AGENDA NHS Leeds CCG Governing Body Meeting

Date: Wednesday 22 July 2020 Time: 14:00 – 17:00 Venue: Microsoft Teams

Please note: agenda timings are approximate Item Description Lead Paper Time GB Welcome and Apologies N 14:00 20/31 Purpose: To record apologies for absence and confirm the meeting is quorate.

GB Declarations of Interest Y 20/32 Purpose: To record any Declarations of Interest relating to items on the agenda:

a) Financial Interest Where an individual may get direct financial benefit from the consequences of a decision they are involved in making;

b) Non-Financial professional interest Where an individual may obtain a non-financial professional benefit from the consequences of a decision they are involved in making;

c) Non-financial personal interest Where an individual may benefit personally in ways that are not directly linked to their professional career and do not give rise to a direct financial benefit, because of the decisions they are involved in making; and

d) Indirect Interests Where an individual has a close association with another individual who has a financial interest, a non-financial professional interest or a non-financial personal interest who would stand to benefit from a decision they are involved in making.

GB Questions from Members of the Public N 14:05 20/33 Purpose: To receive questions from members of the public

GB Minutes of the Governing Body Meeting held on 20 May Y 14:10 20/34 2020 and 17 June 2020

Purpose: To receive the minutes for approval

GB Matters Arising N 20/35 Purpose: To consider any matters arising that are not Item Description Lead Paper Time considered elsewhere on the agenda

GB Action Log Y 20/36 Purpose: To review the outstanding actions

CHIEF EXECUTIVE’S REPORT GB Chief Executive’s Report Tim Ryley Y 14:15 20/37 Purpose: To receive a report from the Chief Executive, including an update on the current position relating to COVID- 19

RISK GB Corporate Risk Register Sabrina Y 14:35 20/38 Armstrong Purpose: To receive the corporate risks for review

GB Governing Body Assurance Framework Sabrina Y 20/39 Armstrong Purpose: To receive the Governing Body Assurance Framework to approve the changes and review

STRATEGY GB Shaping Our Future – New Operating Model Tim Ryley/ Y 14:50 20/40 Sabrina Purpose: To receive an update and approve the next steps Armstrong BREAK FOR 5 MINUTES COMMITTEE CHAIRS SUMMARIES GB Primary Care Commissioning Committee – 3 June 2020 Sam Senior Y 15:25 20/41 Purpose: To receive the summary for information and assurance

GB Remuneration & Nomination Committee – 10 June 2020 Sam Senior Y 20/42 Purpose: To receive the summary for information and assurance

GB Audit Committee – 15 July 2020 Sam Senior Y 20/43 Purpose: To receive the summary for information and assurance

GB Quality & Performance Committee – 15 July 2020 Phil Ayres Y 20/44 Purpose: To receive the summary for information and assurance COMMISSIONING & FINANCE GB Integrated Quality & Performance Report Helen Lewis Y 15:35 20/45 Purpose: To receive the IQPR and consider any issues escalated by the Quality & Performance Committee

Item Description Lead Paper Time GB Finance Update Visseh Pejhan- Y 15:45 20/46 Sykes Purpose: To receive the finance report for information

GB 2020-21 Operational Financial Planning and Annual Visseh Pejhan- Y 15:55 20/47 Budgets Update Sykes

Purpose: To receive the update and the current position with the financial plan

GOVERNANCE GB Maternity and Neonatal Services Consultation Jo Harding Y 16:10 20/48 Purpose: To receive the outcome of the consultation and approve the implementation

GB Workforce Information Reporting and Assurance Sabrina Y 16:25 20/49 Arrangements Armstrong

Purpose: To receive the update and approve the proposed changes to the terms of reference

GB Procurement Policy Visseh Pejhan- Y 16:30 20/50 Sykes Purpose: To receive the policy for approval

GB Forward Work Programme 2020/21 Chair Y 16:35 20/51 Purpose: To receive the forward work programme for 2020/21

GB Any Other Business Chair N 16:40 20/52

Exclusion of the public - it is recommended that the following resolution be passed: "That representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest" Confidential Section - Held in private GB Confidential Minutes of the Governing Body held on 20 Chair Y 16:45 20/53 May 2020

Purpose: To receive the minutes for approval

GB Procurement Update Visseh Pejhan- Y 16:50 20/54 Sykes Purpose: To receive an update on the procurement plan and approve the planned procurements

Dates of Future Meetings:  23 September 2020 (including AGM)  25 November 2020  27 January 2021  24 March 2021

Item Description Lead Paper Time ITEMS FOR INFORMATION IFI1. Minutes of the West Yorkshire & Harrogate Joint Chair Y N/A Committee – 14 January 2020

Purpose: To receive the minutes for information

NHS Leeds CCG Governing Body Meeting - 22 July 2020 Declarations of Interest Title Name Job Title Role Practice B Declared Interest- (Name of the organisation and Type of Interest Is the interest Interest From Interest Until Action Taken to Mitigate Risk (where applicable) Code nature of business) direct or (Practice indirect? Only) Angela Collins Lay Member for Patient and Governing Body Member N/A Nil Declaration Public Participation Dr Ben Browning Member Representative Governing Body Member B86020 GP Partner at Lofthouse Surgery Financial Interests Direct 01/02/2019 01/04/2020 Declare any potential or perceived conflict of interest at relevant meetings/workshops

Dr Ben Browning Member Representative Governing Body Member B86020 Shareholder in Leodis Care Ltd (now dormant) Financial Interests Direct 01/01/2011 Ongoing Declare any potential or perceived conflict of interest at relevant meetings/workshops

Dr Ben Browning Member Representative Governing Body Member B86020 Member of Leodis Care LLP (Shell Company) Financial Interests Direct 01/01/2011 Ongoing Declare any potential or perceived conflict of interest at relevant meetings/workshops

Dr Ben Browning Member Representative Governing Body Member B86020 Spouse is a Salaried GP Indirect Interests Indirect 01/01/2019 Ongoing Declare any potential or perceived conflict of interest at relevant meetings/workshops

Dr Ben Browning Member Representative Governing Body Member B86020 Spouse is city-wide lead for Disability Services (NHS Indirect Interests Indirect 01/01/2015 Ongoing Declare any potential or perceived conflict of Leeds CCG) interest at relevant meetings/workshops

Helen Lewis Interim Director of Acute Governing Body Member N/A Trustee, Leeds Jewish Welfare Board Non-Financial Personal Interests Direct 01/12/2017 Up to 9 year Declare any potential or perceived conflict of and Specialised term interest at relevant meetings/workshops Commissioning. Dr Jason Broch Clinical Chair Governing Body Member B86022 Partner at Oakwood Lane Medical Practice Financial Interests Direct 01/01/2006 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Director Jemjo Healthcare Ltd Financial Interests Direct 01/05/2007 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Spouse business Airtight International Ltd Indirect Interests Indirect 10/05/2012 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Spouse business Nails 17 Ltd Indirect Interests Indirect 10/05/2012 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Director Leeds Jewish free school Non-Financial Personal Interests Direct 16/01/2014 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Director/trustee Brodetsky Primary School Foundation Non-Financial Personal Interests Direct 17/06/2014 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Chair of Governor's Brodetsky Primary School Non-Financial Personal Interests Direct 01/09/2012 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Founding Fellow of the Faculty of Clinical Informatics Non-Financial Professional Interests Direct 01/05/2018 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Gartner UK - Clinical Advisor Financial Interests Direct 01/06/2018 01/05/2020 Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Calibre Care Partners Ltd OLMP is a member of this GP Financial Interests Direct 01/06/2018 Ongoing Declare any potential conflict/interest at federation, which is part of Leeds GP Confederation relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Shareholder / Director Chapeloak Services Ltd Financial Interests Direct 01/01/2019 Ongoing Declare any potential conflict/interest at relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Leeds Acupuncture Clinic - father's and brother's Indirect Interests Indirect 10/05/2012 Ongoing Declare any potential conflict/interest at business relevant Governing Body/Committee meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Clinical Lead - Yorkshire & Humber Local Health & Care Financial Interests Direct 01/11/2018 Ongoing Declare any potential conflict/interest at record Exemplar, inc membership of NHSE Clinical relevant Governing Body/Committee Advisory Group meetings Dr Jason Broch Clinical Chair Governing Body Member B86022 Clinical Chair role, NHS Leeds CCG Financial Interests Direct 01/07/2020 Ongoing Was Assistant Clinical Chair between 1/4/2018- 1/7/2020 Joanne Harding Executive Director of Quality Governing Body Member N/A Joint Chair of the NHSCC National Nurses Forum Non-Financial Professional Interests Direct 01/07/2019 Ongoing Declare any conflict of interest at relevant and Safety/Governing Body meetings/workshops. Nurse

Dr Julianne Lyons GP Member Representative Governing Body Member B86110 GP Partner at Leeds Student Medical Practice Financial Interests Direct 01/01/2016 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Leeds Local Medical Committee Member Financial Interests Direct 01/09/2013 31/03/2020 Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Spouse is a Director of Leeds Haematology Ltd Indirect Interests Indirect 01/05/2013 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Spouse is a trustee of UK Myeloma Forum Indirect Interests Indirect 01/01/2013 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Spouse is an employee of the University of Leeds Indirect Interests Indirect 01/01/2015 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 GP lead for Leeds Primary Care Workforce and Training Financial Interests Direct 01/05/2018 Ongoing Declare any potential conflict of interest at Hub Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Spouse has an honorary contract with Leeds Teaching Indirect Interests Indirect 01/01/2015 Ongoing Declare any potential conflict of interest at Hospitals NHS Trust Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Shareholder of Leeds West Primary Care Limited Financial Interests Direct 01/10/2015 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Julianne Lyons GP Member Representative Governing Body Member B86110 I am a member of LSMP and The Light PCN Financial Interests Direct 01/07/2019 Ongoing Declare any potential or perceived conflict of interest at relevant meetings/workshops

Dr Julianne Lyons GP Member Representative Governing Body Member B86110 Daughter employee of Leeds Primary Care Workforce Indirect Interests Indirect 01/07/2019 Ongoing Declare any potential or perceived conflict of and Training Hub interest at relevant meetings/workshops.

Dr Keith Miller GP Member Representative Governing Body Member B86109 Spouse - Advanced Nurse Practitioner, LTHT Financial Interests Indirect 01/01/2008 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Keith Miller GP Member Representative Governing Body Member B86109 GP Partner at Kirkstall Lane Medical Centre Financial Interests Direct 01/01/2010 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Keith Miller GP Member Representative Governing Body Member B86109 Temporary ad hoc role as Project Lead for Care Homes Financial Interests Direct 20/05/2020 Ongoing Declare any potential conflict of interest at for Woodsley and Holt Park PCNs Governing Body/Board, sub committees and relevant meetings Dr Keith Miller GP Member Representative Governing Body Member B86109 Shareholder in Leeds General Practice Limited Financial Interests Direct 01/01/2014 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Dr Keith Miller GP Member Representative Governing Body Member B86109 NHs Leeds Clinical Commissioning Group – Member Financial Interests Direct 01/01/2018 Ongoing Declare any potential conflict of interest at Representative Governing Body/Board, sub committees and relevant meetings Dr Keith Miller GP Member Representative Governing Body Member B86109 Member of GP Confederation Non-Financial Professional Interests Direct 01/01/2018 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees and relevant meetings Phil Ayres Secondary Care Consultant Governing Body Member N/A Personal friendship with the Chief Executive of Leeds Indirect Interests Indirect 27/11/2019 Ongoing The action required to manage any conflicts of and Chair of the Quality and Community Healthcare interest will be agreed with the Chair of the Pewrformance Committee relevant meeting. In relation to the Quality and Performance Committee which I chair, the Deputy chair will be asked to agree any required actions. No confidential/sensitive information to be shared or discussed with the LCH Chief Executive.

Phil Ayres Governing Body Member Governing Body Member N/A I have personal friendships with GP of the Rawdon Indirect Interests Indirect 01/01/2017 Ongoing Maintain awareness of potential influence Surgery over decisions I may take as independent practitioner. Abide by GMC code of conduct. Declare this interest at relevantmeetings.

Sabrina Armstrong Director of Organisational Governing Body Member N/A Personal friendship with a non-executive director of Non-Financial Personal Interests Direct 01/05/2019 Ongoing Declare any potential or perceived conflict of Effectiveness Leeds Community Healthcare NHS Trust. interest at relevant meetings/workshops.

Sabrina Armstrong Director of Organisational Governing Body Member N/A Close friend works as Director of System Capability and Indirect Interests Indirect 01/01/2014 Ongoing Declare any potential or perceived conflict of Effectiveness Operations at NHS England. interest at relevant meetings/workshops.

Sabrina Armstrong Director of Organisational Governing Body Member N/A Pool member with NHS Interim Management and Non-Financial Professional Interests Direct 01/01/2014 Ongoing Declare any potential or perceived conflict of Effectiveness Support (NHS IMAS). interest at relevant meetings/workshops.

Sam Senior Lay Member for Primary Governing Body Member N/A Lay Member for Primary Care Bassetlaw CCG Financial Interests Direct 01/09/2013 Ongoing Declare any potential or perceived conflict of Care Co-Commissioning interest at relevant meetings/ workshops

Sam Senior Lay Member for Primary Governing Body Member N/A Lay Representative National School of Healthcare Financial Interests Direct 01/05/2016 Ongoing Declare any potential or perceived conflict of Care Co-Commissioning Science interest at relevant meetings/ workshops

Sam Senior Lay Member for Primary Governing Body Member N/A Lay Advisor Health Education England (West Midlands) Financial Interests Direct 01/05/2016 Ongoing Declare any potential or perceived conflict of Care Co-Commissioning interest at relevant meetings/ workshops

Sam Senior Lay Member for Primary Governing Body Member N/A Patient and Public Panel Member - National Institute Financial Interests Direct 01/04/2017 Ongoing Declare any potential or perceived conflict of Care Co-Commissioning Health Research interest at relevant meetings/ workshops

Sam Senior Lay Member for Primary Governing Body Member N/A *Expired* Non-Financial Personal Interests Direct 01/05/2013 18/05/2020 Declare any potential or perceived conflict of Care Co-Commissioning Chairperson - Brampton United Junior Football Club interest at relevant meetings/ workshops (S63 6BB) Sam Senior Lay Member for Primary Governing Body Member N/A Independent Lay Member to Rotherham Federation Non-Financial Professional Interests Direct 29/05/2019 Ongoing Declare any potential or perceived conflict of Care Co-Commissioning Connect Healthcare interest at relevant meetings/ workshops

Sam Senior Lay Member for Primary Governing Body Member N/A Volunteer for CortonWood Miners Welfare Scheme Non-Financial Personal Interests Direct 15/10/2019 Ongoing Declare any potential or perceived conflict of Care Co-Commissioning (registered charity) interest at relevant meetings/ workshops

Dr Simon Stockill Medical Director Governing Body Member N/A Partner at Sleights and Sandsend Medical Practice, Financial Interests Direct 01/04/2016 Ongoing Declare any conflict or perceived conflict Whitby (Hambleton, Richmondshire & Whitby CCG) within context of any relevant meeting or project work Dr Simon Stockill Medical Director Governing Body Member N/A GP Appraiser, NHS England (Yorkshire & Humber) Financial Interests Direct 01/12/2013 Ongoing Declare any conflict or perceived conflict within context of any relevant meeting or project work Dr Simon Stockill Medical Director Governing Body Member N/A Clinical Lead for Quality Improvement, Royal College of Financial Interests Direct 01/09/2016 Ongoing Declare any conflict or perceived conflict GPs within context of any relevant meeting or project work Dr Simon Stockill Medical Director Governing Body Member N/A Clinical Director, Whitby Coast & Moors Primary Care Financial Interests Direct 01/07/2019 Ongoing Declare any conflict or perceived conflict Network within context of any relevant meeting or project work Tim Ryley Chief Executive Officer Governing Body Member N/A Nil Declaration Visseh Pejhan-Sykes Chief Finance Officer Governing Body Member N/A Niece works for CCG as Digital Communications Officer Indirect Interests Indirect 11/12/2017 Ongoing Declare any potential or perceived conflict of interest at relevant meetings/workshops

Draft Minutes NHS Leeds CCG – Governing Body Meeting Wednesday 20 May 2020 2.00pm – 5.00pm Microsoft Teams Virtual Meeting

Members Initials Role Present Apologies Dr Gordon Sinclair (Chair) GS Clinical Chair  Dr Phil Ayres PA Secondary Care Specialist Doctor  Dr Jason Broch JB Assistant Clinical Chair  Dr Ben Browning BB Member Representative  Angela Collins AC Lay Member – Patient & Public Involvement  Jo Harding JH Executive Director of Quality and Nursing  Dr Julianne Lyons JL Member Representative  Dr Keith Miller KM Member Representative  Visseh Pejhan-Sykes VPS Executive Director of Finance  Tim Ryley TR Chief Executive  Samantha Senior (Deputy SS Lay Member – Primary Care Co-  Chair) Commissioning Dr Simon Stockill SSt Medical Director  Additional Attendees Sabrina Armstrong SA Director of Organisational Effectiveness  Victoria Eaton VE Director of Public Health  HL Interim Director of Acute & Specialist  Helen Lewis Commissioning Katherine Sheerin KS Director of System Integration  Laura Parsons LP Head of Corporate Governance & Risk  Sam Ramsey SRa Corporate Governance Manager  BBa  Becky Barwick Head of System Integration (item GB 20/12)

No. Agenda Item Action GB Welcome and Apologies 20/04 GS welcomed everyone to the virtual Governing Body meeting. The Chair welcomed Victoria Eaton to her first Governing Body meeting as Director of Public Health. No apologies had been received and the Chair confirmed the meeting was quorate.

No. Agenda Item Action Due to exceptional circumstances, the Governing Body agreed to suspend standing order 3.12.2 that related to holding the meeting in public. Members were informed that the Audit Committee had agreed at their meeting on 22 April that the suspension was reasonable given the current circumstances.

TR informed members that this would be Gordon Sinclair’s last formal meeting as the Clinical Chair of the CCG. The Governing Body expressed their thanks to GS for all the hard work undertaken within his leadership role in Leeds. There was particular appreciation for his wisdom, understanding of the strategy and governance of the CCG. It was highlighted by members that GS had chaired the CCG when it had received a rating of ‘outstanding’. His support to the non-executive directors, clinical leads and executive team was recognised, as well as his commitment to both Leeds West CCG and NHS Leeds CCG.

The Chair highlighted that this would be Katherine Sheerin’s final Governing Body meeting as she would be leaving the CCG. On behalf of the Governing Body and the CCG, the Chair expressed his thanks for all of her expertise and knowledge and wished KS well in her new role.

GB Declarations of interest 20/05 Members were asked to raise any declarations of interest in relation to agenda items.

KM highlighted that a previous interest in relation to his spouse working for LTHT had been removed but was still current. He also highlighted that he would be taking on a temporary additional role as the project lead for care homes for the Woodsley and Holt Park PCN. This would be added to the register of interests as a financial interest.

No further items were raised.

GB Questions from Members of the Public 20/06 No questions had been received.

GB Minutes from Previous Meetings 20/07 GS presented the minutes from the NHS Leeds Governing Body held on 25 March 2020.

The Governing Body: (a) approved the minutes of the NHS Leeds Governing Body held on 25 March 2020.

GB Matters Arising 20/08 There were no matters arising.

GB Action Log

No. Agenda Item Action 20/09 The Governing Body reviewed the action log and noted updates.

GB Chief Executive Report 20/10 TR presented the Chief Executive’s Report and highlighted the key areas within the report. The report informed Governing Body members of the CCG’s response to the Covid-19 pandemic. An overview of the current situation was provided and it was acknowledged that there was a continued decline in pressure in the acute sector with a reduced mortality. The care home position was stabilising but still concerning and there were small concerns around mental health and the high levels of absence in people accessing services.

TR explained that in the initial six weeks, the CCG with its partners operated under major incident-like conditions. There were a series of critical pieces of work that were undertaken rapidly, for example reducing hospital occupancy levels. Members were informed that there had been fewer admissions and a lower mortality than the initial modelling had predicted.

In relation to care home support, the work was ongoing and members’ attention was drawn to the action plan and the key components that had been put in place.

In response to the concerns around the drop in non Covid-19 related activity, members were informed that two city-wide groups had been instigated. There had been significant work in relation to communications and engagement to primary care, citywide health and care groups and CCG staff.

Members were informed that in relation to financial governance, the CCG had put in place a variety of payment mechanisms in line with national guidance and worked closely with the Council and other partners to capture additional Covid-19 expenditure.

TR provided an overview of the immediate and ongoing challenges. It was acknowledged that the governance and capturing of decision making had been challenging but recognised the work done by teams in ensuring this was captured appropriately. The importance of identifying risks and logging of decisions was acknowledged.

In relation to testing and contact tracing, members noted that Tom Riordan, Chief Executive, Leeds City Council, had taken on a national role which provided an opportunity for Leeds as a locality to take a leadership role. PPE continued to provide challenge due to the lack of a reliable supply and the concern that as services restart this would become more challenging. Members were informed that colleagues and their wellbeing continued to be of the highest importance. Briefings were circulated daily and a live brief had been streamed to colleagues. It was acknowledged that the mental and physical wellbeing of staff was being monitored and advice to support mental health was being distributed.

No. Agenda Item Action A query was raised in relation to staff health and wellbeing in ensuring that there was proactive work ongoing across the organisation. This was recognised as a valid point and TR assured members that further work would be undertaken over the next 4 – 6 weeks, particularly in relation to risk assessments for all staff, and further offers of coaching and other support.

VPS provided further detail in terms of the financial governance processes and informed members that any incidents that resulted in prolonged disruption would become part of standard procedures and incorporate into future learning.

VE expressed thanks to the CCG for all the joint working across the system during Covid-19, particularly in relation to inequalities, care homes and response and recovery. Further detail was provided in relation to the testing and contact tracing work and VE highlighted that Leeds was in a strong position as a city. This was an opportunity but also a challenge to ensure that it was planned and undertaken correctly. The work in partnership with the CCG was welcomed throughout this work.

The Chair summarised that the report provided a good overview of the issues that the CCG and system were facing in the current situation and the ongoing work to address them.

The Governing Body:

a) noted and considered the report.

GB Corporate Risk Register 20/11 SA presented the report and highlighted that this had been separated into three parts; corporate risks, risks aligned to the Governing Body and a summary in relation to Covid-19.

Members were informed there were 62 active risks on the risk register with 1 corporate red risk related to ‘Information Security Maturity’. This risk is aligned to the Audit Committee.

Members noted that there were 13 risks aligned to the Governing Body. These related to Finance, Procurement and the Shaping Our Future programme. Ten of these 13 risks were categorised as ‘Accepted’ risks, which was an increase of one as risk 681: Impact of IFRS16 had been accepted due to the accounting standard being deferred to 2020-21. Of the remaining 3 risks, there was 1 high amber risk relating to the Shaping Our Future programme.

The Governing Body was informed that risks and issues specifically relating to Covid-19 were being logged within teams and workstreams, and escalated as required through the Risk, Action, Issue and Decision Logs (RAID Logs). The Risk Manager was supporting this to avoid duplication, ensure consistent reporting and identify themes or interdependencies. It was noted that where

No. Agenda Item Action there was a system or longer term risk, this would be added on to the Datix system. This approach had been adopted due to the fast moving and time limited nature of many of the risks.

In relation to the corporate risk, members were informed that following the recent training completed on cyber security, an action plan would be received for cyber security compliance. Due to the current situation around Covid-19, a shared tenancy cloud solution was being sourced by NHS digital for NHS organisations. It was acknowledged that this would reduce the risk but further details would follow.

A query was raised in relation to the Governing Body Assurance Framework and the current scores and how the strategic objectives had been affected by Covid-19. It was agreed that SA and PA would discuss this following the meeting.

The Governing Body: a) noted the changes to the Corporate Risk Register; b) reviewed the high scoring amber risk aligned to the Governing Body; and, for both risks; c) considered the control and actions effective and assurances sufficiently robust; and d) agreed no further actions were required to manage the risk to the target set.

GB Addressing the Long Term Implications of Covid-19 20/12 TR presented the report and outlined that the paper provided Governing Body members with the opportunity to consider how the CCG may deliver its strategic ambitions within the new Covid-19 environment.

TR provided an overview of the 4 wave impact of a pandemic and how to respond, dependent on which wave. The adjustment for the CCG is to now move past command and control, and use the good leadership practice to consider how to lead and be counter intuitive moving forwards with the challenge of moving to the next phase as a city with our partners.

A query was raised in relation to whether the impact on workforce and training was missing and the potential opportunities lost to provide training. A further comment was made to ensure that clear communications are provided to the population of Leeds to provide clarity around services. TR acknowledged that the communications were key to the population; there was an understanding that there would be long term consequences and there was a need to understand the implications on services.

SS highlighted that the communication videos released in primary care covered a range of topics including prescriptions and appointments with GPs. The communications team was commended on producing and making a significant difference for both professions and citizens.

No. Agenda Item Action

The Chair recognised the work that was already being done in order to support the integration agenda and the learning that could be undertaken. It was acknowledged by members that it was important to be ambitious during this time and use the opportunities available in providing services in a different way. KS informed members that work was ongoing with the left shift blue print and provided assurance that the learning would be built into this.

TR summarised the points that had been raised, and recognised that the conversations were ongoing. In each step taken, it was stressed that there would need to be steps to mitigate and narrow health inequalities.

The Governing Body:

a) noted and considered the report.

GB Health Inequalities Framework 20/13 KS presented the framework and provided an update on how the framework had been developed since the discussion at the Governing Body meeting in July 2019. The Health Inequalities group had supported the work and the feedback from the Governing Body workshop in December had also been included within the framework. Members were informed that the framework had not been amended in light of Covid-19, however it did highlight the need to make the framework a reality.

BBa was present at the meeting to provide an overview of the framework and what had been amended since the previous iteration. Members noted that sections 1 – 6 had remained very similar, however section 7 onwards provided further detail and the Governing Body was being asked to approve the framework. Three investment principles had been included and following the approval of the framework, the principles would be adopted in a widespread way. Members were informed that section 9 outlined initial thoughts on measuring the impact.

In relation to the use of resources, VPS queried whether there should be explicit reference made that the CCG viewed addressing Health Inequalities as an essential and potentially outweighing principle in undertaking value for money tests . A statement should be made as to how value has been assessed so that this can be explained to auditors when they assess the CCG on value for money.

TR welcomed the detail in relation to value for money and suggested that work was undertaken with VPS to ensure the wording was correct within the framework. Members were informed that work was ongoing across the city in relation to health inequalities and a discussion would be taking place at the Partnership Executive Group (PEG).

A query was raised in relation to the care home population and whether they

No. Agenda Item Action would be included as part of the health inequalities drive. BBa confirmed that this would be considered as part of the frail population and through population health management.

The scale of challenge of the framework was recognised by the Governing Body and it was highlighted that the case for prevention was cost effective; therefore there was an economic case as well as moral one.

The report was commended as well as the ambition of the CCG in tackling inequalities. The importance of using experience from Covid-19 was also highlighted. In relation to the principles, a query was raised regarding how services might need to change with people working together locally. This could potentially impact on differentially investing in secondary care and it was queried as to whether this was clear within the principles.

An example was provided to the Governing Body of the current work ongoing in relation to the street sleeping population and the accommodation that they had been placed in as a life saving measure due to Covid-19 transmission. It was highlighted that this work needed to be capitalised on, otherwise it would be seen as a missed opportunity.

It was recognised that the framework would work alongside the shaping our future programme and the left shift blue print.

A query was raised in relation to the public engagement exercise that was due to take place in April. BBa confirmed that it had been put on hold due to Covid-19 and if there was no opportunity to reschedule by September, a virtual engagement would be considered.

TR summarised that there were two additions to be made to the framework, one in relation to value for money with regards to impact measures and one in relation to the left shift in resources and potential disproportionality in investment. The Governing Body agreed to approve the framework with the caveat that these two amends were made and the updated Framework circulated to the Governing Body.

The Governing Body:

a) approved the updated CCG Health Inequalities Framework for Action, with the caveat of the above amendments; and b) noted the increased risk to health inequalities caused by the COVID-19 pandemic.

GB Finance Update 20/14 VPS presented the report which provided members with a summary of the financial and contracting arrangements in place during the Covid-19 period. Members were informed that the deadline for submission of the draft annual accounts was extended and the CCG had submitted these accordingly.

No. Agenda Item Action Members noted that the audited accounts were not due until the end of June and an additional Governing Body meeting had been scheduled to approve these. It was noted that the IFRS16 had been deferred due to its complexity.

The Governing Body was informed that a number of key changes had been made to the NHS Financial Regime to cover the period of 1 April – 31 July 2020. Guidance had been issued in relation to contracting support and relief arrangements for suppliers of services to the NHS. VPS provided the Governing Body with an overview of the current situation as outlined in the report. Members were assured that all costs had been covered across the system and there would be a retrospective process to assess what could be covered from allocations and what would need to be applied for through the treasury.

The CCG would be able to claim back any costs incurred as a result of Covid- 19 throughout March and April.

VPS outlined that in principle the costs as a system should be covered for the year, within reason. With regards to commissioning planning spend, there would be a requirement to reassess what should be invested in and ensure clarity of what providers could deliver. The Governing Body was being asked to support the approach.

A query was raised in relation to the process and VPS confirmed that the finance team would be working with commissioners and would consider the position sector by sector. In relation to activity based contracts, the need to understand the capacity across health care buildings and the impact on potential activity was raised.

The Chief Executive summarised that it was important to take an approach whereby commissioning managers could add value and providers would deliver intentions. The health inequalities framework should also be considered when investments were being made.

VPS informed members that a system conversation would take place to ensure that the money was appropriate to deliver the best for the system.

The elective backlog was raised, which would continue into 2021/22. There was a need to consider what action could be taken during 2020/21. Members agreed that opportunities should be looked at as a system and reprioritised for this year and next year.

The Governing Body agreed that a sector by sector review should take place and supported the Executive Team to work through the review.

The Governing Body:

a) noted the changes to Statutory Accounts and Reporting for 2019-20;

No. Agenda Item Action b) noted the changes to Corporate Accounting and Contracting in 2020-21 during the COVID 19 period (April – July 2020); c) noted the Contracting Arrangements for April-July 2020; d) noted and commented on the COVID related costs March – April 2020; and e) endorsed the Financial and Corporate Governance arrangements during this period already reviewed and supported by the Audit Committee on 22nd April 2020.

GB Committee Chair’s Summary – Audit Committee – 22 April 2020 20/15 SSe presented the report and highlighted that assurance had been given from Counter Fraud that the Self Review Tool (SRT) for 2019/20 was to be rated as green.

Members were informed that a meeting between Internal Audit and the Audit Committee Chair and Executive Director of Finance would take place in between Audit Committee meetings. The first of these had taken place and was positive and the plan for quarter 1 and quarter 2 had been reviewed. It was noted that 3 audits had been deferred and VPS would pick these up with EMT.

The Governing Body: a) received the report.

GB Committee Chair’s Summary – Remuneration & Nomination Committee – 20/16 8 April SSe presented the report and highlighted that recommendations from the Committee would be presented in the confidential section of the Governing Body meeting.

The Governing Body: a) received the report.

GB Committee Chair’s Summary – Quality & Performance Committee – 12 20/17 May 2020 PA presented the report and informed members that the Committee had changed the usual format of the meeting and focused on a small number of key topics that were deemed to be important to consider the CCG response to the evolving situation in relation to quality. The Committee had agreed a reasonable level of assurance and was particularly impressed with the work undertaken in relation to considering the potential health impacts.

The Governing Body: a) received the report.

GB Review of Committee Effectiveness 20/18 GS presented the report and informed members that minor amendments were recommended to the Quality & Performance Committee and Primary Care

No. Agenda Item Action Commissioning Committee terms of reference.

It was noted that there had been feedback from the Remuneration and Nomination Committee in relation to the effectiveness of the Governing Body when considering recommendations from the Committee and members acknowledged that the Governing Body effectiveness review would be undertaken later in the year.

It was highlighted that in relation to the Primary Care Commissioning Committee, the Committee required a more strategic focus and this would be taken forward by the Chair and lead Directors.

The Governing Body: a) received the annual reports; and b) approved the proposed amendments to the Quality & Performance Committee and Primary Care Commissioning Committee terms of reference.

GB West Yorkshire & Harrogate MOU for Collaborative Commissioning 20/19 GS informed members that a review of the memorandum of understanding (MOU) had been undertaken and the report outlined the amendments that had been made.

TR highlighted that the MOU was an important holding position as work was ongoing in relation to commissioning and how West Yorkshire & Harrogate works together with more intensity moving forward. The Governing Body would be sighted on any future changes as and when required.

A query was raised in relation to the one vote per CCG and whether this was representative of the populations within the CCGs. Members were assured that there was appropriate influence in relation to voting requirements.

The Governing Body:

a) approved the revised MoU and Joint Committee work plan; and b) authorised the Accountable Officer to sign the MoU.

GB Forward Work Programme 2020/21 20/20 The Governing Body’s work programme was presented for information.

The Governing Body: a) received the forward work programme.

GB Any Other Business 20/21 There was no other business.

No. Agenda Item Action The Governing Body resolved that representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.

Date of next meeting: 17 June 2020 – Accounts Approval Only

Approved and signed by:

Dr Gordon Sinclair, Clinical Chair, NHS Leeds CCG

Date:

Draft Minutes NHS Leeds CCG – Governing Body Meeting Wednesday 17 June 2020 2.00pm – 2.30pm Microsoft Teams Virtual Meeting

Members Initials Role Present Apologies Dr Gordon Sinclair (Chair) GS Clinical Chair  Dr Phil Ayres PA Secondary Care Specialist Doctor  Dr Jason Broch JB Assistant Clinical Chair  Dr Ben Browning BB Member Representative  Angela Collins AC Lay Member – Patient & Public Involvement  Jo Harding JH Executive Director of Quality and Nursing  Dr Julianne Lyons JL Member Representative  Dr Keith Miller KM Member Representative  Visseh Pejhan-Sykes VPS Executive Director of Finance  Tim Ryley TR Chief Executive  Samantha Senior (Deputy SS Lay Member – Primary Care Co-  Chair) Commissioning Dr Simon Stockill SSt Medical Director  Additional Attendees Sabrina Armstrong SA Director of Organisational Effectiveness  Victoria Eaton VE Director of Public Health  HL Interim Director of Acute & Specialist Helen Lewis  Commissioning Katherine Sheerin KS Director of System Integration  Laura Parsons LP Head of Corporate Governance & Risk  Sam Ramsey SRa Corporate Governance Manager  Rashpal Khangura RK External Audit, KPMG  Sofie Kockelbergh SK External Audit, KPMG  Sam Jones SJ Senior Finance Manager 

No. Agenda Item Action GB Welcome and Apologies 20/27 GS welcomed everyone to Governing Body meeting. Apologies had been received from Jo Harding, Victoria Eaton and Helen Lewis.

No. Agenda Item Action

Rashpal Khangura and Sofie Kockelbergh were in attendance from KPMG.

It was noted that there had been no requests from members of the public to attend the virtual meeting.

GB Declarations of interest 20/28 Members were asked to raise any declarations of interest in relation to agenda items.

No further items were raised. GB Annual Report & Accounts 2019/20 20/29 VPS presented the annual report and annual accounts for 19/20, She emphasised that the CCG had met all of its financial Members were informed that despite Covid-19, the annual report was required and the accounts had to be approved and published on the website by 8 July 2020. NHSE required them by 25 June 2020.

It was confirmed that the Audit Committee had considered the accounts with external and internal auditors and was satisfied that the CCG had met all statutory duties. It was highlighted that there was a small surplus, however there had been a prudent approach to accruals at year end and the CCG was close to the break-even position. The Audit Committee was assured and recommended the Governing Body approve the annual accounts.

An amendment was highlighted in the Governing Body attendance table within the annual report to include Phil Ayres. It was confirmed that this would be actioned prior to the report being published.

A query was raised in relation to a summary document to present the celebrations of the CCG. It was agreed that this would be reflected on and consider other options to present as a public facing easy read document.

RK presented the external audit reports and confirmed that a complete set of financial statements had been received and the information provided from the Finance department had resulted in a smooth audit process. RK confirmed that the role of external audit was to issue an opinion on the financial statements and the value for money (VFM) conclusion. The position, once the accounts had been signed would be clean accounts and a clean VFM conclusion. No information was identified that would suggest the CCG was not a going concern.

A minor amendment to the annual report on page 158 was highlighted and acknowledged.

The Chair highlighted that assurance had been provided by the Audit Committee and auditors and the Governing Body approved the annual report

No. Agenda Item Action and accounts.

Thanks were expressed to the finance team from both external audit and the Governing Body, particularly given the unusual circumstances the team was working under.

The Governing Body:

a) approved the Annual Report & Accounts 2019/20.

GB Any Other Business 20/30 There was no other business.

Date of next meeting: 22 July 2020

Approved and signed by:

Dr Gordon Sinclair, Clinical Chair, NHS Leeds CCG

Date:

MINUTES ACTION LOG – GOVERNING BODY

ITEM ACTION ACTION: ACTION BY: COMPLETED/UPDATE NO: NO: 25 September 2019 19/68 1 Approval of Procurement Plan In progress. Procurement Policy to be revised following discussion regarding risk VPS Policy update underway. Delayed stratification approach. due to COVID-19. To be presented to Audit Committee on 15 July 2020. On agenda for July Governing Body. 25 March 2020 19/128 1 CCG Operating Plan & 2020/21 Budgets LP/GS In progress. A query was raised in relation to the visibility of the financial situation Added to the forward work plan. of the Integrated Care System (ICS) and it was agreed that there was further detail required on this which could take place in the form of a workshop.

20 May 2020 20/13 1 Health Inequalities Framework KS Complete. Amendments to be made to framework in light of comments. Amended document circulated. Approved in light of amendments. Agreed sentence to be circulated to GB members following the meeting.

Agenda Item: GB 20/37 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 22nd July 2020

Title: Chief Executive’s Report

Lead Governing Body Member: Tim Ryley, Chief Tick as Category of Paper appropriate Executive () Report Author: Tim Ryley, Chief Executive Decision

Reviewed by EMT/Date: N/A Discussion 

Reviewed by Committee/Date: N/A  Information

Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care  5. People will live in healthy, safe and sustainable communities 

Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge  2. Failure to assure the delivery of high quality services, leading to commissioned services not  reflecting best practice and improving care 3. Failure to achieve financial stability and sustainability  4. Lack of provider and clinical support for change will impact on the development and  implementation of the CCG strategy 5. Resources are not targeted effectively to areas of most need, leading to failure to improve  health in the poorest areas 6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions  7. Failure to enable partners to work together to deliver the CCG commitments  8. Failure of system to be adaptable and resilient in the event of a significant event 

EXECUTIVE SUMMARY:

The report this month will update the CCG Governing Body on the following areas of work and proposes that the CCG adopt in full the West Yorkshire and Harrogate recommendations in support of a more diverse leadership attached at Appendix 3. Two of our colleagues from the CCG BAME network Kaysha Maynard and Shak Rafiq will introduce this item. Given the fast pace of change, the details will be as available at the time of writing.

- Latest position on Covid19

- Stabilisation and Reset

- Implications on Performance

- Health Inequalities Update

- Operational Update

- Diverse Workforce Proposal

1: Covid19 Position At the time of writing there are 59 people in hospital with Covid19 and of these 1 is in intensive care. This compares to the peak position of 231 and 43 in mid-April and is the lowest position th since March 30 .

The total number of people in Leeds with a positive Covid19 test to date is 3660 and this has fallen from a rolling 7 day average at its peak of 569 confirmed cases in a week to 53 cases currently. The total number of registered deaths with Covid19 recorded as a factor to date is 633. The number of deaths registered in the latest 7 day period is 2, which is down from the highest figure of 131 deaths in a week in mid-April.

This clearly indicates that the situation is continuing to improve, but as lockdown eases and given pressures elsewhere in West Yorkshire we need to watch this carefully.

The city is now in an Outbreak Control phase rather than assumed general community transmission. There is a city Outbreak Control Group in place chaired by the leader of the council and including a wide range of partners including business, council functions, transport, police and community engagements. The CCG Chief Executive represents the NHS on this. Beneath this group the Health Protection Board has led the development of the Outbreak Control Plan and is overseeing its implementation. The plan is attached at Appendix 1 within the supporting information documents.

Currently Leeds has a 6.1 per 100,000 rate which is one of the lowest in the Yorkshire and Humber region and more akin to rural communities.

The NHS continues to plan on the basis of a second wave in winter that may coincide with the winter flu season and NHS Gold chaired by the CCG Chief Executive is meeting every two weeks to ensure that the Health & Social Care system is being managed effectively in a coordinated way.

2: Stabilisation and Reset Since the start of May the CCG has been working with colleagues to understand the medium and long-term implications of the loss of access to routine and urgent services. I will be including some of the early findings from that work at the September Governing Body meeting in my report and will invite Dr Bryan Power who is leading this work to attend.

At the same-time commissioning colleagues have been working together with providers to ensure that we have the maximum possible safe access to services. There is a weekly Stabilisation and Reset Silver Group reporting into the Health and Social Care Gold Group and co-ordinating this work. This is chaired by Dr Sarah Forbes for the CCG and Joanna Forster- Adams (LYPFT) for the providers and is essentially a meeting of the city Chief Operating Officers. Their decision making approach has been approved and is attached within the supporting information (Appendix 2).

The work of the Stabilisation and Reset group is based on the principles embedded in the Health and Wellbeing Strategy; alongside the partnerships approach of valuing ‘working with’ the citizens of Leeds and tackling the health of the poorest fastest. Whilst it would take up the whole of the rest of the report to articulate all the work that has been undertaken I thought it would be helpful to give you a flavour of the breadth and depth of work that is going on.

 LTHT: By the end of the financial year they expect to deliver 75% of usual monthly elective activity. They have created an alternative pathway for people with LD or autism who may struggle to comply with the 14 day isolation period which is required prior to elective admission.

 Social Care: They saw a reduction in demand during March and April for new referrals including safeguarding but these are now on the increase. They have been embracing technology such as using WhatsApp to engage with younger people with LD.

 Public Health: There has been a refocus of third sector contracts to allow more on response to volunteers, food etc. They have continued to raise the profile of health inequalities within the group.

 Third Sector: The third sector working together in partnership with each other. They are bringing together a network of twenty organisations around homelessness, LGBT, men, women, BAME and different voices about how they use this network to communicate those messages in terms of inter-communities.

 YAS: There has been a string focus on working in partnership with Leeds and making sure there is strong clinical representation in the work and impact with those patients. They have commissioned some work looking at targeting homelessness and what needs to be put in place to allow them to respond appropriately to their requirements

 Children’s Hospital: They have converted 82% of outpatient appointments from face to face to either telephone or video consultation and received positive feedback from patients as well as clinicians.

 Primary Care: They have been working with care homes and ensuring residents are kept safe and their clinical needs addressed through the use of newly formed MDTs. The primary care live streams are being used to focus on inequalities and there have so far been sessions on BAME colleagues and communities and homelessness.

 LCH: They have developed innovative programmes such as Cardiac rehab programmes that used to be done in leisure centres and now are done through group and personalised tele health programmes. They have had a focus on mental wellbeing of older people and how they can encourage increased use of the Leeds Mental Wellbeing Service.

 LYPFT: Working closely with PCN’s in order to understand where they are seeing changes in needs and demand and adapting staff in to areas to respond as fully as possible. They have a focus on digital inclusion which is feeding in wider city work.

Stabilisation and reset: Communications

A citywide communications strategy is being developed to share messages with our different communities as well as our staff on the stabilisation and reset programme. Our approach is based on local, regional and national insight including engagement with local people in an effort to address concerns but also to manage expectations. Where practically possible we’ll have consistent messages across all partners however there will be a need for tailored, service-specific information.

We recognise that people have different information needs and every effort will be made to develop resources that support and reassure our diverse population. One of our key principles is to align our strategy with the National Voices ‘nothing about us, without us’ report and to use patient personas to truly understand the wider barriers people may face so that our communications are sensitively delivered.

3: Challenges Arising From Covid19 In addition to the medium and long-term implications that we will discuss in September there are a number of more immediate performance and financial challenges.

- Waiting Lists: even with 65% of normal activity now being undertaken waiting lists will still be growing albeit at a slower rate than at the height of Wave 1. For Leeds CCG patients at all providers the total waiting list size reduced dramatically by over 10,000 from the end of February to the end of May, but the numbers of patients waiting longer than 18 weeks grew by 130% to 6900 and will have grown further in June (data awaited) LTHT was close to reducing the numbers of over 52 week waiters to 19 at the end of March (all in spinal surgery) but the position has completely shot back up again month on month as all routine work has been suspended. We are awaiting updated modelling work that now begins to build in the amount of elective capacity that can be delivered once the most clinically urgent patients have been treated. The expectation is that by the end of August the most clinically urgent and cancer patients’ backlogs will have been cleared, and there will then be ongoing prioritisation both by clinical urgency and longest waiters on an ongoing basis. 2 week wait referral demand dropped off badly early in the pandemic, but is up to over 80% of previous rates at the beginning of July which is really encouraging.

- The gap in capacity to see both routine outpatients and routine elective patients presents us with challenges in both managing public expectations and in managing clinical risk in the system. The importance of having a clear decision making framework (as set out in Appendix 1) and rationale for decisions is likely to be essential when delays are challenged. Primary Care Network (PCN) clinical directors are working closely with LTHT and other colleagues to ensure that there is are joint city-wide approaches to managing the clinical risk of the delays. The GP Confederation and LTHT are working together, with support from CCG commissioners, to begin to review greater opportunities for shared care, and more pre-and post –referral work being carried out in community settings. This is in its early stages, and will bring challenges as to how to move at pace, and also to enable resources to follow additional workload shifts without diluting the work of core primary care.

- PCN clinical directors and LTHT clinical directors along with the LMC and with support from the CCG have been meeting to discuss potential models of care going forward. There have been some wider discussions around principles of working and these have been followed up by smaller task and finish groups. There are a variety of themes which aim to build on some of the processes already in place such as “advice and guidance” along with the development of longer term commissioning ambitions around models of shared care. This builds on the previous work which was being done by WYAAT (West Yorkshire Association of Acute Trusts) which was looking at transformation of outpatients. It also links to the broader direction of travel towards Rapid Diagnostic Centres (RDCs) which are part of the NHS long term plan.

Ultimately this will be about care closer to home and what enablers we need to put in place to allow equity of access to a specialist opinion for patients.

- We are continuing to review the additional pressures on public mental health created and exacerbated during the lock-down period. While mental health services continued to operate, they often have had to operate on the phone or by video conference rather than face to face, and the numbers of referrals dropped off substantially earlier in the period. Patients are beginning to come back, but acute admissions are also rising substantially as patients appear to have suffered during this extended period. Out of area placements have also risen, despite some excellent work earlier in the year to ensure as many patients as possible could be transferred to more suitable supported accommodation rather than remaining in acute settings. We are working closely with system partners to try to provide as much psychological wellbeing support across the system as possible, and to encourage the use of helpline and crisis offers as an alternative to acute presentations for people of all ages. We expect these pressures to continue as austerity bites further, and proactive work on mental health remains a major priority for the whole system

 The necessary command and control approach in managing NHS funding in the first 4 months is being extended for the remainder of the year. However, we are still awaiting clarification as to how much local discretion is being allowed to systems locally (at Place or at Integrated Care System level) vs how much of our local resources are being deployed centrally by NHS England. This therefore poses a number of significant financial challenges as set out in the report of the Chief Finance Officer and will potentially require some difficult decisions to be made. The important factor to note in my report is that this is currently limiting our flexibilities and will impact on our ability to invest and carry forward the wider transformation agenda.

We are working closely with colleagues across the city and at West Yorkshire to mitigate these risks and at the time of writing are awaiting the long delayed planning guidance which will set these out in more detail.

4: Health Inequalities Next Steps The CCG Governing Body approved the Health Inequalities Framework subject to some small but important changes. These have been completed and the intention is to launch the Framework at the Leeds Health & Wellbeing Board on 13th September 2020 and to set out a series of immediate investments in Health Inequalities to coincide with this launch. These are currently being developed and will among others pick-up on the suggestion in May of additional support to the Homeless.

Colleagues across Primary Care have developed a BAME network which was launched on the 7th July with Nikki Kanani from NHS England in attendance. This will provide significant insight into some aspects of Health Inequality work at locality level.

The CCG has supported this development and will continue to do so and as Chief Executive, I was pleased to be part of the launch.

Furthermore, the CCG continues working closely with partners across the city to develop our medium term investment plan – the Left Shift Blue-Print – and we have built into this the thinking from the Health Inequalities Framework ensuring that the key outcomes and activity measures will be tracked not just at city level but across localities with significant ambitions to reduce the gap in performance between deprived and non-deprived Leeds. We will bring this investment plan to the Governing Body in September with a view to sign-it off in November ahead of next year’s planning round.

5: CCG Operational Update In line with the clear evidence of the disproportionate impact of the Coronavirus on people from a BAME background, all NHS organisations have been asked to risk assess all staff and publish the data. The CCG has undertaken this. Following discussion with the CCG’s BAME network, we decided that line managers should conduct risk assessments on all staff. We have now analysed all but a handful of reports and the summary headline is that, with nearly all of our staff now homeworking, the risk of work-related infection is significantly reduced. A number of BAME colleagues are also avoiding patient contact which addresses an immediate risk, but will require monitoring. Similarly, as time passes, there is an emerging need to offer further support to people in their home working environment. Monitors, chairs and other deskware have been released from WIRA House as an immediate solution.

We have taken the decision that we will review the opening of Wira House in the first week of each month and not respond directly to the latest announcements. This will give us the opportunity to review the position, ensure all necessary adjustments are in place and give staff time to plan for implications personally. We believe that the safe use of Wira house will allow for only 70-110 of our 350 people in at any time. We currently remain closed and will review the position again in early August.

We continue to monitor the use of annual leave and sickness levels closely. Sickness levels have remained broadly stable throughout the pandemic, if not showing a slight reduction. From a health and wellbeing point of view, we have asked staff to take at least 10 days of their statutory annual leave (pro-rata for part-time staff) by 30th September and we have seen a modest increase in take-up during June. We have also agreed this year that CCG employees will be able to sell up to 5 days leave (pro-rata for part-time staff) or carry over up to five days into 2021-2.

We were sorry in the last month to say goodbye both to the CCG Chair, Dr Gordon Sinclair, and to Katherine Sheerin the Interim Director of Strategy who has moved to take-up a permanent position in the West Midlands.

Dr Jason Broch has been endorsed by members as the new CCG Chair and took up his st position from the 1 July.

The functions undertaken by Katherine Sheerin are being picked-up by various director colleagues in the short-term whilst we complete the next steps on Shaping Our Future: Primary Care is going to Dr Simon Stockill, Children’s Commissioning to Jo Harding, Community Commissioning to Helen Lewis, Left Shift Blue-Print to Visseh Pejhan-Sykes and Shaping our Future to Sabrina Armstrong.

The report for communications and engagement activity during May and June is attached within the supporting information documents and is published here: https://www.leedsccg.nhs.uk/publications/communications-and-engagement-report-may-to- june-2020/

Governing Body members are asked to receive this information as assurance that the CCG is delivering its statutory duties to ensure public involvement and consultation.

Key Messages from the West Yorkshire & Harrogate Joint Committee of Clinical Commissioning Groups

The key messages from the recent meeting of the West Yorkshire & Harrogate Joint Committee of CCGs held on 7 July 2020 are attached at Appendix 4. 6. CCG Annual Assurance Review The CCG recently had its end of year assurance meeting with NHS England which contributes to its overall assessment. We still await the latter, but the report concluded, “In conclusion, we commended you on the range of improvements Leeds CCG has delivered in 2019/20 and the wider achievements we discussed. Following the successful merger of the three former CCGs, it is clear that Leeds has developed its capability and capacity and leadership with strong partnership and collaboration. You have also been supporting wider system leadership capacity and capability and developing innovative approaches across a wide range of topical agendas. You are proactive and have improved your grip on quality issues. Leeds is a place that is seen to be doing well and creating a good foundation for the future.”

7: Achieving our Ambition to Increase the Diversity of Our Leadership Our CCG is committed to developing an inclusive organisation and, working with partners, an inclusive healthcare system at place level as well across our integrated care system. We acknowledge that progress in some areas has been slower than we, our colleagues and our communities should expect. We have committed to tackling health inequalities as key focus for our work going forward which we covered at the Governing Body meeting held in May.

Attached in Appendix 3 you will find a discussion paper and proposal from the ICS that concentrates on our collective ambition to increase the diversity of our leadership here at the CCG and across all our partner organisations. I have asked Shak Rafiq and Kaysha Maynard two of our BAME colleagues to lead this discussion and propose adoption of the West Yorkshire Position Statement.

We are particularly aware that colleagues from BAME backgrounds across the NHS (and other statutory organisations) continue to report the same lack of progress into leadership roles as well as highlighting continual inequalities in the workplace.

This includes concerns that bullying and harassment continues to take place, conscious and unconscious bias affecting recruitment and promotion and the structural inequalities that prevent BAME people from reaching their full potential. We fully supported the Black Lives Matters campaign, but our ambition is to match our words with tangible actions.

Therefore we propose the CCG fully adopts the recommendations set out in the paper from the ICS. Further to this we will share the attached graphic across our organisation so that people are aware of how labels affect colleagues from a BAME background. This has been adapted from a graphic, source unknown, that shows that women are impacted in a similar way.

RECOMMENDATION:

The Governing Body is asked to:

(a) NOTE and APPROVE the adoption of the recommendations from West Yorkshire to increase the diversity of leadership; and (b) RECEIVE the communications and engagement update as assurance that the CCG is delivering its statutory duties to ensure public involvement and consultation.

9 Item 09/20

Partnership Board 3 March 2020

Summary report Item No: 09/20 Item: Achieving our ambition to increase the diversity of our leadership Report author: Members of the West Yorkshire and Harrogate BAME Network Presenters: Fatima Khan-Shah, Shak Rafiq, Wendy Tangen, Wasim Feroze on behalf of the West Yorkshire and Harrogate BAME Network Executive summary Our Partnership’s Five Year Strategy sets an ambition to increase the diversity of leadership across partner organisations, specifically for Black, Asian and Minority Ethnic (BAME). This paper sets out some specific proposals for how we make this ambition a reality. The paper has been co-produced with BAME staff network chairs from across the partnership as well as colleagues working closely or having an active interest in this agenda.

Our workforce is more diverse than it has been any other time previously; unfortunately, across some levels of our organisations particularly in leadership positions, our workforce does not reflect our population. There is considerable evidence which suggests tackling workforce race and equality improve staff experience, organisational efficiency and most importantly improve the outcomes for the people using those services. Furthermore, it is important that our staff should be able to look at the leadership and see themselves represented as well as the population of West Yorkshire and Harrogate.

Research undertaken by the NHS England workforce race equality team has identified that one of the main factors believed to affect patient satisfaction is the experience of staff. This research also demonstrated the extent to which an organisation values its minority staff is a good barometer of how well patients are likely to feel cared for. In addition to this, increased staff engagement also leads to lower levels of absenteeism, decreased spend on agency staff, and increased organisational efficiency and productivity. In the current climate of unprecedented workforce challenges it is crucial that we utilise all the talent available.

Their most recent report which analyses data from NHS trusts published in February 2020; demonstrates a deterioration across four of a total nine indicators which relate to the ‘cultural’ experience of staff have worsened since the data was first recorded in 2016. In particular the share of BAME staff reporting bullying and, harassment or abuse from colleagues saw the largest increase. It was also identified in the NHS Staff Survey that BAME staff are 16% less likely to say that they are offered equal opportunities than their white colleagues.

Experiences of BAME staff in local authorities echo those working for the NHS. 2,580 BAME staff from five local authorities responding to a survey about ‘their experiences fed back about their perception of unfair treatment: being underpaid allied with a lack of effort from management to ensure an equal work environment, to be specific, to prevent discrimination, bullying, and racism at workplace’.

1 Item 09/20

Recommendations and next steps

The Partnership Board is recommended to: a) approve the recommendations are set out in the table at Annex A; b) once agreed, to share and discuss the recommendations within their own organisation’s Boards and Leadership Teams; and c) receive reporting on progress against these recommendations, on a bi-annual basis.

2 Item 09/20

Achieving our ambition to increase the diversity of our leadership

Purpose

1. Our Partnership five year strategy sets an ambition to increase the diversity of leadership across partner organisations, specifically for Black, Asian and Minority Ethnic (BAME). This paper sets out some specific proposals for how we make this ambition a reality. The paper has been co-produced with BAME staff network chairs from across the partnership as well as colleagues working closely or having an active interest in this agenda.

2. The WY&H Partnership Board is asked to discuss and support the recommendations set out in this document at Annex A.

Background: The need for accelerated improvement

3. Our workforce is more diverse than it has been any other time previously; unfortunately, across some levels of our organisations particularly in leadership positions, our workforce does not reflect our population. There is considerable evidence which suggests tackling workforce race and equality improve staff experience, organisational efficiency and most importantly improve the outcomes for the people using those services1. Furthermore, it is important that our staff should be able to look at the leadership and see themselves represented as well as the population of West Yorkshire and Harrogate (WY&H).

4. Research undertaken by the NHS England workforce race equality team has identified that one of the main factors believed to affect patient satisfaction is the experience of staff. This research also demonstrated the extent to which an organisation values its minority staff is a good barometer of how well patients are likely to feel cared for. In addition to this increased staff engagement also leads to lower levels of absenteeism2, decreased spend on agency staff, and increased organisational efficiency and productivity. In the current climate of unprecedented workforce challenges it is crucial that we utilise all the talent available.

5. The most recent NHS Workforce Race Equality Standard 2019 Data Analysis Report , which analyses data from NHS trusts in England published in February 2020; demonstrates a deterioration across four of a total nine indicators which relate to the ‘cultural’ experience of staff have worsened since the data was first recorded in 2016. In particular the share of BAME staff reporting bullying and, harassment or abuse colleagues saw the largest increase. A summary of key findings from the report are enclosed at Annex B and the NHS WRES data for all NHS Trusts in WY&H is available at Annex C.

6. The results from the NHS Staff Survey (which includes Clinical Commissioning Groups as well as NHS trusts) were also published in February 2020; the findings also identified that BAME staff are 16% less likely to say that they are offered equal opportunities than their white colleagues. A national results briefing on the findings

1 West, M. and Dawson, J., 2012. Employee engagement and NHS performance. London: King's Fund. 2 https://www.england.nhs.uk/publication/links-between-nhs-staff-experience-and-patient-satisfaction- analysis-of-surveys-from-2014-and-2015/ 3

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from the NHS Staff Survey can be accessed here, and the findings in respect of staff views on whether their organisation provides equal opportunities for career progression / promotion by ethnicity and disability is available at Annex D.

7. Experiences of BAME staff in local authorities echo those working for the NHS. 2,580 BAME staff from five local authorities responding to a survey about ‘their experiences fed back about their perception of unfair treatment: being underpaid allied with a lack of effort from management to ensure an equal work environment, to be specific, to prevent discrimination, bullying, and racism at workplace’3.

8. This supports findings in earlier reports such as Snowy White Peaks (Kline, 2014)4, demonstrate that while the NHS has a diverse workforce – almost one in five are from a BAME background – the number in senior non-clinical leadership position is not reflective of this. Further research shows that there is a disproportionate number of BAME people in roles at Band 7 and below in relation to the total number of staff from BAME backgrounds.

9. Recent research has identified a gap in the treatment experience between white and black Asian minority ethnic staff. Crucially there is also evidence to suggest some of the experience of BAME staff is not congruent with the values of our partnership. It is important that this is addressed as this is morally the right thing to do. Furthermore studies show that truly diverse organisations that have leaders reflecting their communities make better decisions, achieve better outcomes and have more engaged employees5. To ensure that all perspectives are represented fairly within an organisation it is crucial that we have a diverse workforce at all levels within the organisation.

Progress to date

10. On 1 October 2019, several members of the WY&H System Leadership Executive Group joined colleagues from across the partnership at a session celebrating the diverse talent from across the partnership. The session also involved several facilitated thought-provoking conversations to try and deliver an insight to the experiences of BAME staff within their organisations. One of the key outcomes from this event was to work towards delivering the Partnership’s vision of fairness and equality for all.

11. Many participants fed back how powerful they found the session and there was an appetite to progress the agenda further; this resulted in a further event specifically involving the chairs of BAME networks across the partnership organisations as well as colleagues working closely or having an active interest in this agenda. This took place on 7 January 2020, supported by the WY&H Partnership Team as well as representatives from the WY&H system leadership and development programme.

3 Wang, W. and Seifert, R., 2018. BAME Staff and Public Service Motivation: The Mediating Role of Perceived Fairness in English Local Government. Journal of Business Ethics, pp.1-12. 4 Kline, R., (2014). The snowy white peaks of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England. Middlesex University London 5 The Independent, 2018 Businesses perform better when they have greater ethnic and gender diversity, study reveals https://www.independent.co.uk/news/business/news/business-ethnic-gender-diversity-performance- levels-better-study-workplace-office-mckinsey-a8166601.html 4

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12. Following the two events, there has been a request from the Partnership’s leadership team for a paper to be prepared with recommendations on how to progress this agenda working closely with network members. This fits in with the Partnership’s approach to co-produce solutions in everything that it does, where possible to do so

Current activity across the region

13. The session explored what provision was currently available to support BAME staff and showcased existing good practice from across the partnership network from NHS and Local Authority organisations. The session identified the following good practice:

 BAME networks being involved in the recruitment and selection process of senior staff  Reverse mentoring initiatives  Coaching schemes, springboard schemes and leadership programs specifically for BAME staff  Place-based BAME networks working across organisational boundaries

14. The session also identified that there were several areas where participants would benefit from additional support such as practical tips on developing a proactive and effective BAME network within organisations and progressing beyond grade 7 for equivalent roles. There was also significant appetite from the participants to develop a regional network where they can continue to showcase and share good practice.

15. Equally important was succession planning and ensuring we continue to attract people to work in the public and community and voluntary sectors from diverse backgrounds including those from underprivileged backgrounds.

16. At the meetings to date, members have expressed the importance of being aware of intersectionality6 and how this can impact on a person’s experiences as well as opportunities that may or may not be available to them. This paper advocates the need to promote inclusion and fairness in everything we do.

A fair and representative workforce

17. The group also had the opportunity to shape how the partnership addresses its ambition to have a more diverse leadership and improve the experience of BAME staff in the workplace. The outcomes of these conversations have formed the basis of the recommendations in this paper.

18. The recommendations vary from system wide collective action including formalising the group into the WY&H BAME network. This network will provide critical challenge and support to the partnership on its progress towards our ambition. The recommendations also include activity for specific programmes as well as suggestions for individual organisations across the partnership.

19. Members felt that the network needed to ensure that it offered a mix of critical challenge and solutions-focused approaches which, where possible, use SMART objectives to help the Partnership deliver its ambition. In order for this ambition to be

6 Adewunmi, B., 2014. Kimberlé Crenshaw on intersectionality:“I wanted to come up with an everyday metaphor that anyone could use”. New statesman, 2. 5

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a success it is crucial that we all collectively make the personal commitment within our own organisations as well as across the system to create the right conditions for all our staff to thrive.

Recommendations

20. The key recommendations are set out at Annex A for consideration by the Partnership Board. Once agreed, members are requested to share and discuss the recommendations with their own organisation’s Boards and Leadership Teams.

21. In order we achieve maximum impact and significant progress towards our ambition it is recommended that we report back to the partnership board on a bi-annual basis.

Members of the West Yorkshire and Harrogate BAME Network

Item 09/20 Annex A Recommendations Influence To create a formal WY&H BAME network, which will meet on a quarterly basis. This would not supersede or replace WY&H Partnership Team existing networks but will consist of a network of networks from across the partnership with at least one member of the System Leadership Executive Group attending the meeting.  A representative from the network will also be able to attend the System Leadership Executive meeting.  There will be an invitation for WY&H BAME Network members to attend future System Leadership Executive Group meetings. The BAME network to receive and comment on papers from the System Leadership Executive Group with their views BAME Network being in taken into consideration in the meeting. BAME network members will be offered the opportunity to join the shadow leadership group as part of their personal development and to encourage diversity of views as part of the decision-making process Colleagues from the BAME network are given the opportunity to present this paper and its recommendations to their WY&H System Leadership and individual organisational boards for decision. Some members of the network may require support to do this from the Development Programme / WY&H System Leadership and Development programme. BAME Network / All Partnership Organisations Recruitment, Selection and Succession Planning Mandatory equality and diversity and unconscious bias training which is solely delivered face-to-face All Partnership Organisations Representatives from the BAME network are involved in the recruitment and selection of all senior leadership level All Partnership Organisations appointments to ensure that the senior appointments are reflective of the communities we serve. This will include the composition of the person specification and job description. Where organisations currently have their own network, this can continue to be utilised; if one does not currently exist they can utilise the expertise of the WY&H BAME network. To ensure when we are undertaking career aspirational activity and that we proactively target areas across the All Partnership Organisations partnership where there are significant BAME populations with effort made to offer secondment and career progression opportunities for those currently under-represented. A campaign that actively promotes and champions positive role models from different BAME backgrounds in senior All Partnership Organisations leadership roles 7

Item 09/20 Annex A

Talent Retention and Culture – Making our Partnership the best place to work The BAME network to have oversight of the WY&H implementation of the core offer and Leadership compact in the NHS BAME Network People Plan The BAME network to work in collaboration with the WY&H System Leadership and Development programme to WY&H System Leadership and develop a BAME focused leadership development programme, building on existing good practice and complimenting Development Programme/ existing programmes, to ensure adequate representation of BAME colleagues in the next generation of leaders. BAME Network All organisations should have an inclusion and diversity category in their internal staff awards with the aim of having this All Partnership Organisations in place by December 2021 across all Partnership organisations. A WY&H diversity and inclusion celebration event, led by the WY&H BAME network, showcasing good work taking place WY&H Partnership Team / in this agenda. BAME Network Measurement and Impact All partnership organisations to publish their data on the WY&H Health and Care Partnership website detailing the All Partnership Organisations following as a percentage of BAME to all staff  In each of the AfC Bands 1-9 or Local Authority Grade 4 and VSM (including executive Board members) or equivalent grades for local authorities compared with the percentage of staff in the overall workforce. Organisations should undertake this calculation separately for nonclinical and for clinical staff.  Relative likelihood of staff being appointed from shortlisting across all posts.  Relative likelihood of staff entering the formal disciplinary process, as measured by entry into a formal disciplinary investigation. This indicator will be based on data from a two year rolling average of the current year and the previous year.  Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months.  Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months.  Percentage believing that trust provides equal opportunities for career progression or promotion  Percentage difference between the organisations’ Board voting membership and its overall workforce. This is considered, with supporting action plans, annually by the SLE / Partnership Board with reporting on a bi-annual basis

Extract from NHS Workforce Race Equality Standard 2019 Data Analysis Report for NHS Trusts Item 09/20 Annex B

Key findings

WRES indicators relating to staff In 2019, 19.7% of staff working for NHS perceptions of discrimination, bullying, trusts and clinical commissioning groups harassment and abuse, and on beliefs (CCGs) in England were from a black and regarding equal opportunities in the minority ethnic (BME) background; this has workplace, have not changed for both BME been increasing over time. and white staff.

Across all NHS trusts and CCGs, there were The relative likelihood of white staff 16,112 more BME staff in 2019 compared accessing non–mandatory training and to 2018. continuous professional development (CPD) compared to BME staff was 1.15. This remained the same as last year.

The total number of BME staff at very senior manager (VSM) pay band has increased by 21, from 122 in 2018 to 143 8.4% of board members in NHS trusts were in 2019, and is up by 30% since 2016. from a BME background; an improvement from 7.4% in 2018 and 7.0% In 2017.

White applicants were 1.46 times more likely to be appointed from shortlisting The number of BME board members in compared to BME applicants; a similar trusts increased by 35 in 2019 compared to figure to that reported in 2018, and an 2018 – an additional 18 executive and 17 improvement on the 1.60 times gap in non-executive board members. 2017 and 2016.

In 2014, two-fifths of all NHS trusts in The relative likelihood of BME staff entering London had zero BME board members. the formal disciplinary process compared to As at 1 December 2019, all London trusts white staff has reduced year-on-year, from have at least one BME board member; a 1.56 in 2016 to 1.22 in 2019. significant achievement. 14.7% of Very Senior Managers in London are now from a BME background. Item 09/20 Extract from NHS Workforce Race Equality Standard 2019 Data Analysis Report for NHS Trusts Annex B

Table 1: WRES indicators for NHS trusts in England: 2016 – 2019

WRES indicator 2016 2017 2018 2019

2. Relative likelihood of white applicants being appointed from shortlisting 1.57 1.60 1.45 1.46 across all posts compared to BME applicants

3. Relative likelihood of BME staff entering the formal disciplinary process 1.56 1.37 1.24 1.22 compared to white staff

4. Relative likelihood of BME staff accessing non-mandatory training and 1.11 1.22 1.15 1.15 CPD compared to white staff

9. BME board membership 7.1% 7.0% 7.4% 8.4%

5. Percentage of BME staff BME 29.1% 28.4% 28.5% 29.8% experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months White 28.1% 27.5% 27.7% 27.8%

6. Percentage of BME staff BME 27.0% 26.0% 27.8% 29.0% experiencing harassment, bullying or abuse from staff in the last 12 months White 24.0% 23.0% 23.3% 24.2%

7. Percentage of BME staff BME 73.4% 73.2% 71.9% 69.9% believing that trust provides equal opportunities for career progression or White 88.3% 87.8% 86.8% 86.3% promotion

8. Percentage of BME staff BME 14.0% 14.5% 15.0% 15.3% personally experiencing discrimination at work from a manager/team leader or other colleagues White 6.1% 6.1% 6.6% 6.4% Item 09/20 Annex C NHS Workforce Race Equality Standard 2019 Data Analysis Report – Data Sources

WRES Worksheet Description Indicator 1.1 Non Clinical Skill Mix by ethnicity 1 1.3 Clinical (non medical) skill mix by Percentage of staff in each of the aggregate AfC Bands 1-9, and VSM by ethnicity ethnicity 2 2.0 Shortlisting to Appointment Relative likelihood of staff being appointed from shortlisting across all posts Relative likelihood of staff entering the formal disciplinary process, as measured by 3 3.0 Formal Disciplinary entry into a formal disciplinary investigation 4 4.0 Non Mandatory Training & CPD Relative likelihood of staff accessing non-mandatory training and CPD Available from: KF 25. Percentage of staff experiencing harassment, bullying or abuse from patients, 5 http://www.nhsstaffsurveyresults.com/wp- relatives or the public in last 12 months content/uploads/2019/03/Local-Workforce- KF 26. Percentage of staff experiencing harassment, bullying or abuse from staff in last 6 Equality-Data.zip 12 months KF 21. Percentage believing that trust provides equal opportunities for career 7 progression or promotion Q17. In the last 12 months have you personally experienced discrimination at work from 8 any of the following? b) Manager/team leader or other colleagues Percentage of Board representation by ethnicity and Executive/Non Executive 9 9.1 Board Representation Exec membership 9.2 Board Representation Voting Percentage of Board representation by ethnicity and Voting/Non Voting membership

The detailed definition for each indicator can be found in the WRES technical guidance. The technical guidance also includes the definitions of “white” and “black and minority ethnic”, as used throughout the NHS WRES report and within the narrative for the WRES indicators.

1 Item 09/20 Annex C Data at individual WY&H NHS trust level from the NHS Workforce Race Equality Standard 2019 Data Analysis Report

Table 1.1: Non Medical Workforce Skill Mix by Ethnicity

Definitions: Support (Bands 1-4), Middle (Bands 5-7), Senior (Bands 8a to 9), VSM -Very Senior Managers

SUPPORT MIDDLE SENIOR VSM

Null/ Null/ Null/ Null/ Org name White BME Unknown White BME Unknown White BME Unknown White BME Unknown

AIREDALE NHS FT 90.2% 8.5% 1.3% 88.8% 9.3% 1.9% 91.1% 8.9% 0.0% 100.0% 0.0% 0.0% BRADFORD DISTRICT CARE NHS FT 67.9% 25.0% 7.1% 77.6% 17.4% 5.0% 89.1% 9.4% 1.6% 78.6% 7.1% 14.3% BRADFORD TEACHING HOSPITALS NHS FT 66.8% 30.8% 2.4% 74.8% 24.4% 0.8% 77.7% 20.4% 1.9% 83.3% 16.7% 0.0% CALDERDALE AND HUDDERSFIELD NHS FT 75.7% 10.2% 14.2% 80.8% 12.0% 7.2% 95.1% 4.9% 0.0% 62.5% 12.5% 25.0% HARROGATE AND DISTRICT NHS FT 88.2% 2.3% 9.5% 92.8% 5.2% 2.0% 100.0% 0.0% 0.0% 100.0% 0.0% 0.0% LEEDS AND YORK PARTNERSHIP FT 81.3% 15.9% 2.8% 87.1% 10.8% 2.2% 85.3% 8.0% 6.7% 63.6% 0.0% 36.4% LEEDS COMMUNITY HEALTHCARE NHS TRUST 78.4% 16.9% 4.7% 86.2% 9.7% 4.1% 95.3% 1.6% 3.1% 66.7% 0.0% 33.3% LEEDS TEACHING HOSPITALS NHS TRUST 80.7% 16.9% 2.4% 87.0% 10.1% 2.9% 88.5% 9.0% 2.5% 71.4% 28.6% 0.0% MID YORKSHIRE HOSPITALS NHS TRUST 91.2% 7.6% 1.2% 89.1% 9.6% 1.4% 96.2% 3.1% 0.8% 88.9% 11.1% 0.0% SOUTH WEST YORKSHIRE PARTNERSHIP NHS FT 95.2% 4.8% 0.0% 94.6% 4.5% 0.9% 98.6% 1.4% 0.0% 85.7% 14.3% 0.0% YORKSHIRE AMBULANCE SERVICE NHS TRUST 91.5% 8.4% 0.1% 95.4% 4.6% 0.0% 90.7% 9.3% 0.0% 100.0% 0.0% 0.0%

2 Item 09/20 Annex C Data at individual WY&H NHS trust level from the NHS Workforce Race Equality Standard 2019 Data Analysis Report Table 1.3: Clinical (non medical) Workforce Skill Mix by skill mix and Ethnicity

Definitions: Support (Bands 1-4), Middle (Bands 5-7), Senior (Bands 8a to 9), VSM -Very Senior Managers

SUPPORT MIDDLE SENIOR VSM

Null/ Null/ Null/ Null/ Org name White BME Unknown White BME Unknown White BME Unknown White BME Unknown

AIREDALE NHS FT 85.8% 12.1% 2.1% 84.2% 12.9% 2.8% 95.9% 4.1% 0.0% 100.0% 0.0% 0.0% BRADFORD DISTRICT CARE NHS FT 63.5% 32.6% 3.9% 77.4% 19.2% 3.3% 79.2% 15.0% 5.8% - - - BRADFORD TEACHING HOSPITALS NHS FT 65.0% 33.9% 1.1% 69.2% 28.7% 2.1% 85.2% 12.3% 2.5% 100.0% 0.0% 0.0% CALDERDALE AND HUDDERSFIELD NHS FT 84.0% 13.6% 2.4% 84.9% 12.2% 2.9% 92.8% 5.1% 2.2% 100.0% 0.0% 0.0% HARROGATE AND DISTRICT NHS FT 81.7% 7.1% 11.1% 83.9% 5.6% 10.5% 92.9% 1.8% 5.4% 100.0% 0.0% 0.0% LEEDS AND YORK PARTNERSHIP FT 77.8% 20.6% 1.6% 84.1% 13.9% 2.1% 93.3% 6.7% 0.0% 75.0% 0.0% 25.0% LEEDS COMMUNITY HEALTHCARE NHS TRUST 91.5% 6.1% 2.3% 85.3% 9.2% 5.6% 66.7% 13.3% 20.0% 0.0% 0.0% 100.0% LEEDS TEACHING HOSPITALS NHS TRUST 77.2% 19.9% 2.8% 82.0% 15.8% 2.2% 92.9% 5.5% 1.5% 80.0% 20.0% 0.0% MID YORKSHIRE HOSPITALS NHS TRUST 88.5% 10.2% 1.3% 86.1% 13.3% 0.6% 88.6% 11.4% 0.0% 100.0% 0.0% 0.0% SOUTH WEST YORKSHIRE PARTNERSHIP NHS FT 90.8% 8.9% 0.3% 91.0% 8.6% 0.3% 94.9% 4.1% 0.9% 50.0% 50.0% 0.0% YORKSHIRE AMBULANCE SERVICE NHS TRUST 96.0% 3.9% 0.1% 96.4% 3.5% 0.1% 94.1% 5.9% 0.0% - - -

3 Item 09/20 Annex C Data at individual WY&H NHS trust level from the NHS Workforce Race Equality Standard 2019 Data Analysis Report

Table 2.0: Relative likelihood of White staff being appointed from shortlisting compared to BME staff

2019 Relative likelihood of White staff being Relative likelihood of Relative likelihood of appointed from shortlisting compared Org name shortlisting/appointed (White): shortlisting/appointed (BME): to BME staff:

AIREDALE NHS FT 19% 10% 1.9 BRADFORD DISTRICT CARE NHS FT 18% 11% 1.7 BRADFORD TEACHING HOSPITALS NHS FT 29% 22% 1.3 CALDERDALE AND HUDDERSFIELD NHS FT 24% 31% 0.8 HARROGATE AND DISTRICT NHS FT 24% 11% 2.1 LEEDS AND YORK PARTNERSHIP FT 4% 2% 2.2 LEEDS COMMUNITY HEALTHCARE NHS TRUST 3% 19% 0.2 LEEDS TEACHING HOSPITALS NHS TRUST 16% 8% 1.9 MID YORKSHIRE HOSPITALS NHS TRUST 14% 9% 1.6 SOUTH WEST YORKSHIRE PARTNERSHIP NHS FT 23% 21% 1.1 YORKSHIRE AMBULANCE SERVICE NHS TRUST 21% 12% 1.8

4 Item 09/20 Annex C Data at individual WY&H NHS trust level from the NHS Workforce Race Equality Standard 2019 Data Analysis Report Table 3.0: Relative likelihood of BME staff entering the formal disciplinary process compared to White staff

2019 Relative likelihood of BME staff Likelihood of White staff entering Likelihood of BME staff entering entering the formal disciplinary the formal disciplinary process: the formal disciplinary process: Org name process compared to White staff:

AIREDALE NHS FT 4.0% 4.7% 1.17 BRADFORD DISTRICT CARE NHS FT 1.6% 3.2% 1.98 BRADFORD TEACHING HOSPITALS NHS FT 2.4% 2.6% 1.09 CALDERDALE AND HUDDERSFIELD NHS FT 0.3% 0.2% 0.74 HARROGATE AND DISTRICT NHS FT 0.3% 0.3% 0.92 LEEDS AND YORK PARTNERSHIP FT 1.2% 3.9% 3.29 LEEDS COMMUNITY HEALTHCARE NHS TRUST 0.7% 1.0% 1.34 LEEDS TEACHING HOSPITALS NHS TRUST 0.8% 1.4% 1.71 MID YORKSHIRE HOSPITALS NHS TRUST 0.5% 0.5% 1.06 SOUTH WEST YORKSHIRE PARTNERSHIP NHS FT 1.3% 1.0% 0.77 YORKSHIRE AMBULANCE SERVICE NHS TRUST 2.7% 4.0% 1.48

5 Item 09/20 Annex C Data at individual WY&H NHS trust level from the NHS Workforce Race Equality Standard 2019 Data Analysis Report

Table 4.0: Relative likelihood of White staff accessing non-mandatory training and CPD compared to BME staff

2019 Relative likelihood of White staff Likelihood of White staff accessing Likelihood of BME staff accessing accessing non-mandatory training and non-mandatory training and CPD: non-mandatory training and CPD: Org name CPD compared to BME staff:

AIREDALE NHS FT 18.6% 13.6% 1.37 BRADFORD DISTRICT CARE NHS FT 93.1% 92.7% 1.00 BRADFORD TEACHING HOSPITALS NHS FT 54.0% 45.4% 1.19 CALDERDALE AND HUDDERSFIELD NHS FT 98.7% 99.2% 0.99 HARROGATE AND DISTRICT NHS FT 42.7% 47.0% 0.91 LEEDS AND YORK PARTNERSHIP NHS FT 19.7% 23.0% 0.86 LEEDS COMMUNITY HEALTHCARE NHS TRUST 10.9% 8.3% 1.31 LEEDS TEACHING HOSPITALS NHS TRUST 16.1% 12.5% 1.29 MID YORKSHIRE HOSPITALS NHS TRUST 96.5% 96.2% 1.00 YORKSHIRE AMBULANCE SERVICE NHS TRUST 54.6% 46.2% 1.18

6 Item 09/20 Annex C Data at individual WY&H NHS trust level from the NHS Workforce Race Equality Standard 2019 Data Analysis Report

Table 9.0: NHS Trust Board Representation by Ethnicity and Executive/ Non Executive membership

Total Board members of which: Executive/Non Executive

White BME Null White BME Null Executive Non Executive Executive Non Executive Executive Non Executive Org name member member member member member member

AIREDALE NHS FT 92.9% 7.1% 0.0% 100.0% 83.3% 0.0% 16.7% 0.0% 0.0% BRADFORD DISTRICT CARE NHS FT 86.7% 0.0% 13.3% 83.3% 88.9% 0.0% 0.0% 16.7% 11.1% BRADFORD TEACHING HOSPITALS NHS FT 81.3% 18.8% 0.0% 100.0% 62.5% 0.0% 37.5% 0.0% 0.0% CALDERDALE AND HUDDERSFIELD NHS FT 82.4% 5.9% 11.8% 87.5% 77.8% 12.5% 0.0% 0.0% 22.2% HARROGATE AND DISTRICT NHS FT 100.0% 0.0% 0.0% 100.0% 100.0% 0.0% 0.0% 0.0% 0.0% HULL UNIVERSITY TEACHING HOSPITALS NHS TRUST 93.8% 6.3% 0.0% 87.5% 100.0% 12.5% 0.0% 0.0% 0.0% HUMBER TEACHING NHS FT 65.0% 0.0% 35.0% 100.0% 50.0% 0.0% 0.0% 0.0% 50.0% LEEDS AND YORK PARTNERSHIP NHS FT 92.3% 7.7% 0.0% 100.0% 85.7% 0.0% 14.3% 0.0% 0.0% LEEDS COMMUNITY HEALTHCARE NHS TRUST 61.5% 0.0% 38.5% 80.0% 50.0% 0.0% 0.0% 20.0% 50.0% LEEDS TEACHING HOSPITALS NHS TRUST 93.8% 6.3% 0.0% 100.0% 88.9% 0.0% 11.1% 0.0% 0.0% MID YORKSHIRE HOSPITALS NHS TRUST 87.5% 12.5% 0.0% 100.0% 75.0% 0.0% 25.0% 0.0% 0.0% SOUTH WEST YORKSHIRE PARTNERSHIP NHS FT 81.3% 18.8% 0.0% 85.7% 77.8% 14.3% 22.2% 0.0% 0.0% YORKSHIRE AMBULANCE SERVICE NHS TRUST 100.0% 0.0% 0.0% 100.0% 100.0% 0.0% 0.0% 0.0% 0.0%

7 Item 09/20 Annex C Data at individual WY&H NHS trust level from the NHS Workforce Race Equality Standard 2019 Data Analysis Report

Table 9.0: NHS Trust Board Representation by Ethnicity and Voting/Non voting membership

Total Board members of which: Voting board members/ non voting baord members

White BME Null White BME Null Voting Board Voting Board Voting Board Org name members members members

AIREDALE NHS FT 92.9% 7.1% 0.0% 90.9% 9.1% 0.0% BRADFORD DISTRICT CARE NHS FT 86.7% 0.0% 13.3% 84.6% 0.0% 15.4% BRADFORD TEACHING HOSPITALS NHS FT 81.3% 18.8% 0.0% 75.0% 25.0% 0.0% CALDERDALE AND HUDDERSFIELD NHS FT 82.4% 5.9% 11.8% 81.3% 6.3% 12.5% HARROGATE AND DISTRICT NHS FT 100.0% 0.0% 0.0% 100.0% 0.0% 0.0% LEEDS AND YORK PARTNERSHIP NHS FT 92.3% 7.7% 0.0% 100.0% 0.0% 0.0% LEEDS COMMUNITY HEALTHCARE NHS TRUST 61.5% 0.0% 38.5% 54.5% 0.0% 45.5% LEEDS TEACHING HOSPITALS NHS TRUST 93.8% 6.3% 0.0% 93.8% 6.3% 0.0% MID YORKSHIRE HOSPITALS NHS TRUST 87.5% 12.5% 0.0% 81.8% 18.2% 0.0% SOUTH WEST YORKSHIRE PARTNERSHIP NHS FT 81.3% 18.8% 0.0% 83.3% 16.7% 0.0% YORKSHIRE AMBULANCE SERVICE NHS TRUST 100.0% 0.0% 0.0% 100.0% 0.0% 0.0%

8 Equality, diversity & inclusion in more detail (2)

Item 09/20 Equal opportunities Annex D Staff views on whether their organisation provides equal opportunities for career progression / promotion have continued to vary greatly by ethnicity and disability (q14):

71.2% of BME staff said their organisation provides equal 78.4% of disabled staff said their organisation provides opportunities. In contrast 86.9% of white staff said equal opportunities, compared to 85.3% of non- the same. disabled staff.

% of staff saying their organisation provides equal opportunities % of staff saying their organisation provides equal for career progression / promotion (q14) opportunities for career progression / promotion (q14)

88.3% 87.6% 86.9% 87.8% 86.8% 86.3% 86.9% 85.8% 84.8% 85.3% 79.5% 79.0% 77.3% 77.7% 78.4%

73.4% 73.2% 71.9% 69.9% 71.2%

2015 2016 2017 2018 2019 2015 2016 2017 2018 2019

Survey year Survey year

Disabled staff Non-disabled staff BME staff White staff

West Yorkshire & Harrogate (WY&H) Joint Committee of Clinical Commissioning Groups Summary of key decisions - Meeting in public, Tuesday 7th July 2020

Chair’s update

The Chair noted that since the last meeting in January, health and care partners had been dealing with the impact of the COVID-19 pandemic. The Chair thanked staff for their hard work and commitment. The Chair also noted changes in the commissioning landscape. Bradford and Craven CCGs had merged to form a single CCG and Harrogate CCG had merged to form North Yorkshire CCG, which was now an associate member of the Committee.

Joint Committee governance The Committee considered a governance update, noting that a revised Memorandum of Understanding and work plan had been circulated to the CCGs for formal approval. The work plan included the delegation of new commissioning decisions to the CCG. CCG mergers meant that the PPI Assurance Group now had a core membership of only 5 and there was a need to consider its role and membership, including how it might link into other patient and public assurance mechanisms. The Committee: a) Noted the 2019/20 annual report and the progress in agreeing the new MOU and work plan. b) Requested a report on the future membership and role of the PPI Assurance Group Our response on COVID-19: Implications for the Joint Committee The Committee considered a report on the response of the health and care system to COVID-19 and how programmes had been refocused to support the response. While the specific focus of our work had changed, the Partnership’s Five year plan continued to set the high level objectives. The Committee reviewed the summary plans for each of the work programmes where decisions had been delegated to the Joint Committee. The Committee noted that its work plan and role would need to evolve to reflect new priorities arising from the response to COVID-19. It would also need to reflect the development of strategic commissioning across WY&H (‘Commissioning futures’) The Committee: a) Noted the response to the pandemic and the priorities for the next phase of the response. b) Noted that a revised forward plan for the Joint Committee would be developed based on these new priorities.

Improving Planned Care: Programme Refresh The Committee considered changes to the Improving Planned Care programme. These included integrating the programme with the West Yorkshire Association of Acute Trusts’ Elective Surgery programme. Supporting the restart of planned care was a key priority. This included optimising access to diagnostics and proposals for an elective hub which would help local places to manage planned care. Other priorities included a different approach to pathways, featuring shared decision making between primary and secondary care. The Committee noted the critical importance of this programme for improving both access to care and health and wellbeing outcomes. The Committee: a) Noted the integration of the two programmes to form the Improving Planned Care programme. b) Supported the proposals to address access to diagnostic testing and elective surgery. c) Supported the proposals to address referral and support proactive approaches to managing planned care. d) Agreed to take the proposals back into their individual CCGs for further consideration.

The Joint Committee has delegated powers from the WY CCGs to make collective decisions on specific, agreed WY&H work programmes. It can also make recommendations. The Committee supports the Partnership, but does not represent all partners. Further information is available here: https://www.wyhpartnership.co.uk/meetings/west- yorkshire-harrogate-joint-committee-ccgs or from Stephen Gregg, [email protected].

Agenda Item: GB 20/38 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 22 July 2020

Title: Corporate Risk Register (Operational Risks)

Lead Governing Body Member: Sabrina Tick as Armstrong, Director of Organisational Category of Paper appropriate Effectiveness () Report Author: Anne Ellis, Risk Manager Decision

Reviewed by EMT/Date: 24 June 2020 Discussion  Reviewed by Committee/Date: Quality and Performance Committee 15 July 2020 Information

EXECUTIVE SUMMARY:

The CCG uses Datix as an internal risk management system which enables operational risks to be recorded and managed by all members of staff. Risks are aligned to the appropriate CCG committee for overview and scrutiny.

The risks are included on the CCG operational risk register and reviewed within individual directorates on a regular basis. In line with the Risk Management Strategy, the Executive Management Team (EMT) and relevant CCG Committees receive and review the operational risks rated as high amber (12) and above. The CCG Governing Body receives the corporate risk register (all red operational risks scored at 15 and above) for review at each meeting, supported by the CCG committee chair updates.

Summary Table Current Previous (May 20) Total Risks 62 62 Red Risks 15+ 1 1 Amber 12+ 7 6 Accepted Risks 29 30 New Risks 1 1 Closed Risks 1 0

Accepted Risks There are currently 62 active risks on the CCG risk register, 29 of these risks are categorised as ‘Accepted’ risks. This means that the current level of risk is deemed acceptable. Accepted risks are risks that are at, or below, the target risk score (approved by the responsible Director) or are green on the risk matrix below. These risks are reviewed by management at least on an annual basis or when the CCG becomes aware of a change to the risk. High amber (12) or red risks are unlikely to be accepted and will continue to be reported to the relevant Committee and Governing Body.

Accepted risks have been reviewed in light of the Covid-19 outbreak, this has resulted in an increase in the number of high amber risks.

Impact score Likelihood 1 2 3 4 5 Insignificant Minor Moderate Major Catastrophic 5 Almost 5 10 15 20 25 Certain 4 Likely 4 8 12 16 20 3 Possible 3 6 9 12 15 2 Unlikely 2 4 6 8 10 1 Rare 1 2 3 4 5

Corporate Risks There is one corporate (red) risk recorded on the operational risk register. R721 – Information Security Maturity has a current score of 15, this risk is aligned to the Audit Committee. A summary of the risk is provided below but further detail of the risk, including controls and assurances, can be seen in Appendix 1.

Risk Rating

Current Position

Risk ID Risk

Current

Risk Title Risk

May

Changes to to Changes

Target Date Target Date Target

March Target Score Target

The difference between the scores for this risk and the cyber security risk below is that no mitigation has been carried out for this risk (an action plan is being developed) and this risk includes more

than the risk of cyber-attack. This risk will be closed on completion of the action plan and R578 cyber security will remain but at

a reduced score.

As a result of COVID-19 there have been 15 15 15 9 0 721 delays in creating and implementing an

action plan to resolve critical and high risk 01/03/2021 vulnerabilities. A list of actions has been completed; however dates for completion Information Security Maturity Security Information need to be included.

In addition as a result of an increase in scam emails, text messaging, there is a higher likelihood of a cyber breach.

Risks Aligned to the Governing Body There are 13 risks aligned to the Governing Body. These relate to Finance, Procurement and the Shaping Our Future programme. Nine of these 13 risks are categorised as ‘Accepted’ risks, this is a reduction of one as R551: Fraud and Corruption has been increased temporarily from 6 to 9 during the COVID situation and the temporary finance regime arrangements. Current Previous (May 20) Total Risks 13 13 Red Risks 15+ 0 0 Amber 12+ 1 1 Accepted Risks 9 10 New Risks 0 0 Closed Risks 0 1

Of the remaining four risks aligned to the Governing Body, there is currently one high amber risk, the following changes have taken place: R718: Shaping Our Future – Stakeholder Engagement, Tim Ryley has had 1:1s with all members of PEG and ICS System Leaders in May and June, there has been positive feedback and support for the approach from stakeholders. As a result the likelihood of this risk has been reduced from high amber 12, resulting in a risk score of 9. Therefore this risk is no longer in the high amber category. R719: Shaping Our Future – Impact on Staff, the risk score increased from 9 to12. The likelihood has increased due to; the impact of current remote working arrangements and general levels of staff anxiety during COVID-19 and the publication of the operating model makes the programme real to staff and could increase the likelihood of some staff movement. A summary of the risk is provided below but further detail of the risk, including controls and assurances, can be seen in Appendix 2.

Risk Rating

Current Position

Risk ID Risk

Current

Risk Title Risk

Changes to to Changes

Target Date Target Date Target

March 20 March

Target Score Target January 20 January Risk score increased from 9 to 12 – it is considered that the likelihood of staff

leaving has increased due to:

 The impact on current remote –

working arrangements and general

levels of staff anxiety during COVID-

19. This is key to considerations in

12 9 9 6 /2020 0

the way in which the SOF 719 programme has been re-started and

delivered remotely. 31/12 Impact on Staff Impact on

Shaping Our Future Future Our Shaping  The publication of the operating model makes the programme real to staff and could increase the likelihood of some staff leaving.

Covid-19 Risks

Risks and issues specifically relating to COVID-19 continue to be logged within task groups, and are escalated as required through the command structure via SitReps. Strategic risks and red risks are reported to Gold Command as a standing agenda items.

All operational risks (Active and Accepted) have been reviewed and flagged where they are impacted by the outbreak.

NEXT STEPS:

 All operational risks will be reviewed as per the bi-monthly cycle in accordance with the CCG risk management strategy and presented to the assigned committee for review. The Corporate Risk Register and high amber risks aligned to the Governing Body will be presented to the CCG Governing Body at each meeting.  Risks arising from the COVID-19 outbreak will be logged and escalated via the command structure. RECOMMENDATION:

The Governing Body is asked to:

(a) REVIEW the corporate risk; (b) REVIEW the high scoring amber risk aligned to the Governing Body; and, for both risks; (c) CONSIDER whether the controls, actions are effective and whether assurances are sufficiently robust; and (d) AGREE any further actions required to manage the risks to the target set.

5 Initial Score Current Score Target Score

Reason for

L L L

C C C

Risk ID Risk Description C Positive Controls & Existing Assurance in Place Gaps in Control and Assurance Actions required change to

1-5 1-5

1-25

1-25 1-25

date

Initial Initial

Target Target Target Current

Current Current target date

Risk Title

Committee

Risk Owner

Target Target date

Initial Score

Responsible

Target Target Score

Current Score Current

Date risk added

Changes to Changes target Date last reviewed Engagement with LCC on Full patching Engagement with LCC on Third party patching There is a risk of malicious file (Ivanti) types gaining entry into the Upgrade affected server estate to eradicate enterprise and taking hold as a SMBv1 & .Net result of: Network (RAS) hardening activities - Outdated software Microsoft patching on Desktop and Servers is provided by LCC Assessment of Protective monitoring and - SMBv1 Enabled Anti-virus is installed on all desktop and server estate implementation of controls - Poor Password Culture NHSMail is a centrally controlled ingress Updated password protocol - communications - System misconfigurations Redcentric firewall has been installed on the internet boundary; not yet fully and testing of passwords - Authentication Mechanisms configured Windows 10 roll out and standardisation Review and Formulation of 721 20 15 6 0 N/A

Resulting in: Windows ATP(Advanced Threat Prevention) is installed on all Windows 10 devices Applocker installation to reduce unmanaged Action Plan

Major Major

Moderate Moderate

10/06/2020 01/03/2021 30/01/2020 - Loss of data Symantec Endpoint Protection (SEPP) in installed on all Windows 7 devices applications on desktop and address out of

- Access to data Audit Committee System Event Management installed for Solarwinds to improve monitoring position. support desktop applications - Integrity of data Update configuration of desktop and server

Information Security Maturity - Access to network. estate, including, but not limited to: SMB signing,

In addition could result in failure denied anonymous logons and unique

Expected to occur in most circumstances. Expected to occur in most circumstances.

of the DSPT, resulting in Data flows Visseh Pejhan-Sykes Chief- Financial Officer community strings from NHSD and other Segregate Active Directory from LCH organisations being restricted. Move from HTTP to HTTPs to secure internet Not expected but conceivable. Could occur sometime facing services Initial Score Current Score Target Score

Reason for

L L L

C C C

Risk ID Risk Description C Positive Controls & Existing Assurance in Place Gaps in Control and Assurance Actions required change to

1-5 1-5

1-25

1-25 1-25

date

Initial Initial

Target Target Target Current

Current Current target date

Risk Title

Committee

Risk Owner

Target Target date

Initial Score

Responsible

Target Target Score

Current Score Current

Date risk added

Changes to Changes target Date last reviewed

Targeted conversations with key staff, individually and as part of wider SLT development Honest conversations regarding opportunities and implications of new staffing structures and requirements Communication Plan - Communication and engagement with all staff so that they There is a risk of key CCG staff are clear on the rationale for change and the potential implications. leaving the organisation due to the OD planning and support key part of the programme - resource allocated from uncertainty created by the Shaping

719 12 within partners and CCG lead. 12 Capacity to fill roles / loss of knowledge Contingency Planning 6 0 N/A

Our Future Programme; resulting

Minor

Moderate Moderate

16/06/2020 31/12/2020

22/01/2020 in inability to deliver core services Governing Body

and to support transformation. Sabrina Armstrong

Might occur at some time

Shaping Our Future Impact- on Staff

Will Will probably occur in most circumstances. Will probably occur in most circumstances.

Agenda Item: GB 20/39 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 22 July 2020

Title: Governing Body Assurance Framework (Risks to the Strategic Commitments)

Lead Governing Body Member: Sabrina Tick as Armstrong, Director of Organisational Category of Paper appropriate Effectiveness () Report Author: Anne Ellis, Risk Manager Decision

Reviewed by EMT/ Date: 01 July 2020 Discussion  Reviewed by Committee/Date: N/A Information

EXECUTIVE SUMMARY:

1. The Governing Body Assurance Framework (GBAF) provides a structure and process that enables the CCG to focus on the risks to achieving its strategic commitments and be assured that adequate controls are operating to reduce these risks to acceptable levels (the risk appetite).

2. The principal risks for 2020/2021 have been reviewed and updated; the revised GBAF is attached at Appendix 1.

3. The CCG followed the following process to update the principal risks: a. One to one discussions with EMT members to review the principal risks to be included in the GBAF for 2020-2021; considering the following questions: i. Are the risks still relevant? ii. Are there any additional risks?

b. Initial draft of revised principal risks discussed with Tim Ryley, Katherine Sheerin, Sabrina Armstrong and Laura Parsons (22/05/2020).

c. EMT reviewed and agreed the principal risks (03/06/2020).

d. The following 8 revised principal risks were presented at the Governing Body workshop on 10 June 2020. i. Stakeholder Engagement (Patient, public, partners and professionals) ii. Quality of Care iii. Financial stability and sustainability iv. Health Inequalities v. System Workforce vi. Business Continuity vii. CCG Organisational Effectiveness viii. System Infrastructure

e. Following discussion at the workshop, it was agreed that the stakeholder engagement risk should be split into 2 risks; one risk relating to patient and public engagement and one relating to engagement with partners and professionals. In addition it was agreed that the Health Inequalities risk should be presented as the first principal risk.

f. Following the workshop, the EMT members populated the GBAF risks with controls, assurance and actions and scored the risks, the completed GBAF was reviewed by the EMT at their meeting on 1 July 2020.

4. There are currently a number of risks in which the CCG is operating above the agreed risk appetite. For these risks a number of mitigating actions have been identified and once implemented, the risk level should reduce to the level of risk appetite the CCG has agreed to tolerate.

NEXT STEPS:

The Governing Body will continue to review the GBAF at each meeting and directors will continually monitor and update their risks accordingly.

The Audit Committee will receive assurance at the next meeting (16 September 2020) on the operation of the GBAF. In addition the Audit Committee will receive assurance through an evidence based review of one of the principal risks which is above risk appetite to support the Audit Committee to assess the adequacy and completeness of assurances and actions. The principal risk to be reviewed is yet to be confirmed pending approval of the GBAF for 2020/2021. The Audit Committee Chair’s summary to the Governing Body will provide a summary of the views of the Committee in relation to the assurance received on the operation of the risk management arrangements.

RECOMMENDATION:

The Governing Body is asked to:

(a) REVIEW the Governing Body Assurance Framework; (b) APPROVE the changes to the principal risks; (c) CONSIDER whether the controls and assurances are sufficiently robust; (d) AGREE any further actions required to manage the risks to the target set; (e) NOTE the review and assurance processes.

Appendix 1 Governing Body Assurance Framework (GBAF) 2020/2021

Introduction

The Governing Body Assurance Framework (GBAF) sets out how the CCG will manage the principal risks to delivering the strategic commitments. The GBAF enables the Governing Body to corporately assure itself (gain confidence, based on evidence). The framework aligns principal risks with the commitments, and highlights key controls and assurances.

Where gaps are identified, or key controls and assurances are insufficient to reduce the risk of non-delivery to acceptable levels (within the CCG risk appetite), action needs to be taken. Planned actions will enable the Governing Body to monitor progress in addressing gaps or weaknesses and to ensure that resources are allocated appropriately.

Governing Body responsibility for the GBAF

It is for the Governing Body to:  Establish strategic commitments.  Identify the principal risks that threaten the achievement of these aims.  Identify and evaluate the design of key controls intended to manage these principal risks.  Set out the arrangements for obtaining assurance on the effectiveness of key controls across all areas of principal risk.  Evaluate the assurance across all areas of principal risk.  Identify positive assurances and areas where there are gaps in controls and / or assurances  Put in place plans to take corrective action where gaps have been identified in relation to principal risks.  Maintain dynamic risk management arrangements including a well-founded risk register.

Assurance

The Executive Management Team and Governing Body receive the GBAF bi-monthly. The Audit Committee annual work plan will ensure that principal risks outside risk appetite are reviewed in detail at least once a year, to assess the adequacy and completeness of the assurances, the Governing Body will receive a copy of the assurance provided to the Audit Committee.

The GBAF provides the basis for the preparation of a fair and representative Annual Governance Statement. It is the subject of annual review by both Internal and External Audit.

CCG Commitments:

We will focus our resources to: . Deliver better outcomes for people’s health and well-being . Reduce health inequalities across our city

CCG Risk Appetite Statement

NHS Leeds CCG recognises that the long-term health of its population depends upon the delivery of its strategic ambitions and its relationships with its service providers, staff, public and partners. As such, NHS Leeds CCG will not accept risks that have a material adverse impact on quality of healthcare, health inequalities or life expectancy.

NHS Leeds CCG has a greater appetite to take considered risks in relation to opportunities where positive gains can be anticipated such as clinical and contractual innovation, where necessary, testing the constraints of the regulatory environment.

Summary of Principal Risks

Risk Appetite Current Target Score Key changes since last review Ref Risk to delivering the CCG commitments Score 1 There is a risk of widening or not reducing the health inequality gap; Averse 20 12 The risk has been re-worded to provide greater clarity on the threat and the impact on the delivery of the CCG commitments. Due to not effectively targeting available resources and addressing wider determinants of health in partnership; The current score has increased from 16 to 20 due to the impact of COVID-19 on health inequalities. Resulting in failure to deliver the CCG commitment to reduce health inequalities across our city, through working with our partners and the people of Leeds to:  Support a greater focus on the wider determinants of health;  Increase their confidence to manage their own health and well-being;  Achieve better integrated care for the population of Leeds;  Create the conditions for health and care needs to be addressed around local neighbourhoods. 2 There is a risk to plans for commissioning and delivery of services; Averse 12 4 The risk has been re-worded to provide greater clarity on the threat and the impact on the delivery of the CCG commitments. Due to ineffective engagement with patients and public and lack of transparency in translation of engagement outcomes into decisions; Commissioning projects have been paused during the pandemic therefore there is a lack of engagement. However the risk score is increased to recognise that some changes have been made in response Resulting in failure to deliver the CCG’s strategic commitment to work with our partners to the pandemic. Temporary changes are permitted under regulation and the people of Leeds to: 23(2) of the s.244 Regulations in the interests of protecting the health of  Support a greater focus on the wider determinants of health patients and staff. If it is proposed that a temporary change is to be made permanent as business as usual, the expectation is that engagement or  Increase their confidence to manage their own health and well-being consultation should occur. There is a need to assess the temporary  Achieve better integrated care for the population of Leeds arrangements before the risk score can be reduced.  Create the conditions for health and care needs to be addressed around local neighbourhoods In March 2020 the CCG published an extensive insight report and engagement about changing the way people accessed hospital outpatient services, which includes support for greater use of technology, and therefore supports some of the changes already made. The CCG is now about to undertake a similar review and engagement into changes to primary care services. Current completion date is expected to be end of September.

3 There is a risk to plans for commissioning and delivery of services; Open 12 8 This risk has brought the previous risks 4 and 7 together into one risk relating to engagement with partners and professionals. The risk has Due to ineffective engagement with professionals or partners and lack of transparency been re-worded to provide greater clarity on the threat and the impact on in translation of engagement outcomes into decisions; the delivery of the CCG commitments.

The previous scores for risks 4 and 7 were 9, this has increased to 12 Resulting in failure to deliver the CCG’s strategic commitment to work with our partners due to an awareness of the work that needs to be undertaken to and the people of Leeds to: consolidate the progress made in partnership development and the  Support a greater focus on the wider determinants of health benefits from the COVID-19 response. It may be necessary to gain further integration in line with CCG plans to test these relationships in  Increase their confidence to manage their own health and well-being meaningful change. It will be a fine balance but we will need to have a  Achieve better integrated care for the population of Leeds more significant level of risk at times.  Create the conditions for health and care needs to be addressed around local neighbourhoods 4 There is a risk that the quality of commissioned care is compromised, and does not Averse 8 6 The risk has been re-worded to provide greater clarity on the threat and reflect best practice; the impact on the delivery of the CCG commitments.

Due to inadequate quality assurance and improvement processes, in both The current score has been assessed against the impact of COVID-19 and the controls in place are considered to be operating effectively. commissioning and delivery of care; There has been no change to the current score.

Resulting in failure to deliver the CCG’s strategic commitment to focus resources to deliver better outcomes for people’s health and well-being.

Risk Appetite Current Target Score Key changes since last review Ref Risk to delivering the CCG commitments Score 5 There is a risk of failure to achieve financial stability and sustainability for the Leeds Cautious 16 8 The risk has been re-worded to provide greater clarity on the threat and health and care system; the impact on the delivery of the CCG commitments.

Due to increasing demands on the system, and / or failure of financial controls; Risk levels for 2020-21 on one hand considered to be high in the absence of planning principles almost 3 months into the financial year and considered to be moderate on the basis that all contracting has been Resulting in a breach of financial duties and an adverse impact on delivery of the CCG suspended with NHSE/I taking greater control of process due to COVID- commitment to focus resources to: 19. On balance the uncertainty and issues with current projections result  Deliver better outcomes for people’s health and wellbeing, and in an overall risk score of high risk rating.  Reduce health inequalities across the city. 6 There is a risk of an inability to attract, develop and retain people to work in the Leeds Averse 9 6 The risk has been re-worded to provide greater clarity on the threat and health and care system; the impact on the delivery of the CCG commitments. The risk has also been expanded to include the wider system workforce as the previous Due to our failure to overcome local and national workforce shortages; risk was around primary care workforce.

The risk score reflects the need to establish the workforce requirements Resulting in failure to deliver the CCG commitment to deliver better outcomes for and gaps across the system. people’s health and well-being. 7 There is a risk to business continuity of health and care services disrupted on a major Averse 20 15 The risk has been re-worded to provide greater clarity on the threat and scale; the impact on the delivery of the CCG commitments.

Due to the demands of a significant event (including predictable surge); The current risk score has increased from 12 to 20 due to the ongoing presence of COVID-19 pandemic, and uncertainties around the trade terms for leaving the EU. Resulting in a failure to deliver the CCG commitments to:  Deliver better outcomes for people’s health and well-being; and  Reduce health inequalities across our city. 8 There is a risk to plans for commissioning and delivery of services ; Medium 12 6 This is a new risk added in relation to the organisational effectiveness of the CCG in delivering the CCG’s strategic commitments. Due to the organisational effectiveness of the CCG being constrained by, for example, capacity, structure, business intelligence and cybercrime;

Resulting in failure to deliver the CCG’s strategic commitments, which are:

We will focus our resources to: . Deliver better outcomes for people’s health and well-being . Reduce health inequalities across our city We will work with our partners and the people of Leeds to: . Support a greater focus on the wider determinants of health . Increase their confidence to manage their own health and well-being . Achieve better integrated care for the population of Leeds . Create the conditions for health and care needs to be addressed around local neighbourhoods. 9 There is a risk to plans for commissioning and delivery of services; Medium 16 8 This is a new risk added in relation to system infrastructure to support delivery of the CCG’s commitments. Due to inadequate infrastructure to support plans, such as, estates and or digital provision;

Resulting in failure to deliver the CCG’s strategic commitments, which are:

Risk 1: Statutory Duties: There is a risk of widening or not reducing the health inequality gap; Reduce inequalities in access to services and outcomes achieved.

Due to not effectively targeting available resources and addressing wider determinants of health in partnership; Promote the integration of health services and provision of health services integrated with provision of health related and social care services, where this would improve quality of Resulting in failure to deliver the CCG commitment to reduce health inequalities across our city, through working services or reduce inequalities. with our partners and the people of Leeds to:  Support a greater focus on the wider determinants of health; Promote innovation in the provision of health services.  Increase their confidence to manage their own health and well-being;  Achieve better integrated care for the population of Leeds;  Create the conditions for health and care needs to be addressed around local neighbourhoods.

Risk Appetite: The CCG has an averse risk appetite for health inequalities; this means that the CCG is not Lead Director/risk owner: Helen Lewis- Interim Director of Commissioning, Acute, Mental prepared to take risks in this area. Health and Learning Disabilities

Committee with oversight: Quality and Performance Committee Date last reviewed: June 2020 Risk Rating (consequence x likelihood) Rationale for current risk score: Current score: 20 Current The current risk score is assessed as 20 due to the heightened likelihood of health inequalities increasing 4 x 5 = 20 10 Score supported by evidence from the most recent Public Health Annual Report that identified increased Target score (2020/21): 0 inequalities across the city, with more people living in the 10% most deprived wards. In addition it is llikely 3 x 4 = 12 Target that COVID-19 has significantly increased the inequalities gap. Score Commissioned services and programmes may not always be designed in a way which meets the needs of groups who have poorer access to services, particularly preventive, proactive and primary care services and need to be reviewed in light of emerging evidence. This could result in an increase in health inequalities with some patients receiving sub-optimal care and potentially poor patient experience outcomes.

Rationale for target score: The CCG has an averse risk appetite for health inequalities and a legal duty to reduce inequalities in the population in terms of both access to services and health outcomes. This is a key strategic aim the CCG’s Strategic Plan in line with the Health and Wellbeing ambition that the Leeds will be a healthy and caring city for all ages, where people who are the poorest improve their health the fastest. The target score is assessed at 12 to reflect the current position and the challenge faced by the CCG in reducing the risk during 2020/21. The aim is to reduce both the likelihood and impact, but recognise that it will not be possible to reduce below 12 by the end of 2020/21 due to the impact of COVID-19.

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):

 CCG Strategic plan is grounded in the Health and Wellbeing Strategy and reflects the city Joint Action Owner Due by Strategic Needs Assessment (JSNA) & local health needs with a clear focus on reducing health Investment plans for Q3 being devised Helen Lewis (Becky September inequalities. Barwick) 20  CCG is an active member of the Health and Wellbeing Board and other partnership Actively reviewing further opportunities to Helen Lewis (all October 20 arrangements, e.g. Partnership Executive Group, Leeds Health and Care Plan redirect resources to target on areas of greater heads of for April 21

 CCG Health Inequalities Framework – This is now signed off and moving to implementation. need for commissioning in 21/22 commissioning) This describes how the CCG will use its £1.3bn resource to drive the changes needed to Work with BI and service evaluation to identify Frank Wood December 20 realise the aim of reducing health inequalities. It also sets out how the CCG will use its appropriate measures position as a major statutory body to influence the wider determinants of health and our partners in ways which more positively impact on the inequalities faced by the poorest people in the city.  Action at programme / project level – there is already significant work underway which is targeted at reducing health inequalities, including: . Services for marginalised groups including sex workers, homeless people, gypsies and travellers, ex-offenders, etc. . ‘Equalised’ weighted funding for General Practice and greater focus on health inequalities . New IAPT service has targets built in which direct the providers to ensure effective access 4

for people from BAME communities and people living in deprived Leeds . Community midwifery teams aligned to areas of greater deprivation, working closely with children centres and health visiting teams . Work on disproportionate representation of Black men in Mental Health act admissions  Memorandum of Understanding in place between Leeds CCGs and Leeds City Council to deliver Public Health Healthcare Advisory Service (PHHCAS) with action plan.  CCG commitment to Population Health Management approach will enable providers to work together at very local levels (through LCPs) to shape services around needs.  Commissioning for value programme now established to understand how commissioning investments impact on finance, quality and health outcomes.).  Joint data analysis team in place across Local Authority and CCG.  Each Commissioning lead reviewing actions to reduce health inequalities within their own areas as part of the work on the Left Shift Blueprint  Data consistently broken down into ‘deprived Leeds’, all Leeds to help identify areas with biggest gaps Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  Further work needed to be able to provide more timely data because of very significant lags in  Process measures being developed which clearly identify data on a Leeds/deprived national datasets Leeds/PCN basis to identify variation to drive actions to address these  Further work needed to evaluate within marginal groups where data is not available at granular  All commissioning intention/business cases and Blueprint plans reviewed to ensure sufficiently enough levels to evidence impact through routine data sets and will require proxy measures focused on the needs of most deprived/BAME communities/vulnerable groups as relevant to Link to Risk Register (operational risks): specific areas of work 305 – Compliance with the Equality Act 2010 Public Sector Equality Duty (6) 688 – Utilising patient experience data to inform commissioning decisions (6) Independent Assurance 695 – Learning Disabilities Mortality Review Programme (LeDeR) (9) There are a number of external reporting mechanisms which will be used to build the CCG’s reporting 723 – Deprivation of Liberty (12) framework, including:- 726 – Post-COVID-19 backlog of CHC reviews (12) Public Health England Local Authority Health Profiles Public Health Annual Report Local Authority Quarterly Report

Risk 2: Statutory Duties: There is a risk to plans for commissioning and delivery of services; Involve the public in the planning of, and proposed changes to, commissioning arrangements.

Due to ineffective engagement with patients and public and lack of transparency in translation of engagement Promote the integration of health services and provision of health services integrated with outcomes into decisions; provision of health related and social care services, where this would improve quality of services or reduce inequalities. Resulting in failure to deliver the CCG’s strategic commitment to work with our partners and the people of Leeds to:  Support a greater focus on the wider determinants of health Provide patient choice.

 Increase their confidence to manage their own health and well-being Promote innovation in the provision of health services.  Achieve better integrated care for the population of Leeds Create the conditions for health and care needs to be addressed around local neighbourhoods Risk Appetite: The CCG has an averse risk appetite for public engagement; this means that the CCG is not Lead Director/risk owner: Sabrina Armstrong – Director of Organisational Effectiveness prepared to take risks in this area. Committee with oversight: Governing Body / Quality and Performance Committee Date last reviewed: June 2020 Risk Rating Rationale for current risk score: (consequence x likelihood) All appropriate controls are in place to plan and deliver effective patient and public involvement (PPI). Current score: 20 Current However the consequence of these controls failing has the potential to result in challenge and ultimate 4 x 3 = 12 10 Score referral by Scrutiny board to judicial review. This would impact on the CCG’s reputation as well as delaying Target score: 0 any proposed changes. 4 x 1 = 4 Target Score Commissioning projects have been paused during the pandemic therefore there is a lack of engagement. However the risk score is increased to recognise that some changes have been made in response to the pandemic. Temporary changes are permitted under regulation 23(2) of the s.244 Regulations in the interests of protecting the health of patients and staff. If it is proposed that a temporary change is to be made permanent as business as usual, the expectation is that engagement or consultation should occur. There is a need to assess the temporary arrangements before the risk score can be reduced.

In March 2020 the CCG published an extensive insight report and engagement about changing the way people accessed hospital outpatient services, which includes support for greater use of technology, and therefore supports some of the changes already made. The CCG is now about to undertake a similar review and engagement into changes to primary care services.

The CCG has contingency to move to facilitated online engagement and work with Leeds Voices to engage with people through their volunteer programme.

Rationale for target score: A target score of 4 reflects an averse risk appetite. It would not be possible to reduce the risk to a score lower than 4. This is due to the potential consequence of a control failure supplemented by circumstances outside our control. Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  Volunteer panel in place (PAG): Remit to provide assurance around engagement and/or consultation plans. Action Owner Due by  Significant and major engagement/consultation plans taken to Scrutiny Board for discussion Ensure communications or engagement team Strategy and Ongoing and approval to proceed. reps co-opted onto appropriate commissioning Commissioning steering groups to ensure the patient voice is teams  CCG has a full complement of staff in place to support engagement activity. heard.  Communications and engagement incorporated into Commissioning for Value (CfV) process. Communications and  The engagement plan template includes the Equality and Quality Impact Assessment to identify Engagement Team impact on protected characteristics and discrete communities. Further enhance our approach to engagement Communications and Ongoing  Contract with Voluntary Action Leeds (VAL) to support CCG engagement work across as wide and involvement activity beyond our statutory Engagement Team duties. Our focus will be on proactive, ongoing a reach as possible, and also to undertake broad asset-based engagement in harder to conversations with communities and individuals reach/engage communities. VAL is continuing to recruit to their volunteer Health Champions. to build a foundation of evidence that supports  CCG has a lead role in continuing to develop the citywide engagement hub which includes commissioning plans for health outcomes. engagement colleagues from provider teams. The website is currently being audited to Communications End  CCG works closely with Healthwatch as part of the People’s Voice network. ensure it meets national mandated accessibility team September 6

 CCG community network continues to grow. standards 2020  Bi-monthly communications and engagement reports published and shared Engagement team working more closely with Communications and End August  CCG undertakes regular engagement with GP patient and public groups. patient experience and complaints team to Engagement Team 2020  Deliberative events are independently facilitated, analysed and reported on. triangulate feedback and ensure robust  Formal consultation and engagement processes are independently analysed and reported on. processes in place.  Equality and Diversity lead works with engagement team to ensure all aspects of protected characteristics are covered in line with the Equality Act 2010. Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  Need to ensure feedback from engagement is joined up with insight and intelligence from patient  Evaluation reports written and provided to commissioning teams to incorporate in their plans experience reports and monitoring of contract delivery. and influence service change.  Reports published on the CCG website and shared with members of the public who expressed an interest for further detail: ‘You said, we did’. Link to Risk Register (operational risks):  Regular liaison with, and attendance as appropriate at, Scrutiny Board to support 305 – Compliance with the Equality Act Public Sector Duty (6) commissioning colleagues.  Annual PPI review published in July 2019  Monthly VAL contract meetings and VAL KPIs reviewed quarterly. Independent Assurance  ‘Amber’ assessment rating for PPI from NHS England in 2018/19 (latest rating).  Internal stakeholder engagement audit October / November 2018; this has been rated High Assurance (highest rating). NHS Leeds CCG invited by NHS England to present examples of good practice to Amber rated CCGs at a North of England workshop on Improvement and Assessment Framework (IAF)for engagement and community involvement.

Risk 3: Statutory Duties: There is a risk to plans for commissioning and delivery of services; Co-operate with relevant local authorities.

Due to ineffective engagement with professionals or partners and lack of transparency in translation of engagement Co-operate with other NHS bodies. outcomes into decisions; Promote the integration of health services and provision of health services integrated with Resulting in failure to deliver the CCG’s strategic commitment to work with our partners and the people of Leeds to: provision of health related and social care services, where this would improve quality of  Support a greater focus on the wider determinants of health services or reduce inequalities.

 Increase their confidence to manage their own health and well-being Promote innovation in the provision of health services.  Achieve better integrated care for the population of Leeds  Create the conditions for health and care needs to be addressed around local neighbourhoods Risk Appetite: The CCG has an open risk appetite for partnership working; this means the CCG is willing to Lead Director/risk owner: consider a higher level of risk in this area. Simon Stockill – Medical Director (Professionals) Tim Ryley – Chief Executive (Partners) Committee with oversight: Governing Body/Primary Care Commissioning Committee Date last reviewed: New / revised risk Risk Rating Rationale for current risk score: (consequence x likelihood) There has been a long period of partnership development and through the COVID-19 response this has Current score: 20 Current deepened further. There are a wide range of controls in place to maintain this level of commitment. 3 x 4 = 12 10 Score Target score: 0 Rationale for target score: Target 2 x 4 = 8 It may be necessary to gain further integration in line with our plans to test these relationships in meaningful Score change. It will be a fine balance but we will need to have a more significant level of risk at times.

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  A wide range of partnership multi-agency, multi-professional boards and task groups are in place at all levels across the city where issues can be addressed (PEG, ICE, SRAB, Action Owner Due by

Programme Boards, Clinical senate, HWB, HWB Board-to-Board, Refresh of the city-wide governance with Tim Ryley March 2021 partners  The Chief Executive meets at least monthly with each of his equivalent and there are regular Further develop the depth and range of joint Review Exec-to-Exec meetings Tim Ryley  A range of joint city-wide capabilities in digital, workforce and estates core city functions March 2021  New contracting approaches are in place to encourage greater partnership working  Commissioning teams develop new models of care with partners and always with clinical leadership  All levels of staff heavily involved in West Yorkshire & Harrogate Partnership

Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  Develop a local replacement for the 360 review to gain feedback from partners.  Commissioning for Value monthly EMT meetings to review progress on key plans  Progress in key areas of improvement where partnership necessary for example TCP, IAPT, Waiting Lists Independent Assurance Link to Risk Register (operational risks):  Internal Audit Partnership Review 655: Member engagement (9)  CCG Annual Leadership Rating which includes reflection on partnerships 718: Shaping Our Future Stakeholder Engagement (9)

Risk 4: Statutory Duties: There is a risk that the quality of commissioned care is compromised, and does not reflect best practice due to Secure improvement in the quality of services and outcomes for patients, with particular regard inadequate quality assurance and improvement processes, in both commissioning and delivery of care. This could to clinical effectiveness, safety and patient experience. result in failure to deliver the CCG’s strategic commitment to deliver better outcomes for people’s health and well- Promote the integration of health services and provision of health services integrated with being. provision of health related and social care services, where this would improve quality of services or reduce inequalities.

Risk Appetite: The CCG has an averse risk appetite for service quality; this means that the CCG is not prepared to Lead Director/risk owner: Jo Harding – Executive Director of Quality and Nursing take risks in this area. Committee with oversight: Quality and Performance Committee Date last reviewed: June 2020 Risk Rating Rationale for current risk score: (consequence x likelihood) The CCG has in place quality standards, and measures quality outcomes via a range of methods and Current score: 20 Current processes to assure the quality of care we commission for our patients. We are working on the basis that by 2 x 4 = 8 10 Score having robust quality assurance and improvement processes in place the potential for harm is minimised, as Target score: 0 such the consequence score is 2 (minor), due to the pandemic the current likelihood is assessed as 4 2 x 3 = 6 Target (likely). Score Rationale for target score: A target score of six has been applied to this risk as the CCG aims to minimise the likelihood and consequence of the risk occurring. However it is recognised that it is not possible to eradicate risk to quality and safety completely and as such the target likelihood due to error is 3 (possible) and the target consequence remains 2 (minor). Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  The CCG has multiple team and work streams that encompass all the elements of monitoring and assurance of quality including patient safety, patient experience, effectiveness (clinical Action Owner Due by outcomes) and safeguarding. Review of AQP quality assurance process to completed Deputy Director of September 2020  Various assurance methods and improvement strategies are used in collaboration with all and presented to the Quality and Performance Nursing and providers. This includes intelligence from our IQPR, quality visits, regulatory feedback and Committee in September 2020. Quality compliance with national standards and contractual requirements. This also includes integrated Embed Patient Experience further in the initial stages of Head of Patient January 2021 processes with local authority in relation to the monitoring and improvement quality in care the commissioning cycle to strengthen and inform Safety and homes. developments focused on patients’ experience of care. Experience  The WY&H QEIA tool, used across the ICS and adopted by the CCG, is utilised to ensure all Work with partners across the city to develop a possible Deputy Director of March 2021 quality and equality impacts are considered in all service changes and quality assurance and improvement framework for the Nursing and commissioning/decommissioning decisions. city. Quality  The CCG is leading the local implementation of the NHS England Early Adopter Programme with LTHT for new Patient Safety Incident Response Framework and planning ongoing for rollout to all providers. The CCG leads a Patient Experience Collaborative to ensure robust mechanisms for utilising all Patient Experience in commissioning decisions. This involves wider system partners and will feed into the city wide PE strategy.  The CCG has developed population health management work programmes to ensure quality lens is applied to the commissioning and delivery of care with specific reference to vulnerable groups and health inequalities. Quality outcomes as part of the left shift blueprint work are currently being worked up and will link in with the SOF work around outcomes for populations  CCG is working towards embedding the new liberty protection safeguards (MCA/DoLS). Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  Lack of joined up city wide approach to patient experience  Joint Clinical Quality Review Groups (CQRG) and Primary Care Quality Surveillance  Lack of city wide approach to quality assurance and improvement across the city  Review and monitor key quality, clinical governance and safeguarding (adults and children) requirements and standards, performance information, expectations and performance requesting and monitoring remedial action plans where required Link to Risk Register (operational risks):  West Yorkshire Quality Surveillance Group (QSG) and Quality Leads Meeting (QLM) 28: Learning from medication related incidents (9)  oversight of quality / sharing of intelligence and actions 688: Utilising patient experience data to inform commissioning decisions (6)  Contract Management Board 695: Learning Disabilities Mortality Review Programme LeDeR (9)  update briefings from Providers identifying key areas of concern/under performance and actions 664: Community Care Beds – Medicine Review (9)  Quality and Performance Committee review of quality: 334: Amber Drug Monitoring via Neptune (8) 660: Delivery of high quality primary care services (12) 9

 Integrated Quality and Performance Report, providers under enhanced surveillance, patient experience, incident management,  Robust governance structure in place within the CCG provides assurance on the quality of services to Governing Body  Safeguarding annual declaration for care homes and private hospitals  Qualitative and quantitative monitoring of LeDeR reviews  GP Safeguarding Standards Framework to monitor SG performance of primary care SG  CCG is implementing the host commissioner framework for learning disabilities/autism in in patient settings

Independent Assurance  CQC inspection programme – reports/action plans monitored via provider quality meetings  Internal audits – 2018/19 High assurance of Individual Funding Requests and Patient Experience, Significant assurance of Personal Health Budgets, Safeguarding, Continuing Healthcare and Performance Reporting. 2019/20 High assurance of Incident Management, Significant assurance of Contract Management and the Mental Capacity Act

Risk 5: Statutory Duties: There is a risk of failure to achieve financial stability and sustainability for the Leeds health and care system; Fulfil the financial duties.

Due to increasing demands on the system, and / or failure of financial controls;

Resulting in a breach of financial duties and an adverse impact on delivery of the CCG commitment to focus resources to:  Deliver better outcomes for people’s health and wellbeing, and  Reduce health inequalities across the city. Risk Appetite: Given the statutory nature of financial duties of the CCG, the CCG has a cautious risk appetite for financial Lead Director/risk owner: Visseh Pejhan-Sykes – Chief Finance Officer efficiency; this means the CCG will accept a low level of risk in this area. Committee with oversight: Governing Body Date last reviewed: June 2020 Risk Rating Rationale for current risk score: (consequence x likelihood)  Risk levels for 2020-21 on one hand considered to be high in the absence of planning principles almost 3 months 20 Current into the financial year and considered to be moderate on the basis that all contracting has been suspended with NHSE/I taking greater control of process due to COVID-19. On balance the uncertainty and issues with current Current score: 10 Score 4 x 4 = 16 0 projections result in an overall risk score of high risk rating Target score: Target . Failure to achieve financial stability could normally lead to a breach in our statutory duties and have an adverse effect on our local population. 4 x 2 = 8 Score . Whilst the Leeds system has a number of key financial controls and financial contingencies in place to monitor and deliver financial performance its longer term financial stability is predicated either on the delivery of a significant QIPP/CIP programme, which has been interrupted in 2020-21 as a result of COVID-19 . The system is increasingly being assessed on financial delivery at Place level to include all NHS providers in the City. Therefore the CCG shares the risks of delivery for its NHS Providers as well. Currently the level and magnitude of CIP at LTHT alone is circa 6% of their total income of over £1.3bn. . Leeds as a Place has always contended with significant financial pressures with cost reduction schemes that are significant every year. The West Yorkshire Integrated Care System also has its financial challenges but the system as a whole has so far managed work together to stay within negotiated control totals as a whole. . For months 1-4 the finance regime nationally was to ensure all organisations remained in financial balance. . Awaiting planning guidance for periods 5-12. Rationale for target score: The consequences of failing our financial duties will always be high from a patient care perspective so our ideal target score would be to retain the likelihood levels at 2 and below to manage the risks. Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  Balanced Financial Plan for 2020-21 submitted to NHSE in March prior to COVID-19 and the suspension of the BAU financial regime for 2020-21. Action Owner Due by  The CCG has revised its commissioning trajectories to reflect revised deliverable targets for 2020-21 whilst Currently focussing on planning guidance for M5-12 Governing Body Initial view on 22 July but still remaining on track to achieve its strategic objectives. We have submitted our projections to NHSE/I to phase 3 of COVID-19. dependent on national inform the allocation process for M5-12. timetable  Detailed financial policies and budgetary control framework outlines responsibilities and ground rules. Continuing to retain the integrity of our Governing Body Regular workshops Aligned Incentive Contract with main Acute Provider – major success stories published and year 2 agreed.  commissioning plans for the 5 year planning horizon throughout the year  Regular CFO meetings across Leeds & West Yorkshire and the CCG is also a key member of NHS but reassessing our trajectories post COVID-19 Clinical Commissioners nationally in all disciplines including Finance.  Monthly budget reports are issued and discussed at budget holder meetings. Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  Health and social care economy in Leeds is financially challenged and the magnitude of values involved in one  Monthly finance reports to EMT, Audit Committee and Governing Body identifying any current of the largest “places” in the UK means that the challenge is of significant financial value (and potentially financial risks. unmanageable) nationally and locally if the system spirals into deficit. COVID-19 has only amplified this  Escalation of exception reports to EMT and to Governing Body. especially for the Local Authorities  Procurement Programme monitoring and delivery reporting.  Within the context of the West Yorkshire Integrated Care System (ICS), Leeds is also the only place that is  Lead commissioner monthly forecasts. seen to have financial headroom due to it higher historic surplus retention and is therefore potentially expected  Financial impacts of primary care commissioning appear to be less significant at current stage of to shoulder the added burden of “propping up” other places by considering exceeding its control total delivery. planning.  A shared control total for West Yorkshire does however offer potential (if delivered in its totality) to attract Independent Assurance significant transformational resources into the ICS footprint which will benefit all parties to the ICS. Much of this  Budgetary and governance control systems for identifying and controlling financial risks – ranked high is outside of Leeds’ control to deliver with the added potential burden of having to hold peers to account to assurance by the Internal Auditors again as we enter 2020-21. ensure securing these funds in addition to “keeping our own house in order”.  NHSE assurance meetings have resulted in the Leadership of the CCG across all areas being rated  The wider Leeds Health and Social Care system is also closely interlinked with the provider landscape Green. potentially suboptimal in its current configuration to deliver the most cost effective and seamless care for service users in Leeds. Link to Risk Register (operational risks): 551: Fraud and Corruption (9) 550: QIPP (6) 708: National Shortage of Capital (8)

Risk 6: Statutory Duties: There is a risk of an inability to attract, develop and retain people to work in the Leeds health and care system; Secure improvement in the quality of services and outcomes for patients, with particular regard to clinical effectiveness, safety and patient experience. Due to our failure to overcome local and national workforce shortages; Have regard to the need to promote education and training of current or future health service Resulting in failure to deliver the CCG commitment to deliver better outcomes for people’s health and well-being. staff. Risk Appetite: The CCG has an averse risk appetite for service quality; this means that the CCG is not prepared to Lead Director/risk owner: Jo Harding – Executive Director of Quality and Nursing take risks in this area. Committee with oversight: Quality and Performance Committee Date last reviewed: New / Revised risk Risk Rating Rationale for current risk score: (consequence x likelihood) Ensuring we have the workforce to deliver a sustainable health and care today and a workforce to deliver a Current score: 20 Current transformed health and care for tomorrow is hugely complex. Leeds needs to ensure that this is being 3 x 3 = 9 10 Score addressed at city-wide levels within the context of workforce challenges across the system. We know there Target score: 0 are gaps in required workforce now and the potential for more due to the halt in international recruitment as 3 x 2 = 6 Target a result of the pandemic. Score The National People Plan due out before the pandemic is now delayed and will require review. The Leeds system will need to take account of its requirements locally. As a result the likelihood score is assessed as 3 (possible).

Rationale for target score: The changing nature of healthcare delivery and the introduction of new models of care require an adaptive, agile and integrated system. Keeping abreast of workforce requirements and planning for future skills and competencies will be challenging. There are likely to be workforce shortages as a consequence. As a result the actions detailed below are designed to reduce the likelihood from 3 (possible) to 2 (unlikely).

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  Leaders of main health and care organisations have come together with commissioning and care leaders across the city as the Partnership Executive Group (PEG). This group aims to Action Owner Due by ensure coherence of strategy and approach across the city, and delivery of the goals set out in the Health and Wellbeing Strategy. This includes our approach to Workforce in the City. The LOWSB to review the Leeds ‘One Jo Harding as the October  Governance for Leeds Workforce programme has been reviewed and the new Leeds One Workforce’ vision statement and the 7 shared CCG representative 2020 Workforce Strategic Board (LOWSB) was established to replace the former arrangements and priorities in light of the pandemic and agree a on the LOWSB

their first quarterly meeting was held in November 2019. The purpose of the LOWSB is: to clear strategy for successful delivery. ensure that the Leeds based health and care workforce is fit for now and the future.

 7 Shared Workforce Priorities have been developed and agreed by the LOWSB. Seek to better understand the role and vision of Jo Harding as the October  The Leeds Health and Care Academy (LHCA) is funded by and works with all partners in the the Academy in delivering the ‘Leeds One CCG representative 2020 city. LOWSB works with the LHCA to bring together planning, coordination, resource and Workforce’ ambition statement on the LOWSB delivery of learning and development for staff working in health and care in the city, to meet the citywide workforce challenge. LHCA work programme directly links to the strategic workforce priorities. A new Director of Leeds Health and Care Jo Harding as the September CCG representative 2020  Primary Care Workforce sub-group and action plan is in place – TOR and membership has Academy and Strategic Workforce appointed in on the LOWSB been reviewed to ensure alignment with Strategic workforce priorities and PCN workforce May 2020 and will come into post on 14 challenges and links to the wider system. Workforce action plans being developed at PCN level September 2020 which supports the new GP contract setting out the new roles developing within general practice and the funding to support these roles e.g. care navigation; Rotational Paramedic; role The LOWSB to consider the requirement for a Jo Harding as the October of occupational therapists in primary care pilot; shared roles across a number of practices and workforce needs analysis to better understand CCG representative 2020 many more. the systems priorities in light of the pandemic. on the LOWSB  Leeds actively participates in the national and regional West Yorkshire and Harrogate ICS Workforce Groups and workforce activity is linked/mapped against regional workforce plan.

Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek):  The LOWSB provides assurance to the Health and Wellbeing Board and reporting to PEG on  There is a lack of understanding develop, agree and establish a baseline of accurate workforce data the delivery and impact of the workforce priorities in respect of its own plan, leading on the across the whole Leeds Health and Care System to identify workforce gaps in existing and new roles workforce requirements outlined in the strategic drivers of the city through including the Leeds in order to model the future workforce requirements short/medium/long term. Health and Wellbeing Strategy, Leeds Health and Care Plan, Children & Young People’s Plan,  Workforce Programme of work and action plans to feed into a Leeds One Workforce Strategy has Inclusive Growth Strategy and tackling Climate Change. been delayed due to the impact of COVID-19. Next business as usual meeting due 14 July 2020. Additional Comments:  Leeds accepts the associated workforce risks and that workload and capacity has been negatively Leeds Health and Care System risk owner: Dr Sara Munro – Chief Executive of LYPFT impacted by COVID-19 and the new challenges that changed the focus of our system led work. She is the Senior Responsible Officer for Leeds Health and Care Academy and Workforce – Chair of  Former Director left the post in September 2019 LHCA and Workforce have appointed a Director Leeds One Workforce Strategic Board (LOWSB) and a Member of Partnership Executive Group and they join the team September 2020. (PEG).  The establishment of the Leeds GP Confederation brings new opportunity to engage with primary care ‘at scale’ and develop workforce initiatives for general practice across the city. This is yet to be realised. Link to Risk Register (operational risks): 651: General Practice Workforce (12)

Risk 7: Statutory Duties: There is a risk to business continuity of health and care services disrupted on a major scale; To take appropriate steps to ensure that the CCG is properly prepared to deal with emergencies that might affect it. Due to the demands of a significant event (including predictable surge); Category 2 responder (Civil Contingencies Act 2004) Resulting in a failure to deliver the CCG commitments to:  Deliver better outcomes for people’s health and well-being; and Secure improvement in the quality of services and outcomes for patients, with particular regard  Reduce health inequalities across our city. to clinical effectiveness, safety and patient experience. Risk Appetite: The CCG has an averse risk appetite for service quality and performance; this means that the CCG Lead Director/risk owner: Helen Lewis – Interim Director of Commissioning, Acute, Mental is not prepared to take risks in this area. Health and Learning Disabilities

Committee with oversight: Quality and Performance Committee Date last reviewed: June 2020 Risk Rating Rationale for current risk score: (consequence x likelihood) This risk relates to the CCG working with partners to mitigate the impact and to support recovery of the Current score: 20 Current delivery of healthcare services to the Leeds population as a result of a significant event. A significant event 4 x 5 = 20 10 Score can be a ‘rising tide’ or a one off event e.g. epidemic, adverse weather therefore the mitigations and plans Target score (2020/21): 0 are wide ranging across all organisations across the Leeds Health and Care system. Our current score with 3 x 5 = 15 Target regards to a significant event remains high given the ongoing presence of COVID-19 pandemic, and Score uncertainties around the trade terms for leaving the EU.

Rationale for target score: Based on experience during the COVID-19 period, we will try to work towards a moderate impact over the next 9 months. However, while, the CCG aims to minimise the impact of a significant event on healthcare services we have found that we are unable to fully and rapidly mitigate the impact of an ongoing pandemic risk in the way which we had originally considered for significant but shorter term risks. We have evidenced significant system ability to mitigate the impact on the health of the population, but without the ability to avoid adverse consequences which are likely to impact for many years. For example, elective waiting times will definitely rise over the next year, impacting on the health of our population and their experience, despite our best mitigations. Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?): CCG Controls  Engagement at West Yorkshire level with local resilience forum and West Yorkshire urgent care Action Owner Due by meetings EU Exit preparedness: Steering group, self- Debra Taylor Tate Paused  Training for key senior managers JESIP Training, On call training assessment, action plan, and liaison across  Counter Terrorism and Organisational Security Awareness delivered to all staff system and with NHS as directed  CCG Business Continuity Plan

 CCG Incident Response Plan with Action Cards EU Exit agreed. Steering group no longer  On call systems in all providers plus the CCG, linking to NHS England (NHSE) and region at meeting but remains in place and able to stand times of pressure up as required as the negotiations in 2020  EPRR Compliance and Action Plan progress.  Winter plans in place, includes primary care and public health / Comms actions Command and Control structure in place to Tim Ryley Ongoing System Controls coordinate system responses and maximise  System wide Surge and escalation plans in place and tested through exercises, use of staff resources to minimise health  Business continuity plans in place for providers as part of NHS contract, including General impacts practices. Coordinated approach to reset and stabilisation Helen Lewis Ongoing  Emergency Preparedness Resilience and Response (EPRR) Compliance and Action Plan for to ensure ongoing focus on prioritisation so that NHS organisations restarted services pay particular attention to  Operational delivery meetings at LTHT and weekly Operational Winter Group areas and populations of greatest deprivation Emergency preparedness responses reviewed Debra Taylor Tate July 2020  Leeds resilience plan and Forums in place and reflected upon  Leeds Safety Advisory Group (SAG) to discuss the Health and Safety issues relating to an event and offer professional guidance  System Resilience Assurance Board  System and regional meetings. Local Health Resilience Partnership (LHRP). Health and Social Care Resilience Group.  Health Protection Board  EPRR framework for NHS organisations includes clear roles and responsibilities for system wide response 14

 Clear roles and responsibilities for outbreak planning (NHSE, CCG, LA)  Leeds Outbreak Plan and Outbreak Roles and Responsibilities.

Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  None identified  Assurance from providers on EPRR compliance, and business continuity plans..  Regular testing of the CCG Business Continuity Plan  Annual self-assessment against EPRR – goes to Governing Body  Outputs from real or tested scenarios and learning – reports and action plans produced e.g. Link to Risk Register (operational risks): winter reviews. 650 – CCG Business Continuity (6)  Oversight Group in place to ensure mutual aid to areas of greatest clinical needs 706 – Emergency Preparedness Resilience and Response (8)  Coordinated ICS response to ensure prioritisation of staff and capacity for most urgent cases  Planned care boards and other boards overseeing impacts on routine care to ensure shared understanding of ongoing risks  Ongoing feedback from Healthwatch to help identify areas requiring greatest mitigation Independent Assurance NHSE complete an annual CCG assurance assessment through quarterly reviews.  Internal Audit review undertaken on EPRR  NHSE Review of EPRR response during COVID-19

Risk 8: Statutory Duties: There is a risk to plans for commissioning and delivery of services ; To carry out functions effectively, efficiently and economically.

Due to the organisational effectiveness of the CCG being constrained by, for example, capacity, structure, business intelligence and cybercrime;

Resulting in failure to deliver the CCG’s strategic commitments, which are:

We will focus our resources to: . Deliver better outcomes for people’s health and well-being . Reduce health inequalities across our city

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  ‘Shaping Our Future’ established to transform the way the CCG operates to better enable the achievement of the CCG’s strategic commitments to deliver improved population outcomes, Action Owner Due by reduce inequalities and greater provider integration. Review process for providing assurance to the Sabrina Armstrong July 2020  Returning Stronger programme of work. Governing Body on CCG workforce issues  Annual reviews of Governing Body and Committee effectiveness as well as ongoing review to Green Plan in terms of climate change and Sabrina Armstrong September ensure continuing effectiveness (e.g. Quality & Performance Committee, Audit Committee). carbon reduction, planned to go to Governing 2020  Comprehensive Risk Management Strategy approved by Governing Body and implementation Body in September 2020. is overseen by Risk Manager. Stage One Shaping Our Future – redesigning Sabrina Armstrong March 2021  Cyber Essentials Assurance roadmap supported by a detailed IT, IG and BI delivery plan for the CCG the CCG and areas in Primary Care the CCG supports. Establish Outcomes based contract Visseh Pejhan- April 2021 Sykes  BI, IG and IT Committee providing assurance on all aspects of IT, IG and BI to the Audit Regular formal reporting of the CCG’s delivery Visseh Pejhan- September Committee. plan progress (BI, IT, IG) to the SLT / EMT / GB Sykes 2020  Increasing leadership capability re analytics infrastructure support to Commissioning and all Reducing further our operational reliance on Governing Body Mid 2022 other functions of the CCG. premises as a CCG  Reducing reliance on physical premises to develop more agile working capability for the CCG in preparation for its System Integrator function in particular.  NHS Digital has stepped up nationally to reduce cyber risk for all NHS organisations by providing a single NHS Cloud tenancy nationally and contracts with Microsoft for all O365 products including security related options. 16

 Risk assessments carried out on all staff during pandemic phase to ensure that health and wellbeing is being supported effectively and changes to working patterns and locations are being assessed and supported as appropriate. Where a risk is identified, action (including redeployment) will be considered to ensure staff can continue to work in a safe environment. Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  Impact of climate change on CCG effectiveness  Staff survey results.  Assurance to the Governing Body on CCG workforce issues  Cohesive commissioning decisions with high assurance and regular review and affirmation of  Organisation structured around Strategic Commissioning and System Integration capabilities. progress against strategic objectives supported and informed by robust support systems.  New, long term population-level outcomes based contracts established.  CCG’s Business Intelligence reporting and Analytics has been identified as a key areas for development on both the CCG ad the city wide footprint Independent Assurance  All internal audits undertaken during 2019/20 were rated as ‘significant’ or ‘high’ assurance. Head of Internal Audit Opinion provided significant assurance that there is a generally sound Link to Risk Register (operational risks): system of internal control. 650: CCG Business Continuity (6)  CCG rated as ‘outstanding’ under the NHS Oversight Framework. 305: Compliance with the Equality Act 2010 Public Sector Equality Duty (6)  NHS Digital Audit, Self-Assessed annual Toolkit review of CCG’s BI, IT and IG processes and 578: Cyber Security (12) controls plus annual Internal Audit review of toolkit 721: Information Security Maturity (15)  Key outcome metrics and national / local tracking of delivery trajectory confirming positive 718: Shaping Our Future Stakeholder Engagement (9) impact on reducing health inequalities in line with CCG aspirations. 719: Shaping Our Future Impact on Staff (12)

Risk 9: Statutory Duties: There is a risk to plans for commissioning and delivery of services; Promote innovation in the provision of health services.

Due to inadequate infrastructure to support plans, such as, estates and or digital provision; Secure improvement in the quality of services and outcomes for patients, with particular regard to clinical effectiveness, safety and patient experience. Resulting in failure to deliver the CCG’s strategic commitments, which are:

We will focus our resources to: . Deliver better outcomes for people’s health and well-being . Reduce health inequalities across our city

We will work with our partners and the people of Leeds to: . Support a greater focus on the wider determinants of health . Increase their confidence to manage their own health and well-being . Achieve better integrated care for the population of Leeds . Create the conditions for health and care needs to be addressed around local neighbourhoods. Risk Appetite: The CCG has a medium risk appetite towards enablers (digital and estates); this means the CCG Lead Director/risk owner: Visseh Pejhan-Sykes – Chief Finance Officer will accept a medium level of risk In this area. Committee with oversight: Governing Body/Primary Care Commissioning Committee Date last reviewed: New risk Risk Rating Rationale for current risk score: (consequence x likelihood) Three critical non-workforce related support areas have been identified as Estates, Technology and Intelligence. Post Current score: 20 Current COVID, the weightings assigned to Estates and Technology respectively may alter depending on the nature of service delivery, but the data intelligence on which the system should rely on when making decisions remains of the highest 4 x 4 = 16 10 Score Target score: 0 importance. Without access to all three in the right measure, service delivery across the system will be highly 4 x 2 = 8 Target challenging or potentially less than optimally relevant. As Estates costs tend to be high with associated flexibilities Score being lower, the COVID era has highlighted the benefits of transferring reliance on premises to technology where practical in terms of mode of delivery of care – as new developments emerge this will increasingly become the case and Leeds is well equipped to be at the forefront of new ways of working. Our ability to deliver high quality intelligence is currently in the development stages. We currently have a significant backlog maintenance challenge for NHS premises – mainly in the Acute sector – and in some pockets in Primary Care. Rationale for target score: Ideally, our commissioning functions would have access to and rely more heavily on infrastructure and support functions such as IT, Cyber and Analytics to more effectively commission using sophisticated actuarial analytics to inform decisions. If this were the case the consequences of unavailability would be higher as would the benefits of access to this capability when available and working well. Our ideal score would be high reliance but low likelihood of failure due to well maintained and supported infrastructure. Treasury funding made available to LTHT to replace the Leeds General Infirmary will significantly eradicate the City’s NHS backlog maintenance and quality of care delivery issues in Secondary care. We are expecting an accelerated trajectory to the rebuilding of the LGI over the next 5 years. Critical next steps are the approval of the Outline Business Case and proceeding to Full Business Case and procurement processes. Ensuring that the new buildings are affordable to the Leeds System is also an important aspect of the planning process next steps. Business Intelligence development roadmap and leadership are in the process of being put in place.

Controls (what are we currently doing about the risk?): Mitigating actions (what more should we be doing?):  System review of COVID learning to reduce reliance on estates and to increase our full potential in terms of use of Technology. Action Owner Due by  NHS Digital developments around N365 and a common single cloud tenancy for the NHS has significantly Leadership role in reviewing, seizing and Governing Body Late 2020 improved cyber security for the NHS to build its technological service delivery platforms on. embedding change post COVID to ensure that

 New Director Portfolios to increase leadership focus on business intelligence and separation of Digital transformation of service delivery resulting from the COVID era is retained and adopted sustainably by leadership from Analytics to give the space and time to both agendas the Leeds system.  CCG’s roadmap to cyber assurance compliance and Business Intelligence capability developed and Set up Programme of delivery for Analytics support New Director for December phased for Audit review and feedback / assurances. to the CCG which is co-designed and owned by Business Intelligence 2021 SLT, Commissioners and the Wider System System wide Estates and Digital Strategy resets for Strategic Estates March 2021 the City post COVID Group (SEG) and Leeds Informatics Board (LIB)

Assurances (how do we know if the things we are doing are having an impact?): Gaps in assurances (what additional assurances should we seek): Internal Assurance  IT infrastructure adequately developed across the Leeds and wider NHS system to provide a robust  BI – availability of and feedback from leadership and system leaders and stakeholders on impact and and relevant platform for analytics development and support infrastructure – needs more committed relevance of business intelligence as a timely and relevant tool for decision making. partnership working across both Health and Council.  System wide Estates (SEG) and Digital (LIB) strategic developments continue to address barriers to  Information Governance and other related governance and statutory arrangements support the optimal delivery of care. development of the ideal infrastructure and support systems.

Link to Risk Register (operational risks): Independent Assurance 672: Digital Transformation in General Practice (9)  Internal Audit Reviews of progress against plans for delivery

 Annual reports of progress from LIB and SEG to City wide forums such as PEG and the HWB Board

Agenda Item: GB 20/40 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 22 July 2020

Title: Shaping Our Future – New Operating Model

Lead Governing Body Member: Tim Ryley, Chief Tick as Category of Paper appropriate Executive () Report Author: Tim Ryley, Chief Executive Decision  Reviewed by EMT/Date: N/A Discussion

Reviewed by Committee/Date: N/A Information

EXECUTIVE SUMMARY:

NHS Leeds CCG’s Shaping Our Future programme has produced a new operating model for the CCG. This is aimed at creating a health system in Leeds underpinned by Population Health Management capabilities, which incentivise providers to deliver integrated care models that deliver value for the people of Leeds. Creating the right incentives will support providers to drive a left shift in the way clinical care is delivered, facilitating a movement to more integrated, personalised, data-driven care, which in turn will allow the CCG to achieve its strategic aims to deliver better outcomes for people’s health and well-being and reduce health inequalities.

This will require creating a new commissioning role that is more values and behaviours- based. The CCG will encourage providers to work in such a way that they choose to invest resources in prevention and the wider determinants of health. The CCG will encourage the building of relationships, information sharing and communication between providers. The CCG will encourage a new culture of partnership, supporting providers rather than commissioning them, bringing organisations from all parts of Leeds together.

New Population Health Management capabilities will also be required. These include recognising that user input is paramount to understanding value and therefore decisions are made as close to users as possible. They also include understanding population need and value and real cost and financial and clinical risk through use of Health Economic and Actuarial Analysis and behavioural insights, organising sensible teams for integration depending on ‘condition’, understanding risk and developing risk share arrangements and managing networks, managing resource in complex contexts, sharing data legally and effectively, and joining up estates and workforce.

The CCG’s new operating model must focus on how to organise itself given all of the above. The co-production work has concluded that the CCG’s new operating model should have two primary strategic capabilities – Strategic Commissioning and System Integration, underpinned by the organisational capabilities required to deliver PHM. A degree of separation between the Strategic Commissioning and System Integration capabilities is required for two reasons. First, strategically there is a high likelihood in future of the creation of single ICS level units and / or elements of strategic commissioning at place going to local authorities, and the CCG’s operating model must be prepared for this. Second, tactically it would be helpful if the System Integration capability is distinct from financial and quality assurance to increase the chances of provider buy-in. However, until such time as legislation changes, or there is one CCG per ICS, the CCG will retain a set of statutory duties and delegated functions, and will remain one organisation.

The Chief Executive has developed revised Executive Management Team (EMT) roles in line with this direction of travel. However, the new operating model will not be successful if the CCG creates new and separate teams under each Director. Matrix working and an extreme teaming approach will be crucial for success of the new operating model. Staff with different and varied skills and expertise will have to come together to deliver specific capabilities.

To deliver this change the CCG will need to be mindful of the risks associated: regulatory, partnership, performance and adoption risks. These are described and the approach to mitigation is described.

In conclusion, the CCG will focus on building the behaviours and capabilities required to deliver the strategic aims of the CCG. Clearly developments outside of the CCG at the national, ICS and Leeds levels will be important in determining the eventual future state of the CCG. Therefore the CCG proposes to undertake frequent reviews of both the internal and external situation adjusting course as necessary to ensure the CCG’s optimal future state position emerges and is achieved.

NEXT STEPS:

There will be a range of next steps, including:

1. Organisational development will be critical to support the development of behaviours that are so important to the new operating model. Development in these areas needs to be provided for all staff. The CCG can embark on this work immediately. 2. Technical development will also be critical to build the new capabilities required, including the development of a detailed approach to Population Health Management, and development of new approaches to contracting and finance. The CCG can embark on this work immediately, in particular in training the whole organisation in the PHM principles and capabilities that are so important. 3. An organisational design process aligned to an inclusive HR process will be launched to look at the resourcing, skills and expertise required to deliver the capabilities. All staff will be involved and engaged as part of this process.

RECOMMENDATION:

The Governing Body is asked to:

(a) NOTE, DISCUSS & ADVISE on the behavioural, capability, structures and risk management described in the paper; (b) APPROVE the broad direction of travel for the CCG as outlined above; (c) NOTE the Chief Executive’s proposal for restructuring the Director Portfolios; (d) RECOMMEND to the CCG Membership (at the next opportunity) the changes in the voting members job titles in the CCG Constitution; and (e) DELEGATE authority to the Chief Executive and EMT to implement the direction of travel as defined in the next steps section.

1. Summary

1.1 The CCG is committed to playing an essential team role as a population health planner and system integrator in the city of Leeds. We do this because with partners we are committed to working with the citizens of Leeds to improve their health whoever they are or wherever they live.

1.2 Shaping Our Future describes how we will organise the CCG to deliver this contribution to the city. This paper summarises the output of a lengthy period of engagement with staff, partners and others to date and yet the Shaping Our Future programme remains emergent as befits a complex system environment.

1.3 This paper focuses on the changes in behaviour, capability and internal organisation required to better equip us to deliver on our ambitious and challenging agenda. It describes the work to date and the next steps we are planning to take. Such change is not without risk and whilst risk is an inevitable companion to ambition it is important that we manage these as effectively as we can.

1.4 The paper asks Governing Body members to input into shaping the process to and to approve the broad direction of travel.

2. Background

2.1 The CCG set out in its Strategic Plan six Strategic Ambitions that describe its unique contribution to the cities overall ambition to deliver “a healthy and caring city for all ages, where people who are the poorest improve their health the fastest”.

We will focus resources to -  Deliver better outcomes for people’s health and well-being  Reduce health inequalities across our city

We will work with our partners and the people of Leeds to -  Support a greater focus on prevention and the wider determinants of health  Increase their confidence to manage their own health and well-being  Deliver more integrated care for the population of Leeds  Create the conditions for health and care needs to be addressed around local nneighbourhoods

2.2 The CCG recognises that at the heart of population health improvement and the reduction in health inequalities that there needs to be a greater focus on prevention and wider determinants of health and a greater confidence in and focus on individuals to understand and manage their well-being; adding value to the lives of each person and to the population as a whole.

2.3 To achieve this across a great diverse city like Leeds requires much greater integration of services and new mechanisms of engagement with communities and individuals. The core building block of this integration needs to be at the locality level with multi-professionals working together with local people able to make decisions in the best way to address the challenges they face. It also requires greater integration between generalists and specialists, between mental and physical health professionals and between Social Care and the NHS at both a local and city-wide levels.

2.4 Whilst we have made changes in this direction, the CCG needs to ensure it commissions and facilitates change in a way that incentivises this vision of person-centred integration. This ambition is what lies at the heart of the Shaping Our Future programme.

2.5 It is also important to note that this ambition is in line with NHS England strategy which defines the move of CCGs to become strategic commissioners within Integrated Care Systems (ICS) and at a place level the facilitators of integrated working. NHS England desires a team approach within systems characterized by peer support, review and mutual aid between organisations. Specifically, the NHS Long Term Plan describes systems as having ‘population health management capabilities which support the design of new integrated care models for different patient groups, with strong PCNs and integrated teams and clear plans to deliver the service changes set out in the Long Term Plan; improving patient experience, outcomes and addressing health inequalities’.

2.6 In Leeds there is already a good level of partnership working between commissioners and providers, between the NHS and the Council, and in an increasing number of ways between individual providers. This presents an opportunity that can be built on as to date it has not been sufficient in terms of delivering the city vision. The Health & Wellbeing Strategy has as one of its 12 strands the “integration of provision” and there is a collective ownership of this and desire to move forward more tangibly on the agenda building on the partnership structures already in place. Shaping Our Future is part of the CCG’s contribution to this collective ambition.

2.7 Driven by the importance of effective strategy implementation ‘Shaping our Future’ is primarily the alignment of the CCG’s internal resources to these ambitions and this changing operating context. At the heart of this approach is a commitment to Population Health Management. The programme is designed to strengthen the cities capability in two key strategic areas to aid the development of a strong and vibrant health & social care system: Population Health Planning (Strategic Commissioning) and System Integration.

2.8 Wide engagement and consultation within the CCG, Leeds and beyond has been at the heart of developing these proposals. Our Staff and Partners are fully sighted on what we are doing and why we are doing it; and their views and insights have shaped our plans and proposals significantly.

3. Developing the Culture and Capabilities

3.1 To achieve our ambitions, the CCG must create a health system in Leeds where Population Health Management capabilities understand the needs of the population and support the

delivery of new integrated care models to meet those needs, based on a thorough understanding of value and clinical risk for different patient groups.

3.2 Achieving best value then is about achieving the best outcomes at the lowest cost. The aim will be for the CCG to define a set budget for a set population with a specific set of outcomes to be met, with a new contractual form that gives providers more freedom to deliver those outcomes as they see fit within the available financial envelope. Focusing on outcomes for individual citizens throughout the discussion creates the right incentives across the system.

3.3 Basing the new approach on managing clinical and financial risk will also enable the right incentives to be created. Providers have to be incentivised to proactively manage care with personalised interventions that are preventative in nature. For example, a capitated budget for patients with Type 2 diabetes could encourage providers to assess the financial risk of the patient cohort getting worse, and hence investing in behavioural change for these patients to support smoking cessation and weight loss, which could reduce the incidence of stroke, renal or other cardiovascular events, and also reverse the diagnosis in some of the lower risk in the cohort. This risk management approach over a longer period of time will lead to better care, resulting in better outcomes, which meet the needs of the patient, the sustainability of the providers and the ambitions of the CCG.

3.4 Creating the right incentives will support providers to work together to create a team focused on population and individual health outcomes, composed of clinicians who are accountable for those outcomes. As they are accountable for the outcomes, they will have to understand levels of and variations in demand, the clinical effectiveness of ‘interventions’, patterns of activity, the costs of alternative pathways and a detailed understanding of user preferences and the local community’s priorities. The team will be comprised of multiple professionals from different disciplines with different backgrounds, different levels of seniority and different employers.

3.5 This level of integration and understanding will drive a left shift in the way clinical care is delivered, facilitating a movement to more integrated, personalised, data-driven care, which can deliver better value to individual citizens. This in turn will improve health inequalities and patient experiences, cut inefficiencies, and achieve better health outcomes. It will require looking at the broader determinants of health and adopting a genuinely partnership based approach across the whole city of Leeds.

3.6 The CCG’s Strategic Plan and Health Inequalities Framework make clear that we have a philosophical commitment to locality level working building on the long history in Leeds. This is one of our strategic ambitions and the level at which we believe much integration is and will happen through Local Care Partnerships and PCN developments. True PHM thinking requires local responses to local challenges and opportunities and the necessity to develop integrated working at this level will be a key feature of our work.

3.7 The paragraphs above describe the vision and approach the CCG is looking to achieve. To do this, the CCG needs a new operating model. Fundamentally two things are required as part of the new operating model: new behaviours, and new capabilities.

3.8 New behaviours, ways of working and culture are going to be critical. Creating genuine integration will create the adoption of system-wide ways of working, breaking down the commissioner-provider split and working as one Leeds system. The desired culture is where transparency and honesty lead to equal relationships across all partners, built on a foundation of trust, creating a culture of collective commitment, with a compelling vision and a track record, frequent communication and clarity on roles, bravery and taking risks and accepting ambiguity, integrity and honesty, and tolerance and empathy.

3.9 This will require creating a new commissioning culture that is more values and behaviours- based. The CCG will encourage providers to work in such a way that they choose to invest resources in prevention and the wider determinants of health so that the system can reduce health inequalities and improve outcomes and people’s experience of their care. The CCG will encourage and enable matrix working across providers in an uncertain and complex environment. The CCG will encourage the building of behaviours, relationships, information sharing and communication between providers. The CCG will foster a new culture of partnership with a greater emphasis supporting providers rather than contracting with them, bringing organisations from all parts of Leeds together. All partners in the Leeds system will solve problems together.

3.10 Some of these behaviours are already firmly present in Leeds. Clinical teams are working together more and more. Senior leaders are on speed dial to each other and talk about Team Leeds with shared principles. Formal (Primary Care Mental Health) and Informal (Provider CEOs, LCH / Confed) provider networks exist. Mind-sets are moving in the right direction, but well established behaviours across the city need a degree of disruption and challenge to further develop. Changing the CCG’s operating model to focus on supporting providers and creating genuine integration is aimed to do this.

3.11 However, behaviours are not enough alone. The CCG and the system do not have sufficient capabilities either. The traditional approaches to contracting, finance and governance have prevented the ability to ground PHM in understanding value and risk and shifting of recurrent resources accordingly between providers. Indeed financial flows between providers are limited, operational management teams are often stuck in silos, there is limited use of data and long-term population analysis, patient costs across the system are not understood, and there is not a sufficiently enabling infrastructure around digital, estates, and shared information.

3.12 It is also important to note what we mean by capabilities. A capability is the ability to deliver something drawn from a range of expertise and knowledge. CCG staff and partners have much of the expertise and knowledge already, but these elements need to be blended differently with a set of common goals and in some cases additional skills to deliver the right things for PHM. The route to do this is through matrix working and developing strategic alliances.

3.13 The CCG needs to develop the PHM capabilities that deliver its aims. These include recognizing that user input is paramount to understanding value and therefore decisions are made as close to users as possible. They also include understanding population need and value and real cost and financial and clinical risk through use of Health Economic and Actuarial Analysis and behavioural insights, organising sensible teams for integration

depending on ‘condition’, enabling flexibility between teams at different levels, relationship establishment and management, understanding risk and developing risk share arrangements and managing networks, managing resource in complex contexts, working in multiple alliances, sharing data legally and effectively, joining up estates and workforce, and creating shared governance. There are significant gaps in these capabilities as things stand and therefore there will need to be significant investment in people and systems to build the capabilities.

3.14 Given all of the above, the CCG’s new operating model must focus on how to organise itself to adopt the new behaviours and develop the new PHM capabilities. This has been the focus of the Shaping Our Future programme. The co-production work has concluded that the CCG’s new operating model should have two key primary strategic capabilities – these have been named as Strategic Commissioning and System Integration. The goal of the Shaping Our Future programme is to ensure these are optimal to strengthen Leeds’ delivery of a PHM approach and its ambitions.

3.15 Perhaps most important here is the System Integration capability. This capability is intended to support providers to come together, understand needs, value and risk, and deliver care accordingly. As a starting point the System Integration capability will need to develop priorities for a population group based on underlying medium and long term clinical and financial risk and understanding how that risk can be reduced. Integrated and agile personalised services can then be built on the back of this analysis, using resources on those things that really drive value for the people.

3.16 To deliver this approach technical and cultural change will be required on sharing of data, clinical risk management, open book principles and clear mechanisms for financial risk sharing, the prioritisation of workforce, and development of standardised pathways. It is important to note that the System Integration capability will not be ‘leading’ or ‘in charge of’ providers. It will be an enabling support function, providing extra capacity to providers to unlock existing potential.

3.17 As outlined above, the right incentives will also have to be in place to drive provider behaviour change, and a new commissioning approach is required. The Strategic Commissioning capability will drive this. It will set strategy and outcomes in partnership with the Leeds system, and then develop long-term outcome based contracts, based around population groups and supported by capitated budgets. This will transfer some risk to providers and encourage them to take a view of value, which in turn will encourage investment in early intervention and prevention and in the wider determinants of health. The Strategic Commissioning capability should ensure that all decisions are based on the strongest possible intelligence, and setting the environment and incentives to ensure those decisions are then implemented. It will involve close working with a variety of partners including NHS providers, the Council, academia, and the broader private and third sectors.

3.18 Underneath these strategic capabilities then sit the organisational capabilities required to deliver PHM. Some of these will be core to all aspects of the CCG. Some will be specific to either the Strategic Commissioning capability or the System Integration capability. In addition, the CCG will retain all of its statutory duties and corporate capabilities.

3.19 Whilst the exact detail of the required capabilities will emerge over time, the latest thinking is summarised in the diagram below.

4. Next Steps

4.1 The Executive Team, in consultation with colleagues, has been considering best how to shape our teams to develop these capabilities. This will involve increasing capacity in some areas, bringing-in expertise in others and creating new roles. All this will need to be done within existing spending limits.

4.2 The first step has been to look at the EMT portfolios. The Chief Executive has commenced work on this. Initial thinking on the specific roles is summarised below in the diagram, and in Appendix 1 there is a summary analysis of the potential capabilities that sit underneath each of the individual Directors.

4.3 Changing the CCG’s operating model will change the way in which it delivers its statutory duties. A key part of implementation will look at how these duties are enacted going forward. The CCG must be confident that it can achieve its statutory duties in the new

operating model, and must also ensure that statutory duties can be achieved while the new culture is being built in the transition phase. This will require careful planning.

4.4 The proposal has been discussed with NHS England, the CCG’s regulator, and support for the direction of travel has been obtained.

4.5 It is really important to note that all Directors report to the Chief Executive and the CCG at this time is not describing a structural change in relation to other parts of the city partnership and will remain one organisation. It is also important to note that the relationship between strategic commissioning and system integration is a continuum whilst each contains defining features it will be crucial to develop together the underpinning behaviours and capabilities described above.

4.6 Governing Body members are asked to note in particular the following points:

 The Executive Director of Strategy and Performance (currently vacant) will become the Executive Director of Population Health Planning. As this role is set out in the CCG Constitution this will require a formal change.  The current Director of Operational Commissioning role will disappear. This is not a full board member role.  There will be two new non-voting director roles: a Director of Pathway Integration and a Director of System Business Integration.  The CFO role will formally include the designation Deputy CEO which will require a constitutional change but changes little in practice.

4.7 However, the new operating model will not be successful if the CCG creates new and separate teams under each Director to deliver the capabilities outlined in the table above.

Matrix working and an ‘extreme teaming’ approach will be crucial for success of the new operating model. Staff with different and varied skills and expertise will have to come together to deliver specific capabilities and pieces of work for a particular Director and indeed for the city. For example, outcome setting for a particular population group will require expertise from BI, finance, quality, public health, and behavioural insights. Only in this way will the CCG be able to create the required focus on PHM capabilities.

4.8 There will also be important elements of matrix working with other external organisations. Directors may need to develop a set of strategic alliances with a range of joint city capabilities and other alliances with commercial companies or expert individuals.

4.9 There are conversations in hand with Leeds City Council on a range of joint appointments to complement and build on existing arrangements. The City Digital Officer is out to advert as a joint appointment and this month two joint Public Health Consultant posts will also be advertised.

4.10 We already have some of this happening and in some areas it is better developed than others but this is dependent on a variety of factors rather than the standard CCG approach. Such approaches are understood to be critical to delivering the highest improvements in complex and organic systems.

4.11 However, going forward, the CCG cannot be one huge matrix of staff working under Directors. There needs to be a degree of separation between the Strategic Commissioning and System Integration capabilities for both strategic and tactical reasons:

 Strategically the direction of travel for CCGs is very uncertain and there is a possibility of the creation of single ICS level units and / or elements of strategic commissioning at place going to local authorities. In Leeds’ case these could potentially be the same thing. At the same time it is possible that Integrated Care Partnerships at place will take on the system integration elements. If this is in place and working in Leeds there is the possibility of limiting the structural disruption.

 Tactically it would be helpful if the System Integration capability is distinct from financial and quality assurance to increase the chances of provider buy-in and enable greater system partnership working

4.12 This creates a real and potentially creative tension in balancing the principle of matrix working with the principle of sufficient separation.

4.13 It should be noted that until such time as legislation changes, or there is one CCG per ICS, the CCG will retain a set of statutory duties and delegated functions, and will remain one organisation.

4.14 In accelerating the direction of travel in the direction described, organisational development will be critical to support the development of behaviours that are so important to the new operating model. This particularly applies to building the CCG core capabilities shown

above. Development in these areas needs to be provided for all staff. The CCG will embark on this work immediately.

4.15 Technical development will also be critical to build the new capabilities required, including the development of a detailed approach to Population Health Management, and development of new approaches to contracting and finance. The CCG can embark on this work immediately, in particular in training the whole organisation in the PHM principles including Quality Improvement and capabilities that are so important such as matrix working.

4.16 An organisational design process will be launched to look at the staffing resources, skills and expertise required to deliver the capabilities required. All staff will continue to be involved and engaged as part of this process. This will be aligned as necessary to an inclusive HR processes set out in the CCG Organisational Change policy. The aim is for the process to be completed by the end of March 2021.

4.17 At the same-time the Governing Body will use the opportunities in vacancies on the Governing Body to review its membership and ensure that it has the right blend of clinical, commercial and community expertise and experience to provide oversight to the CCG through this period. The Chair and the Chief Executive Officer will bring forward proposals in due course.

4.18 In conclusion, the CCG will focus on building the behaviours and capabilities required to deliver the strategic aims of the CCG. Clearly developments outside of the CCG at the national, ICS and Leeds levels will be important in determining the eventual future state of the CCG. Therefore the CCG proposes to undertake frequent reviews of both the internal and external situation and will adjust course as necessary to ensure the CCG’s optimal future state position emerges and is achieved.

5. Risks & Opportunities

5.1 All change involves a degree of risks and opportunities and these are usually those noted. However, it is important that in a complex and evolving environment that equally no-change creates its own risks too. Shaping Our Future is designed to not only deliver on our strategic ambitions but to overcome existing weaknesses in the way we and the city work together in designing and shaping services.

5.2 In the paragraphs below the CCG describes what it sees as the principal risks in undertaking these changes and how we propose to mitigate them.

5.3 Regulatory The CCG operates in a regulatory environment and under the direction of NHS England. Within statute we have and will continue to have a number of legal duties. There will be the twin risks of either a different organisational form is required nationally or that in making these changes we weaken our ability to maintain delivery of existing statutory duties.

5.4 To mitigate the likelihood of the former the CCG is ensuring that it is fully sighted on latest thinking at NHS England and keeping senior regional decision makers and others informed of the changes we are proposing. The proposals as set out above deliberately take into account both external documented information and soft intelligence. This remains a significant risk whether we change or don’t change.

5.5 To mitigate this we are ensuring that each statutory duty clearly has a director level owner and testing a number of scenarios in key areas of financial and clinical duty and will be involving internal audit to both develop their understanding and to provide advice and test systems as they are developed.

5.6 Partnership The revised CCG Operating Model will only be truly successful if other partners in the city understand it, welcome the role of the CCG it describes and importantly change in parallel. The symbiotic relationship between providers and the CCG has always been the case and it is important to note that as providers change in line with national guidance it is important that we are also aligning so again no change in the CCG operating model contains risks.

5.7 The CCG has engaged all partners throughout the process in one-to-one meetings, executive team-to-team meetings and in partnership forums such as PEG (Partnership Executive Group) and ICE (Integrated Commissioning Executive). It is also facilitating of a smaller group of city Chief Executives to come together around the integration agenda and bringing in external expertise to support this where necessary. To date the approach has been welcomed and the CCG has been actively encouraged to act as the “engine room of integration”.

5.8 Performance The changes proposed will disrupt colleagues and teams within the CCG. There is an important question about whether the degree of disruption is necessary to deliver the aims given the key issues and behavioural and development of new sets of capabilities. Change often results in drops in performance.

5.9 First of all we have spent considerable time engaging colleagues in the need for change and the opportunities of making those changes now. We have also given all staff considerable opportunity to feed-in and shape the process. This will continue at every step of the way.

5.10 It is also important that we don’t over-state the degree of change for many of our colleagues. In some teams little will immediately change, and the changes will be more cultural and a continuation of what we have already started in the CCG. There will be opportunities too to develop new skills and contribute to a wider range of pieces of work.

5.11 However, many behaviours and patterns of work have been established to support an old role of commissioning and a different operating model. To break some of those patterns it is important that there is some disruption. Further and more significantly the CCG’s operational resources (people, time and processes) are orientated to a different approach and to deliver the new approach set out above we will need to shift capacity. This is where

some risk sits and hence the need for continual engagement, fair process and creation of opportunities for staff to fit into the new model.

5.12 Adoption The biggest changes are not structural, they are behavioural and capability related. If the CCG becomes over focused or stays too long in structural discussions it will not truly change its underlying operating model to align with its vision.

5.13 Therefore in parallel and running beyond any structural changes the CCG will embark on a programme of work to develop different behaviours. The most important groups in this work will be the Executive Team, Senior Leadership Team and wider management team. The CCG has heavily involved them in the process to date and will continue to do so and develop a tailored approach to support them to lead the changes.

5.14 We will also need to describe and test a set of clear outcomes that demonstrate a shift in behaviours and capability over the next year, 3 years and 5 years.

6. Summary & Recommendation

6.1 The CCG is continuing its commissioning journey by adapting itself to better deliver on its ambitions for the health of the people of Leeds and to seize the opportunities that changing national expectations and city partnerships offer. Shaping Our Future is an on-going process to create a new operating model for the CCG that fits this new future.

The Governing Body is asked to:

Appendix 1: Draft Director Portfolios.

Deputy CEO and Chief Finance Officer (CFO): The CFO will ensure that the new contracting models and extension of AIC principles are employed. They will also have responsibility for ensuring that the financial and data elements of health economics and actuarial forecasting support long-term population health planning. The CFO will also be responsible for the Corporate and Financial Governance arrangements of the CCG and the full range of the Financial Statutory duties of the CCG.

Director of Population Health Management (DPHP): The DPHP will be accountable for:  Public Behavioural Insight and Experience  Population Health Economic Planning  Scenario Creation and Testing  Outcome Setting and Management  Setting and Managing Thresholds and Standards  Outcome Chain Diagnostics  Population Relationship Management

Director of Nursing and Quality (DNQ): The DNQ will ensure that Children’s services and pathway integration is progressed. In addition they will also have responsibility for ensuring that clinical governance (Patient Experience including complaints, Patient safety and clinical effectiveness) capabilities are deployed as needed across all integration teams. The DNQ will also be responsible for Safeguarding and CHC arrangements within the CCG, and provide Nurse leadership across the integrated arrangements.

Medical Director (MD): The MD will primarily focus on the system integration side. They will ensure that Clinical Leadership is effectively developed across the Provider Alliance. In addition they will also have responsibility for ensuring that the whole Leeds system adopts a common set of approaches for continual quality improvement, research and innovation. The MD will remain the CCG Caldecott guardian and provide leadership of the appropriate use of data to improve pathway integration and safety.

Director of Organisational Effectiveness (DOE): The DOE will provide a wide range of corporate capabilities including:  HR and OD both to the organisation and to support cross sector teams within integration work  Communication and Public Engagement  Public Consultation  Behavioural Insights  Project and planning capacity and expertise to support integration projects and operational planning  Office and administrative resource to the whole organisation  Emergency Planning and Business Continuity

Director of Pathway Integration (DPI): The DPI will be accountable for the following organisational capabilities:  Pathway Integration and Design across all Adult pathways  Risk Stratification  Capacity Planning  Operational Planning & Performance  Managing key Provider Relationships at COO level

Director of Business Systems Integration (DBSI): The DBSI will be accountable for working with providers to deliver the following supporting capabilities:  Alliance Governance Development  Commercial Partnership Management including Primary Care Contracting  City Level Patient Level Costing  Digital Infrastructure  Information Transfer and IG  Estates Planning The DBSI will be the CCG SIRO (Senior Information Risk Owner) and manage the relationship with city CDIO (Chief Digital Information Officer) and CCIO (Chief Clinical Information Officer).

Agenda Item: GB 20/41 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 22 July 2020

Title: Chair’s Summary – Primary Care Commissioning Committee held on 3 June 2020 Lead Governing Body Member: Sam Tick as Senior, Lay Member & Chair – Primary Care Category of paper appropriate Commissioning Committee () Report Author: Karen Lambe, Corporate Decision Governance Officer Discussion  Information Approved by Lead Governing Body Member (Y/N) Y EXECUTIVE SUMMARY: This report provides the NHS Leeds CCG Governing Body with a summary of items discussed and outcomes and risks identified at the Primary Care Commissioning Committee (PCCC) meeting held on 3 June 2020.

RECOMMENDATION: The Governing Body is asked to:

(a) RECEIVE the report.

Description of key items of business discussed and key outcomes 1. Please note that this is a brief summary of the items considered and decisions taken at the meeting of the PCCC meeting held on 3 June 2020. Further information can be obtained by reference to the minutes of that meeting.

Chief Executive’s Update 2. Members were informed of ongoing work by Chief Operating Officers to review the restarting of services across the system. This incorporated the backlog of waiting lists and constraints due to personal protective equipment (PPE), estates and social distancing. A second piece of work was being led by Dr Bryan Power, focussing on the Impact of Covid- 19 on provision of health services for non-Covid conditions. The Chief Executive emphasised the need for the committee to review the hypotheses and recommendations that emerged from the project.

3. The efforts and hard work of general practice and the Primary Care teams from the CCG and the GP Confederation were acknowledged.

4. Two areas of concern were highlighted. Firstly, the need to develop a robust system approach to supporting care homes. The work of primary care and CCG staff in supporting care homes was commended. It was recognised that Covid-19 had exposed care homes as a fragile part of the system that would require significant focus going forward.

5. The second area of concern affected shielded populations and how updated guidance had been communicated directly to patients, bypassing NHS England (NHSE) and practices. It was anticipated that a named clinical lead would be required for each shielded person, which would provide a further challenge.

6. The CCG’s Health Inequalities Framework had been approved by the Governing Body in May 2020. The framework included a set of principles for investment that would incorporate primary care and general practice which, aligned with Shaping Our Future transformation and the Left-Shift Blueprint, aimed to improve health outcomes and reduce health inequalities. There would be a high profile launch of the framework to primary care around September 2020.

COVID 19 – Working Arrangements and Decisions Undertaken 7. Members noted the significant shift in how practices operated in terms of a total triage system, digital delivery and telephone consultations. Starting from a baseline of 30%, there was now 100% availability of online and video consultations. 87% of practices were live with online consultations and the remaining 13% of practices had mobilisation plans in place.

8. A citywide primary care group had been established to oversee the primary care response to Covid-19. The group, made up of CCG and Leeds GP Confederation colleagues along with a Clinical Director representative had worked with practices to rapidly establish daily situation reports (sitreps) and Operational Pressures Escalation Levels (OPEL) scores to determine where additional support would be required. Members noted the positive relationship between the group and practices in their response and commended the support that had been forthcoming across the organisations.

9. A quality approach had been adopted in terms of care homes support. This had included rolling out the local care home scheme to those practices not currently providing the scheme.

10. To date, £826,542 had been paid in respect of general practice costs, including £196,618 on PPE.

11. The committee noted the scale of work required to develop the care home sector over the next few years by the CCG and the local authority.

Primary Care Networks: Direct Enhanced Service Update and Principles 12. The revised arrangements for Year 2 of the Network Contract Direct Enhanced Service (DES) were presented to the committee. All Primary Care Networks (PCNs) had signed up to the scheme. Significant changes had been made to the additional roles reimbursement scheme (ARRS), following feedback from PCNs. All roles would be 100% reimbursable with a maximum amount per role. PCNs would be able to recruit to ten roles including physiotherapists, dieticians and podiatrists, which would facilitate the wider transformation of the primary care workforce.

13. PCNs had requested flexibility with regard to the employment of respiratory focused

physiotherapists. The CCG would be supportive of this principle providing key elements could still be confirmed. Some concern was expressed that recruitment would be carried out at PCN level as opposed to the wider system. It was acknowledged that this was due to the national reimbursement scheme. The committee supported the recommendation of the Primary Care Operational Group (PCOG) to support the approach to first contact physiotherapist (FCP) reimbursement.

14. The committee noted the risk that PCNs might not claim their full entitlements under the ARRS scheme due to Covid-19. Assurance was given that the CCG would give due consideration to any inequity resulting from a lack of available workforce. Further assurance was given that unspent allocations would be monitored via finance reports and addressed with the GP Confederation.

15. With regards to a PCN with an atypical population, clarification was being sought from NHSE around the possible amendment of some of the service specifications to better reflect the needs of those populations.

Primary Care Quality Improvement Scheme – Principles: End of Year 2019/20 Process 16. The committee was presented with a proposed principle based approach to support the revised end of year position 2019/20 regarding the Quality Improvement Scheme (QIS) achievement payment. This was due to General Practice adapting their delivery model of care in response to Covid-19 and the suspension of the QIS on 20 March 2020 in line with the national suspension of the Quality and Outcomes Framework (QOF).

17. In March 2020, the CCG had communicated with practices that local schemes such as QIS would be suspended to support the reduction in any non-essential work. Payments would continue post-April 2020 despite the scheme not being operated fully.

18. In addition to the 85% of funding to practices, a further 15% would ordinarily be funded on delivery of agreed outcomes. Due to Covid-19, not all the data for 2019/2020 was available for the final three weeks of the year. However, significant improvements in the two priority indicators were noted. Severe Mental Illness (SMI) health checks had increased from 39.8% to 59.2%, while learning disabilities (LD) health checks had increased from 65% to 70.2%.

19. The committee agreed to approve the principle of adopting the QOF approach to determining QIS achievement in light of Covid-19 and approved an interim payment to be made based on the QOF principle.

Summary from the Quality and Performance Committee meeting held on 12 May 2020 20. Members received a verbal update on the Quality and Performance Committee meeting. The meeting had focused on a number of issues including: care homes, unmet need for those already in the system; and the impact of Covid-19. Assurance was given that the committee had received the highest reasonable levels of assurance in the circumstances and this had been triangulated with the Chief Executive’s report to the Governing Body on 20 May 2020.

Primary Care Integrated Quality & Performance Report (IQPR) 21. The audit data to support the Quarter 4 Integrated Quality & Performance Report (IQPR) had been delayed due to the Covid-19 situation. Practice level data indicated there had been an improvement in flu vaccinations.

22. The continued decrease in Datix reporting would be reviewed by the Quality Surveillance Group (QSG). Assurance was given that the QSG had been reestablished and would continue to work in partnership with the Care Quality Commission (CQC).

23. Members were informed that CQC had suspended all visits to practices, resulting in one practice still being rated as inadequate. Assurance was given that the CCG and the GP Confederation continued to work with the practice and its rating would be likely to improve once a full inspection had taken place.

Primary Care Risk Report 24. Members noted there were six active risks aligned to the committee. One previous risk relating to R717: Primary Care Procurement Challenge, had been closed due to there being no specific risk to Primary Care procurement and a general risk relating to procurement challenge was already on the CCG risk register (R722).

25. Two high amber (12) risks were reported: R651: General Practice Workforce; and R660: Delivery of High Quality Primary Care Services. Both had been impacted by Covid-19. R660 had increased from nine to 12 due to the suspension of services in accordance with national guidance.

26. With regards to general practice workforce, members noted potential additional risk longer term as students deferred higher education and training opportunities. In addition, there were unknown consequences of Covid-19 on the workforce, including staff burnout due to repeated surges. It was acknowledged that the move to daily sitreps and OPEL reports were a positive development in identifying workforce challenges.

Primary Care Finance and Estates Update 27. The committee was presented with a summary of funding passed to practices to support them through the Covid-19 pandemic. The QOF position showed an overtrade of £339K due to anticipating a higher QOF achievement payment. Practices would receive the higher value of the 2018/19 QOF achievement or the 2019/20 value. The CCG had supported practices through the lockdown by supplying PPE and laptops as well as covering cost across a number of areas in line with national guidance. Practices had also been reimbursed for bank holiday opening over Easter. All Covid-related costs would be reclaimed through the national reimbursement scheme.

28. With regards to prescribing, the under spend had been released when anticipated risks over a ‘no deal’ Brexit did not emerge. The overall prescribing position showed an undertrade against prescribing of £688K.

29. Members were updated on the current position with Community Health Partnerships (CHP) Local Investment Finance Trust (LIFT) practices. A draft of proposed funds for support to offer all GP practices currently occupying LIFT buildings had been compiled. Funds for

support totaled £325k. As charges were from CHP, the CCG and practices had limited control over the increase of future charges. Consequently, full assurance could not be given that similar issues would not reoccur in the future. Further financial support would need to be discussed and considered in-line within the overall CCG affordability. Assurance was given that work was ongoing to identify less expensive local cleaning contracts. The committee noted the risk associated with the CHP situation in terms of future funding requirements. An additional risk was noted in terms of the destabilising effect on practices in LIFT buildings.

Proposal to Commence Patient Engagement – Alwoodley Medical Practice 30. The committee was informed that the proposed patient engagement for Adel Surgery had been signed off. While it had not been possible to hold public meetings due to social distancing guidance, a virtual meeting would be held on 10 June 2020. This would provide an opportunity for patients to submit additional concerns to be considered by the PCCC. The results of the engagement would also be considered by the PCOG.

Strategies/Policies approved N/A

Items of positive assurance or issues to be raised with the NHS Leeds Governing Body N/A

Any additional comments N/A

5 Agenda Item: GB 20/42 FOI Exempt: N

NHS Leeds CCG Governing Body

Date of meeting: 22 July 2020 Title: Chair’s Summary of Remuneration & Nomination Committee Meeting held on 10 June 2020 Lead Governing Body Member: Sam Senior, Lay Tick as Member – Primary Care Co-Commissioning / Category of Paper appropriate Deputy Chair () Report Author: Laura Parsons, Head of Corporate Decision Governance & Risk Discussion  Information Approved by Lead Governing Body member (Y/N): Y EXECUTIVE SUMMARY: 1. This report provides the NHS Leeds CCG Governing Body with a summary of items discussed, outcomes and risks identified at the Remuneration & Nomination Committee meeting held on 10 June 2020.

RECOMMENDATION: The Governing Body is asked to: (a) RECEIVE the report.

Description of key items of business discussed 1. Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Remuneration & Nomination Committee on 8 April 2020. Further information can be obtained by reference to the minutes of that meeting (subject to exemptions under the Freedom of Information Act).

Clinical Chair Recruitment Update

2. The Committee was advised that one candidate had decided to withdraw from the process, leaving only one candidate. Therefore member practices had been asked to endorse the appointment by the end of June.

Shaping Our Future – Emerging Implications of Target Operating Model

3. The Committee was advised that the executive portfolios were being reviewed as a result of Shaping Our Future. The non executive roles on the Governing Body would also be reviewed. Additional Remuneration & Nomination Committee meetings would take place in July and September to consider proposals further.

4. The Committee discussed the need to review recruitment and appointment processes to ensure that the diversity of the Governing Body is more aligned to the local population.

Recruitment of Lay Member – Audit & Conflicts of Interest

5. An update was provided in relation to recruitment to the vacant role of Lay Member – Audit &

1 Conflicts of Interest, which was in progress. In order to ensure a broad field of candidates, a recruitment agency would support the process.

Recognition & Reward for CCG Staff

6. The Committee considered options for staff reward/recognition in light of COVID-19. It was agreed that a note of thanks would be appropriate and the Head of People & OD would consider and agree an appropriate method with the executive team.

National Workforce Reporting Update

7. An update was provided on the NHS England/NHS Employers decision to pause, and now restart, some of the central workforce reporting and monitoring arrangements. It had been confirmed that the Workforce Race Equality Standard (WRES) would be applied this year, and confirmation was still to be received regarding the Gender Pay Gap. The national staff survey would take place this year.

Any Other Business

8. The Committee Chair, Director of Organisational Effectiveness and Head of People & OD had discussed the appropriate route for the Governing Body to receive assurance regarding CCG workforce issues such as absence rates, turnover and training. It was agreed that these assurances should be presented to the Remuneration & Nomination Committee. This proposal is considered in a separate report on today’s agenda (item GB 20/49).

Strategies/Policies approved N/A

Items of positive assurance or issues to be raised with the NHS Leeds CCG Governing Body N/A

Any other Comments N/A

2 Agenda Item: GB 20/43 FOI Exempt: No

NHS Leeds CCG Governing Body Meeting

Date of meeting: 22 July 2020

Title: Chair’s Summary – Audit Committee meeting held on 15 July 2020

Lead Governing Body Member: Sam Senior, Lay Tick as Member – Primary Care Co-Commissioning Category of Paper appropriate /Deputy Chair () Report Author: Anne Ellis, Risk Manager Decision Discussion  Information Approved by Lead Governing Body member (Y/N): Y

EXECUTIVE SUMMARY: This report provides the NHS Leeds CCG Governing Body with a summary of items discussed and outcomes and risks identified at the Audit Committee meeting held on 15 July 2020.

RECOMMENDATION:

The Governing Body is asked to:

(a) RECEIVE the report.

Description of key items of business discussed and key outcomes 1. Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Audit Committee held on 15 July 2020. Further information can be obtained by reference to the minutes of that meeting.

Finance

2. The Committee was provided with an update on the temporary finance regime for 2020/21. The temporary finance regime currently covers the period 1st April 2020 to 31st July 2020. As both 2020/21 allocations and expenditure requirements (in response to the national stabilisation and reset of services) continue to be refined nationally for both CCGs and NHS providers it is currently difficult to assess the likely impact on the in-year financial positions of individual organisations. Although at the time of paper submissions to the Audit Committee formal national operational planning reset guidance for August 2020 onwards was expected imminently from NHSE/I, along with the associated funding reset, indications given at a verbal national update to CFOs on the day before the Audit Committee meeting suggested that the significant changes to the financial regime introduced for the initial four months of 2020/21 will continue for at least another 1-2 months. The planning guidance for the remainder of the financial year will be finalised later in the summer and will likely be similar to the first half of the year for

20-21. However it is likely that more of the national support funding will be diverted directly to ICS level, in line with a ‘system by default’ focus.

3. Feedback is awaited on initial anomalies identified as part of the arrangements for the first four months of 2020/21, although at the verbal update on 14th July, these were acknowledged by NSHE/I as being taken into account for the planning guidance covering the remainder of the financial year. Once details are received the CCG will be better placed to assess the impact on 2020/21 finance in line with service requirements. The Audit Committee noted that the Governing Body will receive a paper outlining the risks and proposed actions to balance the accounts whilst meeting its statutory duty to treat patients.

4. The members received an update on progress relating to VAT provisions and noted that the final outcome was awaited.

5. The Audit Committee was assured on the action taken by the CCG in relation to AQP contracts which were not supported nationally and the associated risk of not supporting continuity of the services provided.

Risk Management

6. At the end of the last reporting cycle, there were 62 active risks on the CCG register, of which 30 were accepted risks. There was one corporate (red) risk reported: R721 Information Security Maturity, which had a current score of 15, following completion of penetration testing. The Committee was assured that the action plan to address this risk was in progress. The majority of issues would be resolved by the action relating to the cloud solution, which was on track.

7. Risks and issues specifically relating to COVID-19 continue to be logged within task groups, and are escalated as required through the command structure via SitReps. Strategic risks and red risks are reported to Health and Social Care Gold as a standing agenda items. All operational risks (Active and Accepted) have been reviewed and flagged where they are impacted by the outbreak.

8. The Committee was updated on progress against reviewing and updating the Governing Body Assurance Framework (GBAF), and the deep dive assurance of individual GBAF risks would resume at the Audit Committee in September following approval of the GBAF for 2020/21 at the July Governing Body meeting.

Information Governance

9. The Committee was updated by the Data Protection Officer. Specific areas to highlight included progress against compliance and submission of the Data Security and Protection Toolkit. The CCG continues to work on meeting the revised deadline of September 2020. There had been two audits of the Toolkit; one undertaken by Audit Yorkshire (AY) provided Significant Assurance. The other undertaken by PWC as part of a pilot on behalf of NHS Digital, provided an Unsatisfactory outcome overall. The Committee was assured that the difference in opinion reflected the different scope, the

2 AY audit focused on controls and processes and the NHS Digital Audit employed technical security experts. The Committee was further assured that the unsatisfactory opinion only related to one section of the audit and the CCG has fed back that this is disproportionate. In addition the CCG was aware of the issues raised by the audit, from the results of the earlier penetration testing.

10. There has been a fast-paced adoption of new ways of working during the pandemic. The Committee was assured that this has been done in a compliant way and whilst there has been some misconception of relaxation of Information Governance rules we still need to comply with data protection laws. There will be retro-evaluation of apps that have been used by GPs to ensure that we do not lose progress in adopting new ways of working but maintaining IG requirements.

11. GDPR audits at GP practices have recommenced virtually using MS Teams. There has been a wide range of results, the IG Team will focus on supporting areas that have low or limited assurance and also share good practice at PCN level.

Internal Audit

12. The Committee was presented with the Internal Audit Progress Report which detailed the audits undertaken in 2020/21. The Committee noted that the CCG response to COVID-19 has had an impact on the progress on the 2020/21 audit plan. A final report has been issued for: Confederation Governance Follow Up, high assurance was provided. Work was ongoing on two audits, COVID-19 Business Continuity and Medicines Optimisation. A further two audits are being planned.

13. The Committee approved the deferral of the Safeguarding audit to 2021/22, being replaced with two audits from 2021/22; Patient Experience and Quality Improvement. This is due to the previous safeguarding audit being relatively recently reported in May 2019.

14. The Committee welcomed the new process for reviewing audit recommendations, which ensures that any slippage in implementing recommendations is sighted by the Executive Management Team. In addition, the CCG will focus on medium and high priority recommendations.

15. The Committee received the revised Strategic Audit Plan for 2019/20 – 2021/22 and the Internal Audit Operational Plan for 2020/21, which includes the agreed deferral of the Safeguarding audit and the two audits brought forward from 2021/22. It was agreed that the Plan would be flexible given the COVID-19 situation.

16. The Audit Committee approved the Internal Audit Charter. The Charter confirms that Audit Yorkshire complies with Public Sector Internal Audit Standards.

External Audit

17. Members were presented with the Annual Audit Letter 2019/20. Assurance was given that a clean audit opinion and a clean Value for Money (VFM) conclusion had been

issued to the CCG. The purpose of the Annual Audit letter is to communicate the findings of the audit to external stakeholders and will be published on the CCG website.

18. The Committee was advised that the Mental Health Investment Standard compliance certificate for 2018/19 had been published and External Audit await guidance in relation to 2019/20.

Counter Fraud

19. The Committee received and considered the Annual Counter Fraud Report 2019/20 and the Counter Fraud Progress Report.

20. The annual report included the Self-Review Tool (SRT), all standards were rated Green with one exception, standard 3.1 (Evaluate the success of measures to reduce fraud) – this was rated as Amber as it is difficult to quantify.

Governance

21. The Committee received the Registers of Interests, Gifts & Hospitality and procurement decisions.

22. The Committee noted that several tender waivers have been required due to COVID-19 and were assured that all tender waivers have been approved in line with the CCG’s Procurement Policy.

23. The Audit Committee received a paper in relation to the procurement of External Audit services from 2021/22. The current contract with KPMG is due to end on 31 March 2021. The Committee discussed the benefits and limitations of a joint procurement exercise with the CCGs in Bradford, Wakefield, Greater Huddersfield and North Kirklees and approved the proposal to further develop the proposal.

Losses and Special Payments

24. Members were informed of a loss relating to IT equipment. The Committee was assured of the actions taken in relation to the loss and noted that there did not appear to be any failings on the part of employees of the CCG and the matter had been referred to the police and counter fraud.

Strategies/Policies approved  Addenda to the Mobile Working Policy and Freedom of Information Policy were approved, the addenda relate to instances of long term business interruption or service delivery change such as the one that has resulted from the COVID 19 pandemic.  The Committee recommended the updated Procurement Policy for approval by the Governing Body.  The Committee approved the updated Anti-Fraud and Corruption Policy.

4 Items of positive assurance or issues to be raised with the NHS Leeds Governing Body The Audit Committee highlighted the following:  The Procurement policy is recommended for approval by the Governing Body  High Assurance provided by the follow up audit of Confederation Governance

Any additional comments N/A

5 Agenda Item: GB 20/44 FOI Exempt: No

NHS Leeds CCG Governing Body

Date of meeting: 22 July 2020 Title: Chair’s Summary of Quality & Performance Committee Meeting held on 15 July 2020 Lead Board Member: Phil Ayres, Chair – Quality Tick as & Performance Committee & Secondary Care Category of Paper appropriate Specialist Doctor () Report Author: Sam Ramsey, Corporate Decision Governance Manager Discussion  Information Approved by Lead Board member (Y/N): Y

EXECUTIVE SUMMARY: 1. This report provides the NHS Leeds CCG Governing Body with a summary of items discussed at the Quality & Performance Committee meeting held on 15 July 2020.

RECOMMENDATION: The Governing Body is asked to: (a) RECEIVE the report.

Description of key items of business discussed 1. Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Quality & Performance Committee on 15 July 2020. Further information can be obtained by reference to the minutes of that meeting.

2. Following on from the Committee meeting on 12 May 2020, the Committee requested an update in relation to the current situation of Covid-19.

Covid-19 Update 3. The Committee was informed that LTHT were on track to complete at least 63% of average elective activity in June and expected to deliver 75% of the usual monthly elective activity by the end of the financial year.

4. There had been an increase in urgent and two week wait referrals, and following an average increase over the last four weeks referrals were now above 80% of normal levels. Members recognised the hard work from secondary care, primary care and patients across the Leeds population.

5. Routine elective activity had been suspended from 23 March 2020 in line with national guidance and members were informed that over 52 week wait breaches had significantly increased during the pandemic as only urgent and cancer patients were treated. It was noted that in June, the average number of routine wait patients were treated; however the

1 volume of patients tipping into 52 weeks was significant.

6. The Committee was given assurance that an enormous amount of hard work had gone into the restart of services, and there was a balance to be struck between reviewing waiting lists and ensuring that patients were being treated. It was noted that clinically urgent patients were being prioritised. Particular improvements had been seen in respect of providing diagnostic services (with the exception of endoscopy). There is good evidence that ‘the system’ and clinicians within it are actively triaging patients when seen.

7. An overview of the Stabilisation and Reset (StAR) group was provided to members by the StAR Chair, Dr Sarah Forbes. The purpose of the group was to ensure that there were coordinated plans for the robust reset of services. The group membership was representative of the health and social care system in Leeds and included the third sector and communications to ensure coordination across the city. There is good evidence that an emphasis on tackling inequalities has a strong focus, with a structured approach to risk assessment. Care is being taken to ‘turn on’ services in a way that does not adversely affect other services.

8. Members recognised that effective communication with patients and the public is essential, and was being coordinated by StAR and then discussed with partners across the city. The Committee was assured that Healthwatch were actively involved and reports were provided to Health & Social Care Gold Command and StAR each week. The influence of and collaboration with Healthwatch was recognised.

9. The Chair commended the level of work that was ongoing across the city and it was agreed that members were fully assured with regards to patient and public communication.

10. A further update was provided on the work in relation to the impact of the pandemic on provision of health services for non-Covid patients. Members noted that the project had considered a number of hypotheses, identified the gaps and developed recommendations. Resulting actions are being embedded within existing structures and ways of working. Emerging themes for action include digital solutions, estates, communications, person- centred care and self-care.

11. The Committee was informed that a final report would be submitted to outline the work that had been undertaken and this would be presented to the Quality & Performance Committee in November 2020 to consider the learning and how it had been embedded.

Update on Care Homes 12. Jo Harding provided the Committee with an update of the response across the city to the challenges of managing Covid-19 in the care home sector. The Committee had received a report which provided a description of the support to care homes and the learning from the first 100 days of Covid-19.

13. Members were provided with detail of the main learning points outlined within the report and recognised that there had been benefits to the care home sector, particularly in the areas of communications, responding to national guidance and the provision of training to staff. Support to care homes from primary and community services was praised and there

2 had been positive feedback from care homes in relation to the swift access to primary care.

14. Other areas of improvement included support for end of life care, bereavement support and counselling and enhancing providers’ digital capacity and capabilities. It was highlighted that care home providers/registered managers had reported a greater level of understanding and appreciation by statutory agencies of the critical service that care home staff provide.

15. The Committee acknowledged that the majority of care homes had demonstrated considerable resilience throughout the peak of the outbreak and noted that care homes were reporting on the capacity tracker.

16. A concern was raised in relation to the viability of the future of care homes because of issues related to workforce, sickness absence and estates and a potential drop in care home admissions. The Committee recognised these concerns and would receive future updates when appropriate.

17. The Chair commended the huge improvement in the care home system in Leeds and members were fully assured with the work that had been undertaken.

Integrated Quality & Performance Report (IQPR) 18. The Committee received the Integrated Quality & Performance Report and recognised the significant cross over with the update on Covid-19 and the performance data that had been discussed.

19. Members noted that the national reporting had been paused and other areas had been affected in the same way. The Committee was informed that planning guidance was delayed until the Autumn and that until this was released, the expectations and timescales for service delivery were unclear.

Providers Under Enhanced Monitoring 20. The Committee received a summary of the providers that were currently under Routine+ Monitoring, Enhanced Monitoring and Formal Action and the actions being taken as a result.

21. Members were informed that surveillance had continued pre and during Covid-19, although routine quality visits to providers had been suspended to safeguard the wellbeing of residents and staff, both in the homes and visitors to the homes. The contract and quality monitoring team had used intelligence from providers and other partners to gain assurance of quality of care in nursing homes.

22. Members agreed that they were fully assured of the process in place.

CCG Risk Register 23. The risk register was presented. Members noted that there were two additional risks aligned to the Committee, one of which was a high amber risk in relation to pausing continuing healthcare reviews and a lack of national guidance on re-starting (R726).

3 24. The Committee discussed Risk 707, System Flow and whether there was an additional risk in relation to harm to patients who would not been seen due to capacity as a result of the pandemic. It was agreed that the Risk Manager would consider this further with the Executive Lead Director.

LeDeR Progress Update 25. The Committee received an overview of the current LeDeR programme, good practice and areas for improvement identified from recent reviews. Members noted that the process, coordination and management of LeDeR reviews sat with CCGs and there was currently a backlog within Leeds due to additional deaths in the last three months as a result of Covid, and a lack of active reviewers due to staff being redeployed or having insufficient capacity to complete reviews.

26. The Committee was informed that NHS England had set a target for all reviews up to July 2020, to be cleared by 31 December 2020. Members acknowledged that this was a challenge due to capacity and the timeframe for completion of reviews. The Committee heard of the actions being undertaken, which included a task and finish group to consider plans for the backlog clearance and designing the future look of the LeDeR review process, and members agreed they had reasonable assurance.

Quality Visit Schedule Update 27. The Committee received an update on the position with regards to the number and type of quality visits completed following the submission of the proposed schedule to the Quality & Performance Committee in January 2019.

28. Members acknowledged the productive visits that had taken place and the engagement with Governing Body members’ attendance. It was recognised that the visits were valuable and complementary to the quality assurance process. Given the current circumstances, further consideration would be given to future visits and when these should recommence.

Strategies/Policies approved  CCG Incident Management Policy – additional sentence to reflect the incident reporting process.

Items of positive assurance or items for escalation to the NHS Leeds CCG Governing Body and/or Audit Committee.

Any other Comments

4 Agenda Item: GB 20/45 FOI Exempt: N

NHS Leeds CCG Governing Body

Date of meeting: 22 July 2020

Title: Integrated Quality and Performance Report Lead Governing Body Member: Tick as Helen Lewis – Interim Director of Acute and Specialised Category of Paper appropriate Commissioning () Report Author: Decision Mark Fox, Head of Operational Planning and Performance Reviewed by EMT/Date: n/a Discussion  Reviewed by Committee/Date: th Information Quality & Performance Committee, 15 July 2020 Checked by Finance (Y/N/N/A - Date): n/a Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care  5. People will live in healthy, safe and sustainable communities 

Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge 2. Failure to assure the delivery of high quality services, leading to commissioned services not  reflecting best practice and improving care 3. Failure to achieve financial stability and sustainability 4. Lack of provider and clinical support for change will impact on the development and implementation of the CCG strategy 5. Resources are not targeted effectively to areas of most need, leading to failure to improve health in the poorest areas 6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions 7. Failure to enable partners to work together to deliver the CCG commitments 8. Failure of system to be adaptable and resilient in the event of a significant event

1 EXECUTIVE SUMMARY:

This report provides an overview of current performance levels against the measures set out in the NHS Mandate and Constitution.

Following the NHS declaration of a Level 4 National Incident on 30 January due to COVID-19 and the consequential response, many of these performance measures have been adversely affected due to the requirement to follow national instruction.

The CCG has worked with providers to develop plans in response to the COVID-19 pandemic in line with the guidance issued by Public Health England (PHE) and NHSE/I in March and a programme associated with stabilising and resetting the local healthcare system is underway.

NEXT STEPS:

The key actions which will be undertaken in relation to performance are as follows:  To continue to closely monitor the commissioner and provider-led actions in relation to recovering to at least pre-covid levels of performance.

RECOMMENDATION: The Governing Body is asked to:

(a) RECEIVE AND REVIEW the IQPR dashboards; discuss the information, note the current areas of underperformance and mitigating action.

1. BACKGROUND

1.1 This report provides an overview of current performance levels against the measures set out in the NHS Mandate and Constitution.

1.2 Following the NHS declaration of a Level 4 National Incident on 30 January due to COVID- 19 and the consequential response, many of these performance measures have been adversely affected due to the requirement to follow national instruction.

3. SUMMARY OF POSITION

3.1 On 17 March 2020, NHS providers were asked to undertake a number of actions to free-up the maximum possible inpatient and critical care capacity as part of the NHS response to Covid-19.

3.2 Consequently, acute providers were asked to postpone all non-urgent elective operations from 15 April at the latest, for a period of at least three months and asked to use local discretion to wind down elective activity to free up staff for refresher training, beds for COVID patients, and theatres/recovery facilities for adaptation work. Emergency admissions, cancer treatment and other clinically urgent care should continue unaffected. Mental health, learning disability and autism providers were asked to consider their responses within inpatient settings.

3.3 The latest official performance data is published typically up until the end of April-20 and is shown in the accompanying tables to this report.

3.4 In summary, performance has deteriorated across many measures due to the requirement to undertake the necessary steps outlined by NHS England/Improvement and as further data is published representing future months, we can expect to observe further deteriorations in performance, particularly with waiting-time associated measures where patients had been referred prior to the postponement of procedures and treatments.

3.5 The CCG has worked with providers to develop plans in response to the COVID-19 pandemic in line with the guidance issued by Public Health England (PHE) and NHSE/I in March and a programme associated with stabilising and resetting the local healthcare system is underway.

3.6 A level of reasonable assurance is being recommended to the committee due to performance not being in line with nationally set targets, although the reasons for underperformance is understood and plans are in place to recover system performance.

4. NEXT STEPS

4.1 The key actions which will be undertaken in relation to performance are as follows:  To continue to closely monitor the commissioner and provider-led actions in relation to recovering to at least pre-covid levels of performance.

4. RECOMMENDATION

The Governing Body is asked to:

(a) RECEIVE AND REVIEW the IQPR dashboards; discuss the information, note the current areas of underperformance and mitigating action.

4 NHS Constitution and Operational Planning Measures Performance Measures (1 of 2)

Measure Target Data Period Current Trend

NHS Constitution - RTT

RTT - Incomplete Pathway (18 week wait compliance) 92% Apr-20 75.8%

RTT - Incomplete Pathway (number of patients waiting) 47,411 Apr-20 36,206

RTT - 52 Week Waits 0 Apr-20 72

A&E 95% National A&E Waiting Times: % 4 hours or less (LTHT - All Types of A&E) May-20 96.4% (93.3% Local) NHS Constitution 99% National Diagnostic Waiting Times Apr-20 48.5% (99.5% Local)

Cancer - 2 Week Wait 93% Apr-20 85.4%

Cancer - 2 Week Wait (Breast) 93% Apr-20 90.8%

Cancer - 31 Day First Treatment 96% Apr-20 95.2%

94% National Cancer - 31 Day Surgery Apr-20 91.4% (94.3% Local) 98% National Cancer - 31 Day Drugs Apr-20 100.0% (98.2% Local)

Cancer - 31 Day Radiotherapy 94% Apr-20 100.0%

85% National Cancer - 62 Day GP Referral Apr-20 80.9% (85.3% Local) 90% National Cancer - 62 Day Screening Apr-20 79.2% (94.4% Local) 90% National Cancer - 62 Day Upgrade Apr-20 80.2% (68.6% Local) Mental Health

Dementia - Estimated Diagnosis Rate 67% May-20 69.7%

22% National IAPT Access (12 month equivalent based on rolling 3 months) Mar-20 17.3% (19.0% Local)

IAPT Recovery Rate 50% Mar-20 50.4%

IAPT Waiting Times - 6 Weeks 75% Mar-20 35.6%

IAPT Waiting Times - 18 Weeks 95% Mar-20 99.2%

53% National EIP - Psychosis treated within two weeks of referral Mar-20 43.8% (57.1% Local) People with a severe mental illness receiving a full annual physical health check 60% 2019/20 Q4 65.2% and follow-up interventions (Rolling 12 Months)

Improve access rate to CYPMH (YTD) 32% 2018/19 29.6%

Improve access to CYPMH (Rolling 12 Months) 34% Mar-20 23.1%

Waiting Times for Routine Referrals to CYP Eating Disorder Services - Within 4 95% 2019/20 Q4 72.7% Weeks (Rolling 12 Months) Waiting Times for Urgent Referrals to CYP Eating Disorder Services - Within 1 95% 2019/20 Q4 87.5% Week (Rolling 12 Months)

IAPT Trainees 8 2019/20 Q4 n/a

Therapists co-located in primary Care 14 2019/20 Q4 n/a NHS Constitution and Operational Planning Measures Performance Measures (2 of 2)

Measure Target Period Current Trend

Primary Care Target Period Current

Proportion of the population with access to online consultations 75% 2019/20 Q4 90.6%

Extended Access Appointment Utilisation 75% Mar-20 78.6%

Learning Disability Target Period Current Reliance on Inpatient Care for People with LD or Autism - CCGs (All Length of 13 2019/20 Q4 19 Stays) Reliance on Inpatient Care for People with LD or Autism - NHSE (All Length of 11 2019/20 Q4 10 Stays) Other Commitments Number of personal health budgets that have been in place, at any point during 1,260 2019/20 Q4 2,462 the financial year

Children Waiting no more than 18 Weeks for a Wheelchair 92% 2019/20 Q3 97.6%

Annual Health Checks (AHCs) delivered by GPs for patients on the Learning 2,888 2019/20 Q3 1,531 Disability Register (YTD)

Agenda Item: GB 20/46 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 22 July 2020

Title: Finance Report for the three months ended 30th June 2020

Lead Governing Body Member: Visseh Pejhan- Tick as Category of Paper appropriate Sykes, Chief Finance Officer () Report Author: Judith Williams, Head of Corporate Reporting & Strategic Financial Decision Planning Reviewed by EMT/Date: N/A Discussion  Reviewed by Committee/Date: N/A Information  Checked by Finance (Y/N/N/A - Date): Y Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives 2. People will live full, active and independent lives 3. People’s quality of life will be improved by access to quality services 4. People will be actively involved in their health and their care 5. People will live in healthy, safe and sustainable communities

NHS Leeds CCG Strategic Commitments We will focus resources to: 1. Deliver better outcomes for people’s health and wellbeing 2. Reduce health inequalities across our city We will work with our partners and the people of Leeds to: 3. Support a greater focus on the wider determinants of health 4. Increase their confidence to manage their own health and wellbeing 5. Achieve better integrated care for the population of Leeds 6. Create the conditions for health and care needs to be addressed around local neighbourhoods

Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge 2. Failure to assure the delivery of high quality services, leading to commissioned services not reflecting best practice and improving care 3. Failure to achieve financial stability and sustainability  4. Lack of provider and clinical support for change will impact on the development and implementation of the CCG strategy 5. Resources are not targeted effectively to areas of most need, leading to failure to improve health in the poorest areas 6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions 7. Failure to enable partners to work together to deliver the CCG commitments 8. Failure of system to be adaptable and resilient in the event of a significant event

EXECUTIVE SUMMARY:

Currently, amended (reduced) allocations have only been issued for the four month period to the end of July 2020. Further guidance is awaited on the financial regime and allocations for the remainder of the financial year (August 2020 to March 2021)

Based on the current allocations the CCG is showing an overspend year to date of £1.7m, after receiving a retrospective non recurrent allocation of £2.9m in June to cover the previously reported year to date overspend of £2.9m at end of May. Covid expenditure of £5.8m, to end of June, is included within this.

The current forecast shows an overspend of £5.2m at end of July, inclusive of estimated Covid spend of £7.7m, and after the retrospective allocation for the overspend to end of May. The forecast position is based on an estimate of the impact of services starting up again as appropriate, and will continue to be revised as the situation evolves, in particular as the Any Qualified Providers work re-starts.

Key changes this month are around prescribing and Funded Nursing Care (FNC). There is an increase in the year to date prescribing spend (£1m) and the forecast (£1.7m), based on April data. The forecast assumes that there will be a decrease in future months and a stabilisation of costs based on trends in previous years. For FNC the increase relates to the one off costs of the nationally mandated backdated increase in rates relating to 2019-20 (£744k). The process around any reimbursement of this is currently unclear. Note there are also pressures around areas of ongoing spend which would normally be covered by in year non recurrent allocations (e.g. primary care extended access, mental health transforming care partnerships).

NEXT STEPS:

Updates on the 2020-21financial position will continue to be presented to the Governing Body and/or Executive Management Team (EMT) on alternate months to ensure that the CCGs’ financial position is formally reported and reviewed each month under the CCGs’ governance arrangements.

RECOMMENDATION:

The Governing Body is asked to:

(a) CONSIDER the Month 3 financial position; and (b) DISCUSS, COMMENT & HIGHLIGHT ACTIONS required to progress and report to the next meeting of the Executive Management Team

2 NHS Leeds Clinical Commissioning Group Finance Report for the Three Months ended 30th June 2020

Page 1 Financial Performance Report 30th June 2020

NHS Leeds Clinical Commissioning Group At 30th June 2020 At Year End 2020-21 RAG RAG

CCG Expenditure does not exceed planned level Programme spend less than allocation Running costs spend less than allocation Delegated Co-commissioning less than allocation Planned Surplus in year QIPP Clear identification of risks against financial delivery & mitigations Delivery of Mental Health Investment Standard (MHIS) Better Payment Practice Code - to pay 95% of valid invoices by due date or within 30 days of receipt of a valid invoice, whichever is later Cash at bank balance within 1.25% of the monthly amount requested or £250k, whichever is greater

The current temporary financial regime, as detailed below in the overview, means that most of the usual metrics are not achievable under these conditions, and so have not been RAG rated Note that the regime does require that the MHIS is still met, but how this is to be done needs to be worked through, especially in light of the nationally mandated block payments to the NHS mental health provider.

Page 2 Overview 30th June 2020

This report provides an update on the financial performance of NHS Leeds Clinical Commissioning Group for the three months to 30th June 2020, and a forecast for the four months to end of July 2020, compared to the amended allocations for this period. NHSEI have reissued CCG allocations for just the first four months of 2020-21, April to July. These are based on modelling (the "covid model") which starts from 2019-20 month 11 spend with adjustments for some growth, and other adjustments such as defunds for certain areas eg national contracting of independent sector. A defund has also been applied to running costs. In the case of Leeds CCG the issued running costs allocation are 29% less than the original published allocation on which budgets were set. The CCG continues to feedback to NHSEI around various issues in the methodology of the "covid model" and the calculation of the NHS block payments, and in particular around the inexplicable defund to running costs. For these four months programme allocations are £12m less than the equivalent pro-ratad original published allocations, and the defund to end of July for running costs is £1.5m

The CCG has uploaded budgets for the 4 months to end of July 2020, as per the national covid model, which gives an amount by area for NHS and Non NHS spend. As there is not a meaningful basis for splitting these budgets down further within areas, the budgets are shown just on these 2 lines for each area. The exception being for known staffing budgets. These are set in specific areas within programme where the posts are agreed as part of staffing budgets, and taken out of the Non NHS spend line for that area. Running costs budgets have been uploaded as originally set and agreed, based upon published allocations and with a negative budget set to match the current reduced allocation.

NHS spend is based upon the nationally mandated block payments, which NHSEI have calculated based upon a 2019-20 national exercise at month 9. So there is a mismatch between NHS block payments and NHS budgets from the covid model. Furthermore in some cases the payment to a provider may straddle a number of areas. For example funding paid to Leeds Community Healthcare would previously have included an element for Improving access to psychological therapies (which would come under the mental health area) and for transformation work such as the virtual frailty ward (which would have been shown in the "other" section). However without an agreed detailed contract it is not reasonable to allocate spend across these areas and so the whole of the payment to LCH is attributed to community as this is the largest element of the spend. And the guidance also stated " We recommend each block payment is coded to one cost centre and subjective, we do not recommend multiple coding of block payments". But this does mean that NHS spend on community, based on the block payments, does not match the NHS community budget modelled by NHSEI, and nor is it on a comparable basis to spend in 2019-20 or plans for 2020-21.

Note that the majority of the acute independent sector is currently being managed and funded centrally by NHSEI, and so there is no spend in the CCG books for such as Nuffield. However the CCG has been through a process to identify strategic specialties within Any Qualified Providers and spend has been forecast against this where activity is due to re-commence. This is an evolving situation.

The current forecast shows an overspend of £5.2m at end of July, inclusive of covid spend, and after the retrospective allocation for the overspend to end of May. The forecast position is based on an estimate of the impact of services starting up again as appropriate, and will continue to be revised as the situation evolves, in particular as the Any Qualified Providers work re-starts.

There is £5.8m of spend relating to covid within the year to date position (£1.8m of this within month). And £7.7m is forecast to the end of July. This is the best estimate of ongoing costs including support to various sectors such as primary care, care homes, Any Qualified Providers etc, and assumes a worst case scenario of no national procurement for personal protective equipment.

The CCG has shown an indicative non recurrent allocation of to cover the reported year to date overspend of £1.7m, and enable reporting of a breakeven position. There is no guarantee that the CCG will receive this. the process around how spend will be validated nationally and whether there will be further retrospective allocations is unclear. Clearly there is a lot of risk around this.

Key changes this month are around prescribing and Funded Nursing Care (FNC). There is an increase in the year to date prescribing spend (£1m) and the forecast (£1.7m), based on April data. The forecast assumes that there will be a decrease in future months and a stablisation of costs based on trends in previous years. For FNC the increase relates to the one off costs of the nationally mandated backdated increase in rates relating to 2019-20 (£744k). The process around any reimbursement of this is currently unclear. Note there are also pressures around areas of ongoing spend which would normally be covered by in year non recurrent allocations (eg primary care extended access, mental health transforming care partnerships).

Further guidance is awaited on the financial regime and allocations for the remainder of the financial year (August 2020 to March 2021)

Page 3 Financial Position Summary 30th June 2020 Year to date as at 30th June 2020

Year To Date NHS Leeds Clinical Commissioning Group MEMO

Revenue Expenditure 2020-21 Budget Actual Variance Covid 19 spend included in actual Year to date as at 30th June 2020 £'000 £'000 £'000 £'000 Programme Services Acute Services 155,831 152,935 -2,895 504 Mental Health Services 40,023 40,226 203 900 Community Health Services including Childrens Services 36,360 39,008 2,648 272 Continuing Care Services 13,999 17,408 3,409 2,058 Prescribing and Primary Care Services 38,945 42,122 3,177 1,926 Primary Care Co-Commissioning 30,622 31,162 541 0 Other 3,915 701 -3,214 82

Total Programme Services 319,694 323,562 3,868 5,743

RUNNING COSTS 2,723 3,066 343 25 Retrospective allocation to end May (running costs) 267 -267

RESERVES 0 365 365 0 Retrospective allocation to end May (programme) 2,596 0 -2,596

CCG Net Expenditure 325,280 326,993 1,713 5,768

Assumed further retrospective allocation for June 1,713 -1,713

CCG break even position 326,993 326,993 0

Page 4 Financial Position Summary 30th June 2020 Forecast - to end of July 2020 NHS Leeds Clinical Commissioning Group 4 months to end of July 2020 VARIANCE Movement from 4 mths 19-20 Revenue Expenditure 2020-21 Forecast to end of Forecast to end of May forecast to to forecast at 2019-20 spend Budget July as at June Variance July as at May end of July end of July pro ratad as 4 Forecast - to end of July 2020 £'000 £'000 £'000 £'000 £'000 months £'000 Programme Services Acute Services 207,774 206,437 -1,337 206,439 -2 219,855 -13,418 Mental Health Services 53,364 54,274 910 53,975 298 53,490 784 Community Health Services including Childrens Services 48,480 52,026 3,546 52,187 -161 49,013 3,013 Continuing Care Services 18,665 22,100 3,435 21,275 825 19,064 3,036 Prescribing and Primary Care Services 51,927 56,099 4,172 54,116 1,983 51,413 4,686 Primary Care Co-Commissioning 40,829 41,538 709 40,829 709 39,415 2,123 Other 5,220 929 -4,291 901 28 1,636 -707

Total Programme Services 426,259 433,403 7,144 429,723 3,680 433,885 -482

RUNNING COSTS 3,631 4,076 445 4,265 -189 4,459 -383 Retrospective allocation to end May (running costs) 267 0 -267 0

RESERVES 0 476 476 509 -33 393 83 Retrospective allocation to end May (programme) 2,596 0 -2,596 0

CCG Net Expenditure 432,753 437,956 5,203 434,497 3,458 438,736 -781

Assumed central non recurrent allocation adjustment 0

CCG break even position 432,753 437,956 5,203

Page 5 Allocations 30th June 2020

NHS Leeds Clinical Commissioning Group 4 MONTH Programme Running Costs Co-commissioning ALLOCATION TO Allocations 2020-21 END JULY 2020 £'000 £'000 £'000 £'000 Opening Baseline Allocation to July 2020 385,430 3,631 40,829 429,890 Subtotal Month 3 Adjustments 2,596 267 0 2,863 Closing Allocation 388,026 3,898 40,829 432,753

MEMO: 4/12 of original published allocations 397,847 5,127 40,634 443,608 Variance -9,821 -1,229 195 -10,855

Month 03 allocations Non recurrent allocations received in month are: £2,863k - Retrospective adjustment agreed to cover overspend at end May 20, the CCG has split this between programme and admin

Page 6 Acute Services 30th June 2020

Year To Date 4 months to end of July 2020 NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Leeds Teaching Hospitals NHS Trust (LTHT) 0 120,337 120,337 0 160,449 160,449 Mid Yorkshire NHS Trust 0 7,280 7,280 0 9,707 9,707 Harrogate Foundation Trust 0 7,575 7,575 0 10,099 10,099 Bradford Foundation Trust 0 1,447 1,447 0 1,929 1,929 York Foundation Trust 0 624 624 0 832 832 Other NHS Trusts 0 848 848 0 1,118 1,118 Non contract Activity (NCAs) 0 595 595 0 793 793 Non NHS Acute 0 1,246 1,246 0 4,131 4,131 Unplanned Care 0 12,984 12,984 0 17,379 17,379 Acute Services: NHS Trusts & FTs budget per covid model 148,773 0 -148,773 198,364 0 -198,364 Acute Services: Other Providers budget per covid model 7,058 0 -7,058 9,410 0 -9,410 Total Acute Services 155,831 152,935 -2,895 207,774 206,437 -1,337

The Acute and YAS, (999,PTS,111) budget has been set as per the covid model and NHSE requirements. The forecast for these contract continues to be based upon central block payments including NCA block payments made to NHS providers. The Planned Care (Non NHS Acute) forecast includes the expected Any Qualified Provider activity where strategic specialties have been determined and activity has re-commenced, this includes ENT, Gastro, Dermatology, Ophthalmology services plus independent sector forecasts for Marie Stopes and BPAS. The majority of independent sector contracts continue to be managed and funded nationally by NHSE (Spire, Nuffield, BMI and Yorkshire Clinic). As a consequence the CCG is pursuing £788k of income from Independent Sector providers relating to 19/20 Q4 reconciliation’s. This income would ordinarily have been reconciled with Q1 payments. This is an evolving situation and forecast will be reviewed on an ongoing basis. In Urgent Care, the forecast is based largely upon West Yorkshire Urgent Care out of hours and MIU/UTC, and non NHS NCAs. NHS NCAs recharges are included within the block payment being received by NHS Providers and are not currently being charged to CCGs. Low value non-NHS NCAs continue to be received.

Page 7 Mental Health Services 30th June 2020

Year To Date 4 months to end of July 2020 NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Leeds and York Partnership Foundation Trust (LYPFT) 0 27,704 27,704 0 36,939 36,939 Tees Esk and Wear Valley NHS Foundation Trust (TEWV) 0 335 335 0 447 447 South West Yorkshire Partnership Foundation Trust 0 325 325 0 434 434 Bradford District Care NHS Foundation Trust 0 50 50 0 67 67 Mental Health NHS budget 0 0 0 0 0 0 Independent/Voluntary Sector/LCC/Other NHS 0 2,065 2,065 0 3,017 3,017 Learning Disabilities 17 7,531 7,514 22 10,044 10,022 Improving Access to Psychological Therapies (IAPT) 0 67 67 0 89 89 Mental Health Specialist Services 0 2,062 2,062 0 3,069 3,069 Mental Health Non Contract Activity (NCA) 0 69 69 0 139 139 Mental Health Other 13 16 3 17 30 13 Mental Health Services: NHS Trusts & FTs budget per covid model 28,919 0 -28,919 38,559 0 -38,559 Mental Health Services: Other Providers budget per covid model 11,074 0 -11,074 14,765 0 -14,765 Total Mental Health Services 40,023 40,226 203 53,364 54,274 910

Mental Health Services: The Mental Health forecast for the 4 month period April – July has increased by £298k. £89k of this is on IAPT as we are now forecasting expenditure on the IAPT Employment Advisors which is usually paid from NHSE pass through money. Remaining £198k increase is on specialist high cost patients for 2 additional patients.

Mental Health NHS contracts: Payments are in line with the NHS England invoice block schedule. Independent/Voluntary Sector/LCC/Other NHS: Payments are based on agreed contracts for 2020-21 Learning Disabilities: LD forecast is based on the previous years final outturn with an estimate for some increases, as it is a demand led service. IAPT: Due to Covid19, spend for this service is included within the LCH block payment, in the community section. Mental Health Specialist Services (which includes the Transforming Care Partnership (TCP), and elective funding, and Section 117): Forecast is based on activity to date, there have been 21 new cases added in May. These cases are often high cost, and previously would have received an allocation from NHSEI, but have not assumed this offset as position is currently unclear.

Mental Health NCAs: Expenditure relates to one NHS nationally mandated block contract payment and a small amount of non NHS providers. There is currently no NHS invoicing outside of block payments. Mental Health Other: Budget set relates to staff costs. Forecast includes collaborative fee payments to GPs for mental health assessments, and some TCP spend that has historically been reimbursed by NHSEI but have not assumed this income for now as position is unclear.

Page 8 Community Health Services 30th June 2020

Year To Date 4 months to end of July 2020 NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Leeds Community Healthcare NHS Trust (LCH) 0 28,874 28,874 0 38,499 38,499 Community Reserves 0 0 0 0 0 0 Voluntary Sector/Local Authority (LA) 0 4,946 4,946 0 6,672 6,672 Community Beds 0 2,011 2,011 0 2,692 2,692 Hospices 0 1,484 1,484 0 1,974 1,974 Reablement 0 957 957 0 1,191 1,191 Safeguarding 205 189 -16 273 252 -21 Community Health Services: NHS Trusts & FTs budget per covid model 26,633 0 -26,633 35,510 0 -35,510 Community Health Services: Other Providers budget per covid model 9,523 0 -9,523 12,697 0 -12,697 Sub Total Community Health Services 36,360 38,462 2,102 48,480 51,279 2,799 Children's Services excluding Continuing Care 0 546 546 0 747 747 Total Community Health Services including Childrens 36,360 39,008 2,648 48,480 52,026 3,546

Community Health Services : The forecast for the 4 month period April – July has reduced by £172k, with most of the change on voluntary sector, due to a reduction in the Equipment store forecast after agreement of the annual charge from LCC. LCH : The LCH payments are in line NHS England invoice block schedule and includes spend on IAPT and community beds. Voluntary Sector/LA : Payments are standard agreed values based on agreed 20/21 contracts Community Beds : Payments are based on agreed contracts with the non NHS sector, and the NHS element will be within the block payment to LCH above. Hospices : Payments are based on agreed contracts Reablement : Spend is the recurrent agreed value with LCC for the service, plus Covid expenditure. Safeguarding : Budget relates to staffing. Underspend is due to a vacancy and because the recharges from LTHT in respect of a designated GP role will be inherent within the block payment shown in the acute section.

Page 9 Continuing Care Services 30th June 2020

Year To Date 4 months to end of July 2020 NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Continuing Healthcare (CHC) 0 9,195 9,195 0 12,130 12,130 Continuing Healthcare Personal Health Budgets (PHBs) 0 4,047 4,047 0 4,976 4,976 Funded Nursing Care (FNC) 0 2,445 2,445 0 3,036 3,036 Children Continuing Care including PHBs 0 291 291 0 391 391 Continuing Healthcare - operational 632 656 24 842 878 36 Neuro-rehab 0 773 773 0 688 688 Continuing Care Services: NHS Trusts & FTs budget per covid model 56 0 -56 75 0 -75 Continuing Care Services: Other Providers budget per covid model 13,311 0 -13,311 17,748 0 -17,748 Total Continuing Care Services 13,999 17,408 3,409 18,665 22,100 3,435

Continuing Care Services: overall forecast for this area for the 4 month period of April – July has increased by £825k in June. The Covid expenditure included in CHC forecast is £2,058k made up of £37k overtime payments, £825k paid to LCC for the Hospital Discharge Programme, £600k paid to LCC for PPE, and £598k for Covid CHC packages.

Continuing Healthcare (CHC): increase in forecast of £435k all attributable to covid costs. There has been an increase in the number of discharges on to CHC packages, and there is a backlog building up as normal processes and procedures have been paused and so patients are staying on CHC packages.

Funded Nursing Care: From 1st April 2020 the rate for FNC increased 11% from £165.56 p/w to £183.92 p/w, the impact of this in 2020-21 to date has been tempered by an increase in the number of deaths. An increase in the FNC rate of 9% was applied retrospectively to 1st April 2019. This has now been paid out in arrears, and is £774k within the figures above. It is unclear what the process is around this element and any potential reimbursement. Children Continuing Care including PHBs: Expenditure includes payment to LCC for the health element of out of area placements, but excludes payments to Leeds Community Health which are included in the Community section above Continuing Healthcare - operational: Staffing is reporting a small overspend at the end of the 4 month initial reporting period as there are additional staff costs due to the Covid situation. Neuro Rehab: 10 patients have been discharged which has led to a reduction in the 4 month forecast of £283k

Page 10 Prescribing and Primary Care Services 30th June 2020

Year To Date 4 months to end of July 2020 NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Prescribing (budget as per covid model) 31,003 32,272 1,270 41,337 43,030 1,693 Ex centrally funded drugs 0 892 892 0 1,148 1,148 Oxygen contract 0 250 250 0 432 432 Primary Care Schemes 27 6,978 6,951 35 9,197 9,162 Clinical Leads 159 128 -31 212 170 -42 Primary Care - GP Information Technology (GP IT) 120 730 610 160 927 767 Out Of Hours 0 23 23 0 41 41 Medicines Optimisation NHSE Non Recurring Funded Projects 98 57 -41 131 100 -30 Primary Care Services: NHS Trusts & FTs budget per covid model 187 0 -187 249 0 -249 Primary Care Services: Other Providers budget per covid model 6,668 0 -6,668 8,890 0 -8,890 Sub Total Prescribing and Primary Care Services 38,261 41,330 3,069 51,014 55,045 4,031 Prescribing Staff 432 385 -48 577 522 -55 Primary Care Staff 199 218 19 265 292 27 Confederation Staff and Delivery Costs 53 189 136 71 240 169 Sub Total GP Confederation 684 792 108 912 1,054 142 Total Prescribing & Primary Care Services 38,945 42,122 3,177 51,927 56,099 4,172

Prescribing (inc centrally funded drugs and out of hours): April 2020 data has now been received. Early indications show an increase in costs compared to April 19, with an increase of £1m. The Prescribing forecast to end Jul 20 is currently showing an expected overtrade position of £1.7M which is a £1.5m overspend against the budget and adverse impacts in relation to final 19/20 expenditure. The forecast assumes there will be a decrease in spend and a stabilisation of costs in-line with previous years once we receive the May to July data. Home Oxygen includes a year-end benefit and expenditure in relation to Covid 19. Primary Care: Forecast spend is anticipated to be in line with original plans, but with additional expenditure relating to Covid 19, and the impact of spend which would usually be offset by non recurrent allocations. GP IT: Full allocation for GPIT has not been provided at present, with only budget shown for staff costs. The overspend relates to business as usual spend on equipment and services, the budget for which will be iwhtin the other providers line. Note that spend tends to be backloaded so the overspend is expected to be higher at year end.

Staffing: Prescribing staffing underspends relates to vacancies. Primary Care Staff overspend relates to additional Covid 19 Costs

GP Confederation: Budget set for embedded staff costs only. Forecast includes delivery costs which were planned to be funded from transformation pot.

Page 11 Primary Care Co-Commissioning 30th June 2020

Year To Date 4 months to end of July 2020 NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 GMS 7,498 8,235 737 9,997 10,982 985 PMS 13,284 12,634 -650 17,712 16,845 -867 APMS 1,780 2,647 866 2,374 3,515 1,141 Premises cost reimbursements 3,928 3,843 -85 5,237 5,124 -113 Other premises costs 234 209 -25 312 278 -34 Enhanced Services 713 645 -68 951 860 -90 QOF 2,606 2,614 9 3,475 3,486 11 Other GP Services(inc PCO) 579 336 -243 772 448 -324 Reserves 0 0 0 0 0 0 Total Primary Care Co-Commissioning 30,622 31,162 541 40,829 41,538 709

Co-Commissioning expenditure is expected to remain in-line with the original pre Covid planned expenditure. This would have included transferring £1.8m budget from primary care budgets to cover the equitable funding scheme as in previous years. The current forecast overspend to end of July is due to this transfer not happening (4 month effect) and because spend is included that would be expected to be offset by non recurrent allocations.

Page 12 Other Services 30th June 2020

Year To Date 4 months to end of July 2020 NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Sustainability and transformation programmes 73 121 48 97 166 68 System wide support and workforce 24 521 497 32 689 657 Cancer Projects 0 0 0 0 0 0 Programme Staff - Transforming care/out of area 40 45 5 53 59 6 Programme Staff - Nursing and Quality 40 14 -26 53 15 -38 Other Services: NHS Trusts & FTs budget per covid model 2,219 0 -2,219 2,958 0 -2,958 Other Services: Other Providers budget per covid model 1,520 0 -1,520 2,027 0 -2,027 Total Other Services 3,915 701 -3,214 5,220 929 -4,291

Budgets on specific lines relate to staffing items Annual budget for transformation would have been £5m as per original plan. The majority of this would have been funding for the virtual frailty ward, led by Leeds Community Healthcare (LCH) Conversations are being held with providers to understand what they are claiming through the top up regime for trusts, and it is understood that LCH is claiming the funding for the virtual frailty ward through this route at present

Page 13 Running Costs 30th June 2020

Year To Date 4 months to end of July 2020 NHS Leeds Clinical Commissioning Group Budget Actual Variance Budget Forecast Variance £'000 £'000 £'000 £'000 £'000 £'000 Pay, set on establishment, as per original allocation 2,507 2,375 -132 3,343 3,157 -186 Non Pay/Income, set as per original allocation 1,338 691 -647 1,784 919 -865 Defund/negative budget to match covid model -855 0 855 -1,229 0 1,229 Total Running Costs (incl retrospective allocation) 2,990 3,066 76 3,898 4,076 178

NHS England provided additional allocation of £267k to cover the overspend at month 2 (against the reduced Apr to Jul running costs allocation). Month 3 year to date variance represents the overspend for Jun against the original reduced allocation. Current vacancies and an underspend on non pay would have shown a significant underspend against pre Covid 19 original NHS England notified budget allocation.

Page 14 Consolidated Statement of Financial Position 30th June 2020 31st March 30th June 2020 2020 £'000 £'000 Current Assets Trade & Other Receivables 76,866 7,882 Cash & Cash Equivalents 0 315 Total Current Assets 76,866 8,197

Total Assets 76,866 8,197

Current Liabilities Trade & Other Payables: (42,159) (58,903) Borrowings (61) 0 Provisions (364) (538) Total Current Liabilities (42,584) (59,441)

Total Assets less Current Liabilities 34,282 (51,244)

Non-current Liabilities Provisions (6,001) (5,650) Total Non-current Liabilities (6,001) (5,650)

Total Assets Employed 28,281 (56,894)

Financed by Taxpayers’ Equity General Fund 28,281 (56,894) Total Taxpayers’ Equity 28,281 (56,894)

The significant movement of total assets employed is due to the nationally mandated NHS block payments paid in advance from April onwards (£68.9m per month) to keep cash moving around the system and ensure finance was not a blocker during the Covid 19 pandemic. The prepayment of these block payments, as they relate to a future period, leads to a reduction in outstanding payables and accruals

Page 15

Agenda Item: GB 20/47 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 22 July 2020

Title: 2020-21 Operational Financial Planning and Annual Budgets Update

Reviewed by Committee/Date: N/A Information

Checked by Finance (Y/N/N/A - Date): Y Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives 2. People will live full, active and independent lives 3. People’s quality of life will be improved by access to quality services 4. People will be actively involved in their health and their care 5. People will live in healthy, safe and sustainable communities

Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge 2. Failure to assure the delivery of high quality services, leading to commissioned services not reflecting best practice and improving care 3. Failure to achieve financial stability and sustainability  4. Lack of provider and clinical support for change will impact on the development and implementation of the CCG strategy 5. Resources are not targeted effectively to areas of most need, leading to failure to improve  health in the poorest areas 6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions 7. Failure to enable partners to work together to deliver the CCG commitments 8. Failure of system to be adaptable and resilient in the event of a significant event

EXECUTIVE SUMMARY:

The Covid pandemic has had a major impact on the financial regime for NHS bodies.

CCG financial plans originally submitted as part of the NHS national planning process on 5th March and reviewed by the Governing Body on the 25th March no longer apply. (Original Allocation of £1.3308 bn.)

Both CCG allocations and spending requirements have changed significantly as a result of the Covid pandemic and resulting changes to the NHS Finance regime nationally.

The CCG has only been informed of revised revenue allocations covering the first 4 months (April to July) of the 2020-21 financial year. The allocation levels for months 5-12 will be set in conjunction with the new planning guidance refresh for 2020-21.

Guidance on the national financial plan refresh, together with confirmation of annual revenue allocations and revised control totals, is expectedly imminently from NHSE/I.

In anticipation of this and for operational continuity reasons, the CCG has conducted a review of 2020-21 spending requirements, taking into account slippage in activity during the lockdown, the need to address waiting lists during the stabilisation and reset of capacity/demand post the initial phase of managing the Covid crisis, the likely future activity levels while restrictions are in place to deliver care safely, the increased costs of infection prevention control measures across the NHS and our continuing focus on meeting our strategic aims to make progress on the health inequalities agenda. Many services have continued to deliver care and some have the ability to increase capacity further to meet unforeseen demand (e.g. Mental Health Sector). The CCG’s current assumptions in setting our forecast position are that we will continue to maximise our safe service delivery across Leeds and for our population. We will endeavour to remain within our original allocation levels in the first instance but if our Covid related costs continue to rise to levels where the CCG is likely to breach its original allocation levels for 2020-21, we will review our position at future Governing Body meetings.

This refresh exercise by the CCG has highlighted a potential financial shortfall on our revised and reduced anticipated full year allocations of circa £14.3m. In deriving this forecast, we have assumed that the CCG will be fully reimbursed for full year Covid related expenditure, forecast to be £25.2m. In addition we are working on the basis that prioritised NHS commissioning intentions, which our review has confirmed can still proceed, despite the Covid related changes in capacity, will do. We have therefore assumed that associated costs will be recovered via the provider national Covid ‘top-up’ mechanism for the full year. Currently the top ups for commissioning changes in NHS Providers are channelled directly via the centre to NHS Providers, but the CCG has included the costs of commissioning developments in 2020-21 with non-NHS Providers within its own projections. If the centre does not support Provider top-up costs of these developments in the impending planning guidance, there will be a further financial risk to the Leeds system. This equates to £21.3m.

Therefore the maximum risk exposure at this stage for the CCG over and above anticipated allocations is £60.8m.

NEXT STEPS:

The plan will continue to be refined as more information and guidance becomes available. Further planning guidance is expected within the next month.

We will continue to report our projections against plan to the Governing Body, including any requests for support from Executives for any formal representations that the Leeds system may wish to make during the Covid era in support of its statutory duties to continue to treat patients safely, to continue to pursue its ambitions to reduce health inequalities as a priority, and to ensure that we retain control and a clear trajectory for addressing waiting times for patients. This includes harnessing new and innovative ways to see and treat patients in the Covid and post Covid eras.

RECOMMENDATION:

The Governing Body is asked to:

(a) Note the current position with the CCG financial plan for 2020-21; (b) Note potential exposure to an anticipated financial risk (deficit) of up to c£60m; and (c) Discuss and recommend how the CCG should proceed with balancing its statutory duties to provide care for the population of Leeds, progress with our health inequalities agenda, and continue with service developments that have already commenced prior to Covid, in light of the changing financial position and uncertainties around the finance regime in 2020-21 while we still await planning guidance for 2020-21, 4 months into the financial year.

1. SUMMARY

1.1 The Covid pandemic has had a major impact on the financial regime for NHS bodies. Currently NHSE/I has only issued allocations to CCGs for the first four months of 2020-21, and these are very different to the original published allocations. Payments to NHS providers are based on nationally mandated block figures for this period, which are also substantially different to the contract values the CCG was negotiating. 1.2 The CCG had submitted an initial operational plan to NHSE/I in early March, and expected to submit a final plan at the end of April. But the planning process was paused by NHSE/I on 17 March 2020 due to the impact of Covid. 1.3 New national guidance is expected imminently around planning assumptions to be used for the remainder of 2020-21. 1.4 The CCG has worked through a local refresh of the 2020-21 plan based on a set of assumptions at this point in time. Forecast spend for the full year before Covid is £1,303.9m, plus estimate for full year spend for Covid of £25.2m, which gives a total of £1,329.1m for the year. £m

Original published allocation for 2020-21 1,330.8

Current issued allocations under covid regime projected to full year effect 1,289.7 Variance to original published allocations -41.1

Proposed spend under local refresh for 2020-21, excluding covid costs 1,303.9 Variance to original published allocations (excluding covid costs) -26.9 Variance to current full year effect allocations (derived gap excluding covid costs) 14.3

Risks Derived current gap excluding covid costs 14.3 NHS commissioning intentions etc 21.3 (currently assumed to be claimed back by providers via top up route) Estimated full year effect covid spend, additional to above 25.2 Assumed maximum exposure on current assumptions 60.8 1.5 A summary of proposed high level budgets which make up the total of £1,329.1m is attached at Appendix A, and a bridge to the original plan at Appendix B, and the assumptions at Appendix C. 1.6 The CCG has received an additional non recurrent retrospective allocation of £2.9m in June (month 3). This is to cover the reported overspend up to end of May and produce a breakeven position for the CCG at that point. 1.7 Note that the covid spend within the year to date position was £4m, but was offset by other underspends. And it is the overall overspend of £2.9m that is effectively reimbursed, not the full amount of the covid spend. The position on further allocations is unclear.

1.8 In the absence of allocations or guidance for the period from the end of July, the refreshed plan can only be based on the best information at a point in time and give an indication of the financial position. And as such will encompass a wide range of risks. 1.9 The Governing Body is asked to acknowledge and comment on the likelihood that the CCG spend on running cost will exceed the current reduced allocations. The CCG has ongoing contractual commitments in respect of staffing costs and infrastructure costs such as rent, IT support costs, etc. These costs exceed the current allocations (which equate to a full year defund of £4.5m), but are less than the original published allocation (underspend of £2.1m).The forecast spend/plan is based on staff in post and agreed contracts and so there is limited potential for reducing this spend further. This has been fed back to NHSE/I but there has been no response as yet. £'000

Original published allocation for running costs for 2020-21 15,380

Current issued allocations under covid regime projected to full year effect 10,893 Variance to original published allocations -4,487

Proposed spend under local refresh for 2020-21, excluding covid costs 13,280 Variance to original published allocations (excluding covid costs) -2,100 Variance to current full year effect allocations (derived gap excluding covid costs) 2,387

MEMO: covid costs within running costs 26 1.10 The Governing Body is asked to note the current overall position, recognising the inherent risks due to the uncertainty of the situation, and potential exposure to an anticipated financial risk of c£60m. 1.11 Specifically, the Governing Body is asked to recommend how the CCG should proceed with balancing its statutory duties to provide care for the population of Leeds, progress with our health inequalities agenda, and continue with service developments that have already commenced prior to Covid, in the light of the changing financial position and uncertainties around the finance regime in 2020-21 while we still await planning guidance for 2020-21, 4 months into the financial year.

2. BACKGROUND

2.1 The CCG submitted an initial operational plan to NHSE/I on 5 March in line with the national timetable, and based on forecast position as at December 2019. This was reviewed by Governing Body on 25 March 2020. 2.2 Contract negotiations were ongoing, and there would have been continued refinements of the plan until the final submission on 29 April 2020. High level budgets would have been produced from this.

2.3 The operational planning process for 2020-21 was paused by NHSE/I on 17 March due to the impact of the Covid virus. All contract negotiations for 2020-21 have been suspended and Providers receive funding similar to 2019-20 levels from CCGs and are then “topped up” by the centre for 2020-21 inflation and any additional costs incurred during Covid. 2.4 A new temporary financial regime was brought in and details of this were shared with the Governing Body in the paper “Financial Update Covering National Requirements and Arrangements for the COVID 19 Period” on 20 May 2020. 2.5 CCG allocations were issued, based on national modelling, for the first four months of 2020-21. The split of these across budgetary areas was nationally mandated. 2.6 The CCG has now refreshed the original plans with a starting point of the position at Month 2 (end of May 2020). 2.7 Commissioners reviewed the original cost pressures, pre-commitments and commissioning intentions and identified which were still relevant and achievable in light of capacity requirements impacted by Covid. 2.8 Intentions regarding NHS spend were included within the review and will be used for cross referencing with the top ups requested by providers from NHSE/I, but are not included within the plan as payments cannot be made to NHS trusts outside the mandated block payments. A virtual contract value for 2020/21 will be kept up-to-date with each NHS Provider to ensure there are no duplications or gaps in our assumptions. This will also provide us with an up-to-date starting point for 2021-22 negotiations. 2.9 Assumptions are included at Appendix C. 2.10 Prior to the Covid pandemic and resulting financial regime changes, the CCG had a balanced plan with improving trajectories against a number of key metrics that reflect improving levels of care to the population of Leeds. While the pandemic and lockdown processes have by necessity reduced access to healthcare services, there are many areas where services have adapted to continue and also many service developments that were in train at the time that have also adapted and will continue on their trajectory over the course of 2020-21. 2.11 The revised allocation process has been a very blunt process. Its original intention was to remove focus from finances and allow the NHS to simply deal with the pandemic in the first 4 months of the year. Contracting rounds were halted and Providers were simply paid based on 2019-20 contracts from CCG budgets, with central top-ups added to cover developments, inflation and Covid costs in those first months. CCGs have also been “topped up” for Covid costs in the initial phase of the financial regime for 2020-21. 2.12 However, in planning for months 5-12, the initial indications on how the remainder of the year is likely to work will potentially carry huge risks for all NHS organisations. 2.13 The CCG has a statutory duty to continue to treat patients and to reduce health inequalities. We are therefore recommending that we continue to work hard to maximise our ability to treat patients safely across all settings and to ensure that we restart strongly so that we do not end the financial year with an unacceptable and preventable number of people waiting more than 12 months for treatment.

2.14 We should aim to also contain our costs within what we feel is a reasonable balance between our statutory financial duties and our quality of care. In the absence of any concrete planning information, we propose to work to our original allocation and reject the current indicative reductions on the basis of our revised delivery plan. 2.15 It is worth noting the risks associated with our approach and also to note that our Providers collectively have also declared risks in excess of £75m between them. 2.16 These risks exclude the levels of support that non-NHS Providers such as Hospices and the third sector may need from the Government to remain solvent. 2.17 Leeds City Council has also indicated financial risks of circa £190m. 2.18 Finally, we have concerns that any allocations reductions in 2020-21 may set the basis for future allocation reductions in Leeds.

3. PROPOSAL

3.1 The Governing Body is asked to note the current position, recognising the inherent risks due to the uncertainty of the situation, and potential exposure to an anticipated financial risk of c£60m for Leeds CCG and in the context of further risks across the wider Leeds NHS organisations, non-NHS Providers and Leeds City Council. The Governing Body is also asked to discuss and recommend how the CCG should proceed with balancing its statutory duties to provide care for the population of Leeds, progress with our health inequalities agenda, and continue with service developments that have already commenced prior to Covid, in light of the changing financial position and uncertainties around the finance regime in 2020-21 while we still await planning guidance for 2020-21, 4 months into the financial year.

4. NEXT STEPS

4.1 The plan will continue to be refined as more information and guidance becomes available. Further planning guidance is expected within the next month. 4.2 We will continue to report our projections against plan to the Governing Body, including any requests for support from Executives for any formal representations that the Leeds system may wish to make during the Covid era in support of its statutory duties to continue to treat patients safely, to continue to pursue its ambitions to reduce health inequalities as a priority, and to ensure that we retain control and a clear trajectory for addressing waiting times for patients. This includes harnessing new and innovative ways to see and treat patients in the Covid and post Covid eras.

5. STATUTORY/LEGAL/REGULATORY/CONTRACTUAL

5.1 No full year allocations at this point, or guidance, so unable to agree budgets or a plan. But need to agree direction and acknowledge the risks.

6. FINANCIAL IMPLICATIONS AND RISK

6.1 There is much inherent uncertainty in the current situation, and the plan contains a lot of assumptions (Appendix C) and carries a potential financial risk of up to c£60m as per the table in the summary.

7. RECOMMENDATION The Governing Body is asked to: (a) Note the current position with the CCG financial plan for 2020-21; (b) Note potential exposure to an anticipated financial risk (deficit) of up to c£60m; and (c) Discuss and recommend how the CCG should proceed with balancing its statutory duties to provide care for the population of Leeds, progress with our health inequalities agenda, and continue with service developments that have already commenced prior to Covid, in the light of the changing financial position and uncertainties around the finance regime in 2020-21 while we still await planning guidance for 2020-21, 4 months into the financial year.

Appendix A 2020-21 2020-21 2020-21 2020-21 2020-21 2020-21 2020-21

Variance revised plan excl NHS Leeds CCG 2020-21 High Total MEMO: Budget excl Initial plan covid to Level Budgets NHS NON NHS Budget COVID costs COVID submission initial plan £'000 £'000 £'000 £'000 £'000 £'000 £'000 Programme Services Acute Services 597,533 43,055 640,588 11,988 628,600 631,610 -3,010 Mental Health Services 114,066 49,834 163,900 1,812 162,088 166,953 -4,865 Community Health Services 115,497 37,341 152,838 189 152,649 142,363 10,286 Continuing Care Services 59,594 59,594 4,713 54,881 55,192 -311 Prescribing 130,395 130,395 5 130,390 128,051 2,338 Primary Care Services 33,923 33,923 6,053 27,869 26,143 1,727 Primary Care Co-Commissioning 123,902 123,902 0 123,902 123,707 195 Other 10,727 10,727 439 10,287 19,076 -8,789

Total Programme Services 827,095 488,771 1,315,866 25,201 1,290,666 1,293,095 -2,429

RUNNING COSTS 13,305 13,305 26 13,280 15,380 -2,100

RESERVES 0 0 0 15,677 -15,677

CONTINGENCY 0 0 0 6,654 -6,654

CCG Net Expenditure 827,095 502,076 1,329,172 25,226 1,303,945 1,330,805 -26,860

Current Allocations projected to full year effect: Programme 1,278,777 Running Costs 10,893 Variance projection of current allocations to plan excl covid Programme 11,889 Running Costs 2,387

Appendix B NHS Leeds CCG Bridge from initial 2020-21 plan to revised plan at June 2020 £'000 £'000 £'000 Comments Spend per original plan submission 1,330,805

NHS block payments additional to CCG plan 33,061 Nationally mandated amounts for NHS trusts

Independent Sector -24,891 Currently main independent sector providers capacity bought nationally Other non nhs acute -1,325

IAPT -12,605 Other MH non nhs 5,077

Community beds -3,978 Other CH non nhs -1,323

CHC -311

Prescribing 2,338 Other PC 2,121 GPIT/ primary care services staff etc -394 Primary Care Co-commissioning 195

Other -395

Non NHS change to plan -35,491

Reserves -22,331 No reserves or contingency included Running costs -2,100

Net difference -26,860

Spend per current plan PRE COVID 1,303,945

Covid spend 25,226

Grand total 1,329,172

Appendix C Assumptions 1. NHS provider block payments will continue for the rest of the year. This is an additional cost of £33m compared to initial plan value submission for NHS contracts. 2. Independent sector will continue to be funded centrally and so no costs are included within CCG plan (was £25m in initial plan submission). 3. Any Qualified Providers are included, based on a mixture of contracts remaining on activity x price along with the locally agreed revised contract variations for strategically important services which are paid on a cost only contract. It should be noted that current capacity is reduced, due to social distancing, across all providers. Therefore we are assuming this ‘additional cost’ can be attributed to the COVID-19 pandemic and recovered centrally. AQP contracts are effectively providing additional capacity to LTHT to enable us to reduce and equalise waiting lists across the system. 4. Commissioning intentions and pre-commitments for NHS providers have been estimated but not included (c£21m). 5. Funded Nursing Care (FNC) change in rates has been included. There was a retrospective increase at end of 2019-20 backdated to April 2019 of 9%, and then a further increase of 2% for 2020-21. Overall an increase of 11%. Note that the national model for current allocations/budgets has growth built into it at only 2%. However to date this additional cost has been offset by a reduction in activity due to a large increase in deaths. Also under the current Covid regime people will be going straight on to CHC packages, but numbers on FNC are likely to increase once assessments restart. 6. Continuing Health Care (CHC) - all Hospital Discharge packages after March are funded via Covid, so currently included in the Covid section. All processes and procedures around eligibility and reviews are currently on hold as per NHSE/I guidance, but it is anticipated that there will be an impact later in the year once reviews and eligibility reverts back to normal processes and procedures. 7. Hospital Discharge Programme – have assumed that current process in place for duration of year. This has had a massive impact on CCG assessment and review processes which are all on hold. This will lead to a backlog of work and potential future additional costs. 8. Hospices – CCG is adhering to guidance by keeping local payments flowing in line with contracts 9. Transformation has been paused in respect of new projects. However areas that have already started such as virtual frailty ward are ongoing and the costs are being covered at NHS providers by the provider top up funds from NHSE/I. 10. At the moment there are no non recurrent allocations being passed to the CCG. Costs have been included for ongoing areas such as Transforming Care Partnerships (mental health) and extended access and role reimbursements for Primary Care Networks which would normally be funded by non recurrent allocations. This results in a new additional pressure of c£5.4m. 11. The prescribing forecast has been increased by £2m above original plan. The April data suggests an even larger pressure but it is difficult to extrapolate from only one month’s data.

12. Primary care and primary care co-commissioning – intention is to spend as original plan, but will be additional pressures for items normally covered by non recurrent allocations (as per 2.9.12) and for Covid spend. 13. Running costs have been set based on the original full year allocation, in line with budgets agreed with budget holders and signed off by EMT. Then revised to reflect anticipated spend in the year, taking into account reduction for NHS elements originally within running costs and now not being paid specifically (c£0.3m) and reduction for risk reserve (c£1.6m), and some vacancies. Forecast spend, before Covid spend is £13.3m. This is an underspend of £2.1m against original allocation of £15.4m (but an overspend of £2.4m if current reduced allocations continue at the same rate giving a full year effect budget of £10.9m). 14. Covid costs have been estimated for the full year as £25m, based on support to various sectors such as primary care, AQPs, care homes, etc. This includes an estimate for PPE, assuming a worst case scenario of no national procurement. And also for the AQP services. 15. No contingency or reserves are included. 16. Winter beds – it is estimated that 130 beds have been removed from LTHT as a result of social distancing requirements. These will need to be re-provided elsewhere over the winter period, but currently unclear where. There is ongoing work to review the bed position across the system and how the capacity needs can be addressed, and to quantify the expected impact of this. Indicative costs are estimated to be circa £3.38m but are not included currently. The CCG is also considering commissioning a 52 bedded Discharge- to-Assess-Service within the additional capacity wards at Wharfedale Hospital to address this long standing problem for the system, particularly in the light of significant improvements in patient flow in the past 18 months, and the reduction in bed days for patients staying more than 21 days in hospital. The cost impact would be neutral for the system. 17. Mental health investment standard (MHIS) – initial guidance states that CCG must achieve MHIS, however there are a number of issues around this and further guidance is expected.

Agenda Item: GB 20/48 FOI Exempt: N

NHS Leeds CCG Governing Body Meeting

Date of meeting: 22 July 2020

Title: Building the Leeds Way: Maternity & Neonatal Service Reconfiguration – Decision

Lead Governing Body Member: Jo Harding, Tick as Category of Paper appropriate Executive Director of Nursing and Quality () Report Author: Jane Mischenko, Lead Strategic Commissioner: Children & Maternity Care  Decision Sarah Halstead, Head of Specialised Commissioning, NHS England Reviewed by EMT/Date: 1st July 2020 Discussion Reviewed by Committee/Date: N/A Information Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to:  People will live longer and have healthier lives   People will live full, active and independent lives  People’s quality of life will be improved by access to quality services   People will be actively involved in their health and their care   People will live in healthy, safe and sustainable communities

NHS Leeds CCG Strategic Commitments We will focus resources to: 1. Deliver better outcomes for people’s health and wellbeing  2. Reduce health inequalities across our city  We will work with our partners and the people of Leeds to: 3. Support a greater focus on the wider determinants of health 4. Increase their confidence to manage their own health and wellbeing 5. Achieve better integrated care for the population of Leeds  6. Create the conditions for health and care needs to be addressed around local neighbourhoods Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge  2. Failure to assure the delivery of high quality services, leading to commissioned services not  reflecting best practice and improving care 3. Failure to achieve financial stability and sustainability  4. Lack of provider and clinical support for change will impact on the development and implementation of the CCG strategy 5. Resources are not targeted effectively to areas of most need, leading to failure to improve health in the poorest areas 6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions  7. Failure to enable partners to work together to deliver the CCG commitments 8. Failure of system to be adaptable and resilient in the event of a significant event

EXECUTIVE SUMMARY:

NHS Leeds CCG and NHS England specialised commissioners are committed to working with partner organisations in order to deliver the best experience and outcomes for women and babies in the city (and beyond for specialist provision).

The reconfiguration of maternity and neonatal services is integral to the broader Building the Leeds Way (BtLW) capital programme. This report provides the outcome from the public consultation on reconfiguring Leeds maternity and neonatal services and provides recommendations, in order to support the Governing Body and NHS England specialised commissioners in their discussion and decision. The whole consultation process has followed the service change assurance guidance as required by NHS England/Improvement (see Appendix 1 within the Supporting Information pack). This work has been led by the CCG, working closely with NHS England specialised commissioners (for the neonatal service configuration) and Leeds Teaching Hospitals NHS Trust.

In January 2019 the Governing Body and the NHS England specialised commissioners Board agreed the reconfiguration proposals to be taken to public consultation, once capital investment was secured. Criteria drawn from the NHS England guidance for planning, delivering and assessing service change for patients had been utilised (see below) against a range of options:

 Strong public and patient engagement  Consistency with current and prospective need for patient choice  Clear, clinical evidence base  Support for the proposal from local commissioners  Affordable in capital and revenue terms

This confirmed that inpatient maternity and neonatal services would be centralised and that there would be public consultation on where hospital antenatal services would be provided. Originally there was also an option to provide them only on the SJUH site but there is no clinical (quality & safety) justification for this option. Equally there is no public support for this following a public engagement exercise undertaken in 2018 and so this was removed.

In November 2019 the Governing Body and the NHS England specialised commissioners Board again supported the formal public consultation on the proposed two options for reconfiguration, in order to fulfil the statutory public involvement and consultation duties of commissioners as set out in s.13Q NHS Act 2006 (as amended by the Health and Social Care Act 2012), and the NHS England assurance process for major service changes and reconfiguration.

NHS England/Improvement assures service change proposals prior to public consultation being launched, and in December 2019 provided the assurance that we had met the tests for service change and could proceed to public consultation. The public consultation ran from 13 January until 5 April 2020 and consulted on 2 options.

Option1 Centralise all maternity and neonatal services, including a new, larger midwifery-led unit, at the LGI, and have all hospital antenatal services at the LGI. Maternity services in the community will not change. Our ambition is to increase the number of antenatal appointments available in the community.

Option 2 Centralise all maternity and neonatal services, including a new, larger midwifery-led unit at LGI, but have some hospital antenatal services at St James’s as well as at the LGI site. Maternity services in the community will not change. Our ambition is to increase the number of antenatal appointments available in the community.

Representatives from the CCG, NHS England Specialised Commissioning and LTHT attended the Leeds Scrutiny Board (Adults, Health and Active Lifestyles) in February 2020 as integral to public consultation. The Chair thanked those in attendance for their attendance and presentation; adding that the level of engagement undertaken, including the involvement of the Scrutiny Board, prior to formal consultation had been pleasing to see and could usefully inform the approach for proposed changes across other service areas within the Leeds boundary and beyond. https://democracy.leeds.gov.uk/documents/s206517/SB%20AHAL%20Draft%20minutes%20- %2011%20February%202020.pdf

This report presents the results from the public consultation, as compiled and analysed by an independent evaluator (Brainbox) and includes the comments received from the Leeds Scrutiny Board (Adults, Health and Active Lifestyles). DHSC guidance advises that health scrutiny should be able to receive details about the outcome of the public consultation before it makes its response, so the response can be informed by patient and public opinion. Leeds Scrutiny Board received the public consultation report 19 May 2020 and provided a Scrutiny statement for commissioners (dated 30 June 2020 and included as Appendix 2 within the Supporting Information pack).

Building on the results of the public consultation and the response from the Scrutiny Board this paper sets out recommendations to the Governing Body and NHS England specialised commissioners. These are to support their discussion and ultimate decision, in which option to progress with for the reconfiguration of maternity and neonatal services in Leeds.

NEXT STEPS:  Write to NHS England Assurance Team to formerly notify them of the decision.  Write to LTHT CEO/Board to formally notify them of the commissioners’ decision.  Publish the public consultation report and next steps to inform the public by issuing a press statement and posting on the CCG website.  As part of BtLW governance establish a steering group to oversee the implementation of the reconfiguration. Key roles of the steering group will be to: continue to assure that the design continues to comply with the government’s tests for service change and NHS England test for any proposed bed closures; that the key areas identified as critical through the public consultation are addressed through the implementation and design stages; that there is a clear focus on delivering a left shift in service delivery and reducing any health inequalities.

RECOMMENDATION:

The Governing Body is asked to: a) SUPPORT Option 1

Centralise all maternity and neonatal services, including a new, larger midwifery-led unit, at the LGI, and have all hospital antenatal services at the LGI. Maternity services in the community will not change. Our ambition is to increase the number of antenatal appointments available in the community.

However, to support this in line with our Health Inequalities Framework, the implementation plan will continue to evidence delivery of the government’s 4 tests of service change and will comprehensively addresses the following issues:

 70% of antenatal contacts are currently delivered in the community and this will increase. Better Births national maternity policy is clear on the need to increase community maternity support via the creation of community hubs. In Leeds a priority will be to develop a community hub near the St James’s site.  Maximising the use of digital telemedicine to increase access and deliver more appointments in the community and to ensure digital inclusion is addressed within this work stream. Significant acceleration of digital delivery has occurred in response to Covid-19.  LTHT has an award winning service that supports the BAME population (Haamla); this expertise will be maximised to engage with BAME communities (particularly those near the St James’s site) to ensure equity of access, positive experience and culturally sensitive services.  The clinical and architectural design of the new maternity and neonatal units will work with families to ensure a positive personalised care experience.  Increased capacity of parking at the LGI site for mums and their partners is planned through a new dedicated MSCP.  NHS colleagues will work with council colleagues with an aim to influence bus providers to have routes stopping near the LGI site.  Colleagues across NHS commissioners, providers, and LA, will work together to continually review maternity outcomes and infant mortality, to ensure progress is made faster in more deprived and vulnerable communities, in line with the ambitions set out in the Left Shift Blueprint.

1. SUMMARY

1.1 NHS Leeds CCG and NHS England specialised commissioners are committed to working with partner organisations in order to deliver the best experience and outcomes for women and babies in the city (and beyond for specialist provision).

1.2 This report summarises the proposed reconfiguration of Leeds maternity and neonatal services; these proposals are integral to the broader Building the Leeds Way capital programme and have followed and complied with the service change assurance process as required by NHS England. This work has been led by the CCG, working closely with NHS England specialised commissioners (for the neonatal service configuration) and Leeds Teaching Hospitals NHS Trust.

1.3 The report presents the outcomes from the public consultation, which were compiled and analysed by an independent evaluator (Brainbox) and includes the comments received from the Leeds Scrutiny Board (Adults, Health and Active Lifestyles). DHSC guidance advises that health scrutiny should be able to receive details about the outcome of the public consultation before it makes its response, so the response can be informed by patient and public opinion. Leeds Scrutiny Board received the public consultation report 19 May 2020 and provided a Scrutiny statement for commissioners (dated 30 June 2020 and included as Appendix 2 within the Supporting Information pack).

1.4 Building on the public consultation outcomes and the response from the Scrutiny Board, the paper sets out recommendations to the Governing Body and NHS England specialised commissioners. This is to support their discussion and ultimate decision about which option to progress with to reconfigure maternity and neonatal services in Leeds.

1.5 It was reassuring to read that while this report focuses on preference for the location of hospital-based antenatal services, many of the comments that people left were in praise of the service, both at the LGI and at St James’s and people are very appreciative of the care they received as well as having suggestions for improvements. For the last two years, Leeds Maternity service has been recognised as a high-performer in the UK. The national Maternity Patient Survey seeks feedback from service users of all UK maternity units, and Leeds has been voted in the top 5 for staff kindness, patient experience and overall quality of care. This is a credit to the service and includes feedback from both sites, and from BAME communities. The main source of negative feedback received is around the estate and facilities, and this is one of the drivers to centralise.

1.6 The majority of respondents to the public consultation (58%) expressed support for option 1 (for hospital antenatal clinics to be delivered at LGI alongside the centralisation of maternity inpatient services and neonatal services). However, a significant minority (42%) wanted medical outpatients to be provided at both SJUH and LGI sites.

1.7 Preference often aligned with the site they had accessed for their care (whether for birth or an outpatient appointment). Additional factors which influenced the preferred option included easier access, considering factors such as transport and in particular parking and concern about the impact on the maternity service users that live near to the SJUH site, in

recognition of their increased vulnerability. The full report is included as Appendix 3 (which can be found within the Supporting Information pack).

2. BACKGROUND

2.1 Leeds Teaching Hospitals NHS Trust is planning to build two new hospitals at the Leeds General Infirmary (LGI) in Leeds city centre. The plans - called Hospitals for the Future - centre on developing modern, responsive health facilities for adults at the LGI, and for children and young people at Leeds Children’s Hospital. Work will start to prepare the site later this year and building work will begin in 2022.

2.2 The maternity and neonatal element of the Building the Leeds Way programme is the only service component that required formal public consultation.

2.3 The clinical model and case for change has been presented to NHS England during the last few years through checkpoint 1 & 2 of the service change assurance process. This has included a review of the clinical model by the regional Clinical Senate who provided a report and recommendations to further strengthen the model. Key elements of the proposed new service configuration are:

 Centralised obstetric led care at Leeds General Infirmary (LGI).  An alongside midwife-led unit at LGI (significantly improving choice for Leeds women).  A new, elective caesarean section unit for the birth of over 2000 babies a year, including many of the most high-risk mothers in Yorkshire and Humber.  An antenatal ambulatory care hub with telemedicine capability.  Continue to deliver the majority of antenatal appointments (via community midwives) in primary and community settings.  Hospital obstetric led care outpatients could be located just at LGI, or at both LGI and St James University Hospital (SJUH) (depending on the outcome of the public consultation).  Centralised neonatal care at LGI.

2.4 Previous reports have been to the CCG Governing Body (March 2018, May 2018, July 2018 and November 2019), setting out the proposals and preferred options (criteria and scoring). Despite consensus on the strength of the case for change and support from key stakeholders, such as the West Yorkshire Integrated Care System, the Neonatal Operational Network and Leeds Adults, Health & Active Lifestyles Scrutiny Board, and the Clinical Senate, progress then halted. NHS England assurance and public consultation could not progress in the absence of the necessary capital funds.

2.5 The government announcement on 29 September, 2019 that Leeds had received funds to build the two new hospitals, enabled us to work with NHS England/Improvement to achieve the necessary assurance and to proceed to public consultation.

2.6 Leeds Scrutiny Board (Adults, Health and Active Lifestyles) wrote to NHS England to support the proposals to go to public consultation.

2.7 We received NHS England/Improvement assurance that we had met the tests for service change and could proceed to public consultation on 13 December 2019.

2.8 Formal public consultation to reconfigure maternity and neonatal services took place between 13 January and 5 April 2020. All options included the centralisation of the maternity (deliveries) and neonatal services on one site, as part of the new hospital buildings (Building the Leeds Way). The public consultation focused on the options for where the obstetric outpatient clinics are to be provided from, either only the LGI site, or both LGI and SJUH sites.

2.9 A comprehensive consultation communications plan was developed to involve as many people as possible, including an online and printed consultation document, also available as easy read, flyers in the languages most requested by in the services, video, animation and infographic, plus focus groups and drop in sessions. The supporting documents are on the CCG website: https://www.leedsccg.nhs.uk/get-involved/your-views/maternityleeds/

2.10 This was supported by a quality and equality impact assessment (QEIA) to ensure that the diversity of Leeds was represented and was signed off by the CCG PAG on 4 December 2019. The QEIA identified that we needed a particular focus on the communities in postcodes close to St James’s Hospital.

2.11 The consultation provided several different ways that people could share their views about the plan to centralise maternity and neonatal services at the LGI and the options for hospital-based antenatal services in Leeds. Particular efforts were made to hear the views of people who might be more affected by discontinuing antenatal appointments at St James’s.

3. PUBLIC CONSULTATION OUTCOMES

3.1 Brainbox, an independent company was commissioned by the CCG to analyse the findings from the public consultation and to produce the report. The full report is included as Appendix 3 (within the Supporting Information pack).

3.2 The majority of respondents to the public consultation (58%) expressed support for option 1 (for medical outpatients to be delivered at LGI alongside the centralisation of maternity inpatient services and neonatal services). However, a significant minority (42%) wanted medical outpatients to be provided at both SJUH and LGI sites.

3.3 Preference often aligned with the site they had accessed for their care (whether for birth or an outpatient appointment). Additional factors which influenced the preferred option included easier access, considering factors such as transport and in particular parking.

3.4 People who took part in the consultation prioritised safety and quality over choice and as the consultation document highlighted that centralising maternity services would improve these aspects; this is likely to underpin their preference to centralise antenatal services at the LGI.

3.5 People who had given birth at St James’s, or who had used the St James’s neonatal service, as well as voluntary sector professionals, were more likely to prefer option two,

where hospital antenatal services are delivered at both the LGI and St James’s sites. In addition to feedback on transport and parking access for vulnerable families that lived close to the St James’s site was frequently mentioned.

3.6 Parking was rated as least important, although the comments respondents made indicated that this is a concern and the plans for the new hospital need to ensure sufficient parking.

3.7 The report identifies that people need reassuring that:

 Sufficient parking will be available  There will be buses that stop close to the LGI  The access needs of disadvantaged groups have been considered  The staff in the new unit will understand the needs of ethnic minority women  Most antenatal appointments will remain in the community  Antenatal clinics will not feel overcrowded and will deliver personalised care.

3.8 The key messages from the public consultation that need to inform the discussion and decision today are set out below, in Table 1.

Table 1

Option Shared benefits of Option specific pros and Public consultation feedback centralising cons Option 1  Larger midwifery led unit for  This option is more efficient  58% prefer this option Centralise all maternity and low risk pregnancies but in terms of staff and  This relates to prioritising neonatal services, including a alongside obstetric and equipment. safety, quality and new, larger midwifery-led unit, neonatal services if needed  It is safer for women and efficiency at the LGI, and have all (choice) their babies attending  Many comments hospital antenatal services at  Dedicated caesarean antenatal appointments referenced the safety the LGI. Maternity services in section theatre who are becoming unwell, aspect of having all the the community will not change.  Reducing neonatal as inpatient care is at the experts and services joined Our ambition is to increase the transfers (improved safety same site. up on one site number of antenatal and experience)  It benefits women who  However, despite appointments available in the  Addressing significant have a hospital birth prioritising safety, parking community. staffing challenges of because they will be at LGI was flagged as a covering 2 maternity units familiar with the hospital concern that impacted on and neonatal units; this will from their antenatal their experience and enable 24/7 consultant appointments. needed addressing obstetrician presence  It is less convenient for  No statistical difference in (improved safety, women who live nearer to the two sites in how people experience and St James’s as they will travelled to hospital efficiency) need to travel two miles outpatient appointments  Increased number of further to the LGI. (only 5% walked) operational neonatal cots  It may be less convenient  The challenge of public (system capacity) for women and families transport to the LGI was  Improved estate who drive to their antenatal noted, in that no bus (experience) appointments, as currently currently stops close to the  Maternity, neonatal and parking is reported as being site. children’s hospital services more difficult at the LGI. and expertise all on 1 site 9

Option Shared benefits of Option specific pros and Public consultation feedback centralising cons Option 2  Larger midwifery led unit for  This option is less efficient  Some were concerned that Centralise all maternity and low risk pregnancies but as staff and equipment are people who currently walk neonatal services, including a alongside obstetric and required at two different to antenatal appointments new, larger midwifery-led unit neonatal services if needed sites. at St James’s will face at LGI, but have some hospital (choice)  It is less safe for women additional cost and antenatal services at St  Dedicated caesarean and their babies attending inconvenience, and some James’s as well as at the LGI section theatre antenatal appointments of these people may be on site. Maternity services in the  Reducing neonatal who are becoming unwell, a low income. community will not change. transfers (improved safety as they will need to be  Some people reported that Our ambition is to increase the and experience) transferred to the LGI. they feel staff in St James’s number of antenatal  Addressing significant  It means that women who have a better appointments available in the staffing challenges of have a hospital birth but understanding of the needs community. covering 2 maternity units attend antenatal of women from ethnic and neonatal units; this will appointments at St James’s minorities. enable 24/7 consultant will be less familiar with the  Some people expressed obstetrician presence LGI site. concerns that the (improved safety,  It is more convenient for centralised service would experience and women and families who be too big and see too efficiency) live near to St James’s. many people, resulting in  Increased number of  It may be more convenient long waits in clinics, a more operational neonatal cots for women and families stressful environment, and (system capacity) who drive to their antenatal less personalised care.  Improved estate appointments, as parking is (experience) currently reported as being  Maternity, neonatal and better at St James’s. children’s hospital services and expertise all on 1 site

3.9 A key priority for the CCG and NHS England specialised commissioners is to get the best possible outcomes for the resources we have available. The clinical case is clearly set on how centralising maternity and neonatal services will maximise the expertise in the Leeds workforce and join up critical services. There is strong recognition of this in the public consultation feedback with the majority preferring option 1 and prioritising safety and quality over choice and parking.

3.10 However, as a CCG we also have a commitment to the principles in our Health and Inequalities Framework, where we set out that ‘we will focus on deprived Leeds as well as vulnerable and marginalised groups.’ And that ‘in using our resource we will apply the principle of ‘proportionate universalism’ to make greater impact.’

3.11 There are areas identified in the public consultation that reflect concerns in relation to this. Predominantly two issues are flagged; firstly that the access needs of disadvantaged groups are considered, particularly those living near the St James’s site and secondly that the needs of BAME women and families are met in the new unit.

3.12 Public consultation also identified more general access concerns that need addressing; increased parking facilities and improved public transport. Also, assurance that the size of the service would not result in a loss of a personalised approach or excessive waits was flagged.

3.13 The Governing Body and NHS England specialised commissioners need to make a decision where they are assured that they are achieving best outcomes for their population in the given resource and applying the principles of the health inequalities framework.

3.14 The new hospital is due to be completed in 2025. National and local policy is driving increased antenatal delivery in the community via community hubs and to increasingly adopt telemedicine to further facilitate this. This creates the opportunity to ensure we achieve both of these critical requirements.

4. PROPOSAL

4.1 It is proposed that option 1 is supported.

4.2 However, to support this in line with our Health Inequalities Framework, the implementation plan will continue to evidence delivery of the government’s tests of service change and will comprehensively addresses the following issues:

 LTHT has an award winning service that supports the BAME population (Haamla); this expertise will be maximised to engage with BAME communities (particularly those near the St James’s site) to ensure equity of access, positive experience and culturally sensitive services.  The clinical and architectural design of the new maternity and neonatal units will work with families to ensure a positive personalised care experience.  Increased capacity of parking at the LGI site for mums and their partners is planned through a new dedicated MSCP.  NHS colleagues will work with council colleagues with an aim to influence bus providers to have routes stopping near the LGI site.  Colleagues across NHS commissioners and providers, LA, will work together to continually review maternity outcomes and infant mortality, to ensure progress is made faster in more deprived and vulnerable communities in line with the ambitions set out in the Left Shift Blueprint.

5. NEXT STEPS

 Write to NHS England Assurance Team to formerly notify them of the decision.  Write to LTHT CEO/Board to formally notify them of the commissioners’ decision.  Publish the public consultation report and next steps to inform the public by issuing a press statement and posting on the CCG website.  As part of BtLW governance establish a steering group to oversee the implementation of the reconfiguration. Key roles of the steering group will be to: continue to assure that the design continues to comply with the government’s tests for service change and NHS England test for any proposed bed closures; that the key areas identified as critical through the public consultation are addressed through the implementation and design stages; that there is a clear focus on delivering a left shift in service delivery and reducing any health inequalities.

6. STATUTORY/LEGAL/REGULATORY/CONTRACTUAL

6.1 Public consultation is required on the proposed options for reconfiguration, in order to fulfil the statutory public involvement and consultation duties of commissioners as set out in s.13Q NHS Act 2006 (as amended by the Health and Social Care Act 2012).

7. FINANCIAL IMPLICATIONS AND RISK

7.1 The capital funding for Building the Leeds Way was confirmed by the government in September 2019. NHSE/I confirmed, prior to the commencement of consultation that the centralised maternity and neonatal element of this was under the threshold (£50 million) whereby it would need to go for national assurance in order to proceed to public consultation.

8. COMMUNICATIONS AND INVOLVEMENT

8.1 There has been ongoing engagement with families who use maternity services for several years, beginning with their input to develop the Leeds Maternity Strategy. In 2018, a formal engagement exercise was undertaken to gather views on obstetrics antenatal services. The

report and those relating to other maternity services are published on the CCG’s website. https://www.leedsccg.nhs.uk/get-involved/have-your-say/engagements-consultations/

8.2 A comprehensive communications and involvement plan supported by the CCG’s Patient Assurance Group at its meeting on 4 December 2019.

8.3 Formal public consultation took place 13 January 2020 to 5 April 2020. The report resulting from this is attached as Appendix 3 (within the Supporting Information pack).

9. WORKFORCE

9.1 The proposed centralisation of maternity and neonatal services would maximise the value of the workforce we have in the city, which is currently challenged by having to cover the two LTHT sites.

10. EQUALITY IMPACT ASSESSMENT

10.1 A full Quality and Equality Impact Assessment has been completed.

11. ENVIRONMENTAL

11.1 Not applicable.

12. RECOMMENDATION

The Governing Body is asked to:

a) SUPPORT Option 1

However, to support this in line with our Health Inequalities Framework, the implementation plan will continue to evidence delivery of the government’s tests of service change and will comprehensively addresses the following issues:

 Increased capacity of parking at the LGI site for mums and their partners is planned through a new dedicated MSCP.  NHS colleagues will work with council colleagues with an aim to influence bus providers to have routes stopping near the LGI site.  Colleagues across NHS commissioners and providers, LA, will work together to continually review maternity outcomes and infant mortality, to ensure progress is made faster in more deprived and vulnerable communities in line with the ambitions set out in the Left Shift Blueprint.

Agenda Item: GB 20/49 FOI Exempt: No

NHS Leeds CCG Governing Body

Date of meeting: 22 July 2020

Title: Workforce Information Reporting and Assurance Arrangements

Lead Governing Body Member: Sabrina Tick as Armstrong, Director of Organisational Category of Paper appropriate Effectiveness () Report Authors: John Scott, Head of People &  Decision OD Reviewed by EMT/Date: N/A Discussion Reviewed by Committee/Date: N/A Information  Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives  2. People will live full, active and independent lives  3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care  5. People will live in healthy, safe and sustainable communities 

EXECUTIVE SUMMARY:

Good decision making is based on effective intelligence. The current arrangements for monitoring our workforce information are inadequate. This has been highlighted during the COVID-19 pandemic where immediate accurate and correct data was essential for redeployment and other decision making.

Whilst EMT and the Workforce & Diversity Group currently receive and consider a quarterly report, there is a need for better assurance to the Governing Body so that it can continue to focus on strategic direction and purpose. This paper proposes an increase in regular reporting within the CCG and, in particular, introduces a new role for the Remuneration and Nomination Committee to offer direct assurance to the Governing Body.

NEXT STEPS:

 Communicate changes within the CCG.  Amend Terms of Reference of the Remuneration & Nomination Committee (included within the Supporting Information section of papers), and the Quality & Performance Committee (in relation to health & safety matters).  Develop and trial new arrangements during Quarter 2.  Fully commence new reporting arrangements from 1 September 2020.

RECOMMENDATION:

The Governing Body is asked to:

(a) NOTE the arrangements to be put in place to better monitor our workforce; (b) AGREE that the Remuneration and Nominations Committee extend their terms of reference to include regular monitoring of workforce information and providing assurance to the Governing Body.

2 WORKFORCE INFORMATION REPORTING

Background

1. The Governing Body is asked to take strategic decisions about the work and priorities of the CCG. But, with the exception of staff changes at the most senior levels, the Governing Body currently has little exposure to changes to the CCG workforce or the demographic.

2. It has previously taken irregular reporting from People & OD and has now agreed a bi-annual progress report on the People & OD Strategy. It also sees summary data in the Annual Report and there may be a reasonable assumption that EMT monitors this information.

3. It is right that the Governing Body focuses on strategic thinking and direction. But it should also be assured that our workforce information is being scrutinised and monitored at the appropriate level within the CCG. This paper sets out a framework to ensure that is happening.

Current arrangements

4. Currently, all staff-related information is stored on the NHS-wide central employee records system, ESR. Data is derived and input from HR teams at the CCG and our partners at LTHT and, increasingly, through line manager input (sickness recording and annual leave) and by employees (requesting annual leave and completing statutory and mandatory training).

5. People & OD derive a quarterly report which is shared with EMT and the Workforce & Diversity Group (which is a sub-group of EMT). The quarterly report is derived from our staff data system, ESR.

6. During the COVID-19 pandemic, this intelligence was supplemented by a daily audit of staff absence, redeployment and leave by SLT leaders and collated by P&OD for the EMT/Gold Command. This resource-intensive arrangement has now been stood down but the usefulness of this up-to-date information allowed EMT to reach swift and informed decisions. We have therefore embarked on a programme to improve the currency and quality of data held on ESR so that we can easily access correct and complete information.

Proposal

7. We will formalise reporting arrangements to ensure management are aware of changes in the workforce and can use that information to inform decision- making.

8. The core document to support the business is the quarterly report derived from ESR which is currently shared with EMT and the Workforce & Diversity Group. From the next quarter, this report will, in addition, be reviewed by the Remuneration and Nomination Committee. It is proposed that the Remuneration & Nomination Committee receives assurance regarding staff health and safety issues, which are currently reported to the Quality & Performance Committee. This should give assurance to the Governing Body and allow a clear line of escalation where deemed necessary by the Chair.

9. A table outlining the full reporting regime is at Appendix 1.

Recommendation

10. The Governing Body is asked to: a. NOTE the arrangements to be put in place to better monitor our workforce; and b. AGREE that the Remuneration and Nominations Committee extend their terms of reference to include regular monitoring of workforce information and providing assurance to the Governing Body.

Summary of Human Resource Reporting Proposal

Level Monitoring Information

Governing Body Bi-annual update on the People & OD Strategy (to include data summaries) Remuneration Annually Committee  WRES Report  WDES Report  Gender Pay Gap Report Quarterly Extract from Staffing Quarterly Report to include:  Sickness absence by reason and LTS  New starters/leavers unfilled vacancies and turnover rates  Staff demographic/Equality Monitoring information

Executive Management Annually Team  WRES Report  WDES Report  Gender Pay Gap Report Quarterly Full Staffing Quarterly report including:  Sickness absence by reason and by directorate and LTS  New starters/leavers unfilled vacancies and turnover rates  Appraisal rates  Statutory and Mandatory Training  Staffing demographic/Equality Monitoring Information  Annual leave rates (in comparison with previous years) Monthly  Annual leave rates (in comparison with previous years)  Sickness absence by reason

Senior Leadership Tier Monthly sickness absence rates by reason

Workforce & Diversity Annually Group  WRES Report  WDES Report  Gender Pay Gap Report Quarterly Full Staffing Quarterly report including:  Sickness absence by reason and by directorate and LTS  New starters/leavers unfilled vacancies and turnover rates  Appraisal rates  Statutory and Mandatory Training  Staffing demographic/Equality Monitoring Information  Annual leave rates (in comparison with previous years)

BAME network Annually  WRES Report Quarterly or bi-annually  New starters/leavers unfilled vacancies and turnover rates  Appraisal rates  Statutory and Mandatory Training  Staffing demographic/Equality Monitoring Information

Health & Wellbeing Bi-annual Group  Sickness absence rates by reason and by directorate and LTS

Agenda Item: GB 20/50 FOI Exempt: No

NHS Leeds CCG Governing Body Meeting

Date of meeting: 22 July 2020

Title: Revised CCG Procurement Policy

Lead Governing Body Member: Visseh Pejhan- Tick as Category of Paper appropriate Sykes, Chief Finance Officer () Report Author: Michelle van Toop, Associate Decision Director of Procurement & Contracting  Reviewed by EMT/Date: N/A Discussion

Reviewed by Committee/Date: Audit Committee, Information 15 July 2020 Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives 2. People will live full, active and independent lives 3. People’s quality of life will be improved by access to quality services  4. People will be actively involved in their health and their care 5. People will live in healthy, safe and sustainable communities

Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge 2. Failure to assure the delivery of high quality services, leading to commissioned services not  reflecting best practice and improving care 3. Failure to achieve financial stability and sustainability  4. Lack of provider and clinical support for change will impact on the development and  implementation of the CCG strategy 5. Resources are not targeted effectively to areas of most need, leading to failure to improve  health in the poorest areas 6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions 7. Failure to enable partners to work together to deliver the CCG commitments  8. Failure of system to be adaptable and resilient in the event of a significant event

EXECUTIVE SUMMARY:

The purpose of this report is to present the revised CCG Procurement Policy for approval. The revised policy reflects changes in the CCG’s strategic aims, EU Procurement thresholds and the Operational Scheme of Delegation since the last update.

The aim of this Procurement Policy is to set out how the CCG will implement appropriate procurement and contracting processes and work with our partners and providers to:

 deliver better outcomes for people’s health and wellbeing;

 reduce health inequalities and promote provider responsibilities for addressing health inequalities in accordance with the Health Inequalities Framework;

 use our budget so that we get quality services that offer the best value for the people of Leeds in terms of delivering the best possible outcomes for the resources we have available; and

 facilitate our providers to join up their services, wherever possible, around people so that they get the highest quality of care in the right place.

The policy was reviewed by the Audit Committee on 15 July 2020 and was recommended for approval by the Governing Body. Legal assurance has been sought and the suggested amendments are included in the attached version of the policy.

NEXT STEPS:

Once approved, the Procurement Policy will be adopted and communicated to all staff in the CCG.

RECOMMENDATION:

The Governing Body is asked to:

a) APPROVE the CCG Procurement Policy Version 3.

1. SUMMARY

1.1 The purpose of this report is to present a revised CCG Procurement Policy for approval. The revised policy reflects changes in the CCG’s strategic aims, EU Procurement thresholds and the Operational Scheme of Delegation since the last update.

1.2 The aim of this Procurement Policy is to set out how the CCG will implement appropriate procurement and contracting processes and work with our partners and providers to:

 deliver better outcomes for people’s health and wellbeing;

 reduce health inequalities and promote provider responsibilities for addressing health inequalities in accordance with the Health Inequalities Framework;

 use our budget so that we get quality services that offer the best value for the people of Leeds in terms of delivering the best possible outcomes for the resources we have available; and

 facilitate our providers to join up their services, wherever possible, around people so that they get the highest quality of care in the right place.

2. BACKGROUND

2.1 The role of procurement in commissioning is changing – traditionally just seen as the process for conducting competitive tendering, it can now be seen in the wider context of how we organise the providers we are working with to deliver better health outcomes. Recent innovative ways of working have demonstrated how we can successfully procure outcomes rather than activity and also that the way we design our procurement and contracting processes can have a major impact on encouraging and facilitating system integration and partnership working. Effective procurement is an essential component of commissioning improved services and outcomes for local patients and communities and for ensuring value for money.

2.2 Procurement in the public sector is regulated by primary legislation and there are a range of procurement approaches available depending on the value of the procurement and the number of participants in the market. However, the NHS Long Term Plan describes a movement towards integrated care, delivered through collaboration across health and care systems. These new ways of working will require the CCG to develop new procurement and contracting models in line with guidance from NHS England, and the CCG is already at the forefront of developing and implementing that change.

2.3 The Public Contracts Regulations (PCR 2015) apply to public bodies, including CCGs, NHS England and local authorities, and have implications for the procurement of all contracts commenced after that date above certain thresholds however it is widely recognised that the current procurement rules relating to NHS services are a barrier to delivering the vision of integrated care set out in Long Term Plan because they create a competitive dynamic between organisations which is inimical to creating sustainable integrated services, and also creates continual uncertainty, upheaval and disruption amongst providers.

2.4 NHS England is in the process of consulting on proposals for a new Procurement Regime and the CCG has taken a leading part in this work but the proposals have not been officially published due to the Covid-19 pandemic. The consultation proposes removing healthcare services from PCR2015 and Procurement, Patient Choice and Competition (No.2) Regulations 2013 (PPCCR) and introducing a new set of rules for deciding which providers should deliver services which explicitly recognise the shift towards greater collaboration set out in the Long Term Plan. The new proposed regime would provide a flexible framework for deciding who should provide healthcare services, allowing commissioners to make decisions that best meet the needs of patients and the local population. It would also ensure that decisions about spending public money are made transparently and fairly, and that NHS commissioners are accountable for their actions.

3. PROPOSAL

3.1 Balancing the delay in anticipated legislative changes with the vision of the organisation being developed by the Shaping Our Future programme; this policy is an interim procurement policy which aims to outline a fair and transparent process for deciding which providers should deliver services, gives the CCG ultimate responsibility for decision making, and sets out a duty to ensure that the decisions about who should provide services are made in the best interests of patients, taxpayers and the local population whilst at the same time managing the risk to the CCG of legal challenges.

4. NEXT STEPS

4.1 Once approved, the Procurement Policy will be adopted and communicated to all staff in the CCG.

5. STATUTORY/LEGAL/REGULATORY/CONTRACTUAL

5.1 NHS Procurement is subject to the Public Contracts Regulations (2015) and the NHS (Procurement, Patient Choice and Competition) (No.2) Regulations 2013 (PPCCR). The CCG will take a risk-based approach to the application of the relevant regulations in order to meet the strategic objectives of the CCG whilst avoiding, where possible the risk of legal challenge.

6. FINANCIAL IMPLICATIONS AND RISK

6.1 Procurement is not a risk free activity and legal opinion will be sought as appropriate to manage legal risk.

6.2 In terms of financial risk, one of the main aims of the policy is to use our budget so that we get quality services that offer the best value for the people of Leeds in terms of delivering the best possible outcomes for the resources we have available.

7. COMMUNICATIONS AND INVOLVEMENT

7.1 Once approved the Procurement Policy will be communicated to the Senior Leadership Tier via the SLT meeting and the Contracts and Development & Intelligence Group (CDIG) and

all staff via the Staff Bulletin. It will be published on the CCG’s webpage with other organisational policies.

8. WORKFORCE

8.1 There are no workforce issues.

9. EQUALITY IMPACT ASSESSMENT

9.1 Not applicable.

10. ENVIRONMENTAL

10.1 Not applicable.

11. RECOMMENDATION

The Governing Body is asked to:

a) APPROVE the CCG Procurement Policy Version 3.

GB 20/51 GOVERNING BODY FORWARD WORK PLAN 2020/21

ITEM MAY JUN JULY SEPT NOV JAN MAR Lead Officer STANDING ITEMS Welcome & apologies X X X X X X X Chair Declarations of interest X X X X X X X Chair Minutes of previous meeting X X X X X X Chair Matters arising X X X X X X Chair Action log X X X X X X Chair Questions from members of the public X X X X X X X Chair Patient Voice X JH PERFORMANCE Chief Officer’s Report X X X X X X TR Integrated Quality & Performance X X HL/SA X X X Report FINANCE Finance Report X X X X X VPS Approval of Annual Report & Accounts X VPS Approval of Annual Budget X VPS STRATEGY CCG Operating Plan (incl. high level X SA/VPS budgets) People & OD Strategy/Refresh X SA Shaping Our Future – New Operating X TR Model Left Shift Blue Print X VPS Climate Change X SA RISK Governing Body Assurance X X X X X X SA Framework Corporate Risk Register X X X X X X SA GOVERNANCE Approval of Procurement Plan 2020/21 X VPS Approval of Business Cases/Investments over £1.5m (as Various required) Chair’s Summary of Committee X X X X X X Committe Meetings e Chairs Committee Terms of Reference X Committe

e Chairs

Update to Committee Terms of Chair Reference & Scheme of Reservation & 1

ITEM MAY JUN JULY SEPT NOV JAN MAR Lead Officer Delegation Committee Annual Reports X Committe

e Chairs Governing Body Effectiveness X GS Maternity and Neonatal Services X TR Consultation Approval of Governing Body Appointments / Reappointments (as Chair required) Approval of amendments to Chair Constitution (as required) Forward Work Plan X X X X X X Chair Policy Approval (as required) Various Review of Operational Scheme of X VPS Delegation Patient Experience & Complaints X JH Annual Report System Resilience Plan (included in X PA/HL Q&P Summary) EPRR Compliance (included in Q&P X PA/HL Summary)