner or owner of a private or not for profit company, business or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations. • A consultant for a provider; • In secondary employment; • In receipt of a grant from a provider; • 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). Non-Financial This is where an individual may obtain a non-financial professional benefit from the consequences Professional of a commissioning decision, such as increasing their professional reputation or status or Interests promoting their professional career. This may include situations where the individual is:
• An advocate for a particular group of patients; • A GP with special interests e.g., in dermatology, acupuncture etc. • A member of a particular spec ialist professional body (although routine GP membership of the RCGP, BMA or a medical defence organisation would not usually by itself amount to an interest which needed to be declared); • An advisor for CQC or NICE; • A medical researcher. Non-Financial This is where an individual may benefit personally in ways which are not directly linked to their Personal professional career and do not give rise to a direct financial benefit. This could include, for Interests 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 in or connection with a voluntary sector organisation; • A member of a political party; • Suffering from a particular condition requiring individually funded treatment; • A financial advisor. Indirect This is where an individual has a close association with an individual who has a financial interest, Interests a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). This should include:
• Spouse / partner; • Close relative e.g., parent, [grandparent], child, [grandchild] or sibling; • Close f riend; • Business partner.
Blank Page Enc A
GOVERNING BODY
Members • The Chair – Dr Sarah Raistrick
• The Accountable Officer – Mr Phil Johns
• The Chief Finance Officer – Mr Adrian Stokes
• A Secondary Care Specialist - Dr Jonathan Timperley
• A Registered Nurse – Ms Elaine Strachan-Hall
• Three Lay Members: - Mr Richard Percival (Finance and Audit) - Mr Zubair Khan - Mr Ghulam Vohra
• Four Practice Members of the Governing Body): - Dr Deepika Yadav (Coventry Place) - Dr Jonathan Menon (Rugby Place) - Dr Sukhi Dhesi (South Warwickshire Place) (Clinical Vice Chair) - Dr Imogen Staveley (Warwickshire North Place)
Quorum The quorum will be six members which must include at least: • One Practice Member • One other healthcare professional • One Lay Member; and • One Executive Member (or their deputy)
Please note: • No person can act in more than one capacity when determining the quorum. • Any member of the Governing Body who has been disqualified from participating in a discussion on any matter and/or from voting on any motion by reason of a declaration of a conflict of interest, shall no longer count towards the quorum. • In instances where the quorum is not available due to declared conflicts of interests, or in an emergency, an alternative quorum of five non-conflicted members shall apply which must include either the Secondary Care Specialist or the Registered Nurse. The Chair is required to ensure a diverse and balanced representation of views is available in the given circumstances. The rationale for and use of this alternative quorum will be recorded in the minutes of the meeting. Enc A Blank Page Enclosure B NHS COVENTRY AND WARWICKSHIRE CCG - Register of Interests for Governing Body Meeting
Current position (s) held- i.e. Declared Interest- (Name of the organisation and Title First Name Surname Governing Body, Member practice, Type of Interest Date of Interest nature of business) Employee or other To Indirect Interests Declared Professional Professional Non-Financial Non-Financial Non-Financial Non-Financial Personal Interests Personal Financial Interests Financial
Members
Practice Member of the Governing 1. GP Partner at Croft Medical Centre, Leamington Dr Sukhdeep Dhesi Mar-08 Ongoing Body (South Warwickshire Place) Spa Practice Member of the Governing 2. Croft Medical Centre is a Member of South Dr Sukhdeep Dhesi Mar-15 Ongoing Body (South Warwickshire Place) Warwickshire GP Federation Practice Member of the Governing Dr Sukhdeep Dhesi 3. CD of Leamington South PCN May-19 31/03/2021 Body (South Warwickshire Place) Practice Member of the Governing Dr Sukhdeep Dhesi 4. Director of Dhesi Medical Ltd Jan-15 Ongoing Body (South Warwickshire Place) Practice Member of the Governing Dr Sukhdeep Dhesi 5. Husband is a Dental Surgeon Jan-15 Ongoing Body (South Warwickshire Place) Practice Member of the Governing Dr Sukhdeep Dhesi 6. CEO of NEC in Birmingham, relative. Jan-07 Ongoing Body (South Warwickshire Place) Practice Member of the Governing 7. Chief Information Officer at McKesson UK, brother Dr Sukhdeep Dhesi Jan-18 Ongoing Body (South Warwickshire Place) in law. 1. Member of Chartered institute of Public finance Mr Phillip Johns Accountable Officer Dec-20 Current Accountants (CIPFA) 2. Member of Healthcare and financial management Mr Phillip Johns Accountable Officer Dec-20 Current association (HFMA) 3. Wife is director of Seren Melyn - providing OT Mr Phillip Johns Accountable Officer Dec-20 Current services 4. Wife is employed as an Occupational Therapist at Mr Phillip Johns Accountable Officer Dec-20 Current SWGHFT Mr Zubair Khan Governing Body Lay Member 1. Lay Member Tribunals Ministry of Justice Mar-21 Current
2. Lay Manager Birmingham and Solihull Mental Mr Zubair Khan Governing Body Lay Member Mar-21 Current Health NHS Foundation Trust (honorary agreement)
Mr Zubair Khan Governing Body Lay Member 3. Lay Chair Gate Medical Centre Mar-21 Current NHS COVENTRY AND WARWICKSHIRE CCG - Register of Interests for Governing Body Meeting
Mr Zubair Khan Governing Body Lay Member 4. Consultants Recruitment AAC Panel Mar-21 Current 1.Director of Rugby Health Ltd (PCN) company (until Practice Member of the Governing Dr Jonathan Menon June 2021) (No longer current as at June 2021, to be Feb-20 Jun-21 Body (Rugby Place) removed in December 2021) Practice Member of the Governing 2. Brookside Surgery is a shareholder in Rugby Health Dr Jonathan Menon Feb-20 Current Body (Rugby Place) limited. Practice Member of the Governing Dr Jonathan Menon 3. GP partner at Brookside Surgery. Oct-20 Current Body (Rugby Place) Practice Member of the Governing 4. Brookside Surgery is a member of the Coventry and Dr Jonathan Menon Jan-16 Current Body (Rugby Place) Rugby GP Alliance Practice Member of the Governing 5. Coventry and Rugby GP Alliance Extended Access Dr Jonathan Menon Jan-16 Current Body (Rugby Place) work Governing Body Lay Member - 1. Independent Audit Committee Chair Queen Mr Richard Percival Apr-21 Current Finance and Audit Alexandra College, Harborne, Birmingham Governing Body Lay Member - 2. Member of Diabetes UK (no executive or decision Mr Richard Percival Apr-21 Current Finance and Audit making responsibilities) Dr Sarah Raistrick CCG Chair 1. GP Partner Willenhall Primary Care Centre 1 Jul-15 Current Dr Sarah Raistrick CCG Chair 2. Practice is a member of the GP Alliance Current
3. Husband is a leader (I am a member) of a church in Dr Sarah Raistrick CCG Chair Current Coventry supporting Hope Coventry initiatives.
Dr Sarah Raistrick CCG Chair 4. Practice is a member of Sowe Valley Cluster Current Dr Sarah Raistrick CCG Chair 5. Non-voting Member of Coventry GP Board Jan-19 Current Dr Sarah Raistrick CCG Chair 6. Member of West Midlands Clinical Senate Dec-19 Current
Practice Member of the Governing Dr Imogen Staveley 1. Salaried GP at Bedworth Medical Centre Sep-17 Current Body (Warwickshire North Place)
Practice Member of the Governing 2. Role as Clinical Lead for transforming primary care Dr Imogen Staveley Jan-17 Current Body (Warwickshire North Place) team, health London Partnership
Mr Adrian Stokes Interim Chief Finance Officer Director of Flexible Health Solutions 2014 Current Ms Elaine Strachan-Hall Governing Body Registered Nurse 1. Director for Strachan-Hall Associates Jan-13 Current
Ms Elaine Strachan-Hall Governing Body Registered Nurse 2. Director of Dane Hill Associates Jan-09 Current
Ms Elaine Strachan-Hall Governing Body Registered Nurse 4. Clinical Associate for KPMG Jan-20 Current Consultant at Northampton General Dr Jonathan Timperley Secondary Care Doctor May-20 Current Hospital Mr Ghulam Vohra Governing Body Lay Member 1. Grandson employed by UHCW Oct-19 Current Mr Ghulam Vohra Governing Body Lay Member 2. Trustee - Umar Education Welfare Trust 2012 Current NHS COVENTRY AND WARWICKSHIRE CCG - Register of Interests for Governing Body Meeting
Mr Ghulam Vohra Governing Body Lay Member 3. Treasurer - Hillfields Muslim Association 2002 Current Mr Ghulam Vohra Governing Body Lay Member 4. Vice Chairman - Coventry Muslim Forum 2010 Current Mr Ghulam Vohra Governing Body Lay Member 5. Co-Chair Coventry Community Forum (IAG) 2016 Current
Mr Ghulam Vohra Governing Body Lay Member 6. Chair of Governors - Lyng Hall Secondary School 2016 Current
Mr Ghulam Vohra Governing Body Lay Member 7. Vice Chair - Eden Girls Secondary School 2014 Current 8. Board Member - Faith Strategic Partnership Group - Mr Ghulam Vohra Governing Body Lay Member 2021 Current WMCA Mr Ghulam Vohra Governing Body Lay Member 9. West Midlands Police Scrutiny Board 2015 Current
Practice Member of the Governing Dr Deepika Yadav 1. GP Partner, Willenhall Primary Care Centre Jun-20 Current Body (Coventry Place)
Practice Member of the Governing 2. Husband is GP, Locum in Coventry and Dr Deepika Yadav Sep-14 Current Body (Coventry Place) Warwickshire
Practice Member of the Governing Dr Deepika Yadav 3. Member of Coventry LMC Apr-16 Current Body (Coventry Place)
Practice Member of the Governing 4. Resident in local area with children who go to Dr Deepika Yadav Mar-04 Current Body (Coventry Place) school locally
5. Director future aesthetics LTD, providing aesthetics Practice Member of the Governing Dr Deepika Yadav treatments (No longer current as at March 2021, to be Apr-19 Mar-21 Body (Coventry Place) removed in September 2021)
Practice Member of the Governing Dr Deepika Yadav 6. RCGP Midlands tutor Sep-20 Current Body (Coventry Place)
7. Clinical Director of Integrated care - University Practice Member of the Governing Dr Deepika Yadav Hospitals Coventry and Warwickshire (UHCW) and the Apr-20 Current Body (Coventry Place) CCG.
Practice Member of the Governing Dr Deepika Yadav 8. Joint role as Clinical Director for Strategic Oct-20 Current Body (Coventry Place) partnerships CWPT Attendees Director of Public Health Dr Shade Agboola Nil May-21 Current (Warwickshire County Council)
Chief Planning and Performance Shareholder of Applied Geology (can undertake Ms Alison Cartwright Jun-13 Ongoing Officer site/ground investigations for NHS organisations)
Ms Jo Galloway Chief Nursing Officer Nil Sep-20 Current Director of Public Health Coventry Ms Liz Gaulton Nil Feb-20 Current (Coventry City Council) NHS COVENTRY AND WARWICKSHIRE CCG - Register of Interests for Governing Body Meeting
Mrs Anna Hargrave Chief Strategy Officer Nil Apr-16 Current Spouse is Managing Director of East Staffordshire Mr Andrew Harkness Executive Lead for Coventry Place 2017 Current CCG
Executive Lead for Warwickshire Jointly appointed - George Eliot Hospital (Director of Ms Jenni Northcote Nov-19 Current North Place Strategy, Service Improvement and Primary Care)
Associate Director of Governance Mother is an employed by NHS Professionals working Mrs Anita Wilson Jul-18 Current and Corporate Affairs within the George Eliot Hospital. Enclosure C
Unconfirmed Minutes of the Governing Body Meeting Held in Public On Wednesday, 19 May at 10.15am held by Microsoft Teams
Dr Sarah Raistrick Chair Mr Phil Johns Accountable Officer Mr Adrian Stokes Interim Chief Finance Officer Dr Jonathan Menon Practice Member of the Governing Body (Rugby Place) Dr Sukhi Dhesi Practice Member of the Governing Body (South Warwickshire Place) Dr Imogen Staveley Practice Member of the Governing Body (Warwickshire North Place) Dr Deepika Yadav Practice Member of the Governing Body (Coventry Place) Mr Richard Percival Lay Member – Audit and Governance Mr Ghulam Vohra Lay Member Mr Zubair Khan Lay Member
Dr Jonathan Timperley Secondary Care Specialist Ms Elaine Strachan-Hall Registered Nurse
In Attendance: Ms Jo Galloway Chief Nurse Mrs Anna Hargrave Chief Strategy Officer Mr Andrew Harkness Chief Transformation Officer Mrs Ali Cartwright Chief Delivery Officer Mrs Anita Wilson Associate Director of Governance and Corporate Affairs Ms Rose Uwins Senior Communications and Engagement Manager Dr Jane Fowles (deputising Consultant in Public Health Medicine for Ms Liz Gaulton) Dr Shade Agboola (until Director of Public Health, Warwickshire County Council 11.15am) Mrs Victoria Scholes Governance and Corporate Affairs Officer (Minutes)
Apologies: Ms Jenni Northcote Chief Strategy and Primary Care Officer Ms Liz Gaulton Director of Public Health, Coventry City Council
Item Action No: 1. Standing Items:
1.1 Welcome and Apologies Dr Raistrick welcomed Governing Body Members and attendees to the Governing Body meeting held in Public.
1.2 Confirmation of Quoracy The meeting was confirmed as quorate.
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Enclosure C
Item Action No: 1.3 Declarations of Interest Members were reminded of the need to declare their interest in any items requiring a decision and to remove themselves from such decision making. No additional declarations of interest were made to those recorded on the Register of Interests.
1.4 Minutes of Previous Meeting held on 28 April 2021
The minutes were approved as a true record of the meeting.
1.5 Matters Arising/Action Schedule
Action Ref: 200: Ms Jo Galloway to present the Autism Spectrum Disorder Strategy to the Governing Body when available. Ms Galloway hoped for the strategy to be available by the July 2021 Governing Body meeting.
Action Ref: 4: Race at Work Charter to be presented to a future Governing Body meeting. Mrs Wilson confirmed that the CCG had completed the application process and an update would be provided in the Equality and Diversity Report to the July 2021 Governing Body meeting.
1.6 Chair’s Report
Dr Raistrick expressed thanks to all staff who had ensured a smooth transition to the new CCG. She also thanked and offered continued support to wider colleagues, including primary care practitioners, clinicians in provider organisations and those working in vaccination centres.
Dr Raistrick highlighted that primary care services were open, as they had been throughout the pandemic, and GPs were seeing patients as appropriate following a clinical triage. She added that the CCG supported GP practices to manage their caseloads as appropriate.
Members NOTED the report.
1.7 Accountable Officer’s Report
Mr Johns reported that there continued to be significant pressure relating to children in crisis being admitted to acute wards in University Hospitals Coventry and Warwickshire and South Warwickshire Foundation Trust. This was being responded to as a major incident by the system. Ms Galloway was leading the work on behalf of the CCG and a further update would be provided to the Governing Body in July.
Mr Johns reported that a tweet had been circulating on social media which appeared to express racist and discriminatory views. He confirmed that the incident did not relate to the CCG and did not reflect the CCG’s values. The CCG was supporting the organisation to which the incident related to and had commissioned an independent investigation, the outcome of which would be reported to the Governing Body. Mr Johns reported that the CCG was also in contact with NHS England and the Nursing and Midwifery Council regarding the incident.
Mr Johns explained that although cases of Covid-19 were reducing, there were some concerns regarding the new variant. Dr Agboola reported that Public Health
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Enclosure C
Item Action No: England had notified Warwickshire County Council that less than 10 cases of the variant had been identified in Nuneaton and Bedworth. Surge testing had therefore been commenced in the area, to which the response from the public had been positive.
Mr Khan asked whether a choice of Covid-19 vaccination could impact vaccination uptake in hard to reach communities. Dr Agboola explained that the vaccination programme would not deviate from the Joint Committee on Vaccination and Immunisation (JCVI) recommendations on vaccinations, however, there was a focus on encouraging people to accept their vaccination when offered. There had been a concurrent increase in vaccine uptake in other areas where surge testing had been implemented
Mrs Cartwright added that the CCG and Local Authority were developing plans f or a ‘surge plan’ approach and there was capacity to provide more vaccinations. She confirmed that patients do not have a choice of vaccines and the programme was following JCVI guidance.
Mr Percival highlighted that the government had announced that the timescales for second Covid-19 vaccinations were being brought forward and asked how this was impacting delivery. Mrs Cartwright confirmed that there were 125k patients to bring forward in Coventry and Warwickshire. Plans were in place, but the additional workforce requirements needed to be considered and vaccine availability was dependant on national supply.
Members NOTED the report.
2. Assurance and Governance
2.1 Assurance Framework
Mrs Wilson presented the Assurance Framework, explaining that the following three risks had been rated as extreme: • GBAF 2 – Elective Care; • GBAF 8 – Transforming Care; and • GBAF 11 – Leadership and Capacity to deliver Population Health Management (PHM).
Mrs Wilson explained that the Assurance Framework was provided for assurance and that the risk owners were present for any questions.
Mr Percival highlighted that GBAF4 – Financial Position and Control Total referred to H1 (the first half of the financial year) but did not reference the uncertainty surrounding H2 (the second half of the financial year). He added that there was also uncertainty surrounding the Elective Recovery Fund’s gateway criteria and asked whether the risk should be rated as extreme.
Mr Stokes explained that the risk around H1 would be further discussed in the Opening Budgets report, but this was relatively low and may be able to be downgraded. With regards to H2, Mr Stokes explained that the risk was unknown as the CCG was awaiting guidance on system top up and Covid funding, which AS could be reflected in the Assurance Framework. He highlighted that the system had an £80m deficit prior to the pandemic so there was a risk, but the scale was unknown.
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Enclosure C
Item Action No: With regards the Elective Recovery Fund risk, Mr Stokes confirmed that this would be reflected in the Corporate Risk Register. The Elective Accelerator AS Programme reduced the Elective Recovery Fund risk but did not fully mitigate it.
In relation to GBAF6 – Workforce Wellbeing and Resilience, Mr Khan asked whether there was a backlog of annual leave to be taken that may impact on restoration of services. Mrs Wilson explained that she had recently received outstanding annual leave figures f or CCG staf f, which were not concerning. Mr Johns highlighted that this was likely to be more of an issue for provider organisations.
Dr Raistrick highlighted that one of the mitigations for GBAF2 – Elective Care was that a single prioritised approach to waiting list management and delivery of procedures was under development. She asked whether this was a system wide approach and when this would be in place. Mrs Cartwright explained that a single patient tracking list was in place and the three provider organisations were working through this together. This meant that speciality pressures were being managed jointly across the system.
Dr Yadav asked whether the single waiting list was for all elective care or some specialities. Mrs Cartwright confirmed a full list was planned for Referral to Treatment pathways.
The Governing Body: • RECEIVED the GBAF, noting the risks, mitigations and assurances in place; and • Were ASSURED that adequate actions were being taken to manage the risks.
2.2 Public Health Reports Coventry Health and Wellbeing Strategy Update
Dr Fowles was in attendance on behalf of Ms Gaulton. The strategy set out three strategic ambitions: • People are healthier and independent for longer; • Children and young people fulfil their potential; and • People live in connected, safe and sustainable communities.
The strategy was developed following a Joint Strategic Needs Assessment (JSNA) and extensive consultation with key stakeholders and communities. As part of the JSNA and consultation process, short term priorities were identified: • Loneliness and social isolation; • Young people’s mental health and wellbeing; and • Working differently with our communities.
Dr Fowles highlighted some key areas of work, including initiatives aimed to reduce social isolation and loneliness, the Grapevine Summit, the Call to Action on Health Inequalities and the Coventry Health Challenge. She thanked Dr Raistrick who had been supporting the Call to Action work.
With regards to the next steps, a review would take place in summer 2021, with a revised strategy being brought to the Health and Wellbeing Board in Autumn.
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Enclosure C
Item Action No: Warwickshire Health and Wellbeing Strategy Update
Dr Agboola explained that strategy covered the time period 2021-2026 and was a high-level plan for improving health and wellbeing and reducing inequalities. It was informed by data and evidence from the JSNA, as well as Warwickshire’s Covid-19 residents survey and Coventry and Warwickshire’s Covid-19 Health Impact Assessment.
The following long-term strategic ambitions were aligned with the Health and Care Partnership’s long-term ambitions: • Healthy people; • Strong communities; and • Effective services.
The Health and Wellbeing Board agreed to take a population health approach and focus on three priorities over the next two-year period: • Help children and young people have the best start in life; • Help people improve their mental health and wellbeing, with a focus on prevention and early intervention; and • Reduce inequalities in health outcomes and the wider determinants of health.
There were three place-based Health and Wellbeing Partnerships in Warwickshire, which would play a role in delivering on the priorities.
An overarching Delivery Plan was being developed by the Health and Wellbeing Executive Group to monitor progress. Direction of travel indicators would be developed and the CCG would receive an annual review progress report.
Mr Vohra asked about strategies for community partnership to address the equality agenda. Dr Agboola explained that the strategy was high level and detail would be captured via delivery plans produced by each place-based Partnership. With regards to the Coventry strategy, Dr Fowles explained that the breadth of work being undertaken with communities could not be captured in a high-level paper, however, the aim was to continue working differently with communities.
Dr Yadav asked about methods used to signpost people to the work that was happening and whether social prescribers were utilised. Dr Fowles confirmed that there were opportunities in terms of social prescribers and they had been front and centre to the work. Helping people to navigate services continued to be a challenge and conversations were ongoing with organisations, communities and individuals.
Mr Khan asked whether the patient and public engagement undertaken had considered protected characteristics. He also asked whether there was an issue with regards to young people accessing services. Dr Agboola confirmed that protected characteristics were incorporated into all engagement exercises. She was not able to answer the question regarding young people, however, she could provide the breakdown of people who responded to engagement if required. Dr Fowles confirmed that she could also share this information if required.
Dr Dhesi asked whether a reasonable amount of time had passed for the priorities to be measured. Dr Agboola confirmed that the direction of travel indicators, outcome measures and associated timeframes would be shared with the CCG. With regards to the Coventry strategy, Dr Fowles explained that a review would be undertaken during the summer.
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Enclosure C
Item Action No:
Governing Body Members NOTED the update on the Coventry Health and Wellbeing Strategy.
Governing Body Members: • ENDORSED the final Health and Wellbeing Strategy 2021-2026 and its three short-term priorities; • ENDORSED the proposed annual review reporting mechanism to the Health and Wellbeing Board; and CCG; and • ENDORSED the development of local place-based implementation plans (through the Health and Wellbeing Partnerships and Health and Care Executives).
3. Strategy and Planning 3.1 Transition to an Integrated Care System Mrs Hargrave presented the report, which provided an update on the key activities being undertaken to deliver the CCG’s Strategy Towards Strategic Commissioning. The main area of activity related to the development of an Integrated Care System and the transition for staff.
Mr Johns explained that the CCG was awaiting national guidance regarding how Integrated Care Systems will be constituted.
The Governing Body NOTED the content of the report.
3.2 Organisational Development Plan
Mrs Wilson presented the report, explaining that a Human Resources and Organisational Development Strategy and Plan was developed to support the merger application of the predecessor CCGs. The report provided assurance on progress to date with the associated action plan.
Mrs Wilson explained that the action plan was in draft format and would be shared with the Clinical, Quality and Governance Committee in due course. The action plan could also be shared with Members who were interested in reviewing the draft version.
Mrs Wilson reported that at the heart of the strategy was the recognition that the skills and competencies of staff were critical to the success of the organisation. The strategy comprised of six workstreams: Building our Structure; Creating our Culture; Developing our Leaders; Managing our People; Developing our commissioning capacity and capability; and Redesigning how we work.
The action plan was developed pre-merger and since April 2021 there had been opportunities for Governing Body members, the Executive Team and wider staff to further enhance thinking and plans. This culminated most recently in a CCG Staff away on the 4 May where staff shared feedback which will form the next iteration of the plan.
Mrs Wilson explained that some actions were carried forward from the predecessor CCGs and some were already complete.
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Enclosure C
Item Action No: Governing Body Members; • NOTED were ASSURED by the progress to date within the Action Plan at Appendix 1; and • CONFIRMED that they would receive for assurance a progress update at the September Meeting.
4. Quality 4.1 Reports from Clinical Quality and Governance Committee: 25 March and 29 April 2021
Mr Khan provided a summary of the Clinical Quality and Governance Committee meetings which took place on the 25 March and 29 April 2021. Committee Members had highlighted the increase in safeguarding activity across Coventry and Warwickshire for the attention of Governing Body.
Members NOTED the report.
4.2 Nursing and Quality Report Ms Galloway presented the report, which provided information and assurance regarding current nursing and quality issues and areas of escalation on the Quality Assurance Framework (QAF). Detailed discussions regularly took place at Clinical Quality and Governance Committee meetings.
Ms Galloway highlighted the following current nursing and quality issues:
• A new Learning Disabilities Mortality Programme (LeDeR) national policy was issued in March 2021. The programme has been renamed ‘Learning from Life and Death Reviews – people with a learning disability and autistic people’ and would now incorporate reviews for people with autism.
Dr Dhesi asked whether workforce capacity was available to undertake the additional reviews of adults with autism. She also asked how the CCG would ensure that any learning would be shared across the system.
Ms Galloway explained that the first part of policy, which related to training and how reviews were undertaken, was implementable from the 1 June 2021 and a plan was in place for this. The CCG was working closely with NHS England (NHSE) on modelling the additional resource to manage the autism part.
With regards to learning, the LeDeR Annual Report for 2020/21 would be presented to the Clinical Quality and Governance Committee in June and the Governing Body in July. Ms Galloway explained that the CCG had been performing poorly with regards to annual health checks but the target had now been over achieved
• The Government had confirmed its aim to implement the Mental Capacity (Amendment) Act (2019) on the 1 April 2022, at which point any new Deprivation of Liberty Safeguards (DoLS) applications must be made under Liberty Protection Safeguards. The CCG had a working group in place to ensure readiness.
• There had been a sustained increase in safeguarding activity across both Coventry and Warwickshire, including a number of Warwickshire young people
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Enclosure C
Item Action No: who had tragically taken their own lives. A 'Safeguarding Alert' had been produced to help raise awareness of the support services available.
Dr Agboola left the meeting at 11.15am.
Mr Percival asked whether there were sufficient resources to deal with the volume of safeguarding activity and any future increase.
Ms Galloway explained the CCG was also looking into putting additional resources into the operational approach, some of which had already been put in place.
Dr Raistrick suggested that Members and the public familiarised themselves with the Kooth website, which was a digital mental health platform.
• The Local Maternity and Neonatal System (LMNS) had received feedback against George Eliot NHS Trust (GEH), South Warwickshire NHS Foundation Trust (SWFT) and University Hospitals Coventry and Warwickshire NHS Trust’s (UHCW) Assurance Assessment Tools from NHS England/Improvement (NHSE/I) and this had informed the production of a detailed action plan from each Trust. The LMNS meeting in May focused on a quality deep dive, a review of Serious Incidents and the quality dashboard. The terms of reference were also reviewed, which included greater independent scrutiny into the LMNS.
Mr Johns asked whether there was a timeline for when the Ockenden recommendations would be met. Ms Galloway confirmed that a plan was in place. Some of the recommendations were regional and national and the Trusts also had areas that they were working on. Some recommendations were reliant on workforce and a bid for additional workforce had been submitted. Ms Galloway confirmed that she could provide further information JG on when each of the recommendations would be met.
• The System Quality Surveillance Group continued to meet on a bi-monthly basis and the terms of reference were being reviewed to support transition from quality surveillance to a wider remit which included quality improvement. A Quality Strategy was also in place.
Ms Galloway highlighted the following areas of escalation on the QAF:
• Coventry and Warwickshire Partnership NHS Trust (CWPT): One additional concern had been added to level two in relation to serious incident management and closure. A plan was in place to address this.
• George Eliot Hospital NHS Trust (GEH): The Safeguarding (medical) concern had been de-escalated following the recent appointment of a Named Doctor for Safeguarding Children. Mortality had been de-escalated due to SHMI (Summary Hospital-level Mortality Indicator) being sustained within the expected range and assurance provided by the Trust regarding the actions in place. Care Quality Commission (CQC) inspection had been de-escalated following assurance provided regarding progress with the action plan.
• South Warwickshire Foundation NHS Trust (SWFT): Work had commenced with SWFT to discuss the future use of the QAF and review current quality data for incorporation. There were no escalated concerns for SWFT.
DRAFT Governing Body Public Meeting_Unconfirmed Minutes – 19 May 2021 8
Enclosure C
Item Action No:
• University Hospitals Coventry and Warwickshire NHS Trust (UHCW): The level three concern regarding Children and Young People in Crisis was a system-wide concern. This related to delays being experienced by patients waiting for Tier 4 beds and was impacting UHCW and CWPT. A Quality Risk Summit took place in January 2021 and an action plan was in place. There had been a reduction in numbers of patients waiting over the previous week, however, close oversight of the position continued.
• Primary Care: All practices registered with the CQC continued to be rated as overall ‘good’ or ‘outstanding’.
• CCG Internally Provided Services: The Clinical Assessment and Placement team (CAPT) had one concern at level three. This related to workforce and was due to the demands of sustained 7-day working and the backlogs created by the pandemic. The CCG was developing a workforce plan to ensure staf fing was in place.
The Governing Body RECEIVED the report.
5. Finance and Performance 5.1 Report from Finance and Performance Committee: 5 May 2021
Mr Khan provided a summary of the Finance and Performance Committee meeting which took place on the 5 May 2021. Committee Members had highlighted the following for the attention of Governing Body:
• The Corporate Risk Register; • Work commencing on H2 (second half of financial year) budget; • Transforming Care and Annual Health Checks; and • Year-end positions for the predecessor CCGs and potential deterioration of the SWCCG position.
Members NOTED the report.
5.2 Performance Report
Mrs Cartwright presented the report, which included the February 2021 position regarding performance against national targets and priority indicators.
7 out of the 19 constitutional and acute priority indicators were achieved, the areas of concern remained:
• The Referral to Treatment (RTT) 52 week breach target was not achieved, with 6620 patients waiting over 52 weeks. This was an improved position and was reflective of the increased elective activity taking place. The Elective Accelerator Programme would also be put in place to improve the waiting list position before the end of July.
• The Cancer 2 week wait Breast target had not been achieved but the position had improved significantly since the previous month. Most patients were seen within 3 weeks and the CCG was working with GEH to improve the position.
• The Cancer 62 day standard target was not achieved. All Trusts had prioritised patients waiting over 104 days, which had improved. Issues remained in DRAFT Governing Body Public Meeting_Unconfirmed Minutes – 19 May 2021 9
Enclosure C
Item Action No: relation to diagnostic performance and the CCG was working with the Trusts regarding this.
• The Learning Disability Annual Health Checks target had been achieved.
• The target for Annual Health Checks for patients with Severe Mental Illness had not been achieved and a recovery plan was in place.
Ms Strachan-Hall asked about Ambulance Handover performance. Mrs Cartwright confirmed that the performance had improved.
Dr Staveley directed Members to page 12 of the report, highlighting that this stated that even with Covid subsiding the impact on elective waiting times has worsened as fewer referrals had been received from primary care during that time. She asked what the implications would be when there was an increase in patients visiting their GP.
Mrs Cartwright explained that RTT performance worsened if referrals decreased and patients waiting a long time remained constant or increased. The pause on non-urgent elective care activity set during the first Covid wave had also impacted on waiting times. Part of the Elective Accelerator Programme related to increasing overall capacity and building in a planned increase for GP referrals. Mrs Cartwright explained that GP referrals had already increased in most categories except for non-urgent.
Dr Staveley asked whether the CCG had confidence that new services such as musculoskeletal (MSK) would mitigate the position rather than worsen it. Mrs Cartwright explained that any previously unmet demand would be monitored carefully when new services were implemented.
Mr Percival asked whether a direction of travel could be indicated for performance against the RTT 52 week breach target, cancelled operations and cancer waits. Mrs Cartwright explained that weekly data was received from each Trust and performance was improving as activity was being restored.
Dr Raistrick noted that progress was being made but thought that the Governing Body should also note that over 6000 patients waiting over 52 weeks was not an acceptable position.
Governing Body NOTED the contents of the report.
5.3 Finance and Contract Reports Month 12: Warwickshire North / Coventry & Rugby CCG and South Warwickshire CCG
Mr Stokes presented the reports which provided the pre-audit financial positions for the predecessor CCGs. SWCCG reported an in-year deficit of £6.2m. CRCCG and WNCCG both reported a small surplus. The positions were better than the forecasts predicted halfway through the year.
Mr Stokes reported that Continuing Healthcare (CHC) and Section 117 continued to be volatile for WNCCG and CRCCG. This was an ongoing issue and more work needed to be undertaken to prevent this. Mr Stokes also highlighted that an issue in resolving overseas visitor payments with UHCW had seen CRCCG's Acute position deteriorate by close to £0.9m.
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Enclosure C
Item Action No: With regards to SWCCG, Mr Stokes explained that some items were under- accrued at the end of the year and may be highlighted in the review by the external auditors. Mr Stokes explained that the greatest impact of the SWCCG deficit was the impact on the H1 position.
Mr Stokes confirmed that the Finance and Performance Committee had agreed deep dives into specific areas, including an external review that was being undertaken into Continuing Healthcare and packages of care.
Mr Stokes summarised that the financial positions were largely as expected and good in the context of the Covid-19 pandemic. The CCG’s main focus in H1 and H2 was the overall cost base of the system.
Mr Percival emphasised the importance of the Governing Body recognising liability or cost in terms of proper accounting practice rather than targets that had been externally set. Mr Stokes confirmed that this was discussed at the Finance and Performance Committee and principles had been agreed going forward.
Members NOTED: • The pre audit position for Warwickshire North CCG and Coventry & Rugby CCG for month 12; and • The reported in-year deficit of £6.2m for 2020/21 for South Warwickshire CCG (subject to Audit confirmation).
5.4 Opening Budgets 2021/22 Mr Stokes presented the opening budgets, explaining that the block payments to providers gave some certainty around H1. The same amount of Covid funding that had been received in the latter part of the last financial year had been received for H1. Mr Stokes explained that the funding was generous as there were significantly reduced number of Covid patients in hospital compared to the previous year, however, a further wave of Covid could increase the costs again.
Mr Stokes confirmed that the Finance and Performance Committee had considered the opening budgets, including the detailed line review and the assessment of risks going forward. The Committee felt that the CCG had been underfunded by £3.3m and the budget therefore contained a deficit of this amount. Conversations were ongoing with NHSE in order to rectify this and the Finance and Performance Committee signed off the budget subject to agreement from NHSE.
Mr Stokes directed Members to the risks to H1 outlined on page 6 of the report. He explained that the Elective Recovery Fund presented a risk as providers needed to achieve certain gateway criteria.
With regards to H2, Mr Stokes explained that further guidance on the allocation was expected later in the year. The system’s cost base had grown during the Covid-19 pandemic and the system also had a £80m deficit prior to the pandemic which needed to be resolved.
Ms Strachan-Hall asked whether the under-accrual at the end of the previous year was likely to happen again. Mr Stokes thought this was low risk based on the allocation.
Dr Staveley highlighted that the report stated that funding for the Hospital Discharge Programme would be reduced and asked whether the CCG had DRAFT Governing Body Public Meeting_Unconfirmed Minutes – 19 May 2021 11
Enclosure C
Item Action No: confidence that the funding would be met. Mr Stokes confirmed that additional funding had been added to the package of care budget. The Hospital Discharge Programme funding would still be received in H1 at a slightly reduced rate.
Dr Staveley highlighted that the report stated that the Primary Care Prescribing budgets produced a cost pressure of £2.9m for the CCG and asked whether the Finance and Performance Committee thought that this could be achieved. Mr Stokes explained that work would continue as part of a recurring deep dive and growth would mitigate some risk. The CCG’s Head of Medicines Optimisations had also attended the Committee to provide assurance.
Mr Johns explained the importance of the system cost base and working in partnerships with provider colleagues. The CCG remained statutorily responsible for the CCG’s financial position but the Integrated Care System’s financial position would also need to be presented.
Dr Raistrick asked Mr Stokes whether there were any other issues that would cause significant concern for Members. Mr Stokes confirmed that the £3.3m unresolved deficit and the Elective Recovery Fund risk were the two main concerns.
Dr Raistrick asked Mr Stokes whether he thought the £3.3m was likely to be resolved. Mr Stokes confirmed his opinion that NHSE were likely to ask the system to manage this.
The Governing Body: • DISCUSSED the opening budgets as set out; • NOTED the risks inherent in the opening budgets as presented; and • APPROVED the CCG’s opening 2021/22 budgets.
6.1 For Approval 6.1 Procurement Policy
Mrs Cartwright presented the Procurement Policy, which outlined key principles and considerations that would inform decision making on requirement for procurements to ensure that that the CCG meets the current procurement legislative framework and NHS procurement guidance for procurements of services.
The Finance and Performance Committee reviewed the policy on 5 May 2021 and recommend its approval to the Governing Body.
Dr Staveley directed Members to section 14.4 of the policy which detailed the Social Value Act 2012 and asked whether Finance and Performance Committee Members felt that it was sufficient. Mrs Cartwright confirmed that this was not raised by the Committee. She offered assurance that the policy had been developed by the Commissioning Support Unit and was based on those adopted by other CCGs, as well as the relevant legislation and guidance. The policy would also be updated to reflect any change in legislation or guidance related to EU Exit.
Ms Strachan-Hall was pleased to note that the policy referenced early public and patient engagement.
The Governing Body APPROVED the Procurement Policy.
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Enclosure C
Item Action No: 7. For Information 7.1 Communications and Engagement Report
Mrs Wilson presented the report which provided an overview of communications and engagement activity undertaken during April and May 2021. She highlighted that fortnightly Covid vaccination briefings were ongoing. A vaccination briefing session was also held for members of staff who worked f or Coventry Refugee and Asylum Seekers. A video was in progress regarding the vaccination for African Caribbean communities.
Dr Raistrick expressed her thanks to the team for their engagement across many different communities.
Mr Vohra stated that he had been a recipient of the engagement work and he felt that it was very valuable and effective.
The Governing Body NOTED the report, which was provided for assurance and information.
8. Questions from Visitors
None received.
9. Any Other Business
None declared.
The meeting was closed at 12.09.
10. Date of the Next Meeting Held in Public:
Date: 21 July 2021 Time: 9.30am
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Enclosure C
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ENC D: ACTION SCHEDULE - GOVERNING BODY - TO BE HELD IN PUBLIC
ACTION MEETING AGENDA ACTION RESPONSIBLE COMPLETION CURRENT UPDATE REF DATE ITEM OFFICER DATE STATUS 200 22/01/2020 9.5 Jo Galloway Nov-21 Not yet due Autism Spectrum Disorder Strategy: Jo Galloway to take Autism Spectrum Disorder Strategy to GB when available. 4 28/04/2021 1.4 Anita Wilson Sep-21 In progress The Race at Work Charter application was postponed so that we could apply as NHS Race at Work Charter: Race at Work Charter to be presented to a future Coventry and Warwickshire CCG. The CCG has now completed the application process Governing Body meeting. and an update will be provided in the Equality and Diversity Report to the 15 September 2021 Governing Body meeting.
5 19/05/2021 2.1 Adrian Stokes 07/06/2021 Complete Financial risks on the Corporate Risk Register and Assurance Framework: • Mr Stokes to incorporate the H2 (the second half of the financial year) risk onto the Assurance Framework. • Mr Stokes to incorporate the Elective Recovery Fund risk onto the Corporate Risk Register. 6 19/05/2021 4.2 Jo Galloway Jul-21 Complete Information to be circulated to Governing Body Members week commencing 19 July 2021. Timeline for Ockenden recommendations: Ms Galloway to provide information on when each of the Ockenden recommendations would be met. Blank Page NHS Coventry and Warwickshire Clinical Commissioning Group Enc E
Report To: Governing Body
Report Title: Chair’s Report
Report From: Dr Sarah Raistrick, Chair
Author: Dr Sarah Raistrick, Chair
Date: 21 July 2021
Previously Considered by: N/A
Action Required (delete as appropriate)
Decision: Assurance: Information: Confidential
Purpose of the Report: To advise the Governing Body of activity since the previous meeting.
Key Points: • Governing Body Meetings • COVID-19 Vaccination Programme • Coventry and Warwickshire Shadow Integrated Care System • Equality and Diversity • Elective Accelerator Fund • Thank you to Dr Jon Timperley
Recommendation: Members are requested to NOTE the report.
Implications
Objective(s) / Plans 1. Creating Value supported by this 2. Building capacity report: 3. Developing at Place Conflicts of Interest: N/A Non-Recurrent Expenditure: N/A Recurrent Expenditure: N/A Financial: Is this expenditure included within the CCG’s Financial Yes No N/A Plan? (Delete as appropriate) Performance: N/A Quality and Safety: N/A General Statement: The CCG is committed to fulfil its obligations under the Equality and Diversity: Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any
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decision that is finalised without being influenced by appropriate due regard could be deemed unlawful. Has an equality impact assessment been Yes No N/A undertaken? (Delete as (attached) appropriate) Patient and Public N/A Engagement: Clinical Engagement: N/A Risk and Assurance: N/A
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Governing Body Meetings
1.1. As a Governing Body we are continuing to meet remotely using the technology that has served us well over the COVID-19 pandemic. As cases continue to rise and having shown our ability to conduct rigorous and proper meetings via Microsoft Teams with members of the public in attendance, we will keep to our schedule of Coventry and Warwickshire Governing Body meetings and remain on a virtual platform, taking a careful review before our planned meeting in September.
COVID-19 Vaccination Programme
1.2 Our teams, General Practitioner members and partners in the system are continuing with the COVID-19 vaccination programme and, as I write, are discussing the next steps in “booster” delivery, as well as endeavouring to reach our whole adult population for first and (after 8 weeks) second doses. “Pop-up” vaccination clinics in areas of most need or with lower uptake have been hugely successful, with the Coventry Transport Museum hosting a drop-in clinic and vaccinating over 600 people, who were also able to benefit from the City of Culture events going on nearby; physical and mental wellbeing being served in one setting! Our public health teams across Coventry and Warwickshire are teaming with us to enable targeted delivery, as well as the mainly Primary Care led vaccine effort in Local Vaccination Sites and the Mass Vaccination centre and hospitals. Please see the Communication and Engagement report (Enclosure W), which details the work that I and other Governing Body members have been privileged to support as we meet, explain, listen to and update our communities.
Coventry and Warwickshire Shadow Integrated Care System
1.3 Our Accountable Officer, Phil Johns, has taken on the role of system lead for the Coventry and Warwickshire Integrated Care System (ICS) and I would like to extend our thanks to his predecessor Professor Andy Hardy, Chief Executive Officer of University Hospitals Coventry and Warwickshire NHS Trust, for steering us thus far.
Equality and Diversity
1.4 The Governing Body had a positive development session last month, which included Equality and Diversity training. Equality, diversity and inclusion are core to our beliefs and working at the CCG and we have Mr Zubair Khan as the Governing Body Equality, Diversity and Inclusion Lead. Please do watch the video produced by the CCG as our contribution to Warwickshire Pride.
Elective Accelerator Fund
1.5 The Elective Accelerator Fund and the intense work to implement and embed change to reduce our waiting lists and improve our activity has started to reap rewards, with high levels of patients receiving their outpatients, diagnostics, surgery and other interventions. We have a long way to go to redress the legacy of the pandemic while continuing to work in COVID-saf e ways, but are moving at pace and are determined to see sustainable positive changes for our patients. The Performance Report (Enclosure T) highlights areas of improvement as well as those of continued pressure, and we are working with our provider colleagues to prioritise and address our position.
Thank you to Dr Jon Timperley
1.6 I would like to thank Dr Jon Timperley, our secondary care representative on the Governing Body, for his excellent work with us and enthusiasm to take on projects of work and add his rigor around quality, data and clinical areas. This will be his last public Governing Body meeting and we wish him well.
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NHS Coventry and Warwickshire Clinical Commissioning Group Enc F
Report To: Governing Body
Report Title: Accountable Officer Report
Report From: Phil Johns, Accountable Officer
Author: Phil Johns, Accountable Officer
Date: 21 July 2021
Previously Considered by: N/A
Action Required (delete as appropriate)
Decision: Assurance: Information: Confidential
Purpose of the Report: To provide a briefing to the Governing Body on priority issues and key business items.
Key Points: Briefing on current position relating to emerging/ongoing issues • Integrated Care System; • System Pressure; • Special Educational Needs and Disabilities (SEND) Inspection; and • Warwickshire Pride Online Event Submission.
Recommendation: Members are requested to NOTE the report.
Implications
Objective(s) / Plans 1. Creating Value supported by this 2. Building Capability report: 3. Delivering at Place Conflicts of Interest: None Identified Non-Recurrent Expenditure: N/A Recurrent Expenditure: N/A Financial: Is this expenditure included within the CCG’s Financial Yes No N/A Plan? (Delete as appropriate) Performance: N/A Quality and Safety: N/A General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions Equality and Diversity: may need to be adjusted in line with any equality analysis or due regard. Any decision that is finalised without being influenced by appropriate due regard could be deemed unlawful.
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Has an equality impact Yes assessment been undertaken? No N/A (attached) (Delete as appropriate) Patient and Public N/A Engagement: Clinical Engagement: N/A Risk and Assurance: N/A
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Integrated Care Systems
1.1 On the 16th June 2021 NHS England and Improvement (NHSE&I) published a document titled ‘Integrated Care Systems: Design framework’, providing more detail on how NHSE&I expect NHS organisations to respond in the next phase of system development on their journey to transitioning to function as a statutory Integrated Care System (ICS) from April 2022.
1.2 Although further guidance will be issued over the forthcoming months in response to the legislation the guidance we have received to date and enabled us to produce a System Development Plan which identifies several key work streams.
• Governance and decision making; • Quality assurance and improvement; • Finance and activity; • Digital and business intelligence; • People and organisational development; • Communications and engagement; • Estates and ways of working; • Clinical and professional leadership; and • Strategic Commissioning (incl. Integrated Care Partnerships, Population Health Management).
1.3 A Programme Director has been identified and the ICS Transition Workstreams Leads Forum will co-ordinate the delivery of the plan. The System Strategy and Planning Group will oversee the transition programme and report to the Shadow ICS Board.
1.4 The Health and Social Care Bill 2021 was published for its second reading on the 6th July. A Second reading is the first opportunity for MPs to debate the main principles of the Bill.
System Pressure
2.1 Like most systems regionally and nationally we are experiencing pressure in many of our services.
General Practice 2.2 Our 123 GP practices are experiencing high levels of demand with activity at 119% of that of April 2019.
2.3 This is as a result of many multi factorial issues including pent up demand, seeing patients with complex conditions, patients chasing secondary care appointments and referrals, Covid vaccination queries and finally many queries being asked of GPs that would have traditionally gone elsewhere in the system e.g. NHS App, website and 111 and local pharmacists
2.4 General Practice has needed to make changes to the way in which it delivers services so that they were able to focus on ensuring both patients and their workforce were kept as safe as possible and the continuation of a wide range of consultation methods including telephone, on line and video to meet demand means that they are able to respond to the current increase in activity.
2.5 The CCG continues to support practices implement new consultation methods and ensure that practices can meet the current levels of demand.
Children and Young People 3.1 We are experiencing unprecedented system pressure because of a significant spike in the number of children and young people (CYP) who have acute mental health or emotional wellbeing
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challenges. This has resulted increased numbers of children and young people who are a risk to themselves attending A&E or being admitted to a Paediatric ward in an acute hospital. Recently the numbers peaked at 37 across the system with 22 at University Hospitals Coventry and Warwickshire NHS Trust (UHCW) and 15 at Warwick hospital. In addition to those on the wards and A&E we have notable increased demand in the community.
3.2 Actions have been taken to ensure improved timeliness and quality of discharges and the number of children on our Paediatric wards has reduced to between 7-12.
3.3 Additional resources have been deployed as required to ensure all CYP are both safe and cared for. Further work continues to improve the situation and the Partnership Executive Group have approved a plan to develop a Children’s Mental Health Task Force to lead the development and delivery of a fit for purpose sustainable service.
Special Educational Needs and Disabilities (SEND) Inspection
4.1 A joint Care Quality Commission (CQC) and Ofsted inspection of processes for children and young people SEND has taken place in Warwickshire. The inspection took place between 12th and 16th July to ensure that the SEND reforms set out in the 2014 code of practice have been embedded.
4.2 Key lines of enquiry centred on how services have been maintained during the COVID pandemic, partnership working between Health and the local authority, and commitment to ongoing investment into the SEND agenda as well as an assurance that SEND will be an ICS priority.
4.3 Initial feedback was received on the 16th July and the written report is expected within the next 2-3 weeks.
Warwickshire Pride Online Event
5.1 For the second year running, the CCG has made a submission to the Warwickshire Pride Online Event which is happening on Saturday 21st August 2021. The CCG Equality, Diversity and Inclusion (EDI) Network have produced a video https://youtu.be/VgTY_HfQhmE of a spoken word poem relating to Pride and the colours of the rainbow to illustrate diversity.
5.2 The Network wanted to showcase the CCGs commitment to EDI which it achieves through the promotion and progression of an inclusive working environment where everyone can be themselves and where differences are understood, respected and valued, which will then be reflected to the local population especially to the local LGBT+ community.
5.3 Our focus in 2021 is to promote and progress EDI around the Disabilities protected characteristic, especially those with Hidden Disabilities. The purpose of the network is to promote and progress an inclusive working environment where everyone can be themselves and where differences are understood, respected and valued. The network plans to bring the lived experiences of disabled people to the attention of the CCG and to remove the barriers that exist for them.
5.4 So far this year our work programme has already included raising awareness and suggesting resources and training available around Asperger Syndrome; hearing difficulties; Downs Syndrome; Epilepsy; Autism; MS; Ehlers-Danlos Syndrome; Accessibility; Learning Disabilities and Post Traumatic Stress Disorder. Further plans throughout the year are around Disability; Dyslexia; Stammering; and, Sight awareness and training. The EDI network progresses the work of the CCG and serve as a valuable resource for consultation in respect of policies, strategies, projects and initiatives.
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Recommendation
6.1 Members are requested to NOTE the contents of the report.
End of Report
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Enclosure G
Audit Committee Report for the Meeting held on 9 June 2021
Achievements / Decisions Made / To Note: Key Issues for the The Chairlllllllllllllllll confirmed that the Audit Committee was quorate. Governing Body:
The following items were discussed • Audit Results Reports for
predecessor CCGs were External Audit noted. • Provisional Audit Results Reports for CRCCG, SWCCG and WNCCG were • Final Heads of Internal noted. Audit Opinions provided • Assurance was received from the Auditors on their audit of the annual significant assurance. accounts. There were no material adjustments and no impact on the • Annual Accounts were financial position reported in the draft accounts. approved subject to
auditors’ final checks. Internal Audit • Achievement of MHIS • The final Head of Internal Audit Opinions for each of the predecessor compliance statements. CCGs provided significant assurance. • Final Annual Governance • The draft Internal Audit Plan 2021/22 was approved by the Committee, Statement and Annual following confirmation that it had been reviewed by the management team. Reports approved.
Annual Accounts • The 2020/21 Annual Accounts for each of the predecessor CCGs were received and approved subject to external auditors’ final checks.
Finance • The audit process for CRCCG/SWCCG/WNCCG Mental Health Investment Matters referred to Standard (MHIS) Statement of Compliance was explained and the Governing Body for Committee noted the achievement of the MHIS compliance statements. approval, debate or further consideration: Governance • The draft Final Annual Governance Statement and Annual Reports 2020/21 were submitted to the Committee and approved. The f inal submission date • There were no matters to was 15 June 2021. be referred to the • The Final Due Diligence Report – Merger was presented and assurance Governing Body for was given to the Committee that good progress was being made and the approval, debate or completion would be confirmed at the October Audit Committee Meeting. consideration.
Key Information: • Committee Chair:
Richard Percival • CCG Lead:
Adrian Stokes, Chief Finance Of ficer
• Date of Next Meeting: 11 August 2021
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Report To: Governing Body
Report Title: NHS Long Term Plan Prevention and Inequalities Update
Report From: Liz Gaulton, Director of Public Health and Well-being, Coventry City Council Shade Agboola, Director of Public Health, Warwickshire County Council
Author: Dr Jane Fowles, Consultant in Public Health Medicine
Date: 21 July 2021
Previously Considered by: N/A
Action Required (delete as appropriate)
Decision: Assurance: Information: Confidential
Purpose of the Report: To provide an update on the NHS Long Term Plan (LTP) Prevention and Inequalities workstreams.
Key Points: Chapter Two of the NHS LTP sets out new, funded, action the NHS will take to strengthen its contribution to prevention and health inequalities. • Wider action on prevention will help people stay healthy and also moderate demand on the NHS. Action by the NHS is a complement to - not a substitute for - the important role of individuals, communities, government, and businesses in shaping the health of the nation. Nevertheless, every 24 hours the NHS comes into contact with more than a million people at moments in their lives that bring home the personal impact of ill health. The Long Term Plan therefore funds specific new evidence-based NHS prevention programmes, including to cut smoking; to reduce obesity, partly by doubling enrolment in the successful Type 2 NHS Diabetes Prevention Programme; to limit alcohol-related A&E admissions; and to lower air pollution. • To help tackle health inequalities, NHS England will base its five year funding allocations to local areas on more accurate assessment of health inequalities and unmet need. As a condition of receiving Long Term Plan funding, all major national programmes and every local area across England will be required to set out specific measurable goals and mechanisms by which they will contribute to narrowing health inequalities over the next five and ten years. The Plan also sets out specific action, for example to: cut smoking in pregnancy, and by people with long term mental health problems; ensure people with learning disability and/or autism get better support; provide outreach services to people experiencing homelessness; help people with severe mental illness find and keep a job; and improve uptake of screening and early cancer diagnosis for people who currently miss out.
• Governance structure has been agreed locally to manage LTP priorities: - Midlands Regional Oversight for Health Inequalities and Prevention (ROIP) Board, chaired jointly by PHE and NHSEI will oversee the LTP Prevention and Inequalities workstreams. - Midlands Regional LTP Prevention Programmes Working Group has been set up. This group will support delivery and implementation of the LTP Prevention programmes - Alcohol, Tobacco, Obesity and Tuberculosis (TB), working in partnership with other prevention workstreams and stakeholder organisations including local authorities. - Midlands Regional Health Inequalities working group has been established supporting delivery and partnership working around health inequalities.
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- The Coventry and Warwickshire Population Health and Prevention Enabling Delivery Group (P&P EDG) will oversee both workstreams locally. - Coventry and Warwickshire LTP Prevention Task and Finish Group has been established to enable delivery and coordination of the LTP priorities. - Coventry and Warwickshire Health Inequalities Task Group has been established to support delivery of high impact actions on health inequalities and the Call to Action.
Recommendation: The Governing Body is requested to BE ASSURED by the update on the NHS Long Term Plan Prevention and inequalities workstreams.
Implications
Objective(s) / Plans NHS Long Term Plan sets out the priorities which support this report. supported by this report: Conflicts of Interest: No Conflict of interest noted Adult Weight Management Grant; Non-Recurrent Expenditure: Coventry City Council £331,229 Warwickshire County Council £173,884 Financial: Recurrent Expenditure: Tobacco Dependence £226,000 Is this expenditure included Yes within the CCG’s Financial (Tobacco No N/A Plan? (Delete as appropriate) Dependence) Progress updates against the workstreams will be reported to the Coventry and Performance: Warwickshire Population Health and Prevention Board. Quality and Safety: Not applicable General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non-discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any decision that is finalised without being influenced by appropriate due regard could be deemed Equality and Diversity: unlawful. Has an equality impact assessment been Yes No N/A undertaken? (Delete as (attached) appropriate) Patient and Public Not applicable Engagement: Clinical Engagement: HCP Respiratory and Cancer Boards Risk and Assurance: Not applicable
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Introduction/Background
1.1. Chapter Two of the NHS Long Term Plan (LTP) sets out new, funded action the NHS will take to strengthen its contribution to prevention and health inequalities. Wider action on prevention will help people to stay healthy and also moderate demand on the NHS. Action by the NHS is to complement - not a substitute for - the important role of individuals, communities, government, and businesses in shaping the health of the nation. Nevertheless, every 24 hours the NHS comes into contact with more than a million people at moments in their lives that bring home the personal impact of ill health. The LTP therefore funds specific new evidence-based NHS prevention programmes, including to cut smoking; to reduce obesity, including increased take up of the successful Type 2 NHS Diabetes Prevention Programme; to limit alcohol-related A&E admissions; and to lower air pollution.
1.2. To help tackle health inequalities, NHS England will base its five-year funding allocations to local areas on more accurate assessment of health inequalities and unmet need. As a condition of receiving Long Term Plan funding, all major national programmes and every local area across England will be required to set out specific measurable goals and mechanisms by which they will contribute to narrowing health inequalities over the next five and ten years. The Plan sets out specific action, for example to: cut smoking in pregnancy and in the population with long term mental health problems, as well as to ensure people with learning disability and/or autism get better support; provide outreach services to people experiencing homelessness; help people with severe mental illness find and keep a job; and improve uptake of screening and early cancer diagnosis for people who currently miss out.
1.3. This paper sets out system progress with the LTP Prevention and Inequalities workstreams, including the ‘Business Call to Action’.
Governance
2.1 The Governance structure has been agreed to manage LTP prevention priorities. The Midlands Regional Oversight for Health Inequalities and Prevention (ROIP) Board, chaired jointly by PHE and NHSEI will oversee the LTP prevention and inequalities workstreams. A Midlands Regional LTP Prevention Programmes Working Group has been set up. This group will support delivery and implementation of the LTP Prevention programmes - Alcohol, Tobacco, Obesity and Tuberculosis (TB), working in partnership with other prevention workstreams and stakeholder organisations including local authorities. A Midlands Regional Health Inequalities working group has been established supporting delivery and partnership working around health inequalities.
2.2 The Coventry and Warwickshire Population Health and Prevention Enabling Delivery Group (P&P EDG) will oversee task groups for the prevention and health inequalities priorities. The C&W LTP Prevention Task and Finish Group has been established to enable delivery and coordination of the LTP priorities. The C&W Health Inequalities Task Group was established last year to provide oversight and coordination of system activity to address inequalities. The group has identified a number of high impact actions where system partners could tackle inequalities by working together. Coventry and Warwickshire Joint Place Forum is supporting a ‘Business call to Action’ on inequalities.
Prevention
3.1 The LTP Prevention Task and Finish Group has been established with key partners from across the system to map and coordinate the LTP prevention priorities.
3.2 Key actions include mapping the current service offers/pathways for tobacco control, obesity and alcohol for Coventry and Warwickshire. Further understanding about the system tuberculosis requirements will be sought from PHE/NHSE colleagues. The key priority is to ensure that additional NHSE funding complements and enhances current pathways, system
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integration and partnership working. This paper focuses on two key areas of additional investment – weight management and smoking cessation.
3.3 Weight management - In terms of the LTP obesity priority there are 3 key areas of additional NHSE investment outlined below:
3.3.1 GP Enhanced service: Weight management 2021/22 - This ES begins on 1 July 2021 until 31 March 2022. GP practices must be invited to participate in this ES by 8 July 2021, and must sign up to participate in this ES on or before 31 July 2021. In agreeing to sign up to this ES, GP practices commit to restoring the practice Obesity Register to, at a minimum, the level of recording at 31 March 2020 (insofar as that is possible and / or clinically indicated). For individual patients recorded on the QOF Obesity Register as of 31 March 2021 and those identified as living with obesity during the service period, the GP practice should make an individual assessment of patient readiness to engage with weight management services and record the outcome of this assessment in the patient record. This should include ensuring a recent (within 12 months) BMI is recorded (unless clinically inappropriate to do so) and an offer of a referral to an appropriate weight management or specialist service. Acceptable referrals will include:
• NHS Digital Weight Management services for those with hypertension and/or diabetes. This should be the default option for this cohort of patients;
• Local Authority funding tier 2 weight management services;
• Diabetes Prevention Programme for those with non-diabetic hyperglycaemia
• Tier 3 and Tier 4 services
3.3.2 NHS Digital Weight Management Programme - From 1 July the new NHS Digital Weight Management Programme (DWMP) offers online access to a 12-week tier 2 weight management services for those living with obesity plus diabetes or hypertension or both. With three levels of support and a choice of Providers, it is designed to offer service users a personalised level of intervention to support them to manage their weight, improve quality of life and improve longer term health outcomes. The offer is designed to complement, and not replace, existing Local Authority commissioned weight management services. NHS service users living with obesity will continue to be able to access Local Authority commissioned weight management services where the new digital services are inappropriate for their needs, and for those without the comorbidities of diabetes or hypertension. Referral into the NHS Digital Weight Management Programme will be initiated by General Practice via the NHS Digital e-Referral system (e-RS) to the NHS England & NHS Improvement commissioned front-end ‘Referral Hub’. The Referral Hub acts as a single point of contact for all potential participants, facilitating their triage and allocation to the most appropriate level of intervention within the programme. The 3 levels of support are; • Level 1 – access to digital content only. Intended for people with characteristics suggesting they are less likely to require coaching support and more likely to support their own health and wellbeing. • Level 2 – access to digital content, plus access to a minimum of 50 minutes of human coaching throughout the 12-week programme. Intended for people with characteristics suggesting they may be less likely to successfully complete a weight management programme and who may benefit from additional human coaching to support them to complete the programme. • Level 3 – access to digital content, plus access to a minimum of 100 minutes of human coaching throughout the 12-week programme, and additional features such as supported introduction to the programme, challenges and games. Intended for people with characteristics suggesting they may be less likely to successfully complete a weight management programme and who therefore require a more personalised and supported journey with more intensive human support. NHS Long Term Plan Prevention and Inequalities Update Page 2 of 6 Public Governing Body – 21 July 2021
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3.3.3 Local Authority Adult Weight Management Funding Coventry and Warwickshire – additional funding has been allocated to both local authorities to support expansion of access to Tier 2 weight management services. Each LAs approach is outlined below: • Coventry - HLS Coventry is the mainstream provider of T2 weight management interventions. People with high-risk characteristics are target groups for HLS and are over- represented among weight management intervention commencements in comparison to the city average population (with potentially the exception of those with an LD). Men are under- represented; with 28% of all those starting an intervention being male. The funding has been used to establish a universal offer for primary care by providing each PCN with a dedicated health coach via HLS to recruit patients on a T2 WM intervention and deliver the intervention. To further target our male population, 3 sports sector programmes have been commissioned and 2 programmes that will offer Tier 2 weight management programmes to businesses • Warwickshire - Fitter Futures Warwickshire is the provider of the T2 weight management interventions. The grant will provide an opportunity to deliver targeted support to Warwickshire residents. We know that living with obesity reduces life expectancy and increases the chance of serious diseases such as cardiovascular disease, type 2 diabetes and some cancers. Covid-19 has shone a light on health inequalities, and WCC are hoping this short-term funding will help support Warwickshire residents lead a healthier lifestyle and contribute towards tackling health inequalities. The grant will be used to support the following groups: those diagnosed with post COVID syndrome. individuals seeking pre conceptual or post-natal care, individuals registered with a severe mental illness, individuals registered with a physical and/or learning disability. Users will receive 12-weeks free tailored nutritional support from one of the following AWM providers:
o Weight Watchers - Experience weekly group support with a range of incentives to help you on your journey to losing weight. Earn great prizes and get rewarded with WellnessWins™, and access the audio fitness trainer, helping you to move more - when, where and how you want to.
o Everyone Health - participate in healthy eating and physical activity workshops. The nutritional topics will include portion sizes, eating out and food labelling. Whilst the physical activity element will help you improve your health and fitness in a safe and encouraging environment.
o Slimming World - Share healthy swaps, recipes, menus, eating out tips and strategies each week in group, and discover tools, planners and even more tips and ideas on the free members-only website and app to stay motivated and on track. Referrals can be made via the Fitter Futures Warwickshire online portal – https://www.warwickshire.gov.uk/fitterfutures
3.4 Tobacco Control and Smoking Cessation - The LTP outlines the following priorities supported by additional funding at system level. • By 2023/24, all people admitted to hospital who smoke will be offered NHS-funded tobacco treatment services
• The model will be adapted for expectant mothers, and their partners, with a new smoke-f ree pregnancy pathway including focused sessions and treatments
• A new universal smoking cessation offer will also be available as part of the specialist mental health services for long-term users of specialist mental health and in learning disability services.
3.4.1 Funding will be devolved to systems, via lead CCG’s from NHS England through Integrated Care Systems (ICSs) – to allow all providers to offer these services either individually or across local systems in conjunction with NHS and LA partners. Funding will be increasing year on year from 2021/22 to 2023/24. Each system should establish a prioritisation process,
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identifying where delivery will be rolled out, e.g. by targeting implementation to areas of greatest prevalence/need based on local data. TC Coventry and Warwickshire HCP allocation £226,000 (£157,837 inpatient/£68,163 Maternity).
3.4.2 The existing C&W Tobacco Control Partnership has met to discuss the LTP priorities and system funding allocation. A Task and Finish group involving key partners will be established to develop system pathways and response to additional funding.
3.5 Alcohol - An Alcohol Care Teams Innovation and Optimisation Network (ACTION) is being developed and all areas are encouraged to participate. In the Midlands 11 sites were identified for ACT funding, one of which was UHCW. However, they will not receive funding for ACT in this wave. PHE and NHSE&I have asked all trusts to complete a checklist to build a better picture of ACT provision. Systems are encouraged to ensure community services and hospital ACT services work together, building clear pathways for individuals. PHE WM and NHSE&I encourage all sites to invest in ACTs using the CCG health inequalities funding supplement and encourage all to engage in ACTION and the Midlands Alcohol Forum.
Health Inequalities
4.1 NHS inequalities priorities and high impact actions – The Inequalities Task Group has undertaken mapping of system activity against the national NHS inequalities priorities and the local COVID impact assessment. From this exercise the group has identified a number of high impact actions where HCP partners could tackle inequalities by working together and offer leadership in response to the wider Call to Action on inequalities. These include:
• Financial strategy: applying universal proportionalism • Population health management: data, monitoring and engagement • Workforce: improving diversity and recruitment • Digital inclusion: joining up Digital Transformation Board and bottom-up approaches • Economic recovery: engagement with wider businesses and CWLEP • Commissioning and procurement: support social value and local supply chains
4.2 The task group also has an ongoing role in monitoring and reporting on system progress against the NHS inequalities priorities, as well as overseeing and making links between related projects, such as the Health Equality Partnership Programme.
4.3 Business call to Action - Development of the Call to Action on Health Inequalities across Coventry and Warwickshire aims to involve businesses and organisations in pledging to make changes to improve health and reduce health inequalities in the light of COVID19. The Call to Action will be themed to specific areas and will be system wide. Although it will encourage organisations to consider several ways that they could make change to tackle health inequalities, the two core areas of focus are:
• Review/update of HR policies and processes to ensure that there is no unconscious bias and that there are no barriers for BAME employees in recruitment or progression.
• Development of a social value policy or inclusion of social value approaches in procurement and other processes, to ensure wider benefits to the community through core social value such as offering apprenticeships to local people as part of a local project, as well as added social value which adds value over and above the goods or works being provided.
4.4 The current, initial focus is on the private sector, with Public Health working with colleagues in Economic Development and other public-facing roles to raise awareness with employers about the implications of health inequalities and suggest actions that they can take which will benefit the business as well as the wider community. Actions include things like paying the real living wage, taking a social value approach in their business, ensure they have fair
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working practices which don’t present barriers to certain groups, upskilling staff, and undertaking community initiatives.
4.5 A Call to Action website is in place to provide background to the initiative and information about health inequalities. We will also be providing a range of resources and support for the various actions that we have suggested for businesses. We are asking that businesses sign up on our Commitment page and make a public commitment to the actions that they will take.
4.6 An online event was delivered on 10 June in partnership with the Chamber of Commerce and work is now underway to engage further with businesses.
Next Steps
5.1 LTP Prevention programme – Key actions include mapping the current service offers/pathways for tobacco control, obesity and alcohol for Coventry and Warwickshire. Further understanding about the system TB requirements will be sought from PHE colleagues. Tobacco control task and finish group will be established to specifically focus on the three funding priorities.
5.2 Collaborative working as a system is required to enable the successful delivery of the LTP prevention priorities.
5.3 Business Call to Action; we will be moving onto the voluntary and statutory sector organisations next, however, a number are already involved in the programme through their engagement in a range of multi-agency and cross-system groups which are examining health inequalities.
Conclusion and Recommendation
6.1 To NOTE the update on the NHS Long Term Plan Prevention and Inequalities workstream and the Business Call to Action.
End of Report
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Report To: Governing Body
Report Title: System Development Plan
Report From: Rachael Danter, System Transformation Director, Coventry and Warwickshire Health and Care Partnership
Author: Rachael Danter, System Transformation Director, Coventry and Warwickshire Health and Care Partnership
Date: 21 July 2021
Previously Considered by: Integrated Care System Shadow Board, 13 July 2021 Partnership Executive Group, 19 July 2021
Action Required (delete as appropriate)
Decision: Assurance: Information: Confidential
Purpose of the Report: The purpose of the report is to share with members the updated System Development Plan (SDP) that was submitted to NHS England/Improvement (NHSE/I) at the end of June 2021.
Key Points: In line with the national requirement, the System Development Plan (SDP) was updated and shared with NHSE/I. The plan highlights some of the progress made since the first submission in late December 2020 and also identifies further activities/areas of focus that the system intends to work on to demonstrate a transition to a mature and thriving Integrated Care System (ICS).
The plan has been updated through a co-produced approach with the system and is a ‘live’ and evolving document that should continue to be updated as progress is made or more national guidance is received.
Recommendation: Members are asked to NOTE the contents of the updated SDP and share any feedback or further updates they wish to include.
Implications
Objective(s) / Plans 1. Creating Value supported by this 2. Building capacity report: 3. Developing at Place Conflicts of Interest: N/A Non-Recurrent Expenditure: N/A Development of a medium-long term financial Recurrent Expenditure: plan which ensures system sustainability is Financial: detailed in the finance section of the plan. Is this expenditure included within the CCG’s Financial Yes No N/A Plan? (Delete as appropriate)
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Development of a new model of assurance in line with the new national System Performance: Oversight Framework is highlighted in the plan. Development of a new model of system Quality and Safety in line with the new Quality and Safety: national guidance is highlighted in the plan. General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any Equality and Diversity: decision that is finalised without being influenced by appropriate due regard could be deemed unlawful. Has an equality impact Yes assessment been undertaken? No N/A (attached) (Delete as appropriate) Patient and Public An updated approach to patient and public engagement is recognised as one of the Engagement: activities in the plan. Clinical engagement and leadership is a critical workstream highlighted in the plan Clinical Engagement: with activities identified. The biggest risk to delivery of the plan is the delayed national guidance. This risk Risk and Assurance: has been mitigated by agreement that work will continue underpinned by local determination rather than wait for national guidance.
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System Development Plan
June 2021
1 Contents
Section Page Section Page
Executive Summary 3 Our approach to transition 16
Our vision 4 How w e approach transition 17
What system development means to us 5 Design principles 18
Learning from the last 18 months 6 How w e w ill deliver transition activities 19
Our progress so far on our journey to ICS 7 Transition structure overview 20
Review ing our progress 8 Transition w orkstreams 21
Our revised SDP priorities 9 Transition w orkstreams plan by quarter 31
How as an ICS w e w ill deliver our priorities 10 How w e w ill manage dependencies 34
Our Operating Model 11 Developing at Place 39
How our future architecture w ill be structured 12 Establishing Provider Collaboratives 40
ICS Health and Care Partnership 14 Workstream Leads 41
ICS Board 15 Programme Management Office 42
2 Executive Summary Our updated system development plan builds on our successes and learning to date with a view to accelerate progress ahead of April 2022
● The system’s response to Covid-19 has been transformational and builds on our existing work to transition from operating as an STP into an ICS. This includes: ○ A common vision and agreed principles regarding the way partners will work together ○ Well established ICS leadership and governance arrangements ○ Well developed, distributed Place based arrangements which include all key NHS and LA partners, PCNs, VCS and our communities working together to tackle inequalities and unnecessary variance ○ A history of strong clinical leadership in supporting service transformation, including the Out of Hospital arrangements, integrated discharge teams and more recently, the redesign of Stroke services and a robust mutual aid framework both internally in the system but externally for other systems ○ A strong commitment to support and develop our workforce so that they are able to offer the best care to our patients and communities ○ Growing capability and capacity to deliver a Population Health Management approach at all levels of our architecture ○ An emerging system approach and governance structure that supports collective management of quality, performance and finance
● We will embed the learning from COVID-19 and continue to develop new ways of collaborative working to drive integration faster and further
● As we enter the next phase of our jurney, the system remains fully committed to delivering our Five Year Plan, focusing initially on a number of key priorities
● We believe that operating as a functioning ICS will provide the culture and framework we need to deliver our Five Year Plan, reduce and address health inequalities and improve the health and wellbeing of our population
3 4 What system development means to us Our system development plan outlines our vision and priorities
Our Vision: “We will enable people across Coventry and Warwickshire to start well, live well and age well, promote independence, and put people at the heart of everything we do”
We will work together, develop strong partnerships and The system development plan sets out how we will continue listen to our citizens and staff to develop together as a system Our system development plan has outlined our progress to ICS Our vision for Coventry and Warwickshire centres around every Designation and proposed next steps in developing the operating part coming together to deliver better outcomes for our standards and model for the ICS. This transition plan builds on population. We have defined what this means for us and how the work we have outlined in the System Development Plan and we will do this, namely: develops in further detail the steps we need to take to achieve full • Working together to improve population health ICS status by April 2022. • Developing strong partnerships This transition plan is intended as a subsection of the System • Establishing integrated care collaboratives in each Development Plan and will continue to be referred to in tandem place with the detail developed in the System Development Plan. • Strengthening partnerships between care providers across our system and pan-system where advantageous • Seeking and acting on feedback from our patients, our communities and our staff • Recruiting and developing system leaders and staff to realise this vision
5 Learning from the last 18 months The next year is an important step in our system development journey
We can build on our history of managing successful We are committed to developing together as a system transitions Building on our success of closer collaboration due to the merger As part of our streamlined commissioning approach, we have and COVID-19 working, we know there are benefits for already undergone considerable change through the merger of integrated system working for our people and for the population three CCGs to form the Coventry and Warwickshire CCG. in Coventry and Warwickshire. The way we approached the merger and the execution of As such, we are responding to legislation and national guidance activities showcases the ability of Coventry and Warwickshire to and continuing our transformational journey to transition to full be able to adapt to change, develop and deliver an exemplar integrated care system (ICS) status by April 2022. transition. While this is an important milestone we know that this is not the We worked closely together as a result of COVID-19 end for system development. We are committed to working to We have also shown our success in working collaboratively transform as a system and delivering better outcomes for our across boundaries as a result of COVID-19 challenges. We now population. have the opportunity to build on this momentum to support the We understand that how we transition to April 2022 and the development of the future ICS. behaviours and ways of working we foster, will be influential on Our development of approach to Population Health and how we will operate as a system in the future. addressing Inequalities We have already made considerable progress towards ICS We are fully aware of the impact Covid has had on increasing status, our plan is not starting from zero, but continuing the inequalities across our population. Work undertaken through our momentum we already have. JSNAs and restoration highlights the areas for focus going forward. Building on the strong foundation already in place we are committed to ensuring addressing inequalities runs through everything we do.
6 Our progress so far on our journey to ICS We have made significant strides as a system advancing our maturity and capabilities
• Throughout Covid, strong system collaboration approach developed to deal with prevention, ongoing management and recovery including robust vaccination programme and good mutual aid process across organisations
• Strong clinical leadership in place across the system with the future model of clinical and professional leadership being co-produced • A strong commitment to support and develop our workforce so that they are able to offer the best care they can • Updated governance framework to support operating model which differentiates between strategic planning, priority setting and assurance/oversight ‘v’ Place based/Provider Collaboration delivery. This includes required sub-committees and arrangements between NHSEI and system and system with Place
• Strong Place based partnerships developed with lead roles/teams identified and relationships established with key partners such as primary care/PCNs and VCS. Further discussion to be undertaken regarding ICPs and lead provider arrangements
• Work undertaken to understand the impact of Covid in relation to increased health inequalities and unnecessary variation and agree priorities for addressing these issues
• Population Health strategy and model developing with clear strategy and plan to embed and mature capability at Place going forward
• Building on the successful merger of the CCGs, continued development of our approach to integrated commissioning which aims to deliver an outcome based framework and process for prioritisation
• Some progress made with regards to system financial planning and management and a shared risk management approach • Transformation plan in development (including digital) to improve efficiency, productivity and quality as well as deliver long term financial sustainability
• Work on Anchor Alliance progressing well with all partners committed to delivering the agreed priorities
7 Assessing our Progress Key: Self Assessment: We have assessed our maturity against the draft system Significant progress Some progress progression tool (NB this is still in draft and may be updated) Lots to do
Theme 1: System and Digital Transformation
Preliminary Launch Advanced
Theme 2: People and Transition
Preliminary Launch Advanced
Theme 3: System oversight and quality improvement
Preliminary Launch Advanced
Theme 4: System Roles and Capabilities
Preliminary Launch Advanced
Theme 5: Financial framework and Use of Resources
Preliminary Launch Advanced
Theme 6: System leadership, Governance and Accountability
Preliminary Launch Advanced
8 Our revised System Development Plan priorities We remain fully committed to delivering our Five Year Plan. However, following Covid-19 we have revised our agreed priorities to reflect changing circumstances
Our revised priorities as a system are to: • Accelerate preventative programmes and activities that target those at greatest risk, e.g. pre-rehabilitation, mental health programmes • Work together, as partners, at system and Place to identify and address health inequalities and variations in health and care provision • Protect the most vulnerable, ensuring inclusivity runs though everything we do • Focus our delivery on Place-based care, supported by strong, well developed PCNs • Successfully manage urgent emergency care (UEC), particularly winter pressures (including Flu) alongside managing any further Covid-19 surges (including Covid-19 vaccination and mass testing) • Restore elective care to ‘better than’ pre-Covid levels, with particular focus on long waiters, cancer and diagnostics • Care for and develop our workforce ensuring they continue to have the resilience and support to deliver the best care to our patients and communities particularly our BAME employees • Maximise all enablers that support us deliver our Five Year Plan commitments e.g. digitally enabled care • ‘Live within our means’ and become financially sustainable
9 How as an ICS we will deliver our priorities? Working as an ICS provides us with the right conditions to address our system challenges and deliver our system priorities and better outcomes
As a system we recognise that working together differently, in a more integrated way is the only way to manage the population pressures we face, address inequalities, effectively respond to the diversity of our populations and improve the health and well being of our communities. We already have experience of working like this and believe the key elements for success are: • PHM – will enable us to design and target interventions and investment to specific population cohorts and enable us to monitor and understand the effectiveness of those interventions • Different clinical leadership– leadership at all levels with a focus on prevention and self-care, addressing inequalities and clinical variation across the system, as much care delivered as close to the population as possible and mutual aid • Operating Model – Place becomes the vehicle for planning and delivering the majority of integrated, safe, high quality delivery and transformation as close to the population as possible. This covers all of the wider determinants of health, articulated through one Place plan developed by all partners. At system, opportunities will be taken across organisations, where working at scale adds real value, both for clinical and non-clinical services • Oversight – continue to develop performance management (including quality) and assurance processes to allow the system to take collective responsibility for performance and outcomes • Financial Framework – Place based allocation/budgets, underpinned by PHM approach to drive investment decisions closest to the population
10
How our future architecture will be structured Our emerging view of the components of Coventry & Warwickshire ICS
Developing our structure We are continuing to develop all of our Places, ICPs and Provider Collaboratives as part of our overall future system design. Throughout transition we will continue to iterate this as a system as part of ongoing evolution. We have an emerging narrative for what we see as the core components for our system structure.
Syste m Opportunities will be taken across organisations where working at scale adds real value, drives our priorities, and is an enabling force for improvement at Places. System Place Place is the vehicle for planning and delivering the majority of integrated, Place Place Place Place safe, high quality delivery and transformation as close to the population as possible. This covers all of the wider determinants of health, articulated ICPs through one Place plan developed by all partners.
Integrated Care Partnerships (ICPs) Provider Collaboratives A collaboration of NHS providers and local authority partners that may deliver care through a contractual relationship with the system. These may cut across a number of Places.
Provider Collaboratives Giving opportunities for providers to collaborate within the system and pan-system on priorities identified from our system strategy.
12 Strategic Planning and Priority Setting
Coventry and Warwickshire Health Coventry HWBB Warwickshire HWBB and Care Partnership
NHS ICS Board PEG
Monthly System Review - Finance, Performance, Quality, Audit and Renumeration
Place Based and Provider Collaboration Delivery
Places working together
South Coventry Rugby Warwickshire Warwickshire Place Based Place Based North Place Based Delivery Delivery Place Based Delivery Models Models Delivery Models Models
Provider Collaboratives/System-wide delivery models
Individual Provider Organisations, Statutory Bodies and Partners ICS Health and Care Partnership Our emerging view of the design, purpose and function of a key governance forum
ICS Health and Care Partnership The ICS Health and Care Partnership will: Core Membership ● Bring together health, social care, public • Independent Chair health and other key partners such as VCS • Members of the NHS ICS Board and members of the wider “public space” • Health and Well Being Board Chairs (both (such as social care providers, housing LAs) providers) • District Borough Council representation • Place representation ● Be responsible for developing a overarching plan that addresses the wider health and • Healthwatch (Coventry and Warwickshire) public health needs of the system • Voluntary Sector Representatives (both LAs)
● Have due regard to the Joint Strategic For local consideration Needs Assessment and Health and • Additional Local Primary Care (LMC, LOC, Wellbeing Strategies. LDC etc). • Education Institution representation • Social Care Provider Representatives • Local Housing Provider Representatives • Local Employer Representatives
14 ICS Board Our emerging view of the design, purpose and function of a key governance forum
ICS Board The ICS Board will: Core Membership ● Be responsible for the strategic direction • Independent Chair and planning, to meet the health and care • 2 Independent NEDs needs of the population. • ICS Chief Executive • CFO, ● Undertake the statutory duties of the new organisation. • CNO • CMO ● Develop a Capital Plan for NHS Providers • All NHS Trust CEOs – in line with national guidance Be accountable to NHSE for spend, performance, • Local Authority Representatives commissioning, planning population health need • Primary Care/ General Practice and capital plans Representative
For local consideration • Other system Executives • Other system NEDS/Chairs • Other stakeholders e.g. VCS
15 Our approach to transition
How we move forward to realise the benefits of integrated system working
We are already clear on the benefits of closer system We can realise these benefits through setting the working foundations through our transition In our ICS Designation Application we outlined how as an ICS we How we transition will be foundational to how we will operate as a will deliver our priorities in managing population pressures, system. We want to be operating and working as an ICS addressing inequalities and improving the health and throughout the transition, so by April 2022 the move to a wellbeing of our communities. These priorities remain statutory ICS is already part of our normal working day. We unchanged and we continue to see the main benefit of continuing recognise that embedding ICS working will be fundamentally to develop as a system for Coventry and Warwickshire that: realised by bringing our teams along on this journey with us.
We can address complex challenges through closer collaboration. Developing care models to improve population health, ensure improvements in quality and health and wellbeing outcomes, reduce inequalities and enable future financial sustainability.
We can develop targeted understandings of local populations and work with other organisations involved in people’s health and wellbeing such as local charities, community groups, patients and local residents in the planning and delivery of services.
We can work collaboratively across different organisations to benefit patients. Staff will be supported by improved technology, digitally enabled support, care and treatment, which will be easier to use and more efficient than current manual processes.
16 How we approach transition Our transition will be rooted in collaborative design
Designing the ICS and the transition is not done in isolation Our Transition oversight is transacted through our System Strategy and Planning Group. Underpinning this group is a Transition Programme Board which reports progress on a fortnightly basis. We have identified sources where we can bring good practice and innovative thinking into the design of our ICS and also the transition. While it is important to develop a central vision for the future ICS and transition that is communicated consistently outwards, we will not work in silo of our people or external organisationsand miss opportunities to bring in good practice. It will be important to leverage the expertise of our people in Coventry & Warwickshire, who have the local knowledge and experience to shape the design and transition in a way that suits the need of our population. We will also take lessons learned from our merger experience and shape the transition in a way that emphasises the strengths of our people and addresses the areas that need additional support. We also will be an outward reaching system that readily shares good practice and lessons learned with other organisations and NHSEI to co-design the future of the ICS and deliver an effective transition.
External good practice Coventry & Warwickshire expertise
Good practice elsewhere Data and patient experience insights from our population We have already identified areas of good practice from other We can also leverage our work for insights to what our ICS systems that we have tak en into account when designing should prioritise for our populations
Derby buddying Teams We will work closely with Derby and other partner systems to Our teams have in depth k nowledge of our populations in share k nowledge and test our transition and future design Coventry & Warwick shire
NHSEI collaboration Leadership We are committed to proactively work ing with NSHEI to Our leaders will tak e decisions enabled by information and develop our ICS in line with guidance data developed through Coventry and Warwickshire teams
17 Design principles Our design principles have guided our thinking about transition
1 We think this is important to do During COVID response w e have been able to There is still a lot of uncertainty about w hat the What w e design w on’t be perfect, but doing this w ork in a different w ay, w e w ant to build on this future looks like but w e need to start thinking this w ill help us to test ideas, gain momentum and progress and move beyond transactional through. Our biggest risk is not getting started. make real change happen on the ground. relationships into making change happen together. 2 How we want to design
We acknow ledge that this w ill impact people’s jobs We need a w ay to We are safe to ‘experiment’ and mean change for all of challenge and disagree w ith Our reasoning for w hat This is about creating the and try things that may not us. We believe that our each other to get to the right goes w here is as important w ay w e w ant to w ork in the w ork (and can alw ays people need to be a part of answ er (that is alw ays as the end result. future, it should excite us. change our minds). defining w hat the future respectful). looks like. 3 First principles We should not be bound by w hat We do not w ant to replicate the We should start by thinking how might be possible today. If w e w ould Some functions may be easier to CCG w hen w e design the ICS (or things w ould w ork best for our need new things in place (e.g. data, develop than others / there are ICP, or place). populations and not how technology, support teams, funding some certainties w e know today System/Place/Neighbourhood is not organisations or roles w ork today. flow s) w e should identify these as and some w e don’t know defined by any one organisation. w e go. 4 We agree that
Most activity should be happening at place, and the system should w ork to Working at place is about reaching the w ider determinants of health of w hich enable/create the environment for place to succeed health and social care is only a part
18 How we will deliver transition activities We have identified a number of workstreams who will be responsible for driving our transition activities
Workstream delivery will cover the necessary things we have to do, and our bigger ambitions In the transition to ICS there are a number of changes that we will need to make to meet NHSEI and legislative requirements. These comprise the “what we have to do” as part of the transition, and we have developed our workstream scopes accordingly. Our experience of CCG merger will be critical to much of this. As important as these will be to complete, it is unlikely that just by meeting these requirements we will be able to achieve the benefits of working as a system that we would like. Therefore there will also be some wider goals set by the system, comprising “what we want to do”, to complete the picture of a thriving ICS. Each workstream will have responsibilities to sort out the functional changes but will also have responsibility to take on foundational questions about the future of the system.
Fig 2. Coventry and Warwickshire CCG transition workstreams Functional workstreams Workstream elements for developing a mature ICS Lead
Governance & Decision Making Anita Wilson Quality assurance & Improvement Jo Galloway Finance & Activity Adrian Stokes & Susan Rollason Digital & Business Intelligence Danny Roberts People & Organisational Development Theresa Nelson Communications & Engagement Rose Uwins Estates & Ways of Working Haq Khan Clinical and Professional Leadership Kiran Patel and Sarah Raistrick Strategic Commissioning (ICP development, PHM) Anna Hargrave Programme Management Office (PMO) Peter Carr
19 Transition structure overview Our workstream leads will need support from each other and from decision makers
Our transition structure will set the foundation for thriving ICS governance Our indicated transition structure governance outlined below provides a strong foundation for supporting what we need to do during the transition and enabling a smooth transition to a shadow ICS.
Shadow ICS Board, regional teams etc. ] Design Authority System strategy Directors
Strategic Oversight [transformation & assurance] Rachael Danter & Alison Cartwright
Programme Workstream forum Management Office Work stream Leads Peter Carr
Adrian Kiran Patel Anita Jo Stokes & Danny Theresa Rose Anna Haq Khan and Sarah Wilson Galloway Susan Roberts Nelson Uwins Hargrav e Lead Raistrick Lead Lead Rollason Lead Lead Lead Lead Co-Leads Co-Leads Workstream collaborations Workstream collaborations
20 Transition Workstreams
21 Governance and decision making An overview of the responsibilities and areas of focus of the workstream
One of the major features of transition will be the new executive roles, boards and groups that this workstream are responsible for establishing. There is significant work ahead of us to make sure that these roles and forums are fit for purpose, aligned to our system objectives, and sit within a wider governance structure and approach that helps us to have assurance/oversight over the workings of the system and continue to drive transformation and innovation.
In order to support the transition to a thriving ICS, this workstream will define clear reporting and escalation arrangements for the key governance forums to ensure that the forums have the right information to support them and that issues and risks are appropriately escalated. We are aiming for a shadow form of the ICS to go live in Q3 which will allow us to improve this governance structure and arrangements ahead of formally transitioning in April 2022.
As part of our transition, we will have to complete a lot of due diligence activities related to governance. Our successful CCG merger will provide the blueprint for how we manage this transition over the next year.
Key responsibilities: ● Confirm governance arrangements for the Health and Care Partnership and NHS ICS Body ● Enable the People and Organisational Development workstream to make key appointments for the new boards and groups ● Define clear processes for identifying and escalating risk ● Due diligence activities (including information governance) ● ICS NHS body constitution and MOU arrangements with NHSEI and between system and Place
22 Quality and improvement An overview of the responsibilities and areas of focus of the workstream
One of the central benefits of moving to an integrated way of working is to improve the quality of services and care across the system so our quality workstream is key to our successful development. We have already made significant progress in setting up System Quality Governance forums and task and finish groups, and developing a strategy and framework that will act as a foundation for our transition. Our task for the next phrase of transition is to embed what we have done so far.
We will continue to work with our forums to ensure that they have the right information, attendance and reporting to assure progress on quality in the system. In order to support this, in line with national guidance, we will build on our Quality Assurance Framework so that we have a clear picture of the risk thresholds between forums and an understanding of the reporting of risks across the system. We will also support the governance workstream to make sure that quality is high on the agenda of all forums and governance introduced.
We have made significant progress at system level and will now turn to focus on Place development. We are in the process of appointing Place quality leads and will work with each Place to codesign a coherent approach to quality at Place which has the differentials needed but consistency in reporting back to system.
As outlined in the transition plan, assurance is a central component of our system development. Meeting this robustly will require collaboration between our finance, governance and clinical and professional leadership workstreams.
Our main ambition is to embed a quality and improvement culture throughout the system. We will focus on engaging with our staff, patients and the wider public and collaborating with people across all levels to design what the future looks like. We will also work closely with the people and clinical and professional leadership workstreams to ensure that there is an organisational development focus on quality. We will do this by building on our existing quality and continuous improvement infrastructure and focusing on creating a common language throughout the system.
Therefore, our responsibilities are: quality governance and oversight, developing an approach for system assurance of quality and developing a culture of quality and continuous improvement.
23 Finance and activity workstream An overview of the responsibilities and areas of focus of the workstream
As a system, we have made progress in our collective approach to financial management. We now work with a much higher level of transparency and have the experience of collaborating and working together to address problems. We will use this year to continue to develop how we work as a system. Key to this will be managing financial savings and opportunities as collective ‘system’ problems rather than as individual organisations. We will have significant financial pressures to address which go beyond the responsibility of a single organisation, and beyond the scope of a single organisation to address.
In order to progress with our milestones, all system partners must agree that the cost base cannot grow. This will mean living within a cost commitment and not going beyond allocation. This is a trigger point from which everything else will flow forward. Not agreeing this will impact on our ability to progress.
Key activities: ● Through transition there will be a number of due diligence activities to complete which will have to be done by April 2022. Our successful CCG merger has given us experience which we can build on to do this successfully. ● Co-design a robust ICS financial framework and approach with system partners, which enables us to properly resource and focus on the work that will give the system the greatest benefit. ● Work with system finance partners to agree a collective approach to efficiency to collaboratively tackle challenges and identify opportunities for savings or income generation ● Support the People and Organisational Development workstream with the appointment of system financial leadership ● In collaboration with the Governance and Quality workstreams, develop an assurance approach, incorporating roles, governance forums and reporting lines ● In coordination with the Strategic Commissioning workstream, explore financial arrangements to support Place
24 Digital and Business Intelligence An overview of the responsibilities and areas of focus of the workstream
The digital workstream is a critical enabler in supporting our system to deliver our Long Term Plan commitments and to continue to develop as an Integrated Care System.
Our Digital Transformation Board has been established and brings together people from across the system. We are clear about our priorities, which will form the basis of our Digital Strategy. Over the next year, our focus will be on developing and embedding our system strategy and completing our priorities, such as coordinating systems across the ICS.
Digital will be central to most of our system transformation. Therefore the Digital and Business Intelligence workstream will need to collaborate with a number of the other workstreams to ensure that we are taking advantage of opportunities for digital transformation and improvement throughout the transition. In particular, the Digital and Business Intelligence workstream will need to support the Population Health Management function to ensure that the function has the necessary data for their outcomes driven approach.
Key priorities: ● Develop and embed our digital strategy and deliver our transformation priorities ● Facilitate data, intelligence and insight across the ICS to inform service delivery strategy, resourcing deployment and capacity planning at system and place levels ● Support Population Health Management through collecting, monitoring, sharing and reporting data ● Support the interim CCG CIO with Digital and Business Intelligence due diligence ● Implement our Integrated Care Record programme
25 People and organisational development An overview of the responsibilities and areas of focus of the workstream
Transitioning to working at system, and place will have an impact on our people in the roles that they do and the ways in which we are asking them to work. We are also clear that it is our people that will have the biggest impact on our ability to work in a different way and deliver the benefits of integrated working at every level.
Therefore a focus on workforce over the next year is crucial in guiding our transition. The workstream is clear as to the objectives required and the activities that are within scope. However, we are clear that this workstream will have connections to all of the other workstreams and a pivotal role to play in the transition.
Central to this will be guiding how we transition, which will be outlined in the transition plan. This includes the commitments that we want to make to staff about how we will undertake this work, the involvement that we want them to take in designing the future and the ways in which we want to start working from today.
Key responsibilities: ● In order to make sure that we transition to a new organisation properly, there is a significant portion of workforce due diligence that will need to be completed. ● To support this, the workstream will need to be clear on what the future of the organisation will look like, in terms of the structure of the organisation, the roles required, and the behaviours, values and skill sets of the organisation. This will help us to train and upskill our staff, retain skilled members of staff and build our workforce through recruiting capable individuals. ● It is important to focus on culture from the early stages of the transition. The responsibility for setting and building a produc t ive culture sits across the entire programme and all workstreams.
26 Communications and engagement An overview of the responsibilities and areas of focus of the workstream
Effective communications and engagement is the foundation for people to feel that that they are listened to and informed of changes as the transition progresses. It does not only consist of the information that is given, but also its influence in how we feel about the future. This workstream will have a pivotal role in how workstreams coordinate with each other and develop a narrative that we can give to people about what the change means for them, their care and their work.
This workstream is an enabler helping each workstream to deliver its work. It will work closely alongside the Governance and Workforce workstreams to design and deliver consultations, and act as a consistent source of information. We do not want to design the future of the system in isolation of the people who will be working within and using its services. Therefore, alongside communicating what is happening it will be vital that we have the mechanisms to truly engage with a variety of stakeholders and involve them at each stage of the transition.
Engagement will also be integral to our work as an ICS as it is how we can determine whether we are delivering excellent outcomes for our population. Another priority for this workstream will be capability building at system and Place to create an engagement framework that will help our system at every level have better relationships and engagement with our population. While we will continue to have staff dedicated to communications and engagement, everyone in the system will need to gain skills in these areas. Therefore, during the transition stage, we will make particular effort to upskill workstreams and teams to engage effectively.
All of this will happen alongside our business as usual activities (BAU), including supporting programmes already underway and responding to media and other issues as they arise. Moving to a system way of working may increase BAU demands (e.g. more external scrutiny). As this workstream will be called on to support so much of the programme, it is crucial that we prioritise work to make sure that the vital capability building activities can still happen.
27 Estates and ways of working An overview of the responsibilities and areas of focus of the workstream
We have a system estate plan that is rated good. This is in effect an aggregation of organisational estates strategies and devel opment plans. The transition to an ICS provides the ideal opportunity to develop the estates strategy into truly a system strategy that is focussed on enabling the delivery of system priorities. Pooling our assets will give us the ability to improve the efficiency and quality of our estates and help us to work in new ways that suit our staff and the populations that we serve better. Changes to estates tak e time so we believe that in order to deliver the changes required in 3-5 year’s time, we will need to start planning today through this transition.
As we complete the formal transition to an ICS, there will be some due diligence required around our estates to make sure that it is managed properly. There is also the possibility to use this transition as an opportunity to review our existing estates and identify if there are any opportunities or changes that can be made, particularly as leases are due to come to an end and we are returning to a more hybrid model of working after the COVID-19 pandemic, where some staff will continue to work remotely from home.
Finally, as we start to think about where staff will be working, whether at system or Place, it is important to consider how we can best use our estate and virtual tools to support people to feel a part of their wider teams and be supported in their roles in a way that will help our overall system ambitions. The People, Digital, and Estates workstreams will need to work closely together to best support our people. There are additional opportunities for estates but it is unlikely that we will have the resources to pursue every one of these. Therefore, prioritisation of activities is critical for the estates programme plan.
Key responsibilities: ● Transition due diligence and preparations for property transfers from the CCG to the new ICS Body ● Delivering the System Estates Strategy and developing and prioritising a 5-year estates programme plan ● Work with the People and Digital workstreams to ensure that estates appropriately facilitate the agreed ways of working for staff
28 Clinical and professional leadership An overview of the responsibilities and areas of focus of the workstream
Both our Long Term Plan and the subsequent System Development Plan have identified the importance of clinical and professional leadership to our maturing system. We have a history of strong clinical and professional leadership in supporting services transformation, and have clinical leaders working at various levels across our system. The Clinical Forum provides consistent clinical and professional leadership at system.
If we are committed to being clinically and professionally led, this will need to be a foundation in how we structure and design the future ways of working at system and at place. This means that our system governance and structure should have clinical and professional leadership at every level and involved in all aspects of decision making, rather than acting as a parallel ‘add on’. This workstream will be responsible for acting as a source of expertise for other workstreams, particularly Governance and Quality, in defining the role that leadership will play in our future ways of working.
Clinical and professional leadership goes beyond individual leadership roles towards a culture and way of working for the system. Clear shared principles will be a powerful way to support our clinicians to work across organisational boundaries together for the benefit of our populations.
The Clinical and Professional Leadership workstream incorporates activities that will enable us to develop these areas over the transition. We will define our clinical priorities in collaboration with our people, the public and our wider system partners, prioritise them appropriately and deliver. These priorities will not be delivered in silo. The Clinical and Professional Leadership workstream will need to closely work across the other workstreams to bring clinical priorities that drive quality and address inequalities to the forefront.
Our areas of responsibility are: 1. Define a strategy and vision for clinical and professional leadership, with a joint focus on driving quality and addressing inequality 2. Agree on evidence-based clinical priorities and deliver these throughout the transition 3. Ensure that there is appropriate clinical and professional leadership representation at system and at place to establish a clinically-driven system. 4. Work with clinicians from across the system to define and implement a culture of clinical system leadership.
29 Strategic commissioning An overview of the responsibilities and areas of focus of the workstream
Our system vision is to enable people to start well, live well and age well and to put people at the heart of what we do. As we design our future system, it is crucial that our approach is based on the needs of our population and drives the outcomes that we have committed to.
The Strategic Commissioning workstream spans a number of areas. Our focus over the next year will be identifying the priorities and outcomes that we want to see across system, Place, ICPs, neighbourhoods and with constituent organisations. We will also focus on embedding population health management which will support us in achieving our vision for improving population health and addressing inequalities. This will underpin how we plan and deliver services and allocate resources, and therefore should be embedded at every level of our system across both health and social care.
Whilst this workstream is responsible for owning the design, none of this can or will be done independently or in isolation. This will be a whole system effort and will be tested iteratively. Designing and embedding the new approach to strategic commissioning will take longer than this year of transition, but it is vital that we create a foundation on which we can improve our commissioning of services to better meet the needs of our population. This workstream is not responsible for Place development, but will work particularly closely with the developing places as many of the features outlined in this milestone plan will be designed and delivered at place.
Key responsibilities: ● Setting a system integrated strategic commissioning strategy: This workstream will be responsible for coordinating discussions between system partners to agree an overall approach to commissioning. ● Supporting the development of ICPs: Place will become the primary vehicle for planning and delivering the majority of care delivery and transformation. This workstream will help ICPs to establish clear boundaries and will work with them to set expectations and outcomes for them to deliver. ● Setting an outcomes strategy and framework: This will involve being explicit around what outcomes we want to achieve as a system and at Place, and creating a framework to ensure a consistent flow between each level of the system while allowing for local determination. ● Embedding of PHM capabilities: We have set a population health management strategy cutting across infrastructure, intelligence and interventions and will begin to deliver on a number of these priorities over the next year.
30 Workstream Overview - This provides an overview of the key milestones for each quarter ahead of April 2022
Workstream Purpose Objectives Quarter 1 - 2021/22 Quarter 2 - 2021/22 Quarter 3 - 2021/22 Quarter 4 - 2021/22
Governance and Develop appropriate • Confirm governance • Rev iew existing • Test and conf irm key • Support ICS Board in • Apply lessons learned governance arrangements gov ernance arrangements gov ernance meetings, setting up sub-committees f rom shadow form ahead Decision-Making arrangements and of April 2022 arrangements that • Make arrangements for • Agree the process for • Set up processes for recruiting the ICS Chair reporting lines reporting perf ormance to • Finalise governance support collaborative system wide decision- making and Chief Executive • Agree with NHSEI the the ICS Board handbook Lead: Anita decision making and • Define the remit and • Def ine the process for additional roles required • Establish the process to • Finalise MoU and submit establish clear lines Wilson authority of leadership due diligence and remit and authority of identif y and escalate risks ICS NHS Body of reporting at system, place and these • Def ine the remit and Constitution for approval neighbourhood • Confirm to NHSEI the authority of leadership at • All due diligence complete • Set up processes for composition of the ICS sy stem, place and due diligence Board neighbourhood lev els • Draf t MoU arrangements • Discharge system roles f or 2022/23 • Shadow f orm ICS go live
Quality Monitor performance • Establish Quality • Def ine quality • Def ine processes and • Ensure new roles • Ensure new roles and quality across Oversight groups arrangements and best gov ernance to identify and understand assurance understand assurance Assurance and practices with NHSEI escalate quality risks obligations obligations the ICS and work in • Develop processes to • Identify and appoint Place • Establish processes for • Embed quality • Identify system leadership Improvement collaboration with identify and manage quality risk Quality Leads system quality gov ernance at Place representatives dedicated system partners to • Develop, review and perf ormance reporting • Dev elop and embed to quality in Place improve service Lead: Jo update quality engage with partners quality improvement • Agree a shared Galloway pathways improvement priorities • Create OD plan f or dashboard understanding and vision • Support a culture of system quality • Share best practices for f or quality to rollout across quality and continuous • Establish feedback routes identif ying quality risks the sy stem improvement f rom patients across the system • Rev iew quality improv ement priorities
Finance and Complete due • Complete finance due • Agree goals and • Dev elop a ICS financial • Dev elop and implement • All due diligence complete diligence and diligence principles f or financial f ramework and approach the ICS assurance • Ensure that f inancial Activity ov ersight f ramework preparations required • Develop a system • Collective agreement of sy stems are ready for go • Begin f inance due system finances, funding • Dev elop risk sharing liv e for staff and property financial framework diligence gaps and opportunities agreements • Undertake efficiency Leads: Adrian to transfer by 1st • Collective agreement of system finances • Agree the prioritisation • Implement financial planning f or 2022/23 April 2022, ensuring Stokes and • Outline efficiency f ramework and define and arrangements at Place that there are Susan Rollason opportunities share ef ficiency • Support with the appropriate • Develop risk sharing programme opportunities appointment of ICS frameworks and arrangements f inancial leadership mechanisms in place • Improve collective financial risk management Workstream Overview - This provides an overview of the key milestones for each quarter ahead of April 2022
Workstream Purpose Objectives Quarter 1 - 2021/22 Quarter 2 - 2021/22 Quarter 3 - 2021/22 Quarter 4 - 2021/22
Digital and Facilitate the • Develop and embed • Determine digital • Digital Strategy and • Agreement on data, • Begin implementation of a effective collection system digital strategies requirements for the ICS Roadmap signed off intelligence and insight comprehensive shared Business sharing record and analysis of data • Deliver our • Create digital and data plans • Join up health and social • Ensure that digital and Intelligence to support system transformation priorities • Support with IT due care data data sy stems are in place level decision making • Facilitate data, intelligence and insight diligence • Establish a cross-system f or go liv e Lead: Danny sharing across the ICS • Set up a f orum f or PHM intelligence function Roberts and BI teams across places
People and Manage the • Agree with NHSEI the • Begin workf orce due • Recruit ICS Chair and • Recruit ICS Board, • Recruit additional ICS workforce transfer to job specifications and diligence Chief Executive including f inance, medical NHS Body senior roles Organisational and nursing directors the new ICS body, recruitment process • Identify terms and • Onboarding of new staff conditions of staff • Undertake staff Development including the • Recruit ICS NHS Body • Initiate the staff transfer leadership roles and employ ed in the CCG consultation and union process recruitment of ICS board positions engagement • Understand the legal • Create a staff Lead: Theresa board positions, • Complete workforce requirements for staff • Map job descriptions for dev elopment plan whilst continuing to due diligence transf er current posts to those of Nelson • Complete yearly review of progress system • Complete staff transfer the ICS • Agree with sy stem use of resources across people priorities and • Future proof the ICS partners how we will • Agree staff transfer the sy stem to identify instilling a workforce collaborate as employers process opportunities transparent and • Prov ide additional support • Agree the f uture people collaborative culture to teams where needed f unction
Communications Communicate and • Develop and agree the • Agree internal and • Dev elop a staff • Identify and transfer • Rev iew, finalise, and engage regularly with communications and external communications communications and duties that should be done embed sy stems narrative and Engagement and engagement engagement plan (e.g. set at an ICP/ place level by staff, wider system engagement approach for transition approach f or transition up staf f forums) upskilling teams partners, and the • Develop and • Dev elop an initial systems • Test and ref ine the • Dev elop an approach for Lead: Rose general public disseminate a narrativ e systems narrative VCS representation in through the transition Uwins compelling systems • Agree an initial f ramework • Agree resourcing f or sy stem governance narrative f or engagement engagement capability • Dev elop and implement • Develop an building the PHM engagement engagement systems • Begin the roll out of f ramework framework models of engagement • Upskill teams to improve • Roll out models of workstreams: ICP, VCS, engagement capability engagement PHM, and patient and with staf f, public and public engagement patients Workstream Overview - This provides an overview of the key milestones for each quarter ahead of April 2022
Workstream Purpose Objectives Quarter 1 - 2021/22 Quarter 2 - 2021/22 Quarter 3 - 2021/22 Quarter 4 - 2021/22
Estates and Establish plans to • Complete due diligence • Set up a Task and Finish • Establish a • Create a 5-y ear estates • Use the estates deliver efficient and and preparations for group to assess the scale comprehensive view of programme plan programme plan to inform Ways of Working of estates related financial under utilised space the 5 y ear capital plan effective fit for property transfers • Create plans to achieve a benef its from agile • Collate and rev iew each greater ef ficiency of the • Establish plans to achieve purpose estate that • Assess the potential scale of estates related working organisation’s current ICS estate a sizeable reduction in the Lead: Haq Khan enables the delivery financial benefits from • Identify potential buildings estates development ICS’ carbon f ootprint of services to agile working to be targeted f or release plans • Transf er properties from patients in line with • Create a 5-year • Set up a f orum with • Create an estates transfer the CCG to the ICS Body the system priorities programme plan representatives from IT, plan • Assess opportunities to whilst facilitating the People and Estates • Ensure that estates future ways of improve the utilisation f acilitates agreed ways of of available space working for staff working
Clinical and Embed clinical and • Develop a clinical and • Rev iew the involvement • Def ine the strategy and • Continue to deliver clinical • Continue to deliver clinical professional professional leadership of clinical and professional v ision for clinical and priorities priorities Professional leadership in current prof essional leadership leadership across the strategy • Agree sy stem behaviours • Rev iew clinical and gov ernance arrangements • Agree ev idence-bas ed and commitments for prof essional leadership at Leadership system and drive the • Define and deliver clinical priorities clinical priorities clinical and prof essional all gov ernance levels creation and • Embed clinical and • Deliv er initial clinical leadership • Continue to deliver embodiment of a Leads: Kiran professional leadership priorities (rest to complete • Deliv er system clinical system clinical and Patel and Sarah clinical leadership into system governance in Q3/Q4) and prof essional prof essional leadership and the quality culture within our • Embed clinical leadership leadership support and support and dev elopment Raistrick framework people into the sy stem dev elopment • Create a system gov ernance approach culture for clinical leadership • Plan sy stem clinical leadership dev elopment • Provide system clinical leadership support
Strategic Commissioning • Set a system integrated • Rev iew current • Dev elop a system • Conf irm regional • Agree Spec Comm services using commissioning strategy commissioning integrated commissioning arrangements for Spec transition plan Commissioning arrangements strategy and priority Comm transition outcome-based • Support the • Implement PHM • Def ine integrated programme • Draw learnings f rom programme, including a decision making in development of ICPs commissioning scope, • Dev elop a PHM NHSEI PHM support digital PHM tool Lead: Anna collaboration with • Define an outcomes framework and strategy principles and design programme of work programmes • Dev elop contractual local partners to Hargrave • Embed and improve approach • Identify and develop PHM • Roll out the outcomes arrangements with ICPs determine needs for population health • Lead sy stem agreement capabilities pilot • Agree the ref ined local populations management on the number and • Def ine the boundaries outcomes framework capabilities composition of ICPs and expectations of ICPs • Design and deploy whole • Care model design • Dev elop an outcomes person care models for at strategy and framework risk groups • Capacity planning How we will manage dependencies There are a number of dependencies that cut across the nine identified workstreams which will need to be closely managed
We will organise ourselves as we mean to operate in the future
The workstreams will need to collaborate to design on a number of different areas. For example, implementing population health management cuts across Strategic Commissioning, Digital and Business Intelligence, Governance and Decision Making, Quality and Improvement, and Clinical and Professional Leadership. Managing these dependencies will be significant so we have identified some overarching areas to provide oversight and coordinate development. Our key dependency areas are:
● Transformation - responsible for managing the workstreams, monitoring system development and leading our system transformation priorities. Lead: Rachael Danter. ● Assura nce - responsible for bringing workstreams together to ensure that we have a coordinated system approach to assurance and oversight. Lead: Alison Cartwright. ● Place development - each place will be responsible for its own development though we need to ensure that this happens in a integrated way and in alignment with system design of our workstreams. Lead: Place Directors (tbc). ● Provider collaborative development - our approach for provider collaboration needs to be set to deliver the system outcomes that we are seeking to achieve, there are some key milestones that need to be achieved before April 2022. Lead: Glen Burley.
These areas will help to coordinate our transition, but are also central to our future governance and operation.
The System Strategy and Planning Group will be an additional point of reference for the coordination of our transition by our transformation and assurance leads by acting as the Design Authority Group for the transition. Principally this group can help set the strategic direction and provide decision-making capabilities for prioritisation activities.
34 Workstream Dependencies - This provides an overview of the key milestones to manage these dependencies for each quarter ahead of April 2022
Dependency Purpose Objectives Quarter 1 - 2021/22 Quarter 2 - 2021/22 Quarter 3 - 2021/22 Quarter 4 - 2021/22
• Create the programme • Complete due diligence • Launch the ICS in • Finalise the transfer Transformation To manage the • Manage the structure detailed planning shadow f orm w orkstreams, workstreams • Plan transf ormation • Finalise the transition plan • Coordinate the MoUs with • Agree the ICS NHS Body priority programmes for • Monitor sy stem monitor system Place MoU with the region 2022/23 Lead: Rachael dev elopment • Finalise the System development and Dev elopment plan • Finalise transformation • Act as a coordinating • Act as a coordinating Danter • Lead on sy stem priority programmes and point f or guidance point f or guidance lead our system transf ormation • Act as a coordinating gov ernance structures transformation priorities point f or guidance • Act as a coordinating priorities • Coordinate MoUs at point f or guidance sy stem and place
• Agree interim ov ersight • Create consolidated • Support place leads to Assurance To ensure that w e • Dev elop an arrangements reporting f or all system implement performance have a coordinated assurance framework • Ensure that executive f orums reporting • Ov ersee the overall system approach leads and Place • Agree with ICPs the • Finalise and approve the Lead: Alison perf ormance of the to assurance and arrangements are in place terms of reference and assurance framework Cartwright system • Co-design the maturity how they will engage on oversight • Agree with place matrix with Place leads assurance leads how they will • Dev elop a draft engage on assurance • Dev elop a single risk management policy and assurance framework approach f or the ICS
• Ensure Place Directors • Dev elop a MoU with • Agree indicative Place Place To ensure that the • Create the are in place system budgets f or 2022/23 development of gov ernance structures and arrangements for • Agree the v irtual teams • Jointly agree place plans • Agree the reporting and each place Lead: Place operating at place supporting place • Co-design place ov ersight for key forums happens in an Directors (TBC) • Agree place plans • Ref ine the Place vision dev elopment with VCS, and priorities serv ice users and PCNs integrated w ay and • Co-design on aligns w ith system priorities with VCS, • Draf t Place plans • Assess capabilities at design serv ice users and • Create engagement place and identify gaps PCNs f rameworks
• Assess existing • Agree touchpoints and • Prov ider Collaboratives Provider To establish • Establish Provider collaborations reporting lines f or PCs in are established and are Collaboratives across Collaboratives Provider sy stem and place beginning to deliv er the sy stem • Agree the number, Collaboratives in composition of PCs in the gov ernance (PCs) • Agree the system • Agree delegated authority order to deliver the gov ernance system outcomes arrangements for PCs • Agree the v ision and • Agree the process for Lead: Glen purpose of PCs additional approvals and that w e are • Dev elop a workplan Burley • Undertake priority setting sign of f seeking to achieve f or PCs and dev elop a workplan f or PCs Transformation focus and responsibility Our system is undergoing a dramatic transformation of how we operate and this is being done alongside our delivery of ambitious priorities and recovery
We already have programmes of work for system transformation priorities underway and recovery activities in planned care remain a priority. Our transformation programmes align with our Long Term Plan commitments, agreed financial savings and the system priorities outlined in our System Development Plan.
Though we have broad ambitions as a system we also want to remain focused. In order to meet our priorities we need to be able to provide the appropriate effort, resourcing and funding. We will need to continue to prioritise as a system.
Every workstream is focused on transformation and it will be important that we can work together and learn from each other through this process. The transformation lead will act as a central coordination point, providing structure, advice and guidance. As we continue to develop as a system, the transformation lead will support each workstream to make sure that we are designing a coherent system which reflects our ambitions and is aligned with guidance and legislation as it is released.
The transformation lead is responsible for: • coordinating the delivery of workstreams and ensuring that they align to the system priorities and are working to time and managing risks; • working with system partners to remove obstacles to delivery; and • keeping NHSEI updated on our progress.
36 Transformation: coordinating due diligence The transformation lead supported by the PMO is responsible for coordinating due diligence activities in order to transition to a full ICS by April 2022
Why is due diligence essential for transition We have to complete due diligence in order to safely and properly transition to a full ICS status by April 2022. The due diligence activities that will be completed across the next year will ensure that the organisation can operate fully as an ICS and that the ICS is se t up for succe ss.
How we will mange due diligence All of the workstreams will have to complete due diligence activities in order for the organisation to transition to a full ICS. Therefore, each workstream has a milestone about completing due diligence on their workstream plan. The workstream leads are responsible for ensuring that their workstream has appropriate support and resource in order to complete these activities by the agreed deadlines. The due diligence activities that the workstreams must complete are connected. Many of the due diligence activities are dependent on the activities completed by another workstream, or require collaboration from more than one workstream to complete. Therefore the Transformation lead, supported by the PMO, will be responsible for coordinating the due diligence activities that sit within the workstreams and ensuring that these are completed ahead of the deadlines. The PMO has created a due diligence workstream plan, which contains the milestones and activities required for ICS transition due diligence across all of the transition workstreams. This plan was created based on guidance and discussions with the workstream leads and using the latest merger due diligence as an example. Over the next few weeks, the PMO will test and develop this plan with each of the workstream leads.
37 Assurance oversight As we develop as a system we will take increasing responsibility to oversee the quality of our services and our overall performance as a system.
Assurance goes beyond the responsibility of a single workstream as it incorporates governance, quality assurance, financial management and clinical performance. Accurate data and timely reporting will also be necessary to make sure that we have the information we need. We are planning to operate in shadow form as an ICS from Quarter 3. This will mean that we will increasingly take on assurance accountability as a system and begin our reporting and new relationship with NHSE/I. Our approach to assurance will reflect the oversight framework and will be developed in partnership with the region, with system partners and at Place. Assurance will only be reliable if every part of our system can work together and we can have a coordinated approach to reporting and oversight. The assurance lead is responsible for: • aligning workstreams around a consistent vision for assurance (particularly Governance, Quality, Finance); • taking responsibility for liaising with system partners to agree a single approach to assurance; and • supporting codesign with NHSEI partners.
38 Developing at Place We have made a commitment that most activity should be happening at place and therefore place will be the key component of our system development
Our Places are already well underway with development. Our Places will rightly look different to each other and have priorities s uited to their populations’ needs. The purpose of this dependency is not to mandate structures but instead to create consistent points of interaction and make sure that the system is creating the environment for Places to succeed.
In terms of milestones we will be asking our Places to make sure that they have the leadership and team capacity around them in order to start delivering priorities and preparing us to operate in shadow form from Quarter 3. In this year this will likely be through virtual teams who remain employed by their organisations but will work in new ways.
We will work at Place where we want to reach the wider determinants of health going much broader than just health and social care services. It is the collaboration and interaction between organisations around our priorities that will help to drive outcomes. This is why we have prioritised engagement with different stakeholders as key milestones for development this year.
By focusing on these components we believe that this will help us to lay a strong foundation at Place on which we can continue our system development in coming years.
Key activities ahead of April 2022: ● Continuing to expand the teams required to operate at Place with identified CCG staff being allocated; ● Formalising the roles and responsibilities between Place and system through an MOU; and ● Deepening and formalising engagement between organisations, with service users and with VCS.
39 Establishing Provider Collaboratives Our Provider Collaboratives will be the engines driving service change and supporting our recovery as a system
Our provider organisations have long worked together to address shared challenges, particularly during our ongoing response to COVID-19. The move to more formal PCs within our ICS structure will help us to build on this progress and work in partnership with each other. We will be expected to form PCs who will agree and deliver plans to achieve service recovery and restoration and to transform services to make sure that they are sustainable and meet the needs of our population.
Our PCs will be responsible for service transformation across wider clinical services. They will be able to set priorities of focus and lead clinical design. This will need to be done in close partnership with the Clinical Forum and reflect the emerging clinical strategy.
Recovery and restoration will continue to be a priority focus, and we believe that this will be best led by PCs working together to address these challenges. Our first priority will be to agree the form and composition of our existing and new PCs. It is likely that our organisations will be a member of more than one collaborative and continue to work on different footprints. This will make it important that we design our PCs in the context of the wider system.
Key activities ahead of April 2022: ● Agree form and purpose of existing and new PCs, e.g. system PC, acute PC, MH and LD PCs, LA collaborations; ● Review existing PCs and update as necessarily in line with new national guidance; ● Form any new PCs and agree priority areas of focus; ● Establish how PCs will operate within the system; and ● Agree delegated authority to support PCs to begin delivering.
40 Workstream Leads The workstream leads are integral to this transition as they will drive the delivery of milestones and work together to design the future ICS.
Delivery of milestones Reporting progress The workstream leads are accountable for making The workstream leads are responsible for sure that the milestones (outlined in the deep reporting the progress of their workstream, dive pack) are met by the required deadline. The and any issues, risks or barriers to success to workstream leads should ensure that their team the PMO lead, at the monthly ICS transition have sufficient capacity and workstream leads forum and any capability in order to achieve this. other forums required.
Workstream Lead Responsibilities Co-design our future ICS Test work in progress The workstream leads should work The workstream leads area together to design our future ICS. responsible for testing work in To achieve this, workstream leads should identify progress with relevant stakeholders, including areas of collaboration across workstreams at the the workstream leads, system partners, and ICS monthly ICS transition workstream leads forum and staff, and then adapting it to ensure that the work collaborate to design and deliver these. completed meets expectations.
41 Programme Management Office The PMO is the central point of contact for the ICS transition, and is responsible for coordinating the workstreams to ensure a successful transition
Overview of PMO responsibilities Criteria for success
The PMO is the central point of contact for the ICS The PMO recognises some key criteria for success: transition. The PMO is responsible for monitoring ● Regular open and transparent progress of each of the workstreams, and reporting communication and engagement with the overall progress of the transition to Rachael Danter Rachael Danter (Transformation Lead), Alison and Alison Cartwright, in addition to relevant boards Cartwright (Assurance Lead) and relevant and groups. boards and groups ● Consistent monitoring and reporting of the The PMO lead should become a trusted advisor to the overall transition progress workstreams, providing guidance and tactical ● Relationship built with the workstream leads support and helping them to identify, mitigate and so that concerns are shared and resolved escalate risks and remove barriers to progress. The quickly workstreams will need to work together to deliver key ● Identification, mitigation, and where appropriate, activities so the PMO lead is responsible for escalation of risks and issues identifying areas of collaboration and creating Frequent assessment of capacity and appropriate forums and groups to ensure that ● capability and subsequent capacity planning collaboration can take place. and capability building Additionally, the PMO lead needs to regularly assess ● Provision of strategic guidance, tactical and address whether the workstreams have the support, collaboration opportunities, and appropriate capacity and capability required to resource required to plan, design, test, and deliver activities. execute key activities
42 Programme Management Office The PMO will be critical in monitoring progress, identifying and resolving blockers, facilitating collaboration, and coordinating due diligence activities
Act as a point of liaison Monitor progress and remove barriers
The PMO will liaise with the workstream Monitor progress The PMO will monitor progress across the leads and key groups, such as the workstreams, identify and escalate risks and and remove System Strategy and Planning issues, and remove barriers to progress. barriers Group, to ensure that This will include ensuring that there is all relevant individuals and capacity and capability across groups are kept informed and Act as a workstreams to deliver activities. involved with the transition. point of Facilitate liaison collaboration Facilitate collaboration Facilitate organisational learning and development The PMO is responsible for establishing appropriate forums Integrated The PMO will support PMO for people to collaborate on key LVC Training Hub learning by facilitating the Responsibilities priorities, discuss shared issues and sharing of best practices, concerns, and discuss and test disseminating guidance, and Provide thinking on elements of the transition. identifying and addressing Facilitate guidance opportunities for improvement.organisational Provide guidance and support learning and support The PMO will provide strategic Coordinate due diligence for direction and guidance to the workstreams, in addition to providing transfer Coordinate due support and appropriate resource for the The PMO will support the Transformation diligence workstreams to plan, design, test and execute workstream to coordinate the due diligence key activities. activities that sit with the workstreams and ensure that these are completed by the deadlines.
43 NHS Coventry and Warwickshire Clinical Commissioning Group Enc J
Report To: Governing Body
Report Title: CCG Annual Assessment 2020/21 Performance
Report From: Anita Wilson, Associate Director of Governance and Corporate Affairs
Author: Victoria Scholes, Governance and Corporate Affairs Officer
Date: 21 July 2021
Previously Considered by: N/A
Action Required (delete as appropriate)
Decision: Assurance: ✓ Information: Confidential
Purpose of the Report: To present the letter received from NHS England/Improvement (NHSE/I) regarding the assessment of the predecessor CCGs against the CCG Annual Assurance criteria for 2020/21.
Key Points: • NHS England is legally required to review CCGs’ performance on an annual basis. • A simplified approach was utilised for 2020/21 therefore no CCG was given an overall rating for 2020/21. • NHSE/I completed a review of the CCGs’ performance across five key priority areas. • The assessment also outlined areas of focus for 2021/22 across the five key priority areas. • The assessments and feedback recognised the positive contribution made by the CCGs during the last year in both the COVID response, the establishment and delivery of the vaccination programme, the successful merger as well as the strong restoration performance as an accelerator site.
Recommendation: The Governing Body are requested to NOTE the assessment of the predecessor CCGs against the CCG Annual Assurance criteria for 2020/21.
Implications
Objective(s) / Plans 1. Creating Value supported by this 2. Building capacity report: 3. Developing at Place Conflicts of Interest: N/A Non-Recurrent Expenditure: N/A Recurrent Expenditure: N/A Financial: Is this expenditure included within the CCG’s Financial Yes ✓ No ✓ N/A ✓ Plan? (Delete as appropriate) Performance: Performance information outlined within the assurance letter. Quality and Safety: Quality and safety information outlined within the assurance letter.
Page 1 of 2 NHS Coventry and Warwickshire Clinical Commissioning Group Enc J
General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any decision that is finalised without being influenced by appropriate due regard could Equality and Diversity: be deemed unlawful. Has an equality impact assessment been Yes ✓ No ✓ N/A ✓ undertaken? (Delete as (attached) appropriate) Patient and Public Patient and public engagement information outlined within the assurance letter. Engagement: Clinical Engagement: Clinical engagement information outlined within the assurance letter. Risk and Assurance: N/A
Page 2 of 2
Julie Grant Director of Strategic Transformation, West Midlands
St Chad’s Court 213 Hagley Road Birmingham B16 9RG
T: 0300 123 2620 E: [email protected] W: www.england.nhs.uk and www.improvement.nhs.uk Phil Johns Accountable Officer NHS Coventry and Warwickshire CCG
Sent via Email 25 June 2021
Dear Phil CCG Annual Assessment 2020-21 Performance I write to you in connection to the CCG Annual assessment for 2020-21. As you are aware NHS England is legally required to review CCGs’ performance on an annual basis. Historically, this has been carried out under the auspices of the CCG Improvement and Assessment Framework and, more recently, the NHS Oversight Framework, with the overall assessment ratings based on a CQC-style four label categorisation. The 2020-21 process was a simplified approach, taking account of the different circumstances and challenges CCGs have faced in managing recovery across the phases of the NHS response to Covid-19. Due to the impact of Covid-19, it was not possible to apply the established arithmetic methodology and therefore no CCG will be given an overall CCG rating for 2020/21. As part of the simplified process CCGs have completed a self-assessment against fourteen National determined Key Lines of Enquiry. NHS England and NHS Improvement has completed a review of the CCGs’ performance across five key priority areas and where possible have incorporated feedback from your local Health and Wellbeing Board. The assessments and feedback, including that from Cllr Caborn, the outgoing Chair of the Warwickshire Health and Wellbeing Board, recognised the positive contribution that has been made by the CCGs during the last year in both the COVID response, the establishment and delivery of the vaccination programme the successful merger as well as the strong restoration performance as an accelerator site. 1. Improve the quality of services The CCGs demonstrated the development and delivery of an effective and agile command and control system, providing leadership to a range of multi-agency meetings. We would like to commend the CCG for their leadership within the vaccination response and with the engagement and support to the care home sector. We also recognise the important contribution CCG colleagues have made in their involvement in IPC, testing as well as 1 support discharge and safeguarding and the establishment of a successful home oximetry service.
The CCGs demonstrated good system engagement within the System Quality Oversight Group and with the local Healthwatch as well as the use of technology to support the oversight of quality risks during the pandemic. We would encourage you to build on this in order to achieve a sustained impact. The quality team should be commended for having been shortlisted for both the HSJ patient safety awards and value awards for the geographical hosting policy.
2. Reduce health inequalities The CCGs made an active contribution to the system discussions associated with improving health outcomes and reducing inequalities, as highlighted by Cllr Caborn. There is also strong leadership for inequalities which is overseen at a strategic level by the Coventry and Warwickshire Joint Place Forum.
It has also been encouraging to see the Coventry and Warwickshire Population Health Management Strategy and the CCG mental health commissioners supporting the development of a mental health thematic JSNA. The CCGs delivered improvements in a number of areas, including a renewed focus on learning disability annual health checks, with a significant increase from 39% in 19/20 to 71.3% in 20/21. The IPS service is also working well and you are making good progress in understanding the needs of your population at a local level.
The response provides evidence regarding the actions taken to look after the most vulnerable, with a focus on safeguarding issues. Excellent examples have been cited on how the CCGs have reached out to the diverse local population, such as the local Roma community.
3. Involve and consult the public The CCGs highlighted your strategy to identify the specified audiences using demographic data and work with the community and voluntary sector to engage with them effectively, including good engagement with the local Healthwatch. Some excellent examples are given including reaching out via faith centres, food banks and the use of community champions. There is evidence of good progress being made in commissioning pieces of work to understand the needs of the population and in co-production.
4. Comply with financial duties The year-end deficit position for South Warwickshire CCG was expected and the planned deficit was slightly ahead of the plan at year end due to some support from the other CCGs in the system. We recognise that the deficit is historic and relates to two main areas of spend, firstly the contract with the local acute provider, South Warwickshire NHS Foundation Trust, and secondly the CCG’s Continuing Healthcare budget.
All CCGs achieved the Mental Health Investment Standard and remained within the running cost allocation for 2020/21
2
5. Leadership and Governance The CCGs demonstrated excellent engagement and communication throughout the merger process, recognising the opportunities that a single merged healthcare commissioning organisation across Coventry & Warwickshire is the best way to deliver the goals of the NHS Long Term Plan and improve the health and wellbeing of their population. The CCG have also demonstrated the evidence of actions they have taken to support their staff.
The three CCGs came together to jointly write the CCG Strategy ‘Towards Strategic Commissioning’, which makes clear the commitment to developing their capacity and capability in relation to Population Health Management (‘PHM’). This commitment has underpinned the development of the Coventry and Warwickshire Population Health Management Strategy which sets out the benefits that you expect to see as this is embedded and you work to build PHM capacity and capability at all levels of the system including strategic commissioner and Place.
Areas of focus for 2021-22 Improve the quality of services, the CCG will need to:
• Work effectively with all system partners in your collective response as an accelerator site to the inclusive restoration of services, ensuring that consideration is given to harm reviews associated with delays in care, particularly in relation to CVD and cancer. • Work collaboratively with system partners to develop the ICS response to supporting children and young people in crisis and in improving performance in the delivery of physical health checks for individuals with Serious Mental Illnesses (SMI). Continue to build upon the improvement in your LD annual health checks. • ensure there is appropriate oversight and governance of quality and patient safety issues and embed joint ownership/responsibility for risks along with the clear identification of areas for improvement in the next stage of your journey to becoming an ICS. • continue to work with partners in the delivery of the system Quality Strategy and the agreed System Quality Priorities, as well as the Coventry and Warwickshire Population Health Management Strategy. • Ensure that appropriate and timely discharge arrangements are maintained and ensuring they work effectively with partners in the development of the system urgent care strategy and in winter planning, such as the use of virtual wards.
Reduce health inequalities
• It will be important for the CCG to understand the lessons learnt from the impact of the pandemic on health inequalities and specific actions they have taken as a result. Emphasis should be given to ensure that lessons learned are understood and the impact of interventions can be demonstrated i.e. addressing health inequalities post-covid and supporting staff well-being, ensuring that the needs of culturally diverse groups are met.
3
Involve and consult the public
• It is advised that the CCG continue their positive work, being clear on the areas to develop and improve, such as the ongoing work with Children and Young People. • You will need to ensure that your engagement/consultation is undertaken as appropriate in relation to any service changes, including the relocation of services and that the services are restored inclusively and populations are not disadvantaged such as through digital exclusion.
Comply with financial duties
• The CCG must ensure that you continue to comply with the financial duties and investment standards
Leadership and Governance
• Whilst the CCG has undertaken positive steps to support the workforce, you should ensure that the needs of culturally diverse groups are met. The CCG should also consider opportunities to improve diversity in the workforce as well as your role as an anchor institution in reducing poverty across local communities including offering apprenticeships and internships as a wider system. • As the ICS continues to develop the CCG should ensure there is effective clinical leadership and engagement within the ICS transition, with clearly identified areas for development. The CCG will also need to ensure that senior / executive leadership structures are established and embedded to provide appropriate oversight and governance.
Overall, thank you for your continued support and the completion of the CCG Self- assessment proformas. In line with previous years please could you feedback to your Governing Body the assessment of your predecessor CCGs against the CCG Annual Assurance criteria for 2020-21. If you have any queries regarding this letter, please do not hesitate to contact me.
Yours sincerely
Julie Grant Director of Strategic Transformation – West Midlands
Cc Dr S Raistrick, Chair of Coventry and Warwickshire CCG
4
NHS Coventry and Warwickshire Clinical Commissioning Group Enc K
Report To: Governing Body
Report Title: Community Diagnostic Hubs – Year 1 (2021/22) Business Case
Report From: Adrian Stokes, Interim Chief Finance Officer
Author: Steve Snead, System Lead for Diagnostics, Coventry & Warwickshire Integrated Care System Date: 21 July 2021
Previously Considered by: Investment Panel, 14 July 2021
Action Required (delete as appropriate)
Decision: Assurance: Information: Confidential
Purpose of the Report: This case represents a bid for year one of a National bid to support an increase in diagnostic provision. It is expected that future years will be part of subsequent bids and business cases. It also covers the potential costs should future years allocations do not materialise.
Key Points: • As a System, we have identified and support the need for three community diagnostic hubs (CDHs). • All three hubs will offer a range of diagnostic services that have been designed so that collectively there are shared benefits for our System, whilst prioritising local access and ensuring the whole system has sufficient capacity to meet demand. • The CDHs will increase community diagnostic capacity allowing acute diagnostics to focus on unplanned and emergency work. • The specific sites for investment are Nuneaton (Warwickshire North Place), Stratford (South Warwickshire Place) and Coventry (Coventry and Rugby Place). • The investment will be across three organisations: University Hospitals Coventry and Warwickshire NHS Trust (UHCW), South Warwickshire NHS Foundation Trust (SWFT) and George Eliot Hospital NHS Trust (GEH). • The cost in the current financial year will be £7.7m. • The costs in future financial years (including recurrent impact) will be: - Year 2: 1.6m; - Year 3: 0.4m; and - Year 4: 0.4m. • Benefits will include reduced delays for patients (faster diagnosis), increased diagnostic capacity and tests for heart and lung diseases to be increased and enhanced. • It is anticipated that there will be additional funding and bids in future years to support the full ambition but this is presented as a worst case scenario in terms of future costs. • The bid was considered by the Investment Panel on the 14 July. The Panel recommended that the case is approved, subject to assurance being received from providers that they would cover the year 2 costs through efficiency savings if national funding was withdrawn.
Page 1 of 2
NHS Coventry and Warwickshire Clinical Commissioning Group Enc K
Recommendation: Given that year 1 is fully funded, and that we will benefit from significant, needed, capacity expansion the recommendation is for the Governing Body to APPROVE the bid and recognise a potential future financial risk, which we would task provider colleagues with mitigating fully (either by prioritising future growth or cost reduction).
The CCG should also look to work closely with subsequent bids to ensure we get the right system wide coverage as part of the wider ambition.
Implications
Objective(s) / Plans 1. Creating Value supported by this 2. Building capacity report: 3. Developing at Place Conflicts of Interest: None identified. Cost Current Financial Year: £7.7m (Backed by income) Non-Recurrent Expenditure: Cost Future Financial Year (inc. Recurrent impact): Yr2 1.6m / Yr3 0.4m / Yr4 0.4m Financial: (maximum exposure) Recurrent Expenditure: As detailed above. Is this expenditure included within the CCG’s Financial Yes No N/A Plan? (Delete as appropriate) Benefits will include reduced delays for patients (faster diagnosis), increased Performance: diagnostic capacity and tests for heart and lung diseases to be increased and enhanced. Aims to improve population health outcomes, contribute to reducing health Quality and Safety: inequalities and deliver a better more personalised diagnostic experience. General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non-discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any decision that is finalised without being influenced by appropriate due regard could be deemed Equality and Diversity: unlawful. Has an equality impact assessment been Yes (To No N/A undertaken? (Delete as (attached) f o llow) appropriate) Patient and Public This case has had input across the region from a wide range of stakeholders. Engagement: Clinical Engagement: This case has had input across the region from a wide range of stakeholders. The top three risks are as follows: 1. If long term funding is reduced schemes may need to be scaled back impacting patient care and increasing the risk of harm 2. If the CDHs do not address equality and deprivation patients may be unfairly Risk and Assurance: impacted by lack of access to healthcare services and may result in patient harm. 3. If downstream services are not adequately funded (ie pathology) they may become a bottleneck resulting in longer turn around times which may cause patient harm.
Page 2 of 2
Short form plan for Investment Panel consideration This document should only be completed for new projects.
PROJECT/PROGRAM DETAILS Programme Name/Area Clinical Diagnostics
Project Name Community Diagnostic Hubs – Year 1 (21/22) Business Case
Senior Responsible Officer Dr Catherine Free (SRO)
Project Lead Steven Snead
Finance Lead Antony Hobbs
Clinical Lead Dr Neil Anderson
Proposed Start Date 1/10/21 Proposed Completion 31/3/22 (note this is a 5-year Date programme with a year 1 pump prime)
Year 1 Business case Available within Pack 2
PROJECT OVERVIEW (Max 100 words)
As a System, we have identified and support the need for three community diagnostic hubs, phasing our approach and services to each hub by planning to increase capacity where we need it most. All three hubs will offer a range of diagnostic services that not only meet the criteria for a community diagnostic hub; but each have been designed so that collectively there are shared benefits for our System, whilst prioritising local access and ensuring the whole system has sufficient capacity to meet demand. The CDHs will increase community diagnostic capacity allowing acute diagnostics to focus on unplanned and emergency work.
BENEFITS AND DIS-BENEFITS including quality/equality/inequalities (top 3)
BENEFITS DIS-BENEFITS
• Tests for emergency and elective diagnostics to • Expensive be separated reducing delays for patients (faster diagnosis)
• Diagnostic capacity to be significantly increased (i.e. CT scanning capacity to be doubled over the next five years to meet increasing demand and to match other developed countries)
• Tests for heart and lung diseases to be increased and enhanced given the link to coronavirus
QUALITY/ EQUALITY IMPACT ASSESSMENT – Available Yes/No or to follow Yes/No
To follow
FINANCIAL DELIVERY AND PROFILE
Cost Current Financial Year: £7.7m
Cost Future Financial Year (inc. Recurrent impact): Yr2 1.6m / Yr3 0.4m / Yr4 0.4m
Savings current Financial Year: Not calculated
Savings Future Financial Year: Not calculated
HIGH LEVEL IMPLEMENTATION PLAN/TIMETABLE (top 5 milestones)
1 | Page
RISKS (top 3)
1. If long term funding is reduced schemes may need to be scaled back impacting patient care and increasing the risk of harm
2. If the CDHs do not address equality and deprivation patients may be unfairly impacted by lack of access to healthcare services and may result in patient harm.
3. If downstream services are not adequately funded (ie pathology) they may become a bottleneck resulting in longer turn around times which may cause patient harm.
OTHER AREAS OF THE SYSTEM AFFECTED • Primary care referral pathways
• Acute diagnostic delivery
• Screening services
• Digital infrastructure
RESOURCES, TIME AND COST 2B. BREAKDOWN OF SCHEME CAPITAL COST (using OB Form headings)
2021/22 2021/22 2021/22 2021/22 2021/22 Total Q1 Q2 Q3 Q4 £’000
2 | Page
£’000 £’000 £’000 £’000
Land & Buildings 2,849 99 688 2,062
Equipment 671 268 403 Optimism bias - Planning contingency - Inflation Adjustment - VAT -
Total 3,520 - 367 1,091 2,062
1) £2.7m of the Land and Building costs relate to the creation of a 15 room Clinical diagnostics Hub in Nuneaton. Costs are based on tendered costs. 2) The remaining Land and building works related enabling works (including IT). 3) The equipment costs include: 2 Echocardiogram's, 2 Ultrasounds, 1 Mammogram and an ECG Machine. 2C. REVENUE COST FUNDING SOURCES
2021/22 FUNDING SOURCE 2022/23 2023/24 2024/25 TOTAL £’000 £’000 £’000 £’000
CDH funding 4,217 4,217
CCG funding* - - Other - Prioritised Allocation / Provider efficiencies - 1,610 445 441 2,496
Other -
Total 4,217 1,610 445 441 6,713
2D. BREAKDOWN OF SCHEME REVENUE COSTS
2021/22 2022/23 2023/24 2024/25 TOTAL £’000 £’000 £’000 £’000 £’000
E.g. Pay - - - 1,652 1,652
E.g. Non-Pay 2,565 1,376 214 213 4,368
E.g. Transport - - - - -
Depreciation - 109 109 109 327
PDC Dividends - 125 122 119 366 Cash releasing benefits -
Incremental impact on I&E surplus / deficit -
3 | Page
Total 4,217 1,610 445 441 6,713
1) All costs are based on 2021/22 prices. 2) Year 1 revenue costs are assumed to be 100% funded from additional CDH allocation. 3) Years 2 costs included £1.2m Independent sector contracts. The contracts relate to a mobile endoscopy unit and a mobile MRI. To secure the assets the system was required to enter into a contract term of a minimum of 12 months. 4) Year 3 to 4 costs reflect capital charges and maintenance costs only. 5) On-going costs beyond year 1 have been supported by the system and will be met from prioritised allocations or provider efficiencies. 6) Appendix 3a includes a breakdown of the years 1 and future years costs by organisation. 7) Appendix 3b provides an indicative assessment of the costs if the year 1 schemes continued into future years. These costs are included to provide an indicative FYE. These will be considered by the system CDH board as part of the year 2-5 business case
Appendix 3a
2021/22 2022/23 2023/24 2024/25 TOTAL Expenditure Expenditure £'000 £'000 £’000 £’000 £'000
UHCW Capital 140 0 0 0 140 Independent sector Revenue 1,690 700 0 0 2,390 NHS Rev 687 34 60 60 841 UHCW 2,517 734 60 60 3,371 GEH Cap 2,750 0 0 0 2,750 NHS Rev 648 375 372 369 1,763 GEH 3,398 375 372 369 4,513 SWFT Cap 630 0 0 0 630 IS Rev 488 488 0 0 976 NHS Rev 703 13 13 13 742 SWFT 1,821 501 13 13 2,348 Grand Total 7,737 1,610 445 441 10,233
Appendix 3b - Indicative costs if year 1 scheme continue into 2022/23 (full year effect) 2021/22 2022/23 2023/24 2024/25 TOTAL Expenditure Expenditure £'000 £'000 £’000 £’000 £'000
UHCW Capital 140 0 0 0 140 Independent sector Revenue 1,690 2,141 0 0 3,831
NHS Rev 687 2,432 3,958 3,958 11,035
UHCW 2,517 4,573 3,958 3,958 15,006
GEH Capital 2,750 0 0 0 2,750 4 | Page
NHS Rev 648 1,224 1,221 1,218 4,311 GEH 3,398 1,224 1,221 1,218 7,061
SWFT Capital 630 0 0 0 630 Independent sector Revenue 488 488 0 0 976
NHS Rev 703 1,339 1,351 1,365 4,758
SWFT 1,821 1,827 1,351 1,365 6,364 Grand Total 7,737 7,623 6,530 6,541 28,431
Note:
1. Year 1 funding is verbally confirmed by NHSEI – business case submitted 2. Years 2-5 pending/to be agreed across the system by end August 21
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Enclosure L CWCCG Clinical Quality and Governance Committee Report for the Main Meeting held on 27th May 2021
Achievements/Decisions Made/Items to Note Freedom of Information Quarter 4 Report – The Committee noted the Freedom of Information Quarter 4 Risk Register - The Committee received the report. Corporate Risk Register noting the mitigations in place and was assured that adequate actions are Legal Cases Quarter 4 Report - The Committee was being taken by risk owners to mitigate the risks and assured of the Legal Cases quarter 4 report. that the assurances provided are satisfactory. The Committee noted the level of risks for some risks on Communication update on CCG's approach to thelllllllllllllllll register that will continue to have a focus for Patient and Public Involvement – The Committee was Committee members. assured that the communications and engagement team are meeting the statutory obligations for patient and Domestic Abuse Bill – The Committee noted a public involvement, as set out in section 14z2 of the briefing paper following Royal Assent received for the NHS Act 2006, as amended by the Health and Social Domestic Abuse Bill on 29th April 2021. Care Act 2012 and noted the update on the work in response. Transforming Care Report - The Committee received an update on the Transforming Care 2020/21 Quarter 4 HR Report for Coventry & Rugby programme and noted the performance and the CCG (Including the Gender Pay Gap Report for the national ranking at the end of 2020/21 together with CCG 2020/21), 2020/21 Quarter 4 HR Report for the positive performance in relation to the reduction in Warwickshire North CCG and 2020/21 Quarter 4 HR Learning Disability admissions. The Committee noted Report for South Warwickshire CCG - The Committee the submission of the 3-year plan, and the was assured of the Q4 reports and approved the Gender resubmission of planned trajectories together with the Pay Gap report once the required amendments had Local Government Association peer review, strategic been made. summit and planned system summit as methods of reviewing the structures, processes and vision. Complaints, Compliments, Concerns and Enquiries Quarter 4 Report – The Committee was assured of the Continuing Healthcare Report - The Committee contents of the Complaints, Compliments, Concerns and noted the Continuing Healthcare report and the action Enquiries Quarter 4 Report. taken to mitigate risks. Complex Case Panel Terms of Reference – The Referral Support Service Assurance report – The Committee reviewed and endorsed the Complex Case Committee noted the contents of the Referral Support panel terms of reference. Service assurance report. Clinical Quality and Governance Legacy handover - Prescription Ordering Direct report - The The Committee approved the Clinical Quality and Committee noted the contents of the Prescription Governance Legacy handover document. Ordering Direct report.
Learning Disabilities Mortality Review Policy –
The Committee noted the change of policy and Matters to be reported to the Governing Body process following the new Learning Disabilities Mortality Review Policy published in March 2021. • Increase in Safeguarding activity.
• The level of some of the risks on the Corporate Risk Special Educational Needs and Disability (SEND) Designated Clinical Officer Update against SEND Register. Code of Practice Compliance - The Committee • A Warwickshire SEND inspection may be announced noted the CCG compliance against the SEND Code in July 2021. of Practice. The Committee noted a Warwickshire SEND inspection may be announced in July 2021. The Committee noted the current SEND challenges across Warwickshire. Matters referred to the Governing Body for Approval
Infection Prevention and Control Q4 Update – The None. Committee noted the contents of the Infection Prevention and Control Q4 Update.
Information Governance Quarter 4 Report - The Committee noted the Information Governance quarter
4 report and confirmed their assurance of compliance Key Information with Information Governance requirements. • Committee Chair: Zubair Khan • Committee Executive Lead: Jo Galloway
• Date of Next Meeting: 24th June 2021 (Main) Page 1 of 2
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Enclosure M CWCCG Clinical Quality and Governance Committee Report for the Main Meeting held on 24th June 2021
Achievements/Decisions Made/Items to Note Medicines Management report – The Committee noted the Medicines Management report. Risk Register - The Committee received the Corporate Risk Register noting the mitigations in place and was Learning Disability Mortality Review (LeDeR) Programme - assured that adequate actions are being taken by risk Annual Report 2020-2021 – The Committee endorsed the owners to mitigate the risks and that the assurances provided are satisfactory. LeDeR Annual Report for approval and publication on the CCG website by 30th June 2021 in line with timescales set by NHS Safeguarding Assurance Report – The Committee England subject to approval by the Chair of the Governing receivedlllllllllllllllll an update and noted the safeguarding assurance Body. report, specifically the increase in safeguarding activity and was assured that proportionate actions are in place to Update on actions from the Learning Review – The address issues identified and mitigate identified areas of Committee was assured that the recommendations of the risk. Learning Event have been appropriately acted on and agreed the timeframes for future updates to be brought to the Coventry Looked After Children Assurance report – The committee. Committee noted the Coventry Looked After children assurance report and the challenges around access to dentistry and the increase in numbers of children coming Quality Accounts – CWPT – The Committee scrutinised and into care. was assured of the contents of the report.
Integrated Provider Quality Report Annual Complaints, Concerns and Enquiries Report 2020/21 – The Committee was assured of the Annual
CWPT have four concerns on level two of the Quality Complaints, Concerns and Enquiries Report 2020-21. Assurance Framework (QAF). Major Incident Plan - The Committee received the Plan for GEH have one concern on level two of the QAF. continuation and was assured and acknowledged the authority assigned to the CCG Accountable Emergency Officer in UHCW have one concern on level three and three concerns implementing Major Incident response arrangements within the on level two of the QAF. plan.
SWFT work is progressing jointly with SWFT to look at Business Continuity Plan/Policy – The Committee received using the Quality Assurance Framework for future the Plan and was assured and acknowledged the authority integrated quality reports. assigned to the CCG Accountable Emergency Officer in implementing Business Continuity arrangements within the The Committee scrutinised and was assured of the content plan subject to a further review to factor in learning from the of the report and noted the areas identified for pandemic and reviewing the new ways of working. improvement.
CAPT Review findings – The Committee received a verbal update on the Continuing Healthcare Review that has taken Matters to be reported to the Governing Body place and noted the final report will be presented to the August meeting. • An Increase in Safeguarding activity In-house services Quality report • Corporate Risk Register to be a continued focus for CQG members Clinical Assessment and Placement Team have two • Children in Crisis Themed session planned for the July concerns on level two and three concerns on level three of the QAF. CQG meeting • Major Incident Plan and Business Continuity Plan/ Policy Prescription Ordering Direct has no current risks rated at subject to a further review to ensure learning from the Level 2 or above. pandemic is included and it is fit for purpose. • The CCG statements for the Quality Accounts 20/21 for Referral Support Services has no current risks rated at Level 2 or above. UHCW, GEH, SWFT and Mary Ann Evans Hospice have been approved. The Committee scrutinised and was assured of the content of the report and noted the areas identified for improvement. Matters referred to the Governing Body for Approval Children Young People Update – The Committee noted the Children in Crisis position across the Coventry and • Learning Disability Mortality Review (LeDeR) Programme - Warwickshire system and endorsed the actions taken and Annual Report 2020-2021 those planned to address the current challenges and to establish a fit for purpose response for the future.
Joint All Age Autism Strategy Update - The Committee noted the position statement on the Autism Strategy and noted that the Strategy will be taken through formal Key Information governance alongside the 3-year plan. • Committee Chair: Zubair Khan • Committee Executive Lead: Jo Galloway • Date of Next Meeting: 29 July 2021 (Themed) Page 1 of 2
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Report To: Governing Body
Report Title: Nursing and Quality Report
Report From: Jamie Soden, Director of Nursing and Clinical Transformation Rebecca Bartholomew, Director of Nursing and Quality
Author: Jamie Soden, Director of Nursing and Clinical Transformation Rebecca Bartholomew, Director of Nursing and Quality
Date: 21 July 2021
Previously Considered by: Clinical Quality and Governance Committee, 24 June 2021
Action Required
Decision: Assurance: Information: Confidential
Purpose of the Report: The Nursing and Quality Report provides information and assurance regarding current nursing and quality issues. The report includes an overview of concerns that are on the CCGs’ Quality Assurance Framework (QAF). An overview of the Quality Assurance Framework (QAF) and escalation levels is included as Appendix one.
Key Points: Current Nursing and Quality Issues:
Learning Disabilities Mortality Review (LeDeR) Annual Report 2020/21 The Coventry and Warwickshire Clinical Groups (CWCCG) Learning Disability Mortality Review (LeDeR) Programme annual report was received and approved at the June 2021 Clinical Quality Governance Committee (CQGC). The annual report has been uploaded to the CWCCG website in line with national guidance.
Safeguarding There has been a seasonal increase in safeguarding referrals in line with the end of the school year. This is impacting on the Multi-agency Safeguarding Hubs (MASH), as well as a rise in demand for providers.
NHS Continuing Healthcare The CCG has commissioned an independent review of its NHS Continuing Healthcare and Section 117 service. A first draft report has been returned with a second draft report expected during the week beginning 5th July.
Local Maternity and Neonatal System (LMNS) The LMNS board met on 14 June 2021. Natasha Lloyd-Lucas, Senior Commissioning Manager for Children and Maternity has commenced in post to support implementation of the Ockenden review recommendations. It was agreed that an update on progress will be made at the August 2021 Clinical Quality and Governance Committee.
System Quality The National Quality Board Position Statement: Position Statement: Managing Risks and Improving Quality through Integrated Care published April 2021 emphasises the importance of prioritisation of
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delivering high quality care. This is crucial at this time of transition and requires a consistent operational approach for quality oversight in systems. The Clinical Forum and System Quality Surveillance group will be reviewing how to operationalise a system quality oversight approach. The System Quality Surveillance Group continues to meet on an alternate monthly basis and the terms of reference are being reviewed to support transition from quality surveillance to a wider remit which includes quality improvement.
Areas of Escalation on the Quality Assurance Framework:
Coventry and Warwickshire Partnership Trust (CWPT) Since the previous report to CWCCG, one additional concern has been added to level two of the QAF, Safeguarding training, the Serious Incident (SI) management and closure at level two of the QAF will be presented to CQGC in August 2021. Wound Care has been deescalated from a level two to a level one following continued assurance. There are five concerns at level two of the QAF and no concerns at levels three and four.
George Eliot Hospital NHS Trust (GEH) Since the previous report to CWCCG, no areas of concern have been escalated or de-escalated on the QAF. There is one concern at level two of the QAF and no concerns at levels three and four of the QAF.
South Warwickshire Foundation NHS Trust (SWFT) There are currently no escalated concerns at SWFT.
University Hospitals Coventry and Warwickshire NHS Trust (UHCW) Since the previous report to CWCCG, no areas of concern have been escalated or de-escalated on the QAF. There are three concerns at level two and no concerns at levels three and four of the QAF.
System-Wide Concern – Children and Young People in Crisis There have been ongoing pressures in our system in the last few months relating to children in crisis presenting at acute hospitals and being admitted to paediatric wards. Following a recent spike in numbers actions have been taken to ensure improved timeliness and quality of discharges and the number of children on our Paediatric wards has reduced. Further work continues to improve the situation and the Partnership Executive Group have approved a plan to develop a Children’s Mental Health Task Force to lead the development and delivery of a fit for purpose sustainable service.
Primary Care All practices registered with the Care Quality Commission (CQC) continue to be rated as overall ‘good’ or ‘outstanding’.
Care Homes There are four Coventry homes and eight Warwickshire homes currently on escalation at Coventry’s Provider Escalation Panel or Warwickshire’s Service Escalation Panel.
CCG Internally Provided Services There are no areas of concern on the QAF in respect of Prescription Ordering Direct (POD) Service and Referral Support Service (RSS). The Clinical Assessment and Placement team (CAPT) has two concern at level three and two concerns at level two of the QAF.
Recommendation: The Governing Body is requested to RECEIVE the report for ASSURANCE.
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Implications Objective(s) / Plans supported by this Constitution targets and CCG statutory responsibilities. report: Conflicts of Interest: None identified. Non-Recurrent Expenditure: Not applicable Recurrent Expenditure: Not applicable Financial: Is this expenditure included within the CCG’s Financial Yes No N/A Plan? (Delete as appropriate) Performance: The CCG is required to meet the national NHS Constitution targets. The report outlines quality and safety issues in relation to commissioned services in Quality and Safety: relation to the CCG’s Quality Assurance Framework. General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any Equality and Diversity: decision that is finalised without being influenced by appropriate due regard could be deemed unlawful. Has an equality impact Yes assessment been undertaken? No N/A (attached) (Delete as appropriate) Patient and Public Not applicable Engagement: Clinical Engagement: Not applicable The report provides information and assurance regarding quality issues on Risk and Assurance: escalation on the CCG’s Quality Assurance Framework.
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Introduction
1.1. The Nursing and Quality Report provides information and assurance regarding current nursing and quality issues. The report provides an overview of concerns that are on the CCGs’ Quality Assurance Framework (QAF). Appendix one sets out the Quality Assurance Framework (QAF) escalation levels for information and reference.
Nursing and Quality
Learning Disabilities Mortality Review (LeDeR) Annual Report 2020/21
2.1 The Coventry and Warwickshire Clinical Groups (CWCCG) Learning Disability Mortality Review (LeDeR) Programme annual report was received and approved at the June 2021 Clinical Quality Governance Committee (CQGC). The annual report has been uploaded to the CWCCG website in line with national guidance.
Safeguarding
3.1 Safeguarding activity – there has been a seasonal increase in safeguarding referrals in line with the end of the school year. This is impacting on the Multi-agency Safeguarding Hubs (MASH), as well as a rise in demand for providers. CWCCGs safeguarding leads meet with colleagues in the Local Authorities, Police and Providers on a monthly basis to monitor the demand and address any specific capacity issues.
NHS Continuing Healthcare
4.1 The independent review of the NHS Continuing Healthcare and Section 117 service has been completed and a first draft report shared, reviewed, discussed and comments returned. A second draft of the report was due to be shared on the 2nd July. The report has not yet been shared with the CCG and is now expected during the week beginning 5th July.
Local Maternity and Neonatal System (LMNS)
5.1 The LMNS board met on 14th June 2021 chaired by Director of Quality and Nursing as the Interim Chief Nursing Officer was not available. Natasha Lloyd-Lucas, Senior Commissioning Manager for Children and Maternity has commenced in post to support implementation of the Ockenden review recommendations. At the June 2021 CQGC it was agreed that the next main CQGC in August 2021 will receive an update on progress.
System Quality
6.1 The National Quality Board Position Statement: Position Statement: Managing Risks and Improving Quality through Integrated Care published April 2021 emphasises the importance of prioritisation of delivering high quality care. This is crucial at this time of transition and requires a consistent operational approach for quality oversight in systems. The Clinical Forum and System Quality Surveillance group will be reviewing how to operationalise a system quality oversight approach.
6.2 The System Quality Surveillance Group continues to meet on an alternate monthly basis and the terms of reference are being reviewed to support transition from quality surveillance to a wider remit which includes quality improvement.
6.3 The Clinical Forum continues to meet monthly; the membership and Terms of Reference are currently being reviewed to ensure an emphasis on system wide shared learning.
Nursing and Quality Report Page 1 of 6 Governing Body 21 July 2021
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Areas on Escalation on the Quality Assurance Framework
7.1 This section of the report provides an overview of new concerns, de-escalated concerns and concerns at level two and three of the Quality Assurance Framework (QAF). The report includes CWCCG commissioned and provided services. A more comprehensive report is provided for assurance and discussion at CQGC. An overview of the Quality Assurance Framework (QAF) and escalation levels is included as Appendix one.
Coventry and Warwickshire Partnership Trust (CWPT)
8.1 Since the previous report to CWCCG, one additional concern has been added to level two of the QAF, Safeguarding training, the Serious Incident (SI) management and closure at level two of the QAF will be presented to CQGC in August 2021. Wound Care has been deescalated from a level two to a level one following continued assurance. There are five concerns at level two of the QAF and no concerns at levels three and four.
8.2 Concerns at level two of the QAF:
• Safeguarding Training – this concern has been added following a review of CWPT’s Safeguarding data for April 2021. CWPT have a plan in place which continues as part of CWCCGs weekly monitoring. The previous head of safeguarding has recently retired, and successful recruitment has taken place with the postholder due to start in July 2021.
• CWCCG and CWPT SI management and closure – this concern is being added to the QAF due to the number of SIs that are open beyond timescale. CWPT have invited representation from CWCCG quality team to a learning event. This event is now scheduled to take place in the third week of July. This externally facilitated event is to explore a revised approach to the management of SI reporting and closure with an emphasis of learning from incidents, themes and trends.
• Looked after Children (LAC) Coventry – this concern relates to completion of health assessments within agreed statutory timescales. Over the past few months there has been an increase in the number of LAC coming into care in Coventry, and the complexity of need has also increased. This increase has had an impact on capacity and the ability to undertake initial health assessments and review health assessment within statutory timescales. In addition, there has been a rise in the number of statutory safeguarding strategy meetings for looked after children that the LAC Nurses need to attend. The CCG has agreed three months additional funding for Paediatricians to complete Initial Health Assessments and the CCG and CWPT are working in partnership with Children’s services to understand current and future capacity to meet the demand.
• Substantive Nursing Staffing - This concern relates to the percentage of substantive versus temporary staffing across registered nurses and care staff. The Trust continues to use long-term placements of bank and agency staff to provide consistency. The Trust continues to focus on staff sickness, recruitment and retention. The position and actions are monitored by the CCG.
• Waiting Times - This concern relates to the waiting times and commissioned capacity for three services; diagnostic waits for the Adult Neurodevelopmental Service (which includes Autistic Spectrum Disorder and Attention Deficit Hyperactivity Disorder); Child and Adolescent Autistic Spectrum Disorder and Attention Deficit Hyperactivity Disorder diagnostic service waiting times; and Children's Therapy waiting times (Coventry). System-wide work has been initiated to redesign the all age diagnostic pathway, including pre and post diagnostic support. This system wide work will be presented at the November themed CQGC to receive an update on progress achieved.
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George Eliot Hospital (GEH)
9.1 Since the previous report to CWCCG, no areas of concern have been escalated or de- escalated on the QAF. There is one concern at level two of the QAF and no concerns at levels three and four of the QAF.
9.2 Concern at level two of the QAF:
• Clostridium Difficile Infection (CDI) - There was no agreed CDI threshold for 2021/22. At the end of 2020/21 the Trust exceeded the previous 2019/20 threshold. The Trust focused on reducing hospital acquired CDI as a key priority for 2020/21. CWCCG Infection Prevention and Control Team (IPCT) work closely with GEH IPCT and themes are reviewed at the monthly IPC meeting.
South Warwickshire Foundation Trust (SWFT)
10.1 There are currently no escalated concerns at SWFT.
University Hospitals Coventry and Warwickshire NHS Trust
11.1 Since the previous report no additional concerns have been added to the QAF. There are three concerns at level two and no concerns at levels three and four of the QAF.
11.2 Level two concerns:
• Clinic Letters requiring prompt action sent within seven calendar days. The Trust continues to remain below the national target of 100% reporting 76.81% in April 2021. The CCG has requested more detail relating to clinical specialities performance. Ongoing work continues by the Trust together with monitoring by the CCG.
• Clostridium Difficile Infection (CDI) - There is no agreed CDI threshold for 2021/22. At the end of 2020/21 the trust exceeded the 2019/20 threshold. The Trust’s Infection Prevention and Control Team (IPCT) undertakes reviews of all cases of CDI. UHCW IPCT work closely with CRCCG IPCT and themes are reviewed at the monthly Infection Prevention and Control meeting. The system-wide IPCT continues to provide support.
• Sepsis Management – This is a trust-wide concern relating to achievement of the 90% sepsis management targets. UHCW have implemented a process to collate real time data. Focusing on using the sepsis bundle rather than the screening tool CRCCG have requested a formal report on the recent audit results.
System-wide Concerns
12.1 Coventry and Warwickshire is experiencing a significant spike in the number of children and young people (CYP) who have acute mental health or emotional wellbeing challenges. These challenges escalate to the point that they present a risk to themselves and often, as a result of self-harm or suicide attempts require admission to either A&E or a Paediatric ward in an acute hospital. Recently the numbers of these children peaked at 37, 22 at UHCW and 15 at Warwick hospital. In addition to those on the wards we have notable increased demand in A&E and in the community. This level of system pressure is unprecedented.
12.2 Actions have been taken to ensure improved timeliness and quality of discharges and the number of children on our Paediatric wards has reduced to between 7-12.
12.3 Additional resources have been deployed as required to ensure all CYP are both safe and cared for. Further work continues to improve the situation and the Partnership Nursing and Quality Report Page 3 of 6 Governing Body 21 July 2021
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Executive Group have approved a plan to develop a Children’s Mental Health Task Force to lead the development and delivery of a fit for purpose sustainable service.
Primary Care
13.1 All practices registered with CQC continue to be rated as overall ‘good’ or ‘outstanding’. CQC has implemented its Emergency Framework monitoring which offers a support model to General Practice. Primary Care and the CCG Primary Care Team are actively supporting the Covid-19 vaccination programme.
Care Homes
14.1 There are four Coventry homes and eight Warwickshire homes currently on escalation at Coventry’s Provider Escalation Panel or Warwickshire’s Service Escalation Panel. All providers have action plans in place, have increased support and monitoring and are reviewed monthly by the multi-agency escalation panels.
CCG Provided Services
15.1 There are no areas of concern on the QAF in respect of Prescription Ordering Direct (POD) Service and Referral Support Service (RSS). The Clinical Assessment and Placement team (CAPT) has two concern at level three and two concerns at level two of the QAF.
15.2 Concern at Level three of the QAF
• Workforce – the combined Coventry and Warwickshire team has a heavy reliance on agency staff due to increased demands of sustained 7-day working and the backlogs created by the pandemic. The shortfall in substantive staff is both in clinical and non-clinical posts. A review of activity and workforce requirements is being completed, alongside actions to support staff recruitment.
• Appeals and Retrospective Cases – There are approximately 110 South Warwickshire cases that require triage and review. A project team has been newly formed to address the backlog. The first screening of the cases has noted a high number of cases many of which are; highly complex, include several appeals in one case and have out of date legal authorities in place. As a result, the full triage will take longer than initially planned and will stretch into July.
15.3 Concern at Level two of the QAF:
• Broadcare Financial Correlations – Work continues to meet this complex challenge and progress has been made in relation to the timeliness of data inputting and reporting from external agencies. The issue still remains, and the multiagency working group is supported by team members who previously worked for South Warwickshire CCG where this issue was successfully mitigated.
• St Matthews Healthcare, Broomhill Hospital - The St Matthews Quality Improvement Board, led by Northants CCG, and the CQC have noted an improving picture at Broomhill with a number of improvement actions closed. Coventry and Warwickshire’s oversight team confirm the same position with no current concerns regarding anyone placed at Broomhill. The system placement stop remains in place until the CQC confirm they are no longer seeking to alter Broomhill’s registration status and the Quality Improvement Board have agreed the service is ready to take admissions.
Conclusion and Recommendation
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The Governing Body is requested to RECEIVE the report for ASSURANCE.
End of Report
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Appendix 1 Quality Escalation Matrix Escalation Criteria Level of risk Action Reports to level
Level Zero All KPIs are being Negligible • Monitor KPIs CCG Quality meeting achieved/within trajectory
Level One Minor concern/s Minor Level Zero, plus: Quality meeting • Risk assess Informal CQRM • Share at informal CQRM
Level Two Moderate concern/s Moderate Level One, plus: CQRM • Consider quality assurance visit/deep dive CQGC • Request action plan Governing Body • Agree trajectory for improvement Risk Register • Escalate to CQRM • Exception report to CPPM
Level Three Major concern/s High Level Two, plus: CQRM • Undertake quality assurance visit / deep dive CQGC • Raise contract query Governing Body • Escalate to joint quality contracting meeting QSG • Consider performance notice Risk Register • Consider inviting executive team to CQGC to provide assurance Level Four Extreme concern/s Catastrophic Level Three, plus: CQRM • Independent review/Appreciative enquiry CQGC • Consider Risk Summit Governing Body • Inform CQC and other regulatory bodies QSG • Invite provider executive team to CQGC to provide Risk Register assurance Blank Page NHS Coventry and Warwickshire Clinical Commissioning Group Enc O
Report To: Governing Body
Report Title: Coventry and Warwickshire CCG’s Response to Provider Quality Accounts for 2020/2021
Report From: Rebecca Bartholomew, Director of Quality and Nursing
Author: Mary Mansfield, Deputy Director of Nursing and Quality
Date: 21 July 2021
Previously Considered by: Clinical Quality and Governance Committee, May – June 2021
Action Required (delete as appropriate)
Decision: Assurance: Information: ✓ Confidential
Purpose of the Report: The CCG is formally required to review provider Quality Accounts and produce a CCG response statement for inclusion in the providers published Quality Account.
Enclosed is the Coventry and Warwickshire CCG’s response to Coventry and Warwickshire Partnership NHS Trust (CWPT), George Eliot Hospital NHS Trust (GEH), Mary Ann Evans Hospice, South Warwickshire NHS Foundation Trust (SWFT) and University Hospitals Coventry and Warwickshire NHS Trust (UHCW) Quality Accounts for 2020/2021, which have been signed off by members of the Clinical Quality and Governance Committee.
Key Points: • The 2020/21 Quality Account provides an opportunity to report on quality and set out improvements in the services the provider delivers to the local communities and stakeholders. • The quality of service delivered is measured and reported through patient safety outcomes; the effectiveness of treatments that patients receive, patient feedback about the care received and staff engagement. • The CCG triangulates the information included in the draft Quality Account against data held by the CCG.
Recommendation: Governing Body Members are requested to NOTE the content of the CCG’s response to the 20/21 Quality Account.
Implications
Objective(s) / Plans 1. Creating Value supported by this 2. Building capacity report: 3. Developing at Place Conflicts of Interest: None identified. Non-Recurrent Expenditure: Not applicable. Financial: Recurrent Expenditure: Not applicable.
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Is this expenditure included within the CCG’s Financial Yes No N/A ✓ Plan? (Delete as appropriate) Performance: Not applicable. The issues raised and the actions taken to address will improve Patient Safety, Quality and Safety: Effectiveness of care and Patient Experience. General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any decision that is finalised without being influenced by appropriate due regard could Equality and Diversity: be deemed unlawful. Has an equality impact assessment been Yes No N/A ✓ undertaken? (Delete as (attached) appropriate Patient and Public Not applicable. Engagement: Clinical Engagement: Not applicable. Risk and Assurance: Not applicable.
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Coventry and Warwickshire CCG Response to CWPT Quality Account 2020-2021
NHS Coventry and Warwickshire Clinical Commissioning Group (CCG) welcomes the opportunity to comment on the draft Coventry and Warwickshire partnership trust (CWPT) Quality Account. The CCG believe that the Quality Account for 2020-2021 contains an accurate reflection of the quality of services provided by the Trust. Whilst some data and narrative were incomplete, the CCG has reviewed the information presented against data sources available to the CCG as part of contract quality and performance management reporting.
The Trust has worked in the spirit of openness and transparency with the CCG over the last year to further develop and strengthen working relationships despite the pressure of the pandemic. This is demonstrated through the Trusts ongoing engagement with the CCG on a range of quality and patient safety related reviews, forums and Committees in order to promote an internal culture and ways of working to achieve service delivery improvements.
The CCG recognises this ongoing commitment to sustaining the Trusts improved CQC rating of “good” and that they are aspiring to achieve ‘outstanding’ in the future. The work outlined in the Quality account reflects the ongoing investment in sustained improvements and the CCG recognises the significant work that the Trust continues to make across the five CQC domains.
The trust has also reflected on the CQC’s work with ‘outstanding’ trusts and has embraced the emphasis on developing knowledge, skill and an improvement culture within these organisations. The Quality Improvement Strategy 2021-24 demonstrates a commitment to the adoption of the QSIR approach as a key enabler of the trusts overall strategic objectives. The trust has adopted a culture of quality improvement to underpin the trusts values and a commitment to delivering high quality patient care. The CCG looks forward to supporting the trust with their approach and working together as their improvement journey progresses.
The CCG commends the significant achievements of the trusts COVID response with the successful deployment of the COVID vaccination programme but also acknowledges the ongoing challenges being exerted by the pandemic. The vaccination programme is an exemplar of collaborative working across both health and social care partners. The CCG will continue to support the trust through the ongoing Post COVID response and its implementation of their restoration plans.
The Trusts continued responsiveness in relation to infection control and prevention (IPC) is also recognised by the CCG. Over the last year a total of 24 COVID outbreaks have been reported in an appropriate and timely manner and IPC processes have matured and embedded over this time.
The Trust is taking a proactive role to improve its response to serious incidents to ensure they are reported in a timely manner, investigated thoroughly and any lessons learnt are disseminated. The Trust has continued its education to support all reporters of incidents and in addition has sourced external training to supplement this.
The pandemic has continued to exert an increased demand on inpatient services and this has remained a challenge for the Trust this year. Admission avoidance and effective triage is being supported by the AMHAT teams being embedded in all the acute hospitals across the health economy. This will also contribute to an improved and timely discharge process and overall patient flow.
The CCG notes there has been delays to the planned work to improve patient involvement in service development opportunities within Learning Disability and/or Autism. The CCG is reassured that the trust is continuing this emphasis throughout 2021/22 with a clear vision of improving both patient experience and the identification of learning from the Learning Disabilities Improvement Standards.
The CCG acknowledges the Trusts ongoing work to embed robust processes for the identification, reporting, review and learning from deaths in line with the recommendations in the national guidance (National Guidance on Learning from Death March 2017). The CCG will continue to work with the Trust and support ongoing improvements in this area.
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The Trust has continued to work with the CCG, local authority and third sector partners across the health economy to support the reduction of suicide. Implementation of safety plans following assessment and an increased emphasis on data capture and analysis will also support this work going forward.
Following a CCG virtual visit in December 2020 we acknowledge the progress within Tissue Viability in implementing daily huddles together with the Place Based Teams and the ongoing commitment to continue learning and improving outcomes. Further work to embed these processes is now being progressed and the CCG encourages continued collaborative work in this area.
The CCG is also pleased to see continued investment in information technology to improve service delivery. The improvements resulting from the increased use of digital technology have demonstrated both innovation and creativity. Patients now have access to personal video services, staff can now agile work and video consultation supports choice for patients and their carer’s. The ‘Attend Anywhere’ service and the ‘Message to a loved one’ service have greatly supported patients to maintain contact with loved ones and to access services from their own homes.
High usage of locum and agency staff continues across the trust with a high number of staff vacancies persisting. The CCG will continue to work with the trust to ensure safe staffing levels and ongoing delivery of quality patient care.
The trust continues to work collaboratively with partners to improve waiting times in community services.
The plans to develop the HCSW workforce within Place Based teams to increase competency and their contribution to care delivery is recognised by the CCG as an important progression in strengthening skill and core staff resource.
In conclusion, we recognise that the Trust has made positive progress in a number of areas last year and can confirm that we support the priorities identified by the Trust in their Quality Account for 2020- 2021.
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Coventry and Warwickshire CCG Response to GEH Quality Account 2020-2021
Coventry and Warwickshire Clinical Commissioning Group (CCG) welcomes the opportunity to comment on the draft George Eliot Hospital (GEH) Quality Account. The CCG believes that the Quality Account for 2020-2021 contains an accurate reflection of the quality of services provided by the Trust. Whilst not all the data fields were complete, the CCG has reviewed the information presented against data sources available to the CCG as part of contract quality and performance management reporting.
The Covid-19 pandemic has impacted on the way in which we have worked as a system and has been an extremely challenging time for the Trust. The Trust should be applauded in their achievements in making and maintaining a focus on quality and safety. In particular, the staff’s responsiveness to the innovative changes made through this time of tremendous uncertainty. Changes to both Urgent and Emergency care has seen a number of quality improvements in respect of the safety and streaming of patients.
The Trust has worked in the spirit of openness and transparency with the CCG over the last year to further develop and strengthen working relationships. This is demonstrated through invitations by the Trust for CCG representation on a range of quality and patient safety related learning forums and Committee’s in order to promote an internal culture, that is accepting of challenge. The CCG in this response takes the opportunity comment on the following areas; reducing preventable deaths, enhancing quality of experience in urgent care, infection prevention and control, patient safety, feedback and involvement.
The CCG conducted several quality assurance visits throughout the year, which included virtual winter preparedness visits with Emergency Department, and onsite Trust wide visits which focused on infection control and prevention and urgent responses during Covid-19 pandemic. Representatives from the Maternity services presented at the CCG Clinical Quality and Governance Committee thematic discussion on Maternity and Neonatal services. The Ockenden Review of Maternity Services outlines the Immediate and Essential Actions (IEAs) to be taken by all maternity units across England. The Trust have identified and shared the Trusts local actions for learning and recommendations.
The CCG recognises the significant progress the Trust made in relation to working towards achieving an improved CQC rating from “requires improvement” and the ongoing investment in these improvements. The CCG continues to monitor the Trust’s improvement action plan.
It is noted that the Trust has made improvements from the recommendations in the Mortality and Deteriorating Patients Improvement Plan which sets out to reduce the number of unexpected deaths a reduction in the number of observed deaths and an increase in the number of expected deaths; and the continual collaboration with commissioners, other organisations local to the Trust which enable system working improvements covering the wider aspects of mortality and improvement required in and outside the hospital setting.
The CCG acknowledges the work achieved in improving patient pathways and providing ongoing assurance to identifying, assessing and reporting any patient harm related to delays as a result of the ongoing Covid-19 pandemic. The revised urgent and emergency pathways and opening of additional beds to accommodate elective work have enabled the Trust to ensure safety and improved quality for patients coming to the hospital.
The CCG welcomes the Trust’s positive impact on ways to achieve user feedback support and build on work already in place to engage with representatives from the community and service users. The work undertaken by volunteers at the Trust during the Covid-19 pandemic is recognised. Plans to engage patient safety partners at all levels of the organisation to inform recommendations to improve and shape patient care and the involvement of service user feedback as a patient safety and quality improvement priority for 2020 -2021 aims to ensure that their voice is at the heart of everything that the Trust does. The Trust’s has a continued focus on strengthening and embedding quality governance and improvements locally. The commitment to focus on the wellbeing offers available to staff particularly
3 those from a BAME and disabled backgrounds offers the workforce support from a mental and physical health perspective.
In conclusion, we recognise that the Trust has made positive progress in a number of areas last year and can confirm that we support the priorities identified by the Trust in their Quality Account for 2021- 2022.
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Coventry and Warwickshire CCG Response to Mary Ann Evans Hospice Quality Account 2020- 2021
Coventry and Warwickshire Clinical Commissioning Group (CCG) welcomes the opportunity to comment on the draft Mary Ann Evans Hospice Quality Account. The CCG believes that the Quality Account for 2020-2021 meets the minimum required content as set out in the national guidance and contains an accurate reflection of the quality of services provided by the Hospice. The data fields which have been completed in the draft account have been reviewed by the CCG against data sources available to the CCG are part of quality, contracting and performance to confirm them as accurate.
The Covid-19 pandemic has impacted on the way in which we have worked across the healthcare system and has been an extremely challenging time for the Hospice, at a time of increasing demand for the services they offered. The Hospice responding quickly to the way they were working in order to continue to offer services to our most vulnerable patients and population during this time. In particular, the innovative way in which changes were made to continue with delivery of community services and working in collaboration with George Eliot Hospital NHS Trust and University Hospitals of Coventry and Warwickshire to support rapid discharges home for people at end of life. The staff’s responsiveness to the changes made through this time of extreme uncertainty should be applauded.
The Hospice has worked in the spirit of openness and partnership with the CCG over the last year to continue to develop and strengthen working relationships. This is demonstrated by their participation in a range of quality and patient safety related working groups, forums and committees across the health economy and also their responsiveness, as a result of the pandemic to enhancing these working partnerships.
The CCG acknowledges the work achieved in improving access to the services offered by the Hospice. The work planned for 2021-2022 to promote and reach more of people with palliative and end of life needs, especially in order to help address inequalities, and for those people with conditions other than cancer will enhance individualised care for each person.
The plan for the Hospice to build on the successes and positives of using technology, as a priority for 2020-2021 to support efficiencies and improve services for both for patients and staff are welcomed by the CCG. This will further enhance patient safety and quality improvement to ensure that individualised and bespoke care for each person is available.
The CCG welcomes the Hospice’s positive impact on ways to achieve user feedback support and build on the work already in place to engage with volunteers, representatives from the community and service users. The work undertaken by volunteers at the Hospice is recognised and the plans to develop and broaden their roles is an essential element in reaching the wider community and its people.
In conclusion, we recognise that Mary Ann Evans Hospice has made positive progress in a number of areas last year and can confirm that we support the priorities identified by the Hospice in their Quality Account for 2021-2022.
They remain a valued member of the health and social care economy in Warwickshire North, providing a caring and responsive service to individuals who are approaching the end of life or bereaved and are a key strategic partner in the development and implementation of end of life services. Their particular expertise in end of life care, and knowledge of the local area, make them a key partner in developing local services and as a community provider they help to deliver the out-of- hospital, care closer to home agenda.
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Statement from NHS South Warwickshire Clinical Commissioning Group (mandatory)
Following our review of the draft version of the South Warwickshire NHS Foundation Trust Quality Account we are pleased to state that this is representative of the work the Trust has undertaken to further develop the quality of its services during 2020/21.
NHS South Warwickshire Clinical Commissioning Group (CCG) (as lead commissioner for the South Warwickshire NHS Foundation Trust contract) continued to work in partnership with the Trust with the overarching aim of ensuring that service users, carers and their families receive excellent quality of care and treatment throughout their healthcare experience, whether this is in the acute sector or in community services.
2020/21 was a challenging year for the NHS due to the ongoing Coronavirus pandemic, and the CCG commend the Trust and their staff for the ongoing commitment to safe and quality care.
The Trust has not participated in any Quality Commission (CQC) reviews or inspections during the year. In 2019, the Trust was awarded an overall rating of “outstanding” with no enforcement actions stipulated.
As part of strengthening quality and visibility of the Trust board at team, ward and department level, the ‘Board to Ward’ initiatives have continued throughout the year. Members of the Executive team also visit areas across the organisation on a regular basis to discuss patient safety, incidents, complaints and issues that impact on the quality of care. As we move towards an integrated care system the CCG attends the Trust’s Clinical Governance Committee and has been impressed and reassured by the committee’s scrutiny of quality within the organisation, as well as the culture of openness and desire to improve within the clinical teams.
Patient Safety is always a joint priority and the CCG is pleased to be an active member of the Trust’s Serious Incident Review Group, supporting its role in assuring the quality of serious incident investigations and dissemination of learning within the Trust. There were two ‘Never Events’ reported during 202/21, and implementation of recommendations are monitored by the CCG until closed.
The Trust complies with the national guidance on Learning from Deaths, improved the mortality review process by developing the Medical Examiner Office and added mortality reviews as part of Consultant job plans. The local Learning Disability Mortality Review (LeDeR) programme is supported with a Trust reviewer and attendance at governance groups. A CCG Governing Body GP attends the Trust’s Mortality Surveillance Committee to both seek assurance and support partnership working.
2020/21 saw a large number of Covid-related admissions and the widespread use of Personal Protective Equipment (PPE), social distancing and cessation of visiting are likely to be linked to the reduction of some healthcare associated infections. The trajectory tolerance target of 24 CDI cases was 27 (3 over trajectory). Root Cause Analysis to identify lapses in care are behind schedule due to Covid-19 pressures, however there are plans to complete these in the first quarter of 2021/22. There was no Trust-attributed MRSA bacteraemia identified, and there was a marked reduction in both MSSA and E-coli bacteraemia.
The overall staff vacancy and turnover position improved during the reporting period, with less staff leaving the Trust and more people wanting to join the NHS due to the pandemic response.
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The Health and Wellbeing programme for staff continued to expand to support staff during the demanding Covid-19 response. The scores across a range of indicators in the National Staff Survey were very positive and the Trust Workforce Action Plan has a continued focus on wellbeing, equality and diversity and leadership development.
The revised Friends and Family Test (FFT) guidance was implemented from 1 April 2020, however submission of data was suspended early in the Covid-19 pandemic and resumed from December 2020. Due to the increase in virtual appointments, teams have encouraged patients to complete the online survey seeing increased submissions over time. The majority of patients report having a good service experience and 95.8% would recommend the Trust.
The Patient Advice Liaison Service (PALS)/Bereavement team work closely with wards and teams across the Trust to ensure early intervention to resolve patient concerns regarding their treatment. The Bereavement Service has supported a higher number of inpatient deaths during the year, assisting with electronic transfer of related certificates and providing support and information for relatives.
The CCG is pleased to note that Mixed Sex Accommodation Breaches have continued to reduce and have remained at zero for the last quarter. There was one breach, affecting four patients, in the Coronary Care Unit in September. The CCG staff are invited to review meetings in respect of breaches and the CCG receives copies of relevant RCA reports.
Cancer waiting time performance was impacted during the Covid-19 pandemic, however the Trust has waiting list management processes in place to restore services. Many cancer waiting time performance measures were improving, however performance for the 62-day cancer wait target has been more variable. This is a key cause for concern for the CCG and we have been working collaboratively with the Trust to help rectify this. The number of patients on the cancer waiting list for more than 62 days at year-end has significantly improved compared to 2019/20. The CCG acknowledges there has been an improvement in timely completion of robust root cause analyses (RCAs) with independent reviewer input providing added assurance at the Clinical Harm Reviews. Learning is disseminated internally and within both primary and secondary care in order to support improvement in delivery.
The Trust has continued to develop a compassionate end-of-life strategy with system partners. There has been an expansion of the specialist palliative care nurse workforce, and recruitment of two Palliative Medicine Consultants to support both the acute sector and community teams. The Covid- 19 response has seen increased integration between the specialist palliative care teams and district nurses to provide support and coordinate care.
SWFT’s maternity lead has provided assurance on the continuity of care model. The primary named Midwife is contacting expectant mothers before and after birth via telephone and text. Social media has been utilised successfully to offer support and advice for expectant mothers. The CCG congratulates the SWFT maternity service as the winner of the Royal College of Midwives Midwifery Service of the Year Award in May 2020.
To conclude, there is evidence that the vast majority of patients are happy with the services they receive from the Trust, staff opinion of the Trust is high and patients feel able to raise issues of concern with the Trust, if and when required. The Trust continues to deliver high quality, safe services and its quality priorities for 2021/22 in the areas of patient outcomes, patient experience and patient safety are welcomed and endorsed by the CCG.
We look forward to a further year of partnership, cooperation and continued improvement in the quality of services for our local population.
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Coventry and Warwickshire CCG Response to UHCW Quality Account 2020-2021
NHS Coventry and Warwickshire Clinical Commissioning Group (CCG) welcomes the opportunity to comment on the draft University Hospitals Coventry and Warwickshire NHS Trusts’ (UHCW) Quality Account. Whilst not all the data fields in the Quality Account were complete, the CCG has reviewed the information presented against data sources available to the CCG through the quality, contracting and performance management of the contract, and considers the draft account an accurate representation of the quality of services provided by the Trust.
The COVID-19 pandemic has impacted on the way in which we have worked as a system. The Trust made early responses to the changes to processes and pathways needed to manage the emerging and continual changing situation during the early part of the Covid-19 pandemic and this should be applauded, in particular the staff’s responsiveness to change their roles and responsibilities at a time of tremendous uncertainty.
The Trust has continued to work throughout this time with the CCG in the spirit of openness, transparency and in collaboration to continue to develop and strengthen the working relationships established through a new way of working. The CCG in this response takes the opportunity comment on the following areas; discharge processes, infection prevention and control, patient safety, feedback and involvement.
The CCG conducted a number of quality assurance visits throughout the year, which included virtual winter preparedness visits the Emergency Department, and onsite infection control and prevention supportive visits to both UHCW and Rugby St Cross during the Covid-19 pandemic. Representatives from Maternity services presented at the CCG Clinical Quality and Governance Committee thematic discussion on Maternity and Neonatal services. The Ockenden Review of Maternity Services outlines the Immediate and Essential Actions (IEAs) to be taken by all maternity units across England. The Trust has identified and shared the Trust’s local actions for learning and recommendations.
The CCG will continue to work collaboratively with the Trust to ensure ongoing improvements in discharge processes. Building on the achievements relating to the data and improvements in patient flow, including discharge to care and residential homes.
It is recognised that there has been a positive impact in the Trust’s response to improve patient pathways, particularly in the emergency department.
The work on emergency surgical pathways to improve patient access into the Surgical Assessment Unit has resulted in a significant shift in practice within the surgical group, Emergency Department and supporting specialties.
The newly merged CCG and the restructuring of a Place based approach and strategic collaborative working creates opportunity for system improvement for the population we serve.
Plans for the Trust to make improvements in the quality of care for patients in relation to patient observations within the Emergency Department. Changes to the management of diabetes for adults and young people with the development of an educational programme provided to all Type 1 Diabetic patients. Ensuring patients attending the Children Emergency Department have the appropriate observations (Paediatric Observation Priority Score POPS) and Paediatric Early Warning Score (PEWS). These improvements, identified through the key actions in of the National Clinical Audit plan’s f or 2020/2021 are welcomed.
It is disappointing that there is no mention in the quality account of the system wide work improving mental health provision and liaison mental health services for children and young people. The CCG acknowledges the Trust’s drive and commitment to improving infection prevention and management and the considerable work that has been undertaken in 2019-2020 and in responding to the Covid-19 pandemic. The CCG will continue to support the Trust’s ongoing improvements for the prevention of sepsis and to work collaboratively with the Trust to deliver high standards of infection prevention and control practice. The CCG is pleased with the overall positive service user feedback in areas including: information
8 received pre admission, signage in public areas, cleanliness, availability of alcohol gel and/or hand washing facilities and welcome the involvement of service user feedback as a patient safety and quality improvement priority for 2020 -2021. Plans to engage patient safety partners at all levels of the organisation will support the service user voice being at the heart of everything that they do.
In conclusion, we recognise that the Trust made positive and sustained progress in a number of areas last year in increasingly difficult times as a result of the Covid-19 pandemic, and confirm that the CCG fully supports the priorities identified by the Trust in its Quality Account for 2021 - 2022.
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NHS Coventry and Warwickshire Clinical Commissioning Group Enc P
Report To: Governing Body Learning Disability Mortality Review (LeDeR) Programme Report Title: Annual Report 2020-2021 Report From: Rebecca Bartholomew, Director of Nursing and Quality
Mary Mansfield, Deputy Director of Nursing Authors: Deidre Giacomin, Interim Head of Quality and Patient Safety
Date: 21 July 2021 Previously Considered by: LeDeR Steering Group, 20 May 2021 Clinical Quality and Governance Committee, 24 June 2021
Action Required (delete as appropriate)
Decision: Assurance: Information: Confidential
Purpose of the Report: To share with the Governing body to the third Learning Disability Mortality Review (LeDeR) Programme Annual Report 2020-2021.
Key Points: • The third Coventry and Warwickshire LeDeR annual report, presents information about the deaths of people with a learning disability aged 4 years and over notified to the programme from 1 April 2020 to 31 March 2021. It is not a direct comparison of all deaths of people with a learning disability within Coventry and Warwickshire. • The Learning Disabilities Mortality Review (LeDeR) programme was established to drive improvements in health and social care for people with learning disabilities, and to help reduce premature mortality and health inequalities within this population. • The issues and causes of death identified within this report reflect the many challenges that people with learning disabilities continue to face and give an indication of how we must do more to support them to live well within their local communities. • There were 69 deaths notified to the programme during the period 2000/2021 this compares with 67 notifications in the same period 2019/2020 and 47 in 2018 /2019. • The key learning identified in 2020/21 will be discussed at Reducing Health Inequalities for People with Learning Disabilities Steering Group with a review to determine actions to take forward to develop learning into action activity and service improvements. • The reviews identified that the care for people with learning disabilities was generally good. • The Health Inequalities Action Plan for People with Learning Disabilities has been updated and forms an appendix to the report. • This annual report was approved for publication by Clinical Quality and Governance Committee by 30 June 2021 in line with NHS England timescales and is available on the CCG website here.
Recommendation: Governing Body members are requested to NOTE the LeDeR Annual Report.
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Implications Objective(s) / Plans supported by this Quality improvement, patient safety, personalisation and transforming care report: GPs are paid to undertake Annual Health Checks for people with learning Conflicts of Interest: disabilities. No decision required for this report. A very small amount of non-recurrent NHS Non-Recurrent England/Improvement (NHSE/I) funding was Expenditure: available last year to support the LeDeR process. Financial: Recurrent Expenditure: Not Applicable Is this expenditure included within the CCG’s Financial Yes No N/A Plan? (Delete as appropriate) Performance: The CCGs are performance managed against NHSE/I LeDeR trajectories The LeDeR process is aimed at improving the quality of care for people with Quality and Safety: learning disabilities through identifying key learning from reviews General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any decision that is finalised without being influenced by appropriate due regard could Equality and Diversity: be deemed unlawful. Has an equality impact assessment been Yes No N/A undertaken? (Delete as (attached) appropriate) Patient and Public Statutory and voluntary sector providers are represented on the LeDeR steering Engagement: group. Clinical Engagement: Not Applicable Risk and Assurance: Not Applicable
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NHS Coventry and Warwickshire Clinical Commissioning Group Enc Q
Report To: Governing Body Meeting
Report Title: Learning Disabilities and Autism Transforming Care Programme Partnership Plan
Report From: Jamie Soden, Director of Nursing and Clinical Transformation
Author: Kathryn Hudson, Interim Learning Disability and Autism Programme Director / Senior Responsible Officer
Date: 21 July 2021
Previously Considered by: Learning Disabilities and Autism Programme Executive Board
Action Required (delete as appropriate)
Decision: Assurance: Information: Confidential
Purpose of the Report: This report sets out the Coventry & Warwickshire Learning Disability and Autism (LDA) Programme performance and programme plan for 2021/22.
The report sets out the current performance, the high impact actions agreed with Midlands NHS England/Improvement (NHSE/I), the Operational Plan 2021/22 and the revised governance for the programme.
Key Points: The LDA programme is on Midlands NHSE/I escalation due to the number of people with learning disabilities and/or autism currently inpatients in mental health services, compared with the NHS Long Term Plan (LTP) targets.
The report sets out the high impact actions put in place to recover the performance during 2021/22.
Recommendation: Governing Body Members are requested to NOTE the performance targets for 2021/22 and the current performance position and BE ASSURED by: • The High Impact Actions to improve the performance position in 2021/22; • The objectives for 2021/22 to achieve the Long-Term Plan ambitions; and • The LDA Programme Governance.
Implications
Objective(s) / Plans 1. Creating Value supported by this 2. Building capacity report: 3. Developing at Place Conflicts of Interest: None Non-Recurrent Expenditure: As per financial section of report Financial: Recurrent Expenditure: As per financial section of the report
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Is this expenditure included within the CCG’s Financial Yes No N/A Plan? (Delete as appropriate) The Coventry & Warwickshire system is currently on monthly escalation reporting Performance: with the NHSE/I Midlands Region for the performance against the Long-Term Plan LDA inpatient targets. • Discharge planning is not meeting the requirements of the 12-point discharge plan and impacting the effectiveness of timely discharges. Quality and Safety: • The Dynamic Risk Registers for adults and children are not in line with national guidance & increasing risk of admissions. General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any Equality and Diversity: decision that is finalised without being influenced by appropriate due regard could be deemed unlawful. Has an equality impact Yes assessment been undertaken? No N/A (attached) (Delete as appropriate) The Learning Disabilities & Autism Programme Board has revised the governance of Patient and Public the programme to include advocacy representation provided by Grapevine; the Engagement: programme has commissioned coproduction support for the programme plan from Grapevine for 2021/22. Clinical and professional representation is included throughout the governance of Clinical Engagement: the LDA Programme Risk 17 on the STP risk register refers to the risk on performance identified in this Risk and Assurance: report.
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Introduction 1.1. In April 2021, the Local Government Association undertook a Peer Review of the Transforming Care (Learning Disabilities and Autism) Programme. Key points of feedback highlighted need to strengthen the link between operational processes and leadership, to have a system shared vision for the programme, the need to strengthen coproduction, and the gap in services for people with autism and no learning disability. It also recommended that we needed to review capacity, costs, and clinical commissioning function of the programme to ensure the basic functions of the Transforming Care Programme are being undertaken effectively. 1.2. We have appointed Kathryn Hudson as Interim LDA Programme Director/SRO to support additional capacity, strengthened leadership, coordination and operational delivery 1.3. A strategic summit took place 14th May 2021 to review programme governance, structure and vision, taking learning from LGA peer review, recent CQC review, and NHSE feedback 1.4. A Regional Escalation meeting took place on 28th May and a set of high impact actions were agreed for an improvement LDA plan. 1.5. This report sets out the performance of the programme and the progress on the high impact actions to date. It highlights the investments being made by the system during 21/22 through the LDA operational plan 21/22.
Background 2.1 The LDA Programme has achieved significant progress on Annual Health Check delivery in 2020/21. Coventry and Warwickshire exceeded the national target and delivered a final figure for 20/21 of 71.3%, a significant improvement on the 2019/20 figure of 39%. Positive progress has also been noted around wider health inequalities work: • Enhanced health facilitation resource continues to be well received with increasing engagement from local practices - plans to continue to commission this dedicated resource • Co-production activity relating to the Reasonable Adjustments Flag is being well received by those who have engaged so far. • STAMP-STOMP research study is underway led by a Coventry and Warwickshire Partnership Trust (CWPT) Clinical Pharmacist – this study will review the prescribing activity associated with a sample of 100 children and young people with LD/A who are known to be on psychotropic medication, the findings of which will influence local delivery of the STAMP- STOMP agenda. • Between November 2020 and March 2021, 275 carers attended information sessions based on key themes emerging from local Learning Disability Mortality Review (LeDeR) reviews including Bowel Health Awareness, Dysphagia, Diabetes and Sign/Symptoms of Cancer and why screening is important.
2.2 The rollout of the Children and Young People’s key worker pilot has been successful with over 50 children and young people (CYP) supported to date.
2.3 The challenges for the programme are evident in the number of adults and children who remain as inpatients in mental health services. The NHS Long Term Plan has set targets for the number of people with learning disabilities and/or autism who are inpatients in a mental health services to be achieved by March 22/23 which equates to the following local targets for Coventry & Warwickshire: 21 Adults (30 per million population) 2 CYP (12-15 per million population)
Learning Disabilities & Autism (TCP) Partnership Plan Page 1 of 6 Governing body – 21 July 2021
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2.4 The current performance (1/07/21) has 37 adult inpatients and 12 children and young people in Tier 4 Child and Adolescent Mental Health Services (CAMHS). The performance on the children and young people deteriorated rapidly in March and June 2021 with 7 admissions. The LDA Programme is therefore on Regional monthly escalation to monitor improvement during 21/22.
Performance as at 01/07/21: 3.1 Inpatient Figures – By Local Authority Cohort Coventry Warwickshire Overall June Trajectory Difference CCG 11 10 21 20 +1 NHSE Adult 10 6 16 16 0 Adult total 21 16 37 36 +1 NHSE CAMHS 6 6 12 12 0 • Ended Q1 with 37 adults against a trajectory of 36. 1 inpatient is on Section 17 leave with a discharge date extended to July 21. • Ended Q1 at 12 CAMHS against our Q1 recovery trajectory of 12. The planned trajectories for improving performance that have been submitted to Midlands NHSE/I are set out below:
3.2 Adult Inpatient Trajectory for 21/22:
Learning Disabilities & Autism (TCP) Partnership Plan Page 2 of 6 Governing body – 21 July 2021
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3.3. Children and Young People Inpatient Trajectory for 21/22:
3.4. Current Position: • There were 6 admissions to CAMHS inpatient services in 2021/22 Q1. This resulted in patient numbers increasing from 7 at the end of March 2021 to a peak of 13 inpatients in mid-June 2021. • At the May escalation meeting with NHS England, our modelling showed that if nothing changed, we would follow a trajectory ending at 10 CAMHS inpatients by March 2022. This was presented as the likely scenario if no further actions to improve were made. • A review of all CAMHS inpatients has been carried out with all system partners during June and the information provided on all the cases indicate that the system should be able to achieve the best-case scenario trajectory, with a plan to end 21/22 at 6 inpatients modelled as follows: • Q2 discharges = 6 with potential for +2 • Q3 discharges = 1 • 3 cases to be reviewed over next month as currently too unwell for discharge date to be agreed • The best-case scenario plan models in 5 admissions between now and end March 2022 with the expectation that 2/5 would be discharged before end March 2022. • This new recovery plan to achieve 6 CYP inpatients by end March 22/23 will be submitted to Midlands NHSE/I before the next escalation meeting on 23rd July.
High Impact Actions Agreed Following Regional Escalation Meeting on 28th May 2021 4.1 The LDA Programme set out high impact actions at the Regional escalation meeting on 28th May 2021 to recover and sustain improvements in performance. These high impact actions were supported by Midlands Region and the status of the implementation of the actions is rated in the following tables:
Learning Disabilities & Autism (TCP) Partnership Plan Page 3 of 6 Governing body – 21 July 2021
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4.2. NHS Long-Term Plan Objectives & Operational Plan 21/22: The LDA Programme has an operational plan for 21/22 with objectives that link to all of the NHS LTP ambitions for people with learning disabilities and/or autism to provide focus across the system contained within 4 areas of development: Better Start, Improving Health, Better Care and Improving Quality. The plans to meet the objectives have been included in the 21/22 system investment plan.
Learning Disabilities & Autism (TCP) Partnership Plan Page 4 of 6 Governing body – 21 July 2021
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4.3. Better Start • Neurodevelopmental / Autism Diagnosis: Improve access & waiting times to assessment of neurodevelopmental disorders; Reducing the current assessment backlog, Redesign neurodevelopmental assessment pathways and reduce the need for diagnosis to access support. • Neurodevelopmental Pathway: Develop a plan to support young people with neurodevelopmental disorders and eating disorders; Develop an integrated neurodevelopmental health, education and social care pathway • Keyworker: Designate a keyworker to all children & young people with the most complex needs by 23/24
4.4. Improving Health • Annual Health Checks: Increase the number of annual health checks received by people with a learning disability and prepare to provide health checks for autistic people • LeDeR: Tackle the causes of morbidity and preventable deaths in people with a learning disability and/or autistic people; Review of the new LeDeR policy to develop an implementation plan for submission to NHSE within the timeline by 30 September 2021 • Health Inequalities: Work to tackle the wider determinants of health: housing; employment
4.5. Improving Quality • Coproduction and Engagement: A coordinated approach to working with people with learning disabilities and/or neurodevelopmental disorders to improve services, System-Wide Communication Strategy for LD and Autism • Workforce Strategy (including training & development): Improve the quality of care provided and reduce the use of restrictive practices, Ensure workforce has the right capability, skills, and capacity to support people with learning disabilities and autistic people
4.6. Better Care • Building the Right Support: Invest in intensive, crisis, and forensic community teams to support people within the community and prevent unnecessary admissions to hospital • Commissioning and Case Management: Strengthen Care, Education and Treatment Reviews, case management processes and embedding the 12 point discharge plan; Develop a sustainable community offer to support people with learning disabilities and/or neurodevelopmental disorders, of all ages to remain living in the community • STOMP & STAMP: Stopping the over-medication of people with learning disabilities and autistic people and supporting treatment and appropriate medication (STOMP & STAMP) • Reasonable Adjustments: Introduce a digital flag system into care records to enable staff to be aware and easily make adjustments for autistic people and people with learning disabilities, Increase specialist LD liaison capacity • Personalised care: Adopt a model of personalised care
Learning Disabilities & Autism (TCP) Partnership Plan Page 5 of 6 Governing body – 21 July 2021
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Programme Governance: 5.1 The LDA Programme Governance was revised in May as follows to oversee and implement the Recovery High Impact Actions and the LDA Operational Plan 21/22:
Learning Disabili�es and Au�sm Revised Governance 21/22
Health and Social Care Scru�ny Health and Wellbeing Boards ICS Board Sub-Commi�ees
Organisa�onal Boards & Sub- Peer to Peer Support Commi�ees LD & Au�sm Board Au�sm Partnership Boards Ci�zens Advocacy
Opera�onal Steering Group Strategic Steering Group
Performance & PlanningTrajectories Au�sm
Opera�onal Plan 21/22 Inequali�es
Performance Escala�on Process 3 year plan
Opera�onal Rigour & Delivery: MH Provider Collabora�ves– Pathway • Commissioning & case Panel/Funds management • Standardised Discharge Process • Dynamic RISK Register • Admission Avoidance 1 Risk & Mitigations: 6.1 The risk on performance is included in the STP risk register with the high impact actions and 21/22 operational plan as mitigating actions. The revised governance will provide additional oversight and review of the plans.
Conclusion and Recommendation 7.1 The LDA programme is on monthly Regional escalation due to the number of adults and children with learning disabilities and/or autism that are currently in mental health inpatient services. The Members are asked to NOTE: • The performance targets for 21/22 and the current performance position; • The High Impact Actions to improve the performance position in 21/22; • The objectives for 21/22 to achieve the Long-Term Plan ambitions; and • The LDA Programme Governance.
Learning Disabilities & Autism (TCP) Partnership Plan Page 6 of 6 Governing body – 21 July 2021
Enclosure R
Finance and Performance Committee Report for the Meeting held on 2 June 2021
Achievements/Decisions Made/Items to Note Key Issues for the Governing Body
Corporate Risk Register: Members were advised that the risks are reviewed by their owners and • Corporate risk register to be a checked that the information is up to date. The current position is 18 open continuous focus of the risks. There were 3 new risks and 2 risks were closed because they were Committee. covered by two new open refreshed risks. The Committee received the report • Note current H2 position and and noted the mitigations in place. challenges. lllllllllllllllll • Elective Accelerator Programme Performance Report: target of 120% improvement in 12 The Committee noted the key areas of concern being 52 week waits, weeks. symptomatic breast two week waits at George Eliot Hospital, 62 day cancer • In house CHC move to CCG. and out of area placements and actions to improve performance. • Note approval for contract extension for ScriptSwitch. Elective Accelerator Programme Update: Members noted the information supplied about this short-term national programme of work which has bought £10m into the system and recognition of how well the system had worked together through COVID. Risks to the programme include workforce fatigue, annual leave and a possible COVID third wave. Matters referred to the Governing Body for approval, debate or
H2 (second half of the financial year) Interim Position: further consideration:
The Committee noted the H2 draft budgets as discussed with NHS England/Improvement (NHSE/I). None.
Mental Health Investment Standard (MHIS) Review: The report informed Members of this review and summarised as follows: • There is a cost pressure that the CCG is working with Coventry and Warwickshire Partnership Trust (CWPT) to mitigate. • The main risks are regarding future year funding of the non recurrent funding and in-year slippage on recruitment. • There is a need for a work programme to ensure the investment is getting maximum return.
Continuing Healthcare (CHC) In housing (South Warwickshire) Team from Commissioning Support Unit (CSU): The Committee were advised of the benefits of being under one management team and agreed that the application be made to NHSE for the transfer of the CHC team currently embedded within the CCG in South Warwickshire.
Procurement Update Report: The Members received the report and approved the procurement for a GP Video Consultation for South Warwickshire GP Practices with approval of the preferred procurement route delegated to the Chief Planning and Performance Officer and Chief Finance Officer. Members also approved the contract extension of the current ScriptSwitch contract for South Warwickshire GP practices.
Key Information: • Committee Chair: Zubair Khan (Lay Member) • CCG Lead: Adrian Stokes (Interim Chief Finance Officer) • Date of Next Meeting: 7 July 2021 Enclosure R
Blank Page
Enclosure S
NHS CWCCG Finance and Performance Committee (F&P) Report for the Meeting held on 7 July 2021
Achievements/Decisions Made/Items to Note Key Issues for the Governing Body
Corporate Risk Register: The Corporate Risk Registers • Monitoring of risk on the Corporate Risk Register were presented to the committee and showed the position as will be a continued focus of the Committee. of the end of April 2021. 4 new risks had been added and 1 • H2 anticipated to be similar approach to H1 in risk had now been closed. terms of block payments and centralised funding. A review into how we approach efficiency Performance report: The CCG achieved 5 out of the 18 requirement going into 2022/23 to be an item of Constitutionallllllllllllllllll and Acute priority indicators in April 2021. discussion through Committee. Areas of concern were discussed and detail of the issues and • A detailed look into forecast achievement of recovery actions for all were outlined. Members noted that all Elective Recovery Fund (ERF) and delivery acute providers delivered in excess of the 70% national activity requirements around gateway assessments to be target as well as their progress with the Elective Accelerator looked at in detail in next Committee. Programme. • The Committee approved the contract extension for the Coventry Beds and Mattresses contract, Continuing Healthcare Update: Members were informed the Medical Notes Summarising Service and the that the external review had now been completed. The final Paramedic Acute Visiting Service. version of the report is being worked on and it is anticipated • The Committee approved the procurement plan that this will be made available to the Committee in August for the Re-procurement of Community Services 2021. for Adults with Learning Disabilities, Autism, Mental Health or Physical Disabilities. Finance Report Month 2: Members were advised that the CCG was forecasting an underspend of £0.5m against the planned H1 (first half of the financial year) deficit of £3.3m. The System has been requested to eradicate the £3.3m planned deficit and members were advised on the plan in place to achieve this.
H1 & H2: The CCG is on target for achieving H1. It is anticipated that H2 (second half of the financial year) will be similar approach to H1 and is in the process of being finalised.
Procurement Update Reports: Update was provided on the 4 live procurement, one of which has been paused nationally. Matters referred to the Governing Body for There are 3 upcoming procurements and approval was approval, debate or further consideration: sought for 3 contract extensions. • None. Re-procurement of Working Age Adult Services: Members were updated on the joint commissioning activity between Warwickshire County Council and the CCG to redesign and re-procure community services for adults with disabilities or mental health needs. Members approved the tender activity and development of a section 75 agreement to enable the delegation of procurement and letting contracts to the Council.
North Leamington Spa Estates Schemes: It was noted that to date in Coventry & Warwickshire, this was the first allocation of Community Infrastructure Levy Funding. Members noted the approach that would be taken in relation to the management of the funds. Key Information: • Committee Chair: Zubair Khan (Lay Member) • CCG Lead: Adrian Stokes (Interim Chief Finance Officer) • Date of Next Meeting: 4 August 2021
Enclosure S
Blank Page NHS Coventry and Warwickshire Clinical Commissioning Group Enc T
Report To: Governing Body
Report Title: Performance Report
Report From: Alison Cartwright, Chief Officer Performance and Delivery
Author: Kerry Doughty, Delivery Manager
Date: 21 July 2021
Previously Considered by: Finance and Performance Committee, 7 July 2021
Action Required
Decision: Assurance: Information: Confidential
Purpose of the Report: To update the Governing Body on the April 2021 position regarding headline activity information and performance against national targets and priority indicators for NHS Coventry and Warwickshire CCG (the CCG).
Key Points: • The CCG achieved 5 out of the 18 Constitutional and Acute priority indicators in April and exception reports with recovery actions for the areas not achieving the required standard are detailed within the report. Areas of particular concern are: • Referral to Treatment (RTT) pathway • Over 52 week waits • Two week wait cancer standards • 62 day cancer standard
• In addition to this, the Coventry and Warwickshire system achieved 5 out of the 18 Mental Health priority indicators. Areas of particular concern are: • CAMHS Autism waits • Annual health checks for patients with SMI • LD Admissions
• During April all acute providers delivered in excess of the 70% (of pre-covid levels) national activity target and are making progress with the Elective Accelerator Programme. Unvalidated data f or May is showing a shortfall against the plan but it is hoped this position will improve following availability of the validated data.
Recommendation: The Governing Body is requested to NOTE the contents of the report for ASSURANCE as to actions to improve performance as required.
Perf ormance Report, 2021/22, Month 1 Page 1 of 31 Governing Body – 21 July 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc T
Implications
Objective(s) / 1. Delivery of Constitution Indicators Plans supported by this report: 2. Improving Performance Conflicts of Interest: Not Applicable Non-Recurrent Not applicable Expenditure: Recurrent Expenditure: Not applicable Financial: Is this expenditure included within the CCG’s Financial Plan? Yes No N/A (Delete as appropriate) Performance: See detail within the report Quality and Safety: See detail within the report General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or Equality and due regard. Any decision that is finalised without being influenced by Diversity: appropriate due regard could be deemed unlawful. Has an equality impact Yes assessment been No N/A (attached) undertaken? Patient and Public Engagement: Not Applicable Clinical Not Applicable Engagement: Risk and High risk area given current performance challenges. Assurance:
Perf ormance Report, 2021/22, Month 1 Page 2 of 31 Governing Body – 21 July 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc T
Executive Summary
1.1 The report details the April 2021 activity for all points of delivery and the indicative Elective Recovery Fund (ERF) income resulting from this activity. In April all providers delivered in excess of the 70% national activity target although GEH and the IS providers are currently below the Elective Accelerator Programme (EAP) plan. The indicative ERF income for April is £3.9m. The data for May is currently looking slightly lower than plan, but as the data is not yet fully validated, this position may change.
1.2 Delivery of the national and local performance priorities has and continues to be impacted by Covid. In April 2021, the CCG achieved 5 out of the 18 Constitutional and Acute priority indicators. Exception reports with recovery actions for the areas not achieving the required standard are detailed within the report. Areas of particular concern are numbers waiting on a RTT pathway (and over 52 weeks), two week cancer standards and the 62 day cancer indicator. Benchmarking has been added to the report if available to provide context.
1.3 Planned care has been impacted significantly during the Covid pandemic which has resulted in long waits for routine referrals, particularly in General Surgery, Orthopaedics, Urology, Ophthalmology and ENT. As mentioned above, the accelerator programme will take forward the key actions to address these risks and improve system performance.
1.4 The Operational Plan, submitted on 3rd June, aims to address and put in place actions to improve performance across the system
Activity
2.1 The overall Coventry and Warwickshire (C&W) activity for each Point of Delivery for April 2021 compared to April 2019 is detailed below. Zero length of stay non-electives have increased when comparing the two time periods, however A&E attendances are lower than pre-pandemic levels. Non face to face activity has also significantly increased as would be expected.
Apr 19 - Apr 21 POD / Service Area 2019/20 2021/22 Diff % Diff A&E Attendances 34,539 28,681 -5,858 -17% Non Elective 0 LoS Admissions 2,622 3,601 979 37% Non Elective 1+ LoS Admissions 5,779 5,719 -60 -1%
Emergency Non-Elective Average LoS 6.90 5.85 -1.05 -15% Non-Electice Non-Emergency Admissions 2,455 2,558 103 4%
Outpatient First appointments 28,437 21,558 -6,879 -24% Outpatient Follow-up appointments 47,175 29,642 -17,533 -37% Outpatient Procedures 28,150 22,881 -5,269 -19% Outpatient NF2F 3,797 21,473 17,676 466% Elective Daycase admissions 9,793 8,208 -1,585 -16% Ordinary Elective admissions 1,281 1,004 -277 -22% Elective Average LoS 2.59 2.66 0.07 3%
2.2 The Coventry and Warwickshire CCG activity for the last 6 months can be seen below, with activity being RAG rated against the relevant recovery targets; for April 2021 these are the elective recovery fund thresholds for the elective points of delivery and the non-elective activity against April 2019 levels.
Perf ormance Report, 2021/22, Month 1 Page 3 of 31 Governing Body – 21 July 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc T
Activity by Point of Delivery for month compared to same month 2019/20
April 2021 Coventry and Warwickshire CCG ERF (All providers inc out of C&W) Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 threshold A&E 65% 64% 59% 62% 105% 83% <100% Daycase admissions 88% 92% 66% 74% 112% 84% 70% Ordinary Elective admissions 85% 82% 53% 47% 91% 78% 70% Non Elective Emergency 95% 101% 90% 100% 129% 111% <100% Non-Electice Non-Emergency Admissions 96% 95% 94% 96% 113% 104% <100% Outpatient First appointments 71% 75% 55% 61% 97% 76% 70% Outpatient Follow-up appointments 59% 62% 47% 53% 81% 63% 70% Outpatients Total (including NF2F) 90% 96% 77% 84% 117% 92% 70% Outpatient Procedures 74% 80% 69% 77% 111% 81% 70%
2.3 This activity data by individual provider is reviewed with the relevant Chief Operating Officer through the Elective Hub meetings and the Urgent Care meetings.
2.4 The table below shows that April 2021 primary care consultations are at 119% of April 2019 levels. The shift from face to face consultations in April 19 (83.3%) has reduced to 50% following the change in operating models implemented during Covid.
Apr-19 Apr-20 Apr-21 Total Appts 323,705 250,179 384,979
Mode Apr-19 Apr-20 Apr-21 Face to Face 83.3% 35.9% 50.0% Home Visit 1.5% 1.1% 0.7% Telephone 15.1% 52.5% 49.0% Video/Online 0% 0% 0.02% Unknown 0% 10.5% 0.0% Source: NHS Digital
Elective Recovery Fund
3.1 The table below shows the total elective activity for April & May 2021 as a percentage of the same period in 2019 for the Trusts and the system. This data is based on initial monthly data for April and weekly snapshot data for May and therefore has not yet been fully coded and costed. The figures have moved upward since the last report, and May especially is expected to increase further as more SUS data becomes available. Reporting of actuals be completed in line with the usual national SUS timetable and confirmed by NHS E.
Accelerator Plan 81% 95% 104% 118% 119% 119% Trust activity Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 GEH 71.9% 84.7% SWFT 87.4% 89.8% UHCW 87.5% 92.0% CWPT 100% 100% CCG IS 77.1% 82.2% STP 84.9% 91.2%
3.2 Based on this early data the tables below show the indicative ERF income. Once the data has been fully costed and report in line with the national timetable, the actual ERF income achieved by system and provider split will be formally reported in the finance report.
Perf ormance Report, 2021/22, Month 1 Page 4 of 31 Governing Body – 21 July 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc T
Accelerator Plan - estimated ERF Income - Original Plan Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 GEH £106,851 £300,766 £887,622 £1,783,091 £1,668,223 £1,817,836 SWFT £177,814 £751,635 £1,251,569 £2,283,799 £2,611,387 £2,713,461 UHCW £2,237,181 £4,159,491 £6,088,033 £7,080,317 £6,610,560 £7,254,094 CWPT £130,800 £104,603 £98,146 £69,406 £62,592 £74,569 CCG IS £575,256 £478,788 £369,810 £753,420 £451,917 £478,803 STP £3,227,902 £5,795,282 £8,695,179 £11,970,033 £11,404,679 £12,338,763
Accelerator Current FO - estimated Income Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 GEH £74,374 £372,110 SWFT £1,174,475 £1,311,153 UHCW £2,816,032 £2,726,205 CWPT £130,800 £104,603 CCG IS £115,066 £86,301 STP £4,310,747 £4,600,372
Variance from Original Plan Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 GEH -£32,476 £71,344 SWFT £996,661 £559,518 UHCW £578,851 -£1,433,286 CWPT £0 £0 CCG IS -£460,191 -£392,486 STP £1,082,845 -£1,194,910
Cummulative £1,082,845 -£112,064
3.3 Although May is currently under plan, the actual position is likely to improve once fully coded and costed data is available.
3.4 The Elective Hub Board and Chief Operating Officers review the data at speciality level and use to inform the forward plans on a weekly basis.
3.5 The system is reviewing further the IS activity reporting to ensure everything is being counted whilst Trusts are sending far more activity this year than in 2019-20 in terms of the day case and elective inpatient numbers, the case mix of this activity coming through SUS appears at present to be less complex than what went through the IS in 2019-20.
3.6 Trust Chief Operating Officers (COOs) remain confident that their operational plans for increasing Elective work activity are on track, and their assessment of June is they will be on target against the accelerator plan.
Perf ormance Report, 2021/22, Month 1 Page 5 of 31 Governing Body – 21 July 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc T
Performance
4.1 The report details April 2021 performance for the NHS Constitution Rights & Pledges and priority indicators for both the CCG and its main providers of services. Actions being taken to address any areas of non-achievement are detailed in the exception reports. The Regional Average has been provided where this is available for the NHS Constitutional targets.
Regional Good Progress Basis Target Apr -21 Trend Average A&E: 12 hour trolley waits Provider 0 0
Cancer – 31 day standard CCG 96% 98.7% 91.9%
Cancer 31 day – anti drug regimen CCG 98% 100% 99.2%
Cancer - 31 day radiotherapy CCG 94% 98.3% 95.6%
Number of operations cancelled for a second time Provider 0 0
Regional Areas of Concern Basis Target Apr-21 Trend Average A&E: Patients should be admitted, transferred or discharged within 4 GEH 91.8% SWFT 95% 88.8% 82.0% hours UHCW 86.2% Ambulance Handovers 60 minutes + Provider 0 90
RTT – Incomplete Pathway CCG 92% 60.8% 61.1%
RTT – 52 week breach CCG 0 6339
Diagnostic Tests – Patients shouldn’t wait more than 6 wks CCG 99% 92.0% 73.6%
Cancer - 2 week wait GP Referrals CCG 93% 85.7% 81.7%
Cancer - 2 week wait Breast CCG 93% 80.1% 42.9%
Cancer - 31 day surgery CCG 94% 89.9% 74.4%
Cancer – 62 day standard CCG 85% 68.9% 72.2%
Cancer – 62 day screening CCG 90% 65.5% 72.2%
Cancer – 62 day upgrade CCG 85% 79.5% 79.7%
Cancer – 104 Day breaches (patients) CCG 0 16
NHS 111: % calls answered in 60 seconds WMAS 95% 83.1% 83.8%
Perf ormance Report, 2021/22, Month 1 Page 6 of 31 Governing Body – 21 July 2021
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Mental Health Performance at a glance
Good Progress Basis Target Apr -21 Trend
Improving Access to Psychological Therapies (IAPT): Recovery CCG 50% 51.0% Rate (February 2021) IAPT 6 weeks - Finished Treatment (February 2021) CCG 75% 95.1%
IAPT 18 weeks - Finished Treatment (February 2021) CCG 95% 97.1%
Care Programme Approach: Proportion of patients followed up CWPT 95% 100% within 7 days of discharge from psychiatric inpatient care
Annual Health Checks - Learning Disability (Q4, published data) CCG 497 1482
Regional Areas of Concern Basis Target Apr-21 Trend Average Service users experiencing a first episode of psychosis or ARMS who waits less than two weeks to start a NICE recommended CCG 50% 36.4% package of care Improving Access to Psychological Therapies (IAPT): Access Rate CCG 22% 17.3% (annualised as at February 2021) Dementia diagnosis percentage (65 + years) CCG 66.7% 55.1% 62.1%
Annual Health Checks for patients with Severe Mental Illness (Q4) CCG 50% 10.6% 22.3%
CAMHS - Referral to Treatment (Emergency - 48 hrs) CWPT 100% 95.8%
CAMHS - Referral to Treatment (Urgent - 5 days) CWPT 100% 83.3%
CAMHS - Referral to Treatment (Routine - 18 weeks) CWPT 95% 71.6%
CAMHS - Waiting time from initial appointment to f/up (12 weeks) CWPT 95% 60.1% CAMHS - patients will have an assessment within 48 hours of CWPT 100% 95.8% referrals to ALT where medically fit CAMHS - referrals for an assessment or treatment of any eating disorder will access NICE concordant treatment within 1 week for CCG 90% 50.0% urgent cases (Quarter 4) CAMHS - referrals for an assessment or treatment of any eating disorder will access NICE concordant treatment within 4 weeks for CCG 90% 41.2% routine cases (Quarter 4) Children and Young People’s Emotional Well-Being and Mental CCG 12 weeks 110 Health Follow-ups (over 12 weeks ) Children and Young People’s Autism Spectrum Disorder Assessment CCG 12 weeks 3269 Waits (CYP ASD) (over 12 weeks - proxy )
While Mental Health reporting is still suspended in the main, CWPT has allowed the use of the CAMHS data. However, during the COVID pandemic period this data has not undergone the usual rigorous validation processes or sign off by operational teams.
Perf ormance Report, 2021/22, Month 1 Page 7 of 31 Governing Body – 21 July 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc T
NHS Constitution Rights and Pledges
2.2 April 2021 performance for Coventry and Warwickshire CCG and its main providers is shown below:
Coventry & Warwickshire Clinical Commissioning Group NHS Constitution Measures
20-21 21-22
Annual 21-22 Mar-21 Q1 Q2 Q3 Q4 20-21 Apr-21 May-21 Jun-21 Measure Target YTD Referral to treatment times (RTT) Patients on incomplete non-emergency pathways waiting no more than 18 weeks from 92% 61.7% 58.8% 48.3% 65.3% 62.8% 59.2% 60.8% 60.8% referral
RTT > 52 weeks breaches - Incomplete Pathways (Snapshot) 0 7,225 475 2024 3501 7225 7225 6339 6339
Patients waiting less than 6 weeks from referral for a diagnostic test 99% 92.0% 62.4% 84.2% 91.7% 91.9% 84.1% 92.0% 92.0%
A&E Waits
Patients should be admitted, transferred or discharged within 4 hours of their arrival at 95% 87.3% 93.5% 91.2% 84.4% 84.1% 88.0% 88.1% 84.9% 86.4% an A&E department
Number of patients spending >12 hours from decision to admit to admission 0 0 0 0 5 0 5 0 0 0
Cancer Waits
Cancer two week wait for first outpatient appointment for patients referred urgently with 93% 90.5% 92.5% 87.9% 88.0% 89.8% 89.2% 85.7% 85.7% suspected cancer by a GP
Cancer two-week wait for first outpatient appointment for patients referred urgently with 93% 76.0% 80.0% 57.9% 40.5% 62.1% 61.0% 80.1% 80.1% breast symptoms
Cancer one month (31-DAY) wait from diagnosis to first definitive treatment for all 96% 95.0% 92.9% 94.1% 97.7% 95.9% 95.3% 98.7% 98.7% cancers
Cancer 31-day wait for subsequent treatment where that treatment is an anti-cancer 98% 100.0% 99.7% 100.0% 100.0% 100.0% 99.9% 100.0% 100.0% drug regimen
Cancer 31-day wait for subsequent treatment where the treatment is a course of 94% 98.6% 93.2% 96.0% 98.0% 98.5% 96.5% 98.3% 98.3% radiotherapy
Cancer 31-day wait for subsequent treatment where that treatment is surgery 94% 87.7% 90.9% 90.2% 93.4% 88.1% 90.7% 89.9% 89.9%
Cancer two month (62-day) wait from urgent GP referral to first definitive treatment for 85% 74.7% 66.2% 74.0% 72.9% 68.8% 70.7% 68.9% 68.9% cancer
Cancer 62-day wait from referral from an NHS screening service to first definitive 90% 73.1% 46.8% 57.9% 81.8% 73.3% 66.4% 65.5% 65.5% treatment for all cancers
Cancer 62-day wait for first definitive treatment following a consultant's decision to 85% 90.2% 81.4% 81.7% 85.5% 90.4% 84.6% 79.5% 79.6% upgrade the priority of the patient
Perf ormance Report, 2021/22, Month 1 Page 8 of 31 Governing Body – 21 July 2021 NHS Coventry and Warwickshire Clinical Commissioning Group Enc T
NHS Local Mental Health Priorities
2.3 April performance for Coventry and Warwickshire CCG at CWPT is shown below. Exception reports for non-compliant standards are detailed further on in the report. Mental Health Dashboard
Indicator Target May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr -21
Adult - % of service users experiencing a first episode of psychosis or ARMS (at risk mental state) who waits less No 50% 50.0% 0.0% 100.0% 100.0% 50.0% 100.0% 100.0% 100.0% 53.3% 75.0% 36.4% than two weeks to start a NICE recommended package of care - Completed Pathways patients
% of patients contacted within (4 hours) of referral to the Crisis Team 95% Monitored Week ly
Adult - % seen, physically reviewed and examined by CWPT POS clinician (Junior Doctor) within 3 hrs of Q4 - 95% Monitored Week ly admission to the unit from time of arrival at POS Adult - 90% of all appropriate referrals received from A&E which have had their assessment commenced within 90% Monitored Week ly 90 minutes from AMHAT receiving the referral. Adult - 90% of all appropriate referrals received from wards have had their assessment commenced within 36 hours from AMHAT receiving the referral. This will be subject to clinical availability and existing clinical 90% Monitored Week ly priorities Dementia Diagnosis over 65 years 67% 56.5% 55.6% 55.0% 55.2% 55.0% 55.4% 55.2% 55.2% 54.5% 54.0% 54.7% 55.1%
IAPT 6 weeks - Finished Treatment 75% 92.0% 88.9% 89.0% 89.4% 88.7% 89.3% 91.2% 94.5% 95.1% Not available
IAPT 18 weeks - Finished Treatment 95% 100.0% 99.3% 98.2% 96.5% 94.4% 94.3% 96.5% 98.2% 97.1% Not available
IAPT Access Rate (annualised) 22% 10.1% 13.6% 13.1% 19.0% 17.2% 17.7% 15.9% 19.5% 17.3% Not available
IAPT Recovery Rate 50% 55.0% 54.0% 56.1% 51.4% 54.5% 54.2% 58.0% 52.7% 51.0% Not available
CAMHS - Referral to Treatment (Emergency - 48 hours) 100% 100.0% 100.0% 100.0% 100.0% 100.0% 98.8% 97.6% 100.0% 100.0% 100.0% 100.0% 95.8%
CAMHS - Referral to Treatment (Urgent - 5 working days) 100% 0.0% 33.3% 100.0% 20.0% 84.2% 94.7% 100.0% 100.0% 100.0% 100.0% 100.0% 83.3%
CAMHS - Referral to Treatment (Routine - 18 weeks) 95% 78.6% 98.2% 88.5% 80.0% 84.2% 85.4% 87.3% 97.1% 92.5% 84.5% 100.0% 71.6%
CAMHS - Referrals Received by Navigation Hub (All CAMHS) 308 472 519 402 602 886 828 719 528 642 593 421
CAMHS - Waiting time from initial appointment to follow up appointment (12 weeks) 95% 35.8% 13.6% 13.5% 24.7% 45.9% 56.9% 62.0% 50.0% 48.7% 50.0% 57.0% 60.1%
CAMHS - ASD Waiting time from referral to assessment (Average wait) TBC 64 67 69 72 75 77 80 82 84 91 94 96
CAMHS - Number of ASD assessments undertaken each month 16 21 11 7 19 22 18 20 44 34 26 36
CAMHS - referrals for an assessment or treatment of any eating disorder will access NICE concordant treatment 90% for 18/19 50.0% 66.6% 40.0% 50.0% N/A within 1 week for urgent cases CAMHS - referrals for an assessment or treatment of any eating disorder will access NICE concordant treatment 90% for 18/19 73.1% 66.7% 39.1% 41.2% N/A within 4 weeks for routine cases
CAMHS - patients will have an assessment within 48 hours of referral to ALT where medically fit 100% 100.0% 100.0% 100.0% 100.0% 100.0% 98.8% 97.6% 100.0% 100.0% 100.0% 100.0% 95.8%
CAMHS - Looked After Children referred within 9 weeks - number of referrals 58 46 60 106 N/A
Please note: Due to Covid-19 some data flows have been suspended. Therefore, there is a delay with some data sets, which is severely impacting the reporting received from Coventry & Warwickshire Partnership Trust (CWPT) for Mental Health. CWPT is working with Commissioners to develop the Qlik data hub, which will enable review of performance in real time. The CAMHS data has not been fully validated and so is subject to change. Monthly Crisis and AMHAT data is not available retrospectively, however a snapshot for March with related actions is available.
Perf ormance Report, 2021/22, Month 1 Page 9 of 31 Governing Body – 21 July 2021 NHS Coventry and Warwickshire Clinical Commissioning Group Enc T
Benchmarking Data
2.4 Benchmarking of Coventry and Warwickshire CCG April performance against both the Midlands and the NHS England position is shown below. The CCG is performing better than England and the Midlands against the Diagnostic standard, A&E performance and 31 Day Cancer standards. Concern remains for 18 Weeks RTT, 62 Day Cancer standards, Dementia Diagnostic rates and Physical Health Checks for people with SMI. For the benchmarking provided in the exceptions report that follow – a green RAG rating indicates the system is performing favourably against both the national and regional averages; Amber indicates the system is performing better than either the national or regional average; Red indicates the system is performing less favourably to both national and regional averages.
Risk - Risk - Compared with Midlands and Compared with Midlands and Description Target Month Data Benchmarked Description Target Month Data Benchmarked England England against England against England
65% 100% Patients on incomplete non-emergency pathways waiting no more 60% Cancer 31-day wait for subsequent treatment where the treatment is a 95% 92% Apr-21 94% Apr-21 98.3% 60.8% course of radiotherapy than 18 weeks from referral 55% 90% England Midlands CWCCG England Midlands CWCCG
100% 100% 50% Cancer 31-day wait for subsequent treatment where that treatment is 50% Apr-21 94% Apr-21 89.9% Patients waiting less than 6 weeks from referral for a diagnostic test 99% 92.0% surgery 0% 0% England Midlands CWCCG England Midlands CWCCG
90% 80% Cancer two month (62-day) wait from urgent GP referral to first 70% Patients should be admitted, transferred or discharged within 4 hours 85% 85% Apr-21 68.9% 95% May-21 84.9% definitive treatment for cancer of their arrival at an A&E department 80% 60% England Midlands CWCCG England Midlands CWCCG
90% 80% 85% Cancer 62-day wait from referral from an NHS screening service to 70% Cancer two week wait for first outpatient appointment for patients 90% Apr-21 93% Apr-21 85.7% 80% 65.5% first definitive treatment for all cancers 60% referred urgently with suspected cancer by a GP 75% England Midlands CWCCG England Midlands CWCCG
85% 100% Cancer 62-day wait for first definitive treatment following a 80% Cancer two-week wait for first outpatient appointment for patients 50% 85% Apr-21 79.5% 93% Apr-21 80.1% consultant's decision to upgrade the priority of the patient referred urgently with breast symptoms 75% 0% England Midlands CWCCG England Midlands CWCCG
70% 100% 60% Cancer one month (31-DAY) wait from diagnosis to first definitive 90% Dementia Diagnosis Rate 67% Apr-21 55.1% 96% Apr-21 98.7% treatment for all cancers 50% 80% England Midlands CWCCG England Midlands CWCCG
40% 100% Q4 20% Cancer 31-day wait for subsequent treatment where that treatment is 99% Physical health checks for people with severe mental illness (SMI) 60% 10.6% 98% Apr-21 100.0% 20/21 an anti-cancer drug regimen 0% 98% England Midlands CWCCG England Midlands CWCCG
Perf ormance Report, 2021/22, Month 1 Page 10 of 31 Governing Body – 21 July 2021 NHS Coventry and Warwickshire Clinical Commissioning Group Enc T
3.1 EMERGENCY CARE TARGETS: 4 Hour Wait Benchmarking
CWCCG MIDLANDS ENGLAND A&E Performance
Beds Occupied by Long Stay Patients as a Proportion of Occupied Beds
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3.1 EMERGENCY CARE TARGETS: 4 Hour Wait
o Too much urgent and primary care activity is being managed Daily sitreps as at 27/06/21 by ED doctors detracting them from managing unwell patients and keeps ED overcrowded. 6 week average Bed Occupancy Last Last 6 Trust Core Escalation Total Beds Week Weeks • On the back of this review a point of prevalence audit has been scheduled for June 2021 to further identify system opportunities GEH 303 0 303 83.8% 86.1% and actions. SWFT 361 17 378 85.7% 85.9% • A&E Delivery Board has agreed the System key priorities to UHCW 1016 0 1016 95.6% 94.7% address the above findings in preparation for winter pressures: Total 1680 17 1697 91.3% 91.2% 1. 111 First – aim to ensure that 70% of all A&E activity contacts 111 before attending. This will not only support with redirecting patients to appropriate services, but also allow for Update: A&E appointments to be booked and thus appropriate • Month 02 A&E published report is now available and shows that although the spread demand to avoid surges in activity. system percentage decreased slightly from Month 01 to Month 02, this is still 2. C&W Urgent Treatment Centre gap analysis to ensure there higher than the Regional and National Average at 84.9%. is a robust directory of services for 111 to divert patients • Attendances for April and May this year compared to last are 97% higher due away from A&E; to lockdown and the quiet period seen during the beginning of Covid, but are 3. Long Length of Stay – focus on discharge to support rapid 7% lower than those levels seen during April & May 2019 prior to this time. discharge; • During the last 6 weeks, beds have been 91% occupied. This varies across 4. Frailty pathway review; providers with UHCW at 94.7% compared to 85.9% at SWFT. 5. Urgent (2 hr) Community Response – focusing on avoiding admissions; • Patients admitted following an A&E attendance has decreased to 19% - the lowest percentage seen for 14 months. Long stay patients (those admitted for 6. End of life pathways; 7, 14 and 21 days) remain lower than the levels seen Pre-Covid. 7. Mental Health Crisis response.
Issues and Recovery Actions: • The System level ‘Missed Opportunities’ reviewed reported: o Significant volume of A&E and Ambulance activity did not necessarily require Emergency Department (ED), and could have been managed more appropriately elsewhere in the hospital or in alternative urgent care services; o Prompt streaming of patients at the front door varied by specialty at each Provider; o Only approximately 10-15% of patients had sought medical support from a health care professional before attending A&E;
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3.2 EMERGENCY CARE TARGETS: 111 and Ambulance Handovers Benchmarking – 111 Only
WMAS MIDLANDS ENGLAND 111 Outcomes Performance Ambulance Handovers
111 Service Improvement Actions: SWFT: • The ‘Think 111 First’ programme has embedded across all three There were 40 reported over 60 minute handovers in April. Coventry & Warwickshire sites with direct booking into ED and SDECs from 111. Work is ongoing to match volume and slot distribution to GEH: patient demand and increase utilisation. There were 2 reported over 60 minute handovers in April. This is the same • The Emergency Departments across the system are using the EDDI as what was reported in March. (Emergency Department Digital Integration) which allows the booking in and transfer of cases to ED. UHCW: • Processes to ensure accurate data monitoring are underway, which will There were 48 reported over 60 minute handovers in April. This is an support project evaluation going forward. increase of 118%.
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4.0 REFERRAL TO TREATMENT: Overview Benchmarking
CWCCG MIDLANDS ENGLAND Update: There has been a fall in the number of 52+ week waiters during April, as a result of more elective activity being delivered and focused effort on validation of longest waiters. The Trusts are delivering activity levels in line with the national target and also met the ERF target in April as a system.
Recovery Actions: 1. The Coventry and Warwickshire System has been successful in its bid to become an Elective Accelerator site. The System has been awarded non-recurrent funding to achieve 120% of pre-Covid activity by July 2020 to support reducing the number of long-waiting patients, with a Specialty 52+ Week focus on these specialties referenced. This is being supported by a breaches number of interventions: General Surgery 1097 Urology 944 o Comprehensive workforce plan being implemented; T&O 889 o Appropriate use of the Independent Sector (IS); Ophthalmology 726 o Digital innovation to support patients at home; ENT 689 o Outpatient review to ensure best use of capacity; o Increased delivery of Advice and Guidance; o Demand management plan in place. Issues: • Following the suspension of routine elective procedures in March 2020, 2. Establishment of the Elective Care Hub to facilitate and monitor the an increase in waiting lists has been seen across the system. The Accelerated Recovery workstreams. breakdown of long waiters by Trust show that there are challenges across all providers, and the breakdown of specialties show that the 3. Work to integrate the waiting lists to create a system view (shared PTL) main specialties with the largest waiters are General Surgery, is underway, with ongoing modelling of demand and capacity. Orthopaedics, Urology, Ophthalmology and ENT.
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5.0 DIAGNOSTICS: Overview Benchmarking
CWCCG MIDLANDS ENGLAND Issues: • In line with National guidance, cancellation of electives also impacted on diagnostics, due to suspension of services. • As specialties begin to work through backlog of outpatients, bottlenecks are being created in some specialties compounding the issue. • The need for social distancing and increased infection prevention measure has created capacity issues due reduced productivity and a lower throughput due to the size of departments.
Recovery Actions: System Level 1. The Acute providers have submitted their bids for Diagnostic Hubs, which are now under review by NHS England.
UHCW 1. Endoscopy and screening are still working to manage capacity, but all other modality pathways are working effectively. 2. Work is underway to identify opportunities for direct access to diagnostics which is being clinically led.
GEH 1. The teams continue to monitor and focus on capacity to provide support of the restoration and recovery plan for April 2021.
SWFT 1. Increase to workforce expected to improve the time from scan to report to prevent bottlenecks in patient pathways.
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6.1 CANCER: Two Week Wait Benchmarking
CWCCG MIDLANDS ENGLAND • The number of out of area referrals are also being monitored due to waiting time issues being experienced by providers outside of the local system. • Direct to test capacity is impacting on waiting times. Organisation % • UHCW have experienced an increase in referrals and capacity issues, CWCCG 85.7% resulting in breach of the 2ww standard. Head and neck contributes to GEH 79.8% this by only achieving 4% with 164 patients required to wait over 2 SWFT 82.4% weeks.
UHCW 89.2% Recovery Actions:
1. To increase use and uptake of FIT (Fecal Immunochemical Test) for 2ww; 2. Working through cancer pathways on a specialty basis to align processes with the 28 Day Faster Diagnosis standard; 3. Waiting list initiatives in place at GEH and additional clinics being run at SWFT; 4. Patients and referrals are being tracked closely with the aim of picking up any inappropriate referrals; 5. Continued focus on Patient Tracking List (PTL) and early escalation; Development and implementation of systemwide 2 ww referral forms and e-triage to enable booking process improvements;
6. Close working relationship established with booking centres to track Issues: progress and issues with 2ww forms. • 520 patients breached out of 3,624 patients seen. Referrals have 7. Close working relationship established with booking centres to track continued to increase in line with resumption of GP services and progress and issues with 2ww forms. national screening programmes, following the initial decline at the 8. UHCW are exploring options for increasing USS capacity, which will beginning of the pandemic. reduce the number of long waiting patients in Head and Neck.
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6.2 CANCER: Two Week Wait – Breast Symptomatic Benchmarking
CWCCG MIDLANDS ENGLAND Issues: • 59 breaches out of 297 patients seen. • Breast screening has resumed, which has caused an increase in referrals. Organisation % • GEH performance has increased in April, however the position at CWCCG 80.1% SWFT has deteriorated which highlights the instability in the service. GEH 54.4% • Capacity in the system and current staffing levels. SWFT 77.0% UHCW 100.0% Recovery Actions: 1. Full data analysis undertaken for 2ww performance, referral overview and cancer conversion; 2. One of the System’s priority specialty areas with action plans shared with Trusts and across the Health and Care Partnership (HCP). 3. Radiology capacity has improved at the GEH and SWFT, preventing bottlenecks in capacity following the running of additional clinics; 4. Demand and capacity review at GEH to understand staff shortfall. Clinic slots amended to reflect demand. Linking in with HCP systemwide group. 5. SWFT recruiting additional clinical workforce to ensure increased capacity for new clinics is sustainable.
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6.3.1 CANCER: 62 Day Standard Performance Benchmarking
CWCCG MIDLANDS ENGLAND 62 Day Cancer – Screening Performance: 62 day Wait from GP referral
UHCW • Eight breaches were identified at UHCW out of 28 in total. Two breaches shared with SWFT; one due to a diagnostic delay, the other patient choice. Two breaches were shared with GEH, both of these were due to an administrative delay. The three breaches at UHCW were due to; patient choice, diagnostic delay and capacity issues.
SWFT • Four breaches occurred out of 9 and all were shared breaches. Two were due to patient choice and the other two were due to diagnostic delays.
GEH • Three breaches occurred at GEH out of 6 patients treated. These Organisation % were shared breaches. Two breaches were an administrative CWCCG 68.9% delay and the other breach is still under investigation. GEH 58.0% SWFT 62.4% UHCW 78.3%
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6.3.2 CANCER: 62 Day Issues and Recovery Actions
Issues: Recovery Actions: • During the pandemic, capacity issues have been significantly affected 1. Development of System wide Performance Improvement Plan (PIP) even though cancer and urgent activity was prioritised. With the added agreed at February Health & Care Partnership (HCP) Cancer Board; needs of social distancing, PPE and cleaning requirements and Covid 2. System wide groups to support development of PIP; isolation pre-treatment restrictions, delays have been compounded 3. Priority areas (including actions on Comms, PLT, targeted Primary further. Care Work, provider pathway mapping, systemwide guidelines etc): • The number of patients waiting longer than 62 Days for treatment has • Head and Neck increased, which will continue to impact on performance as the backlog • Breast is worked through. However, of those waiting over 62 Days, fewer are • Lower GI waiting over 104 Days than at the peak as longest waiters have been • Urology prioritised. • Gynaecology • Where there have been significant issues with 2ww capacity causing 4. Trusts to focus on review of front-end pathway including the increase delays at the beginning of the patient pathway, there has been a of diagnostics capacity; resultant impact on 62 Days. 5. Access to Histopathology data at specialty level; support speciality • Consultant shortages in Gynae & Urology for GEH. level discussions to identify bottlenecks/issues; 6. Detailed action plans shared with providers (during May 2021) and dovetail with individual Trust plans; At SWFT full action plans are available at specialty level (which includes workforce plans) and these are monitored weekly. 7. Oversight and monitoring at future HCP Cancer Board. 8. Digital Transformation work particularly around radiology. 9. Operational Plan submitted focussing on cancer treatment volumes and patients waiting >63 days.
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7.1 MENTAL HEALTH: Adults Benchmarking Indicator Issue Recovery Actions No Improving Access to Psychological • CWPT are commissioned to meet a 22% • Introduction of online referrals/ online Benchmarking Therapies access rate for patients entering treatment therapies (Silvercloud) Data Available for anxiety and depression. • Expanding workforce (PWP • NHSE has applied new prevalence rates Apprenticeships) and modalities; (which was 84,094 and has now increased Counselling for Depression trainees. to 123,621). • Launch of a new IAPT website. • The access rate was not met in 20/21, but • Service expansion & development. a recovery plan is in place to meet the • Scoping an IAPT-ASD offer for C&W. target in Jan 2022, working to the old • LTC pathways, long Covid hubs and prevalence rates University Liaison
• Growing GP concerns on waits from 1st to • Demand and capacity modelling and 2nd treatment times (national expectation M1 & 2 unvalidated data for CWCCG is demonstrating interrogation of waiting time data, split promising performance; is that no more than 10% patients should by place and intervention be waiting 90 days or more). • Developing a sub-contract partnership • Interdependency between balancing to reduce waiting times access rate and recovery rate standards. • Ongoing monitoring, challenge and confirm via a monthly steering group of the refreshed 'IAPT Improvement and Recovery Plan' and trajectory. Dementia Diagnosis • DDR has been significantly impacted by • Review capacity issues in MAS and Covid due to a disproportionate number of look at ways of supporting the deaths with Covid in the population that service to increase diagnosis rates. has dementia, and older people shielding CWCCG • Commissioners and CWPT meet or choosing to avoid non-urgent medical assessment due to vulnerability to Covid. fortnightly to progress actions and • Many of the recovery actions rely on awaiting data on impact of Covid primary care, who have not been able to and capacity measures. MIDLANDS support at the anticipated level due to • Employment of a doctor on a short- Covid. term basis to support with clearing • Arden Memory Service have been able to the backlog of cases from the see a reduced number of patient due to cognitive assessment scheme is on ENGLAND infection-control measures. hold due to lack of GP capacity.
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7.2 MENTAL HEALTH: Out of Area Placements
Issues: Recovery Actions
Since Q4 20/21, significant system pressures have compounded to A refreshed trajectory is in place to reach the OOA zero national ambition by deteriorate performance (ex IPC measures, increasing acuity, end of Q2 of 21/22, as a must-do target. inappropriate use of MH beds by ASD/ under 18s, delayed discharges/ lack of placement suitability and increasing MH caseloads). The revised trajectory reflects the discharge funding made available through the Spending Review monies in 21/22, which for C&W STP is £1,329m on a • As at midday 11/6/2021, CWPT had 23 inappropriate acute out of non r/c basis. area placements, all in independent sector placements, 2 in PICU settings, and a number significant distances from Coventry and OOA continue to be reviewed at weekly multi-agency review meetings to Warwickshire including Norwich, Enfield, London and Bristol. progress discharge and repatriation opportunities where possible and • Due to CQC concerns, there is currently a stop on new admissions to appropriate. There is ongoing review of inpatient IPC arrangements to Broomhill and as a result, we are down to 8 patients in Broomhill/St optimize bed capacity, supported by a monthly OOA SG. Matthew‘s Hospital • There were also 6 patients at Carebright, Earlsdon Placements to Carebright have been extended to 31st July 2021
These total numbers remain high and continue to show the severe pressures facing the whole MH inpatient services.
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7.3 MENTAL HEALTH: Children – 12 Week Follow Ups
Issues: • There is significant, ongoing pressure on clinical capacity, which is being outstripped by demand. • Increased utilisation of the navigation hub impacting on workforce and triage timeframes. • Workforce issues due to Covid and redeployment of staff • Video appointments are not appropriate for all interventions, as unable to read body
language and non-verbal cues. • The average wait by Place as of April 2021 are;
Locality Average Wait Coventry and Rugby 7 Warwickshire North 10 South Warwickshire 8
• Information on the longest wait by locality has been requested and will be provided in the report next month.
Recovery Actions: 1. The service is still working to achieve sign off of the DPIA for the Helios Digital Platform Pilot. This would enhance the digital environment for CYP MH interventions over and above what is offered on Attend Anywhere. 2. The Attend Anywhere platform is still being used to undertake specialist assessments and dedicated interventions. CAMHS is the highest user in the Trust of digital contacts via Attend Anywhere 3. CWPT are accepting Self-Referrals for those Young People and families that chose to not progress with their referral due to Covid. 4. Access and engagement have been key priorities of the Team to support CYP and families during Covid and now into the recovery phase. 5. Evaluation work is being undertaken to continue to strengthen the approach to effectively support CYP who present in Acute Hospitals.
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7.4.1 MENTAL HEALTH: Children – Autism Assessments Performance
Waits by locality for April 2021, by week, are as follows;
Locality Average Longest Wait Wait Coventry – Pre-School Age 51 164 Coventry – School Age 102 257 Rugby – School Age 91 221 Warwickshire North – School Age 92 194 South Warwickshire – School Age 104 201
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7.4.2 MENTAL HEALTH: Children – Autism Assessments Issues and Recovery Actions Issues: Recovery Actions:
• There has been an increase in referrals from education, with an 1. A restoration plan in relation to returning the service to full capacity has associated requirement for commissioned capacity from WCC. been requested from the Trust. 2. The Trust has been asked to clarify the current financial envelope for • Due to the multi-professional and multi-agency nature of assessments, the school age service and a realistic number of assessments within the developing remedial plans is complex. current resources available. 3. Additional funding to CWPT has been identified within LDA • The assessment team includes; Transformation Funds to support waiting list management to undertake Children’s Neurodevelopmental Team (CWPT) validation and prioritisation work and support data development to o enable accurate and detailed reporting of those waiting for assessment o Paediatrician (SWFT) SALT (0-11, SWFT) across all pathways. o 4. The system wide autism strategy is due to be finalised by July 2021 o Educational Psychologist (11+,WCC) which aims to address the challenges currently in place. Aligned to the • The Trust has indicated that the capacity to undertake assessments strategy, a system-wide neurodevelopmental diagnostic transformation within the service is impacted by the complexity of assessment for programme has been established. young people in priority criteria (now over 70% of activity), telephone 5. The strategy and transformation programme aims to reduce the current clinics for people waiting an assessment, triaging referrals, staff backlog by commissioning additional capacity for diagnostic vacancies Including maternity leave and providing cover within the assessments and developing a framework of trusted providers to Crisis Team. support families to exercise choice in provision. 6. CWPT has received additional funding to address the Warwickshire pre- school backlog as an immediate priority. 7. Coventry and Warwickshire are part of the NHSE regional Autism Workstream, which has identified the diagnostic pathway as a priority focus. This links into the national autism workstream which is progressing work to address this national challenge. 8. The Community Outreach Service for Children and Adults with autism has been reviewed, showing a positive impact those on the waiting list. 9. Demand for the service continues to outstrip limited clinical capacity to deliver a service. Some new ways of working are taking affect and is improving patient experience. New digital technologies have been embraced to improve access to patents and empower the patient groups such as the Dimensions App. Detailed recovery plans in are still work in progress. A system wide review is underway to alleviate waiting times pressures
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7.5 MENTAL HEALTH: AMHAT and Crisis Indicator Issue Recovery Actions AMHAT – 90 Minutes • Challenges in meeting the new • Work is ongoing to manage staffing levels to maintain response times remain due to positive response levels. vacancies, lack of office space in • Review and improve data recording to ensure that UHCW, etc. performance is accurately represented. • Pressure on staffing levels due to (non • Ongoing implementation of the service evaluation Covid) sickness and vacancies recommendations, with AMHAT staff returning to the local resulting in capacity deficits. general hospital sites and the development of enhanced • New AMHAT response times of 60 arrangements for those with primarily social care needs. mins, 12 hrs and 24 hrs respectively • CSPI colleagues working to report the new targets. technically commenced from 1 April 2021 in UHCW and SWFT (Core 24).
Crisis • Staffing challenges due to the • Service expansion and transformation continues to be requirement to shield. progressed despite the pressures arising from Covid-19, and • Low uptake of digital alternatives due to the new access hubs successfully started September 2020. patient need and access. • Work is ongoing to validate the data. • CWPT have been awarded funding in 2021/22 to develop crisis alternatives, including crisis plus model, social interventions and strengthening crisis café/community drop in provision.
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7.6.1 MENTAL HEALTH: Eating Disorders Performance Urgent - % seen within 1 week
South Warwickshire CCG Coventry and Rugby CCG Warwickshire North CCG
(not achieved) Routine - % seen within 4 weeks
South Warwickshire CCG Coventry and Rugby CCG Warwickshire North CCG
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7.6.2 MENTAL HEALTH: Eating Disorders Issues and Actions Issues Recovery Actions: • There has been an increase in demand in terms of numbers of children 1. Recruitment to address workforce deficits which impact on the delivery and young people being referred to the Eating Disorders service for of access and waiting times is a priority. Further recruitment to 3rd Urgent and Routine Sector VSC staff to be embedded in the primary care and school’s • An increase has been seen in the complexity of cases being referred. response to educate on Eating Disorders and the need for early help • Between Apr 20-Apr 21 there has been an increased number of CYP and access will aim to slow the urgent referral demand for late with Eating Disorders supported by the Crisis Team, often with presentations. additional diagnoses or complexity. Currently there is no scope to 2. There is a plan to develop intensive support options alongside the provide intensive community treatment, step down to those with severe treatment intervention pathway to support crisis and urgent ED due to lack of capacity within the CYP ED team. presentation is critical for patient outcomes, reduced length of stay, • There have been capacity issues due to long-term sickness within the alternative to admission, enhanced community package of care, workforce. smoother transition between services which includes in reach and step • Increased investment has been received into the service for down from bedded provision either in tier 4 or acute paediatrics. recruitment, however recruitment challenges remain, due to the 3. Currently progressing plans for the CYP ED to expand its operational specialist nature of the service. age and workforce to accept and provide intervention pathways for • The local service provided by CWPT currently supports CYP up to 18, 18-19-year olds as part early adopter of an age independent pathway whereas 18 -19 are supported within the Adult ED service. This is not that will be the focus of both CYP and Adult ED transformation plans. aligned to the way NHS England calculate the waits, where patients up 4. Winter Pressures investment in workforce skills acquisition to to the age of 19 are included within the numbers. This has caused a enhance clinical interventions to maintain patient flow and increase discrepancy due to the differences in waiting time requirements within capacity at the beginning of the pathway. the services. 5. Bid development for MH Transformation funding to support development for Adult ED pathway is continuing. 6. Piloting ED Breach tool with Midlands Clinical Network to understand breach of assurance targets. 7. Reporting on ED performance and recovery actions is being regularly reported to the Health Care Partnership Delivery Board for oversight and escalation.
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7.7 MENTAL HEALTH: SMI and; 8.1 LEARNING DISABILITIES: Mortality Reviews Benchmarking Indicator Recovery Actions SMI Health Checks • The delivery of the schemes launched across the HCP at the end of 19/20 have been seriously impeded by COVID and the limited access to GP settings resulting in the declined performance for Q1 – Q4. • £100k + £67k of NHSE/I resource has been signed off by the SMI Steering Group to be utilised to support SMI health checks, Covid-19 CWCCG Vaccine and Flu Vaccine awareness. • A trajectory to monitor and track performance is in place, in addition to a system wide steering group reporting into the Community MH steering group/HCP Board, to increase strategic links where interdependencies exist i.e. EIP and Community MH teams.
MIDLANDS • The ICS checklist tool kit is in use, and going forwards the CCG will be looking to establish separate workstreams / projects, aligned to the domains in the checklist. • The CCG have met with the ‘rising star’ system and are confident that the proposed model for delivery echos the same model.
• NHSE/I has advised that 3 of the 6 performance-monitored indicators ENGLAND outside of QoF are being reinstated to support PC engagement/uptake. Mortality Reviews • The new national platform and associated training package for No reviewers is awaited, in line with the new national policy. Benchmarking • NHSE have confirmed that LeDeR notifications received during 1 Data Available March – 31 May 2021 will be completed by NECSU to support systems to complete the backlog created by reviews stacked whilst the national system was redeveloped. We await details of the volume of reviews that this relates to for Coventry and Warwickshire. • Work is underway to understand the implications of the new policy and a plan is being developed to support the local system to make the changes required by 1 April 2022. • Learning continues to be acted upon via the Reducing Health These figures reflect the information in the LeDeR online review Inequalities work programme. Themes from the 2020/21 annual report system as of 1st April 2021, covering reviews between 1st April have been captured and new activity will be taken to address learning. 2020 - 31st March 2021. • Comms plan has been developed for LD Awareness Week (14 – 20 June) focussing on improving the experience of people with LD when accessing acute settings, which was a key theme from recent reviews.
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8.2 LEARNING DISABILITIES: Annual Health Checks Following the CCG’s positive performance in 20/21, targets for 21/22 have Number of Annual Health Checks 20/21 been set in line with the national expectation that at least 70% of people on LD registers will receive their annual health check this year. Of the checks Estimate CCG completed during 20/21, 79% took place in quarters 3 and 4 so our trajectory Q1 Q2 Q3 Q4* 20/21 has been modelled upon this pattern recognising the annual nature of these appointments; TOTAL NHS Coventry and Rugby CCG The local GP Alliance in each Place area has access to EMIS Search and 64 115 240 640 1059 Report. The three Warwickshire based organisations are now able to extract Target data based on uniform search criteria. The GP Alliance are working through NHS Coventry and Rugby CCG 1494 GDPR requirements with practices and are not yet able to extract this 77 183 463 771 information. For the May SitRep, 4 of the 7 Coventry based PCNs provided Actual (684) data directly to the CCG*; NHS South Warwickshire CCG 41 73 153 407 674 Recent LD AHC data evidences positive impact of the Enhanced Health Target Facilitation resource which is continuing for the 21/22 financial year to ensure NHS South Warwickshire CCG 875 that practices are supported to deliver a sustainable LD AHC offer to patients 37 170 226 442 on their LD registers; Actual (506) NHS Warwickshire North CCG Stratification of the 20/21 practice/PCN level data will enable further targeting 28 50 104 275 456 Target of this individual support offer where data suggests low performance, combined with ongoing focus on establishing sustainable approaches and NHS Warwickshire North CCG 715 improving quality of checks and across the area. 40 130 276 269 Actual (451) There is a trajectory in place for 2021/22 which estimates a total of 3027 Total Coventry /Warwickshire: Health checks will be undertaken during the year. 133 238 497 1322 2189 Target Total Coventry /Warwickshire: 3,084 154 483 965 1482 Actual (1,641)
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9.0 TRANSFORMING CARE: Overview
• All admissions in May 2021 were people who have ASD and no Learning Disability. • April 2021 national performance data has not yet been released, but it is anticipated that Arden will remain at around the same position for Adults (34/44) and will reduce from 43/44 to 44/44 for CAMHS. • Likely, best, and worst case trajectory models were presented at the NHSE Escalation meeting on 28th May 2021. The likely models were submitted to NHSE as part of Arden’s 2021/22 Operational Planning and will be adopted as Arden’s 2021/22 inpatient trajectory. June’s modelled performance sees a reduction of 1 inpatient in the adult cohort, and no movement in the CAMHS cohort.
Recovery Actions • High Impact Actions to deliver sustainable performance improvements in 2021/22 have been defined: o Focus on operational rigor & delivery: (a) Single commissioning & case management team to be established prior to MOC with 7/7 commissioning support to system, (b) Increase case management capacity, (c) Clear escalation process, (d) Standardised discharge process, (e) Single system dynamic risk register for adults and single system dynamic risk register for CYP, (f) Empower MDT meetings to act and support people in the community 7/7, (g) CYP immediate review of services offered to support CYP, families and carers’, when risk of admission & decision-making process around admissions. o Ensure basics of Building the Right Support are in place and functioning: (a) Community forensic support (LD & Autism) – ensure sufficient capacity to support discharges and includes forensic social work support, (b) IST (LD & Autism) – ensure sufficient capacity to support people with LD and people with autism in prevention of admissions and to support wrap-around of discharges, (c) IST (CYP) – ensure sufficient capacity to support CYP at risk of admission • A strategic summit took place 14th May 2021 to review programme governance, structure and vision, taking learning from LGA peer review, recent CQC review, and NHSE feedback. A system summit is planned for end of July 2021 including wider stakeholders and people with lived experience, to coproduction of LD and Autism vision, 3-year plan and strategic direction.
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10. COVID VACCINATION: Overview
Current Performance: Ongoing Actions • As of 25th June, 1,076,261 Covid vaccination have been administered • Variation across the system, is a key area of focus and every effort is being in Coventry and Warwickshire, of which 618,242 are first dose made across the system to narrow the gap between sites and our vaccinations. 74% of those vaccinated have also received a second populations. dose. • LVS sites with lower uptake rates are working closely with Public Health • Uptake rates remain strong across Coventry and Warwickshire, and colleagues, communication teams and wider system partners to consistently higher than the regional average. The current uptake rate continuously encourage improved vaccine uptake. As the programme has across JCVI cohort 1-9 (over 50s) is 89.9%. Uptake variation across progressed and the younger population has been invited for vaccination, PCNs range from 77.1% to 94.6%. clinic models have been adapted to take into account working hours and • All cohorts (people aged 18 and over) have now been invited and the a more flexible offer is available. The following interventions have either vaccination programme is in its “final sprint” with the aim to vaccinate already been undertaken or are being planned to improve their uptake: 85% of cohorts 10-12 (those aged 18 to 39) having their first dose by o Pop-up clinics at places of worship and for hard to reach communities th 19 July. There currently remains around 118,000 people to be o Additional and extended GP Practice vaccine clinics; vaccinated in order to achieve this target. o Walk-in Clinics at centrally located sites (ie Coventry Transport • Navigation PCN sits in the lower range. This PCN is based in a highly Museum); deprived, multi-cultural population where engagement with health care o Free transport offer; is notoriously problematic. Whilst this site has sufficient vaccine supply o Surge vaccinations and focussed capacity in locations with cases of to deliver high levels of cohort penetration, the population remain Delta variant and lower uptake including a mobile vaccination unit; hesitant. o Targeted community-based communications, including focused • There is a clear commitment from each PCN to re-offer appointments webinars with senior clinicians for targeted audiences. to outstanding cohorts to maximise uptake. Incremental changes are monitored daily and shared with PCNs.
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Report To: Governing Body
Report Title: 2021/22 CWCCG Month 2 Finance Report
Report From: Adrian Stokes, Chief Finance Officer
Author: Kay Speed-Andrews, Deputy Director of Finance
Date: 21 July 2021
Previously Considered by: Finance and Performance Committee, 7 July 2021
Action Required (delete as appropriate)
Decision: Assurance: Information: Confidential
Purpose of the Report: To advise the Governing Body of the financial position of the CCG up to 30 May (Month 2 – 2021/22) and to advise of any other financial issues likely to impact in the current financial year.
Key Points: The CCG is forecasting an underspend of £0.5m against the planned H1 (first half of the financial year) deficit of £3.3m agreed at previous Finance and Performance Committee.
The system has been requested to eradicate the £3.3m planned deficit. This has been agreed across the system, in priority order, by;
• Slippage against planned investment (All).
• Removal of CCG contingency of £2m (CCG).
• Fair shares allocation of residual gap (All).
The system is forecasting a significant income from the Elective Recovery Fund (ERF) (£52m) in addition to the Accelerator Bid (£10m). This will be subject to a monthly update report on actuals and risks given the size of income anticipated.
The Continuing Healthcare (CHC) position needs to be reviewed in line with any recommendations made through the current external review and a review of month on month changes to actuals.
Work continues for H2 (second half of the financial year) looking at run rates both across the CCG but also the system. The key issues are to reduce the excess costs incurred over the COVID period and then look to a medium-term recovery plan based on stronger system cost control and transformation.
Recommendation: The Governing Body are requested to: • NOTE that the system has been requested to eradicate the £3.3m planned deficit; • AGREE to monthly report on forecast Elective Recovery Fund (ERF) and accelerator fund; • AGREE to a detailed review of run rate on CHC and update on external review; and • ADVISE of any areas of concern that need specific escalation.
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Implications Objective(s) / Plans supported by this Financial Plan Delivery, achievement of statutory financial duties, efficiency delivery report: Conflicts of Interest: Not applicable Non-Recurrent Expenditure: Variances to agreed Plan are as reported Recurrent Expenditure: Variances to agreed Plan are as reported Financial: Is this expenditure included within the CCG’s Financial Yes No N/A Plan? (Delete as appropriate) Failure to control costs and provide correct audit trails may prevent a breakeven Performance: position. Quality and Safety: Not directly applicable. General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any Equality and Diversity: decision that is finalised without being influenced by appropriate due regard could be deemed unlawful. Has an equality impact Yes assessment been undertaken? No N/A (attached) (Delete as appropriate) Patient and Public No direct impacts on patient, public and stakeholder engagement. Engagement: Clinical engagement imperative to the efficient deployment of NHS resources and Clinical Engagement: successful delivery of service redesign. A number of risks will need pro-active management throughout the year if the Risk and Assurance: reported position is to be achieved. The risks are recorded on the CCG’s Corporate Risk Register.
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Executive Summary
1.1. The CCG is forecasting an underspend of £0.5m against the planned H1 deficit of £3.3m agreed at previous Finance and Performance Committee
1.2. The system has been requested to eradicate the £3.3m planned deficit. This has been agreed across the system, in priority order, by;
• Slippage against planned investment (All).
• Removal of CCG contingency of £2m (CCG)
• Fair shares allocation of residual gap (All).
1.3. The system is forecasting a significant income from the Elective Recovery Fund (£52m) in addition to the Accelerator Bid (£10m). This will be subject to a monthly update report on actuals and risks given the size of income anticipated.
1.4. The Continuing Health Care (CHC) position needs to be reviewed in line with any recommendations made through the current external review and a review of month on month changes to actuals.
1.5. Work continues H2 looking at run rates both across the CCG but also the system. The key issues are to reduce the excess costs incurred over the COVID period and then look to a medium-term recovery plan based on stronger system cost control and transformation.
Summary Financial Position
2.1. At month 2 the CCG has set budgets in line with planning guidance which cover the financial period month 1-6 2021/22 (H1). These budgets reflect the submitted financial plan on 6th May 2021. Guidance from NHS England/Improvement (NHSEI) stated that all budgets had to reflect the 6th May 2021 submission across each area.
2.2. The CCG has a £3.3m deficit plan against its in-year Revenue Resource Limit. At month 2 the CCG is forecasting £0.5m under performance against the deficit plan.
2.3. The CCG is currently holding a £2m contingency for the system at month 2.
2.4. Since submission of the financial plan on 6th May 2021 the CCG has continued its bottom up budget setting approach and several budgets have changed. This change will be reflected within the month 3 finance report and therefore there will be noticeable difference on budgets and expenditure.
2.5. Following month 2 a revised system plan has been submitted, which results in a break even plan for the CCG. The break-even position results in a risk, however it recognised that this is a shared system risk. There are plans in place to mitigate this risk which includes use of the contingency and slippage against developments across the system.
2.6. There is a paucity of data to build the position on which is usual for reporting at this time of year. e.g. prescribing, CHC, Independent Sector
2.7. There are a range of risks to be managed over the course of the year if the reported position is to be achieved. Notably efficiencies and growth in CHC and Prescribing. These risks are highlighted in table 2 in more detail.
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2.8. The main points are to note at month 2 are:
• Unvalidated reimbursement for Elective Recovery Fund (ERF) and COVID funding in relation to Hospital Discharge Programme (HDP).
• Given levels of growth there has been top slicing of budgets for CHC, Mental Health Non CHC and Prescribing with the reserve held in Other Programme Services. These budgets will be monitored for growth above NHSEI advised growth.
• GP Forward View (GPFV) – any underspends need to be reported to NHSEI and funding will be recovered. Primary Care Team to be aware and ensure appropriate spending plans are in place.
• Continuing Health Care (including Non CHC in Mental Health) – a review of budgets needs to be undertaken to ensure budgets are in line with expenditure.
• Growth in Prescribing and CHC is a risk, however the CCG has funded above recommended NHSEI levels
• ERF principles to be agreed
2.9. The CCG summary financial position, as also reported to NHSEI, is outlined in table 1 below.
2.10. Table 1
YEAR T O D AT E FORECAST
Under / (Over) Annual Forecast Under / (Over) CCG Expenditure Analysis Budget Actual spend Budget Actuals spend
£000s £000s £000s £000s £000s £000s
Revenue Resource Limit (in year) 289,498 871,575
Acute Healthcare 150,212 150,455 (243) 450,756 453,053 (2,297) Mental Health & LD 33,232 33,629 (397) 100,574 101,766 (1,192) Community Services 18,477 18,299 178 55,430 54,896 534 Continuing Healthcare 16,862 18,086 (1,224) 52,669 56,066 (3,397) Primary Care 5,381 5,399 (17) 16,144 16,196 (52) Prescribing 26,592 26,592 (0) 79,777 79,777 0 Primary Care Delegated 25,312 25,312 (0) 75,936 75,936 0 Other Programme 11,573 11,311 262 34,720 34,048 672
Total Commissioning Services 287,641 289,083 (1,442) 866,006 871,736 (5,731)
Running Costs 2,956 2,956 (0) 8,869 8,869 0
Total CCG Net Expenditure 290,598 292,039 (1,442) 874,875 880,605 (5,731)
In Year Underspend / (Deficit) (1,100) (2,542) (1,442) (3,300) (9,031) (5,731)
Manual adjustments to allocation to be actioned by NHSEI central team Reimbursed outside of envelope COVID funding - unvalidated 1,359 4,078 Reimbursed ERF - unvalidated 115 2,169 Adjusted Underspend / (Deficit) - Position reported by NHSEI
Adjusted Underspend / (Deficit) - Position reported by NHSEI (1,100) (1,068) 32 (3,300) (2,784) 516 2.11. COVID expenditure relating to HDP of £4.1m is reimbursed outside of the financial envelope and is currently unvalidated. The manual adjustment is draft and therefore subject to review as part of the monthly assurance process. Once nationally approved, final COVID reimbursement allocation adjustments will be issued.
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2.12. In addition, ERF of £2.2m relating to Independent Sector providers of £2.2m is also unvalidated. In line with guidance only Non-NHS spend relating to the ERF should be included in the forecast outturn (FOT) position.
2.13. All expenditure includes COVID in line with budget agreements and financial plan.
2.14. ERF for NHS providers will not be included within expenditure until allocations are confirmed and received. However initial information has been shared with NHSEI which at month 2 totalled £52m (FOT) (excluding accelerator funding of £10m). ERF payable to NHS providers has been reduced to accommodate a risk fund (20% top slice). However, a temporary arrangement was put in place at month 2 and this still needs to be agreed at Finance Advisory Board (FAB) prior to month 3
• The ERF should be used to access additional funds to undertake activity in H1 2021/22 which is calculated on a monthly basis.
• The process is led by the CCG which ensures all organisations are reporting consistently.
• At month 2 all income reported is estimated pending the final confirmed allocation / income adjustments for ERF
2.15. It is imperative we keep pressure on efficiencies around CHC and prescribing.
Variance Analysis and Risks
3.1. Table 2 details variances and key points in each area as well as identifying any risks. The table is rag rated in terms of variance and % above or below budget.
3.2. Table 2
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Year to Forecast Date % of RAG and % of CCG Expenditure Highlights - Variance Analysis Risks RAG and Budget £m Budget £m variance
Expenditure includes ERF for Independent sector of £0.12m YTD and £2.2m FOT which is currently unvalidated and is outside of the CCG envelope.
Spa medica continues to grow. YTD growth is estimated at £0.138m; whilst this is not expected to grow exponentially there remains a risk that expenditure could continue to growth in line with month 2. Growth in SPA medica and efficiences in relation to Acute (243) (0.2%) (2,297) (0.5%) Acute includes £2m of efficiences in relation to ERF and Independent Sector anticipated ERF income (NHS providers) and (IS) expenditure. It is anticipated that IS expenditure may outturn at lower than Independent Sector underspend against contract value. contract with ERF offset by additional income in relation to ERF (NHS providers).
Mental Health Services is currently reporting on plan and no risks are highlighted. The plan and expenditure includes SDF & SR funding received totalling £4.6m which is mainly payable to CWPT.
The overperformance relates to Mental Health Non CHC. The plan has been top sliced by £0.7m which is based on NHSEI growth assumptions. The CCG Mental Health (inc Non CHC Growth is a risk within Mental Health Non CHC, and this (397) (1.2%) (1,192) (1.2%) anticipated growth element is held in 'Other programme' and due to the MH) will be monitored overpeformance at month 2 this has been released. A review of budgets needs to be undertaken to ensure alignment with expenditure across Non CHC MH, Long Term Conditions and Continuing Care.
The growth element above NHSEI anticipated growth of 1.56% (CCG anticipated growth 9%) will be monitored.
Community services is currently underspent by £0.18m YTD and £0.5m due to Long Term Conditions. As stated above alignment of budgets needs to take Community 178 1.0% 534 1.0% place.
Expenditure includes unvalidated COVID expenditure outside of envelope for HDP of £1.3m YTD and £4m FOT
CHC (excluding unvalidated HDP) is currently underperforming by £0.1m YTD and £0.6m FOT. As stated in Non CHC MH budget reviews need to be undertaken to ensure aligment of budget and expendtiure. Continuing Care (1,224) (7.3%) (3,397) (6.4%) Growth is a risk within CHC, and this will be monitored. The plan has been top sliced by £3.4m which is based on NHSEI growth assumptions. The CCG anticipated growth element is held in 'Other programme'. The growth element above NHSEI anticipated growth of 1.56% (CCG anticipated growth 9%) will be monitored.
Expenditure includes unvalidated COVID expenditure outside of envelope for Asylum Seekers of which accounts for the the small overspend, Oxygen and Primary Care IT. GPFV is a risk as funding may be recovered should underspends occur. Primary Care Finance will ensure Primary Care (17) (0.3%) (52) (0.3%) Primary Care is as per plan due to the paucity of data for Enhanced Services, that the Primary Care Committee is aware and that Oxygen, Primary Care IT and Out of Hours. Work is progressing with regards expenditure plans are in place. to Primary Care Investments with the Primary Care team in order to understand the nature of the contracts. GP Foward View (GPFV) is monitored by NHSEI and any underspends against allocations will be recovered.
Prescribing is currently as per plan due to the paucity of data. Growth is a risk within Prescribing and this will be The plan has been top sliced by £1.9m which is based on NHSEI growth Prescribing () (0.0%) - 0.0% monitored. Regular meetings to take place to assumptions. The CCG anticipated growth element is held in 'Other understand over performance. programme'. The growth element above NHSEI anticipated growth of 0.68% (CCG anticipated growth 4.51%) will be monitored.
Based on budget setting, pressures exist, however Primary Care Delegated () (0.0%) - 0.0% Delegated is currently on plan due to the paucity of data. mitigations may be available to offset these pressures. Once data is received this will be assessed.
There is currently a small overspend with regards to agency spend. This is £3m will be offset against prior year release and whilst offset by the growth element for Non CHC MH of £0.7m. this has not yet been fully modelled it is anticipated that Other Programme Services 262 2.3% 672 7.6% the £3m can be mitigated. Within Other Programme it is anticipated that £3m will be achieved through prior year release in order to offset a negative budget.
Running Costs () 0.0% - Running costs are currently on plan.
Key
0 - 30% +/- 30.1 - 50% +/- 50% +/-
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Run Rate
4.1. At month 2 the run rate forecast is lower than the actual reported forecast. The main contributors relate to ERF and CHC growth increase towards the end of H1.
Financial Control
5.1. The CCG is complying with the Better Payment Practice code (BPPC) for NHS and Non-NHS validated invoices on a cumulative and in-month basis.
5.2. Cash draw down is in line with month 2 maximum cash limit and is within its target for the month end closing cash balance
Conclusion and Recommendation
The Governing Body are requested to:
• NOTE that the system has been requested to eradicate the £3.3m planned deficit;
• AGREE to monthly report on forecast ERF and accelerator fund;
• AGREE to detailed review of run rate on CHC and update on external review; and
• ADVISE of any areas of concern that need specific escalation.
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Enclosure V
CWCCG Primary Care Commissioning Committee Meeting - PUBLIC 27 May 2021
Achievements/Decisions Made/Items to Note Matters to be reported to the Governing Body
MAY (PUBLIC) There were no specific issues raised or escalated to the Governing Body. Under Primary Care Committee Terms of Reference – These were delegation the Committee has a decision- endorsed by the Committee. making remit under the Terms of Reference for the Committee as set out in the delegation Primary Care Financial Plan and Budget: The Committee agreement with NHSE. noted the 2021/22 Financial Plan/revenue Budget as presented for H1 (first half of the financial year), contingency and risks, and noted & approved the planned investment in Primary Care, Primary Medical Services (PMS) and Discretionary funds. Clarification of the conditions for drawing down the additional £0.3m System Development Funding was requested, and it was agreed that this would be provided when known.
Expansion Fund Proposal: Approval was requested for the proposed allocation of payments of the NHS England (NHSE) new General Practice Capacity Expansion Fund established to support general practice during the Covid-19 pandemic and which had been extended to September 2021. The proposed allocations for different elements of primary care had been considered and recommended by the Clinical Advisory Group. The Committee approved the proposal.
Primary Care Quality Report: The Committee was assured regarding the monitoring of quality of care in GP Practices and in particular the work being undertaken to improve the processes for incident reporting and feedback to GP practices across the new merged CCG, and the ongoing work and consideration of equality and diversity and patient experience feedback.
Primary Care Update Reports: The Committee was assured on the following work streams: Healthcare procurement processes and monitoring of new builds; Support to Primary Matters referred to the Governing Body for Care Networks (PCNs); Management of the Covid vaccination Approval programme; Encouraging health checks uptake for people with learning difficulties; Workforce planning. Further information • N/A in this reporting period. was requested on the Welcome Back to Work Scheme and Extended Access data in the next report.
Questions from the Public: Appreciation was expressed for the work of Primary Care and the CCG during the pandemic. Questions were asked relating to telephone wait times in accessing GP Surgeries; the North Nuneaton new development site; use of Patient Participation Groups for obtaining patient experience feedback. Assurance was given that the CCG will take account of the comments, respond to queries, and work collaboratively with practices for solutions to issues with regular reporting back through the public Key Information Committee meetings.
• Committee Chair: Ghulam Vohra – Lay Member • Committee Executive Lead: Alison Cartwright – Chief Planning and Performance Officer • Date of Next Meeting: 14 July 2021 Enclosure V
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Report To: Governing Body
Report Title: Communications and Engagement Assurance Report
Report From: Anita Wilson, Associate Director of Governance and Corporate Affairs
Report Author: Rose Uwins, Acting Head of Communications and Engagement
Date: 21 July 2021
Previously Considered by: N/A
Action Required (delete as appropriate)
Decision: Assurance: Information: Confidential
Purpose of the Report: This report provides an overview of communications and engagement activity undertaken towards the end of May until early July 2021.
Key Points: The report summarises some of the key pieces of work currently being undertaken by the communications and engagement department.
This includes: • COVID vaccination communications and engagement; • Media; • Public Affairs; • Activity to support the merger of the three CCGs; • General Practice Communications; • Internal Communications; and • Business as usual.
Recommendation: The Governing Body are requested to BE ASSURED by the contents of the report.
Implications Objective(s) / Plans Supports CCG Communications and Engagement statutory obligations. Informs supported by this report: commissioning and service developments. Conflicts of Interest: N/A Non-Recurrent Expenditure: N/A Recurrent Expenditure: N/A Financial: Is this expenditure included within the CCG’s Financial Yes No N/A Plan? (Delete as appropriate) Performance: N/A
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Quality and Safety: N/A General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any Equality and Diversity: decision that is finalised without being influenced by appropriate due regard could be deemed unlawful. Has an equality impact Yes assessment been undertaken? No N/A (attached) (Delete as appropriate) Patient and Public The report details patient and public engagement undertaken. Engagement: There has been clinical engagement in a range of communications and engagement Clinical Engagement: activity detailed within this report. The report provides assurance that the CCG is undertaking its duties in respect to Risk and Assurance: patient/public/stakeholder and clinical engagement.
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Introduction
1.1 The NHS Coventry and Warwickshire CCG Communications and Engagement team continue to support the organisation and local population to continue support the vaccination programme and supporting the restoration of services.
1.2 The team have continued to meet the statutory obligations for communications, engagement and involvement in this reporting period, as set out by NHS England’s patient and public participation in commissioning health and care guidance.
1.3 Below is a brief outline of some of the key current communications and engagement activity in train.
COVID vaccination communications
2.1 During the period, the Vaccination Programme has received 10 media enquiries and responded to just over 80 email enquiries in the vaccine inbox.
2.2 We have also facilitated regular interviews with local media with key vaccination programme spokespeople.
2.3 In addition to this, weekly stakeholder briefings which give an update on the local vaccination programme have been issued to over 900 local stakeholder and community groups.
COVID vaccination engagement and communications
3.1 Fortnightly vaccination briefings ongoing
The fortnightly vaccination briefings continue to support communities across Coventry and Warwickshire with relevant updates and access to national and local materials, including social media assets and the latest guidance. This allows us to have a wider reach into our communities by supporting organisations across the county with the latest relevant information to share onwards.
3.2 CARAG
A webinar was held with CARAG (Coventry Asylum and Refugee Action Group) to discuss COVID, its impact on communities and access to services for refugees and asylum seekers. Briefing notes and Q&As were prepared in advance to support the meeting chair, Nathan Ndlovu and the two presenters, Lisa Berry, Virologist University Hospitals Coventry and Warwickshire NHS Trust (UHCW) and Nadia Inglis, Consultant in Public Health. The event covered the importance of vaccinations, the need for testing and the different types and the easy ways to access clinics to get the vaccine.
3.3 Launch of videos – Coventry Black Community Taskforce
We have been working closely with our local Black African and Caribbean communities in the city and together, we have produced some useful and informative videos to support the communities in Coventry and Warwickshire with the vaccination programme. The aim of this activity is to cascade accurate information about the Covid-19 vaccine to the BAME community in order to myth-bust and increase vaccination uptake.
3.4 Foleshill Women’s Training
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The engagement team have been working closely with the Foleshill Women’s Training to deliver a series of online sessions to provide information and provide answers to questions arising around conception, pregnancy and birth. Extensive Q&As were developed based on the information from the Royal College of Gynaecologists and Obstetricians for a coffee morning event led by Dr Deepika Yadav GP.
3.5 Covid vaccination pop-up clinics
Throughout June and July, external communication and social media has continued to promote the vaccination options for the people of Coventry and Warwickshire, including those available through the NBS, GPs and community pharmacies. In recent weeks, an increasing number of pop-up clinics have been held in areas requiring further activity, based on vaccination uptake data. These have been promoted via a range of channels through all ICS partners and associated organisations, including the universities and community and faith leaders. Pop-ups have been organised in a range of venues including museums, schools, community halls, Sikh temples and mosques in order to reach out to as wide a population as possible.
Media
4.1 We have continued to response to a high volume of media enquiries, primarily regarding vaccination and access to vaccination. Regular coverage of the COVID vaccination programme continues in broadcast media, online and through radio and TV. This has included BBC Midlands Today coverage of the pop-up clinic at Coventry in conjunction with the City of Culture and the Assembly Festival in support of the national Big Weekend of COVID vaccinations.
Public Affairs
5.1 Representatives from the CCG continue to meet with MPs, Local Authority Leaders, Councillors and other stakeholders to ensure that they receive the information they need about the activities of the CCG. Recently these conversations have focused on the vaccination programme, primary care access and the work undertaken to ensure high uptake of the vaccine in Coventry and Warwickshire in our diverse communities.
Other activities
CW CCG website
6.1 The new Coventry and Warwickshire CCG website is up and running.
• Phase 2 of the website design is in progress and the additions in phase 2 will include: o Safeguarding; o Infection Prevention; o Equality and Diversity Network; o Medicines Optimisation information; o Care homes resources; and o Prescription Ordering Direct (POD) service information, including call back request.
6.2 The old CCG websites are still live and will continue to be available as we continue the transition process and streamline our process and functions.
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Staff briefings
7.1 These continue to take place on a fortnightly basis virtually on Teams. Attendance during these meetings remains high as below and the briefings are recorded and shared in the staff newsletter for those not able to attend or wish to watch it back.
27th May briefing – 169 staff in attendance 10th June briefing – Cancelled 24th June briefing – 171 staff in attendance 8th July briefing – 152 staff in attendance
CCG Annual General Meeting (AGM) – 8th July
8.1 A virtual AGM was conducted for our patients, staff, stakeholders and members. The AGM was well advertised via email, on our website and on our social media channels which saw an attendance of over 50 people.
8.2 Key areas of work that were highlighted focused on local vaccination programme, access to Primary Care during the pandemic and the George Eliot Hospital (GEH) diabetic foot clinic.
8.3 The presentation slides from the day are publicly available on our website and the recording has been shared with those that have requested it.
General Practice communications
9.1 A project has concluded to help bring the communications and newsletters which were sent out by the three Clinical Commissioning Groups together, ensuring that all of our member practices received the information that they need at both a local and a Coventry and Warwickshire-wide level. Discussions are underway with the Primary care teams to discuss the next steps on how to implement the plan which was created following feedback and discussions with members.
Internal communications activity
In a day in a life of
10.1 This informal weekly session is working well as a medium of getting to know roles and people across the 3 CCGs. We have been running the sessions since August 2020 with over 30 staff members in attendance. Due to work pressures and to ensure the sessions are sustainable, they have moved from fortnight to monthly which is welcomed as we head towards management of change. It has been decided that the session will ‘break’ during the summer and return in September when structures within the organisation are more settled. In addition, we are looking at involving staff from the Healthcare Partnership to be part of these meetings in anticipation of moving towards an ICS.
Staff Forum & Wellbeing Warriors
10.2 Staff forum and Wellbeing warriors continue to meet a monthly basis.
10.3 Notes from each staff forum are fed into the Executive team (from the 11th May onwards) ensuring that the Executive team are sighted on the discussions, concerns and actions of Staff Forum.
Newsletters
10.4 The staff newsletters continue across all 3 CCGs on a Monday and Friday. The content of the newsletters continues to be fluid to accommodate the ever-changing information our workforce requires. We continue to have a mix of formal and informal content and always encourage our staff
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to share their stories and experiences.
10.5 Recently the following items have been shared in the newsletter:
• Email migration; • IT training sessions; • NHS Birthday / Thank you day; • Wellbeing webinars led by Wellbeing warriors; • Local commission of new services / groups; and • System vacancies.
Business as usual
11.1 Other business as usual communications support continues with activities such as:
• Email migration – Phase 2; • Reviewing Intranet solutions via Teams; • Arden Key Worker pilot project; • Supporting learning event actions plans; • Supporting the Alternative Provider Medical Services (APMS) contracts for Weddington and Whitestone; • Continual engagement for long term conditions; and • Media monitoring.
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