GOVERNING BODY MEETING – A meeting in public

Tuesday 3rd November 2015 Nightingale Room, OMH 2pm

AGENDA

Ref No. No Time Item Papers GB15- 1. 2.00pm PRELIMINARY BUSINESS 16/0045 (Chair – Dr P Naylor) 1.1 Apologies for Absence 1.2 Chair’s Announcements 1.3 Declarations of Interest 1.4 Comments/questions from members of the public 1.5 Minutes and Action Points of Last Meeting – held on 1st September 2015 (All) DRAFT GB Minutes Action Points of PUBLIC MEETING 01 09WCCG -PUBLIC GB Mee • Action Points 1.6 Matters Arising

1.7 Patient Story (Lorna Quigley) GB 15- 2. ITEMS FOR ASSURANCE AND 16/0046 APPROVAL 2.1 Chief officer Update (Jon Develing, Chief Officer) 2.2 Corporate Affairs Report (Paul Edwards, Director of Corporate Affairs) Director of corporate Affairs Report Novemb

• Assurance Framework

Cover Sheet - Wirral CCG Assurance Assurance FrameworkFramework November 2.3 Quality and Patient Safety Report (Lorna Quigley, director of Patient Directors report GB meeting of November Quality and Patient Safety 2.4 Commissioning Report (Nesta Hawker, Director of Commissioning) Director of Commissioning Report

• Co-commissioning - Joint Commissioning Application Appendix 1 - Proposal Co-commissioning_join 2.5 Finance Report (David Miles, Head of Finance) CFO Report for GB of November 2015.docx

Agenda – Wirral Governing Body Meeting PUBLIC SESSION – 3rd November 2015 Page 1 of 2 Ref No. No Time Item Papers 2.6 Medical Directors Report (Dr Susan Wells) Medical Director Report for GB -Novem GB 115- 3. ITEMS FOR NOTING 16/0047 3.1 Subgroups (Ratified Minutes):

• Audit Committee Chair Audit Committee Summary – September Chair summary 24 Sep 2015

• Clinical Senate Meeting Clinical Senate of: 29.09.2015 ratified minutes 29 09

• QPF Minutes from 29th September 2015 RATIFIED QPF Minutes 29 09 2015.do

GB 15- 4.. RISK REGISTER 16/0048 Current Risk Register

Copy of Risk register November 15 GB.xlsx

5. ANY OTHER BUSINESS 5.1 6. End DATE AND TIME OF NEXT MEETING Tuesday 1st December 2015 2pm – 4pm Nightingale Room OMH Please forward any apologies to [email protected]

Wirral Clinical Commissioning Group – Future Meetings 2016 Day Date Time Venue Tuesday 5th January 2pm – 5pm Nightingale Room Tuesday 2nd February 2pm – 5pm Nightingale Room Tuesday 1st March 2pm – 5pm Nightingale Room

Agenda – Wirral Governing Body Meeting PUBLIC SESSION – 3rd November 2015 Page 2 of 2

WIRRAL CLINICAL COMMISSIONING GROUP GOVERNING BODY BOARD MEETING Minutes of Meeting – Public Session

Tuesday 1st September 2015 2pm Nightingale Room, Old Market House

Present: Dr Pete Naylor (PN) Chair Jon Develing (JD) Chief Officer Lorna Quigley (LQ) Director of Quality and Patient Safety Dr Paula Cowan (PC) GP Lead – Unplanned Care Dr Laxman Ariaraj (LA) GP Lead – Planned Care Dr Simon Delaney (SD) GP Lead – Primary Care Dr Sian Stokes (SS) GP Lead – Long Term Conditions Paul Edwards (PE) Director of Corporate Affairs Mark Bakewell (MB) Chief Financial Officer Alastair Cannon (AC) Lay Member (Quality & Outcomes) James Kay (JK) Lay Member (Patient Champion) Nesta Hawker (NH) Director of Commissioning Dr Arpan Guha (AG) Secondary Care Doctor Dr Sean MaGennis (SMg) GP Members Representative Mike Sowden (MS) Healthwatch Representative

In Attendance: Allison Hayes (AJH) Board Support/Corporate Officer WCCG

Ref No. Minute GB15- Preliminary Business 16/0037

1.1 Apologies for absence

Apologies were received from: Dr S Wells, Richard Williams, Graham Hodkinson, Fiona Johnston, and Alan Whittle. 1.2 Chairs Announcements/Opening Remarks

PN, Chair welcomed members to the meeting and announced the following new members and their roles:

• Lesley Doherty – Registered Nurse • Dr Arpan Guha – Secondary Care Doctor • Dr Sean MaGennis –Membership Council Chair

3 members of the public attended the meeting.

PE provided members with an overview of the structure of future Governing Body meetings as agreed at Governing Body in July 2015. Future agendas will include reports from Directors who will report to members on their areas of responsibility, aligned to CCG statutory requirements and the NHS England CCG Assurance Framework. PE explained that future meetings will consist of alternate informal and formal meetings commencing from October 2015. This would allow the Governing Body to spend more time on development in line with recommendations of last year’s ‘Capability and Governance Review’. Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 1st September 2015 Page 1 of 9

Ref No. Minute

PN informed members of the Annual Governing Body Meeting which will take place on Tuesday 22nd September at 1pm at Old Market House.

1.3 Declarations of Interest

There were no declarations of interest.

1.4 Comments/questions from members of the public

There were no comments from the public.

1.5 Minutes & Action Points from previous meeting held on 4th August 2015.

The minutes of the previous meeting held on 4th August 2015 were agreed as a true and accurate.

Action Points (see separate action points) – members reviewed and updated the group in relation to current action points.

1.6 Matters Arising

There were no matters arising.

1.7 Patient Story

LQ gave a presentation relating to a patient dealing with terminal cancer and her journey from diagnosis to treatment and from admission to discharge. The presentation highlighted the lessons that can be learnt through the various stages of the pathway.

Members thanked LQ for the patient story presented today and noted the contents. Members agreed for CCG to acknowledge the patient’s experience by letter.

Action – LQ to write a letter on behalf of the CCG acknowledging the patient’s experiences. GB15- 2.0 Items for Assurance and Approval 16/0038

2.1 Chief Officer’s Update

JD provided an update in key areas of activity over the past month.

• JD reported on the Liverpool City Region meetings that he has recently attended, with a focus on how that footprint may form the basis of joint working arrangements across local councils and may fit with the devolution agenda.. • The CCG has further made further progress with its application regarding ‘Healthy Wirral’ as a Vanguard pilot site and is currently awaiting the outcome of the Value Proposition that had been submitted, following the request for further information. • Jo Goodfellow has been appointed as the Model Care of Care Director for the ‘Healthy Wirral’ programme • An event for the nine Vanguard sites in the North of England has been arranged to take place in Leeds in October (Vanguards of the North) • JD provided members with details of the New Care Models that are being proposed in the national pilot sites. • JD explained that some Vanguard sites had defined their final organisational form, but that Wirral would be taking a more evolutionary approach. JK requested that JD keeps

Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 1st September 2015 Page 2 of 9

Ref No. Minute members updated on any proposed changes to organisational form or structures and this was agreed.

Members of the Governing Body noted the Chief Officer’s report presented today.

2.2 Corporate Affairs Report

PE provided an update to the meeting. The report provides the Governing Body with an update on the statutory functions and duties that the Director of Corporate Affairs is responsible for. These areas also align to the external CCG Assurance Framework.

Key areas included:

• A summary of activity regarding Complaints, Compliments, Freedom of Information requests (FOIs), SARs (Subject Access Requests) and MP Enquiries. PE stated that responses to each of these areas were compliant with national standards and highlighted that Continuing Healthcare remains a key theme of complaints. • CCG Assurance Framework. PE stated that the new Operating Manual and details of the ‘Special Measures’ regime had been released accompanying the CCG Assurance Framework. PE assured members that the papers for Governing Body in the new reporting format will help provide evidence on an on-going basis that will be used in the Assurance process. • An update on Organisational Development activity, including the Governing Body development programme currently underway • The updated Complaints Policy, updated to include recommendations from a recent audit • Workforce data on absence and turnover, both of which are compliant with national targets. • PE highlighted that compliance with Statutory and Mandatory training was currently below the required level in some areas and that JD had informed staff that he would expect this to be rectified in September, so that full compliance should be achieved ahead of the next report • Personal Development Reviews, which will be aligned to the some of the outputs from the Governing Body development programme outlined above • Emergency Preparedness, Resilience and Response activity in the areas of: o A recent exercise to update the Business Impact Analysis for each team o Training Exercises attended by CCG staff and the plan for future attendance at future o A planned On Call review that PE will undertake to refresh the rota in light of staff changes, supported by updated action cards o EPRR Groups and Working Groups o The Annual Compliance Assessment, which is requires Governing Body approval and is covered separately.

Emergency Planning, Response and Resilience (EPRR) Compliance Assessment

PE presented a paper regarding the EPRR compliance assessment. The statements of compliance and action plan had completed against the required areas of NHS England’s core standards for EPRR. The CCG has self-assessed as demonstrating the full compliance level against the core standards, and the evidence was shared with Governing Body members.

Governing Body members were asked to note the evidence of assurance and action plan with regard to Pandemic Flu and then to approve the self-assessment compliance level if they were in agreement with the self-assessment.

Members approved the self-assessment compliance level and thanked PE for his work .

Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 1st September 2015 Page 3 of 9

Ref No. Minute

Action: PE to submit Annual EPRR submission to NHS England

2.3 Quality & Patient Safety Report

LQ presented a report detailing the key messages and issues relating to quality and patient safety.

Areas included:

• WUTH – The Care Quality Commission has undertaken an inspection of Arrowe Park hospital in response to a number of concerns that where reported relating to the Trusts escalation processes, and inappropriate staffing levels. The Trust will be undergoing a comprehensive inspection of all services in September and will check that improvements have been made. • Wirral Community Trust – The Trust has reported a never event in July when the wrong tooth was extracted. This is classed as a wrong site surgery. A root cause analysis is being undertaken by the Community Trust to identify cause and effect. • Cheshire and Wirral Partnerships – The CQC has undertaken a comprehensive inspection of services in August and a report is to be published in due course. • One to One Midwifery Service – The CQC has undertaken an unannounced focused inspection in April 2015. This was due to a number of concerns raised about the care of women at the service and to follow up the compliance actions issued. A report is still to be published. • Safeguarding Children and Vulnerable Adults – The safeguarding team continue to ensure that there are robust processes in place across commissioned services to ensure that Children and vulnerable adults are protected. • Nursing and Residential Homes - The CCG continues to work collaboratively with Local Authority colleagues to ensure that quality and safety in nursing homes is maintained • Quality in Primary Care - A System for reporting near misses and serious incidents has been implemented within Primary Care; this system gives Primary Care the ability to report quality concerns about providers to the CCG in addition to self-report which improves quality. • Quality Performance Indicators - There have been a total of 13 serious incidents reported in July from Providers. The biggest area for reporting remains Pressure Ulcers. • Other performance against the NSH constitutional standards - Achievement in June against the 4 hour standard remains a challenge for the Trust and the Health economy. However this has seen an improvement in the latter half of June and July. This has been due to changes to internal processes within the Trust and the impact of some of the projects coming on stream from the Better Care Fund (BCF)

Further discussions took place regarding the never event reported by Wirral Community Trust and LQ provided members with an explanation of the next steps to undertake a Root Cause Analysis and how assurances would be sought to prevent such an incident from happening again.

JK sought further clarity around grade four pressures ulcers reported by Wirral Community Trust. LQ explained the process the Community Trust undertakes to identify specific themes that may contribute towards these.

The Governing Body noted the Directors of Quality and Patient Safety Report.

2.4 Commissioning Report

NH, Director of Commissioning presented the Governing Body with an update around the

Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 1st September 2015 Page 4 of 9

Ref No. Minute following areas:

• Primary Care Quality Scheme - This has been shared with GPs at the Provider Forum and the service document and agreement template for signature and return has been forwarded to GP practices. Work is on-going to support the practices and share best practice. A web portal is now available for GP practices which will show practices their referral activity, as at 21st August, 30 GP practices were signed up to access the portal. • Primary Care Risk Stratification - This is a tool now available via the web portal and will help GP practices to identify patients that are most at risk of requiring hospital admission in the future. As at 21st August, 13 GP practices data is available and it is envisaged that this number will continue to increase. • Co-Commissioning Primary care - An engagement strategy has been developed in order to explore the next steps with members. • Local Authority- Plans are underway for a number of joint commissions with the Local Authority to be undertaken which will result in more streamlined commissioning. Services include complex domiciliary care, advocacy, and home from hospital support and information and advice services. Terms of reference for joint funding panels for complex care for mental health and learning disabilities have now been agreed with the Local Authority. • Crises Care Concordat - This has now been signed off by all partners who are now working against the action plan. • Better Care Fund – there are 7 key work programmes within the fund and a review of performance to date has been undertaken. • Collaborative commissioning - A paper which describes the proposed engagement and governance for collaborative commissioning of specialised services is to be discussed at the Governing Body meeting on 1st September. (See agenda item regarding collaborative commissioning). • Acquired brain injury - In order to address quality issues, a new system has been launched that will ensure gatekeeping and case management of any patients admitted to a rehabilitation unit after an acquired brain injury. • Case Loading Maternity - The procurement process is underway and a provider event will take place at the end of August to discuss the CCGs requirements with prospective providers. New contracts will commence on 1st June 2016. • Direct Access Diagnostics - The procurement process is underway and a provider event will take place in September to discuss the CCG requirements with prospective providers. New contracts will commence on 1st July 2016. • Physiotherapy - The current service specification is to be reviewed and consulted upon prior to commencement of the formal procurement process. The new contracts will commence 1st September 2016. • Podiatry - The current service specification is to be reviewed and consulted upon prior to formal procurement process beginning. New contracts are to commence 1st August 2016. • Audiology. The current service specification is to be reviewed and consulted upon prior to formal procurement process beginning. New contracts are to commence 1st August 2016.

Contract negotiation and reviews

• Contract reviews. All existing contracts of the CCG continue to undergo a review process to ensure alignment with commissioning priorities, review service quality, outcomes, safety, evidence.

Engagement

• Wirral Patient Voice - A meeting was held on the 18th August with representation from 20 practices. Presentations given included information on Healthy Wirral and the Primary, Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 1st September 2015 Page 5 of 9

Ref No. Minute Care Quality Scheme. • Member engagement - Meetings have taken place with GPs, practice managers and practice nurses. A Members and Provider Forum have taken place. Volunteers are being asked to join a workshop to review the future engagement model and meeting arrangements, together with the chairing arrangements for these meetings. • Urgent care consultation - This is now underway with the people of Wirral on how we can change urgent care services in the Wirral. • Learning Disabilities - A public workshop was held earlier this year by the Local Authority to ask how improvements could be made for learning disability services. The learning from this event is to be used for a workshop with professionals on the future commissioning of learning disability services in Wirral. Consultation with the public will follow to test out the suggested new ways of commissioning services.

The Governing Body noted the report presented at today’s meeting.

Collaborative Commissioning

NH presented a paper to the Governing Body to support the proposed governance arrangements in Cheshire and Merseyside to enable the development of collaborative commissioning of specialised services. Members were asked to review the principles underpinning the model of collaborative commissioning and the proposed governance structures and to review the services identified as priorities for collaborative commissioning.

The Governing body were asked to:

• Note the contents of this report. • Support continued engagement with emerging governance structures to facilitate collaborative commissioning.

The Governing Body discussed and supported the continued engagement with emerging governance structures.

2.5 Finance Report

MB, Chief Finance Officer, provided members of the Governing Body with an update of the CCGs financial position to date (July – Month 4).

The Governing Body were asked to consider the CCG position regarding the associated financial risks and ability to deliver the NHS England Business Planning rules within the 2015/16 financial year. Any resulting amendment to the CCG forecast outturn position will subsequently require a formal notification to NHS England in line with relevant escalation processes and operating protocols. This will require the subsequent development of a detailed financial recovery plan and will have impact as part of the CCG Assurance Process.

As at the end of July (Month 4) the year to date operational performance position for Wirral CCG is an overspend of £1.51m before planned surplus. The planned surplus position at this point in the year was £1.61m therefore producing a year to date surplus position of £0.1m, this was a further deterioration to the trend as highlighted in previous months reporting and as discussed in detail at quality, performance and finance committee. The key drivers for the change in financial position were highlighted as being around movement in activity based contracts across a range of NHS and Non-NHS provider contracts as well as adverse movements on prescribing and commissioned out of hospital expenditure areas. This is compounded by continuing effect of the unmitigated ‘QIPP’ gap but partially offset by contingency held as per business planning rules.

The CCG is required to declare in its monthly returns to NHS England the potential risks and mitigation plans with regards to the CCG achieving financial balance at year end in line with Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 1st September 2015 Page 6 of 9

Ref No. Minute Business Planning Rules. The CCG had reported a planned financial surplus of £4.8m as at month 4 reporting on the basis that mitigations / actions plan are successful in delivering the financial plan position. However given the challenging year to date position at month 4 and worsening trend within the financial year, a reassessment of impact / likelihood of CCG actions will be required as part of month 5 and 6 reporting process particularly as a number of the QIPP plans are linked to activity based contract performance and the impact of service redesign/transformation agenda.

Further discussions took place around the CCGs financial position and JD highlighted the importance of supporting a process in developing a recovery/mitigation plan, given the current position. It was suggested that an assessment of the month 5 position, together with a worked up recovery plan would allow Governing Body members to assess whether the in-year activities would mitigate some of the risks of not achieving the planned surplus.

AC acknowledged an awareness of the financial CCGs position and the basis for the elevation of risks and challenges facing the CCG over the last few reporting periods, AC suggested that suggested approach is definitely required in order to enable the CCG to further understand an assessment of the relevant risks and mitigations as appropriate. JK echoed AC comments regarding levels of awareness.

JD asked members to ensure that they had clarity regarding the information that had been presented to them, the potential scenarios regarding the assurance process and the potential next steps. The members agreed by consensus that they have a clear understanding of the CCGs financial position and an understanding of the required processes that are in currently in place. All members stated that they feel well informed regarding the CCG and that further information would be provided regarding the CCG assurance framework and special measures regime for information purposes..

Action: MB to review month 5 position for confidence / assurance regardin forecast outturn position as per standardised reporting process and to use information to assess next reporting position.

This may require further discussions with NHS E ahead of next QPF / GB meeting due to national reporting requirements but the CCG will need to develop Financial Recovery/Mitigation plan due to worsening trend in any instance. An early draft of this document this will be shared with Governing Body members at appropriate point alongside the month 5 position (when available) to provide an updated assessment of the financial position.

Other key points for noting included:

• Commissioning Support Unit - NHS Wirral Clinical Commissioning Group current holds a contract with North West Commissioning Support Unit (NWSCU) for a range of commissioning support services. NHS England announced in February 2015 organisations that they had not been approved to join the new Commissioning Support Lead Provider Framework (LPF)and as such CCG’s have had to establish a process in order to transfer the services it currently commissions to new provision MB described the process that was currently underway for services that were to be bought in from new LPF provider and those that were being brought across on a shared service basis • ICT - No exceptional items to report on operational matters. • Information Governance - There are no exceptional issues to report and a detailed review / assurance is to be discussed at the next Quality, Performance & Finance Committee. There are discussions taking place regarding the IG Toolkit submission in Quarter Four of 2015/16 financial year. • Estates - On-going discussions regarding base accommodation for NHS Wirral Clinical Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 1st September 2015 Page 7 of 9

Ref No. Minute Commissioning Group are taking place.

Action – MB to develop a recovery plan to be presented at the September QPF meeting.

The Governing Body acknowledged the current financial position of the CCG.

2.6 Medical Directors Report

In the absence of Dr Wells members noted the Medical Directors report which included the following areas:

• Urgent Care Activity – including progress on NHS 111 mobilization, Directory of Services, OPAT (out-patient antibiotic therapy), the Single Front Door project and the ‘Think Pharmacy’ scheme’

• Planned Care Activity – including progress on ‘Consultant Connect’ (a project encouraging increased clinical dialogue with consultants regarding individual patient care), Direct Access Diagnostics, Physiotherapy and Musculoskeletal care

• Long Term Conditions – including progress on the diabetes pathway including foot care, Elderly Care (including 5 new pathways of care in association with Community Geriatricians), Respiratory Care, joint work with Public Health regarding Alcohol, Ageing well and Diabetes prevention and the Hypertension Summit to be held jointly with Public Health

• Primary Care – including progress on the Primary Care Quality Scheme, the Directory of Services appropriate for use by GP in consultation, Primary Care prescribing and Co- commissioning of Primary Care

• Clinical Senate – highlighting that a second meeting has taken place.

• Engagement – activities have included: o A Membership Council and Provider Forum have both been held, well attended o Following election of the Chair of Membership Council, a working party of members will be formed in order to review and discuss the structure of Membership engagement o Practice Managers forum event took place and Practice Managers attended the Providers Forum. o Practice Nurse Senate took place in June with further engagement planned o A joint Consultant and GP event took place in July and a further event is planned o Practice Engagement Visits ( Listening and Quality Visits) are currently being planned for all practices o Wirral Patient Voice quarterly meeting due to take place on the date of writing o 2 PPGs have been visited with the intention of extending the offer to all PPGs o Plan to increase the Virtual Patient Group.

• Research – highlighting that currently 50 practices are involved in research and that the Research Champion and Medical Director intend to encourage practice to continue to be research active following this study.

• Caldicott Guardian - highlighting Female Genital Mutilation registration by 2 practices (with more to be encouraged to register), work with current Healthy Wirral Information Governance Task and Finish Group to take forward the Wirral Care Record and advice regarding Information Governance of Risk Stratification and Safeguarding

Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 1st September 2015 Page 8 of 9

Ref No. Minute

GB15- 3.0 Items for Noting 16/0041

3.1 Subgroups for Noting

• QPF of 28.07.2015

Members noted the minutes as detailed above.

GB15- 4.0 Risk Register 16/0042

Members noted the current risk register presented for noting at today’s meeting. 5.0 Any other business

There were no other items of business and the meeting was brought to a close at 17:15pm.

6.0 Date and Time of Next Meeting

The date and time of the next meeting is Tuesday 6th October 2015 in the Nightingale Room, OMH please contact [email protected] with any apologies or agenda items.

Board meeting ended at: 17:15pm

Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 1st September 2015 Page 9 of 9

Wirral Clinical Commissioning Group

Governing Body

Action Points re Meeting of 1st September 2015 (Public Session) Nightingale Room, OMH 2pm Outstanding Actions from: 04.08.2015

Topics Discussed Minute Action Points Responsibility Action Target date Quality and Performance 4.1 • FJ to present Cancer Screening figures at the next GB meeting • FJ • November

Engagement Strategy 2.1 • LQ to bring back an Engagement Strategy Update to GB • LQ • October Informal Vanguard 3.1 • JD to bring regular Vanguard updates to GB • JD • On-going Risk Register 6.0 • PE to update the CCGs risk register • PE • On-going

New Actions from: 01.09.2015 Topics Discussed Action Points Responsibility Action Target date Patient Story • Action – LQ to write a letter on behalf of the CCG acknowledging the patient’s • LQ • ASAP experiences. Emergency Planning, Response and • PE to submit Annual EPRR submission to NHS England • PE • ASAP Resilience (EPRR) Compliance Assessment Finance • MB to review month 5 position for confidence / assurance regarding forecast • MB • ASAP outturn position as per standardised reporting process and to use information to assess next reporting position. • MB to develop a recovery plan to be presented at the September QPF meeting

Action Points – Wirral Clinical Commissioning Group, Governing Body Meeting - PUBLIC SESSION – 01.09.2015 1/2

Agenda Items for next meeting / Decisions to note for next meeting / Date & time of next meeting

The date of the next meeting is Tuesday 6th October 2015 at OMH, Nightingale Room. Agenda items and apologies are to be sent to: [email protected]

Action Points – Wirral Clinical Commissioning Group, Governing Body Meeting - PUBLIC SESSION – 01.09.2015 2/2

Report Title Corporate Affairs Report Lead Officer Paul Edwards, Director of Corporate Affairs

Contributors Laura Wentworth, Corporate Affairs Manager Recommendations • Note key messages in report • Approve the updated Governing Body Assurance Framework as discussed at Informal Governing Body October 2015

INTRODUCTION

This paper provides Governing Body with a report on the statutory functions and duties that the Director of Corporate Affairs is responsible for. These areas also align to the external CCG Assurance Framework.

KEY ISSUES / MESSAGES

• Statutory Compliance as at the reports prepared for Quality Performance & Finance Committee held in September and October 2015.

o Complaints

Within the reporting period of 14th August 2015 to 16th October 2015, 28 new complaints were received, all off of which were acknowledged within 3 working days of receipt in line with national guidance.

A summary of the 28 new complaints received is detailed below:

• 3 complaints raised were regarding Continuing Healthcare (CHC) Retrospective review delays • 6 complaints received were to appeal the decision in relation to patient’s eligibility for Continuing Healthcare (CHC) funding • 1 complaint was regarding the minor ailments scheme • 3 raised in relation to Wirral University Teaching Hospital NHS Foundation Trust (WUTH) – 2 regarding care and treatment provided and 1 relating to cleanliness of the hospital and care received • There were 2 joint complaints received; one regarding care and treatment provided by WUTH, North West Ambulance Service (NWAS) and GP Practice and one in relation to care and treatment provided at WUTH, Royal Liverpool Hospital and GP Practice

• 6 complaints were regarding GP Practices and following consent from the complainant, these complaints were forwarded to NHS England for their investigation and response. These complaints related to: o Prescription delays o Staff attitude o Delayed diagnosis (2) o Difficulties experienced in accessing travel immunisations o Regular flooding at Practice

• The remaining 7 complaints received related to the following: o Funding for the Wirral Holistic Care service o Delay in the final decision for a Personal Health Budget o Waiting times for an appointment with Inclusion Matters o Service provided by Mediquip o Attitude of staff at Walk in Centre o Care received from the Phlebotomy Service o Dissatisfaction with Freedom of Information request response in relation to the ECG service

Trends from this and previous periods identified CHC related complaints as particularly prominent, with a focus on delays in the CHC process and also challenging of the decisions made following assessments (together with requests for copies of all evidence considered to make these decisions).

There were no complaints escalated to the Parliamentary & Health Service Ombudsman (PHSO) during this period.

There were 26 complaints closed (some of which were received in the previous reporting period), all of which were responded to within 25 working days, in line with the CCG’s Complaints Policy. Full details of each investigation, outcome and lessons learned were provided in all complaint responses, in line with the national standards for managing complaints and National Health Service Complaints (England) Regulations 2009.

Of the 26 complaints closed, 5 complainants re-contacted the CCG unhappy with the responses to their concerns raised which are currently being investigated. These reopened complaints were relating to the following:

• Care provided to son from Cheshire & Wirral Partnership NHS Foundation Trust • A number of concerns raised regarding CHC funding and assessment process • Lack of mental health facilities available on Wirral • The manner in which an issue at a nursing home was reported • Incorrect diagnosis from Consultant at WUTH

A questionnaire feedback form is provided when a complaint is closed to determine how a patient feels their complaint has been managed. During this reporting period, of the 26 feedback forms sent, 2 were completed and returned to the Corporate Affairs team, both of which were positive and highlighted that the complainant is happy with the responses and outcomes of their complaints, and how they were managed by the Corporate Affairs team. o Patient Advice and Liaison Service (PALS) The PALS is commissioned by Wirral CCG and provided by Wired to provide ‘on the spot’ help whenever possible, with the power to negotiate immediate or speedy resolution (within 48 hours) of problems. Where appropriate, the PALs service will refer patients to independent advice and advocacy support from local and national sources including HealthWatch.

There were 65 PALS enquiries received within the reporting period of August and September 2015. The most common queries related to GP services.

Of the 65 calls received by the PALS office, 22 contacts were from callers raising a concern, 25 were queries being raised and 18 callers wished to make a formal complaint and were provided with the appropriate contact details to make a complaint together with information about the Complaints Advocacy Service (HealthWatch). All responses were dealt with within the national best practice response time of 48 hours.

(Source: Monthly PALS report provided from Wired) o MP Enquiries

Within the reporting period of 14th August 2015 to 16th October 2015, 8 new enquiries were received, all off of which were acknowledged within 3 working days.

There were 10 MP enquiries responded to and closed within this period, some of which were received in the previous reporting period. Brief details of the subjects of these enquiries closed are detailed below:

• Continuing Healthcare (CHC) – 2 • Procedures of Low Clinical Priority – 1 • Information available in relation to palliative care – 1 • Healthy Wirral (Vanguard) – 1 • Commissioned Services including Inclusion Matters and Wirral Holistic Care Service – 4 • GP Practice & change of medication for patient – 1 (This was referred to NHS England for their investigation and response)

The 10 MP enquiries were investigated and responded to within the CCG’s target Key Performance Indicator of 20 working days, and were therefore fully compliant within this reporting period.

o Freedom of Information (FOI) requests

August 2015: Within the reporting period of August 2015, 27 new FOI requests were received. The subjects of the FOI requests received are detailed below:

September 2015: Within the reporting period of September 2015, 18 new FOI requests were received. The subjects of the FOI requests received are detailed below:

All FOI requests received during this period were responded to within 20 working days, in line with the Freedom of Information Act 2000 and the CCG’s Policy for Management of Freedom of Information requests, and the average response time was 4 working days. Therefore, the CCG were fully compliant in managing and responding to all FOI requests within this reporting period.

o Subject Access Requests (SARs)

August 2015:

There were 4 new Subject Access Requests (SARs) received within the period of August (2 of the SAR’s were received from Solicitors and the 2 were received from family members).

September 2015:

There were 3 new Subject Access Requests (SARs) received within the period of September (1 was received from a family members, 1 from patients Advocate and 1 from the individual themselves).

All of SARs were responded to within 40 working days, therefore the CCG were fully compliant in managing and responding to all FOI requests within this reporting period.

• CCG Assurance Framework 2015/16

nd o The first Assurance Framework visit under the new regime was held on 2 October 2015 (see links below for details of the framework). This visit was attended by senior representatives from both NHS England and the CCG and focused on Quarter 1 of the 2015/16 financial year in the domains outlined in the new framework:

• Well led organisation • Delegated functions • Performance • Planning • Finance

o Whilst formal feedback has not yet been received, the meeting places significant onus on the change in the CCG’s planned financial surplus and the requirement for a recovery plan to address this. It was agreed that, once the CCG’s Governing Body had reviewed the recovery plan, this would be shared by NHS England and that NHS England would work closely with the CCG in both its ongoing development and implementation.

o Links to details of NHS England CCG Assurance Framework:

http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2013/10/ccg-ass-op- man-2015.pdf

and

http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2013/10/spec-meas- ccg.pdf

• Organisational Development

o The following section outlines development in the areas of Organisational Development since the last report presented to the Governing Body on 1st September 2015

• The CCG has utilised resource secured from North West Leadership Academy to engage with PACE Consulting to support its Governing Body development. PACE Consulting have been conducting diagnostic work since April 2015, and the first formal development session was held on 1st September 2015.

This session included work on identifying key strengths, the CCG’s core vision, team behaviors and areas for future development in the next 6 months. A summary report of the key outputs of the first sessions (and the prior diagnostic work) has been produced by PACE Consulting and shared with Governing Body members for comment. The report and member comments will then help shape the next Governing Body development session. This is being planned for 15th December 2015.

• The Director of Corporate Affairs is to lead the development of an updated Organisational Development plan to be brought to Governing Body in Quarter 4 2015/16.

• Following the CCG staff development event held in June, a Staff Forum was established made up of representatives of each team, and of varying grades. This group meets fortnightly and is instrumental in encouraging staff engagement, capturing new ideas, raising key issues and acting as a reference group for proposed CCG developments. Key issues raised are then brought to the attention of relevant senior managers and Directors and acted upon as appropriate.

The group continues to support the development of the CCG’s refreshed Mission Statement, Vision, Values and Objectives. Jon Develing, Chief Officer, is working on bringing this work together with the outputs of the Governing Body development sessions held on 1st September. This will result in a single set of statements that incorporate both pieces of work.

Once the refreshed Mission Statement, Vision, Values and Objectives are agreed, new PDRs will be undertaken aligned to the revised organisational objectives.

This Staff Forum is supporting the development of the next all staff development session to be held in November 2015.

• The Chief Officer continues to hold a weekly team briefing, updating staff on key issues and also giving a weekly opportunity for CCG employees to raise any topics they wish.

• CCG Governing Body Assurance Framework

o The CCG Board Assurance Framework was reviewed and discussed at length at the informal Governing Body held on 6th October 2015 and in line with the quarterly review schedule outlines in the CCG’s Risk Management Policy.

Key areas of discussion and amendment included (see attached Assurance Framework paper, with changes highlighted in red):

• Inclusion of practice visits as part of the engagement approach that is referenced in a number of risk areas • Addition of reference to the new NHS England Assurance Framework across a number of risk areas as an additional control • New Governing Body reporting format added across a number of risk areas as an additional control • Addition of references to new ‘Head of Communication and Engagement’ post to support risks related to patient and clinical engagement • Extension of the production of the new Patient Engagement and Experience Strategy to Quarter 4 to allow consultation with the people of Wirral • Extension of production of refreshed Organisational Development Plan to Quarter 4 to allow further consolidation of Governing Body development programme and staff engagement approaches • Vanguard references updated to ‘Healthy Wirral’ throughout the document as a result of rebranding the programme • Inclusion of serious incidents review processes in the controls related to A2 • Healthy Wirral to result in plan alignment as an additional control in A2 • A5 and C4 – additional narrative to be added around the production of a Financial Recovery Plan in the controls and assurances • Removal of B3 (Failure to understand population due to lack of data or inadequate data) as this was related to historic data access and poor Business Intelligence. This team has now been brought in-house and there now a rich data set available. • B4 - Gap identified around the effective use of the data that is now available that has resulted in B3 being removed • C3 – suggested linking to A1 as covers same risk area, but acknowledged that risk relates to different strategic aims • Section D – Quarter 4 to be stated as date for Patient and Public Engagement to be finalised across all aims • E1 – some progress being made via practices visits, Clinical Senate and Consultant Connect but not sufficient to affect scores at this stage • E2 – suggested linking back to A1 as covers same risk area, but acknowledged that risk relates to different strategic aims • Addition of examples of innovation and good news stories to the assurances on F1 as demonstrations of innovative practice • Members considered adding a new risk related to the procurement of Commissioning Support after the failure of North West CSU to get on the Lead Provider Framework. The Chief Financial Officer and Director of Corporate Affairs stated, however, that as they had been part of the procurement process, they felt more assured that the process and contingencies were robust and should lead to a successful outcome. With that in mind, Governing Body members did not add this as a new risk • Members agreed that in future reviews, gaps would be classified as ‘assurance’ or ‘control’

• Policies

o The revised Serious Incidents policy was reviewed at the Quality Performance & Finance Committee held in September 2015, however this was not formally ratified as the meeting was not quorate. The policy is therefore included on the agenda for the meeting to be held in October 2015 for formal ratification. Following this, a copy of the policy will be updated on the CCG’s public facing website and a copy sent to Provider organisations.

• Workforce/HR

o Turnover – The monthly turnover rate for August was 4.1% and for September 2015 was 1.0%, which is in line with national compliance rates and targets.

o Absence – The monthly absence rate at the end of August was 2.68% and for September was 2.79% which is below the national target rate of 3.32%, and therefore the CCG is fully compliant with national targets.

o Statutory and Mandatory Training

The training compliance as at October 2015 is as follows:

Training Module Compliance (%)

Counter Fraud 92% Equality & Diversity 90% Fire Safety 86% Health & Safety Awareness 95% Infection Prevention and Control 94% Information Governance 82% Safeguarding Adults 96% Safeguarding Children 92%

The target compliance rate for all Statutory and Mandatory training is 85%. The training compliance rates have increased significantly within the months of August and September.

The new on-line training system has the ability to provide reminder emails to staff one month prior to their courses expiring and reminder emails continue to be sent directly to staff members and copied to Line Managers, to continue to address non-compliance.

o Personal Development Reviews

The CCG are currently agreeing new organisational objectives which are due to be established by the end of December 2015. A further email will then be sent to staff as a reminder for Personal Development Reviews to be held as a matter of urgency based on these new objectives as they are cascaded throughout the organisations.

• Emergency Preparedness, Resilience and Response

o Annual Submission for 2015 Assurance Process – CCG assurance evidence requirements are for a suite of documents to be submitted to NHS England by December 2015. These documents include: • Compliance statement • The assurance sheet containing evidence against each standard • Development plan against core standards elements • Minutes of Governing Body meeting to evidence that the above documents have been approved

The compliance statement, assurance sheet and development plan were approved at Governing Body held in September 2015 and will be submitted in line with NHS England deadline.

o Business Impact Analysis update • The Business Impact Analysis templates for each team have been completed and have been reflected within the updated version of the Business Continuity Plan.

o Training exercises • The Director of Corporate Affairs attended a Severe Winter Planning exercise on 13th October 2015. • The Director of Commissioning and Head of Finance (Contracting) are to attend the Introduction to Integrated Emergency Management course to be held on 11th November 2015. • There will be CCG representation at NHS England’s whole system Pandemic Flu exercise to be held on Wednesday 13th April 2016. • A National Pandemic Flu exercise has been arranged for the 23rd May 2016. NHS England and Public Health England will be running the Merseyside element alongside the Mersey Local Resilience Forum. It has not yet been confirmed what, if any, CCG involvement is required.

o On-call review • The Director of Corporate Affairs has revised the on-call rota in line with new senior management structure and undertaken a refresh of the CCG action cards to reflect new North West Ambulance Service and NHS England escalation protocols in Quarter 3. • On-call training has been arranged for new and existing on-call staff to be delivered by Senior Resilience Manager (NWCSU) and will be held on 3rd November 2015.

o Updates from Groups / Working Groups

• Hazards and Risks Sub Group – No impacts to CCG’s. • Capabilities Sub Group – No impacts for CCG’s noted.

CONCLUSION

Governing Body is asked to note the report and approve the updated Assurance Framework.

GOVERNING BODY BOARD REPORT COVER SHEET

ASSURANCE FRAMEWORK Agenda Item: 2.2 Reference GB15-16/0046 Public / Private Public Meeting Date 3rd November 2015 Lead Officer Paul Edwards, Director of Corporate Affairs Contributors Governing Body Members Link to CCG Strategic System 1 Patient and primary care centric and based on high quality primary care, secondary Plan and community services 2 Rigorously developed and agreed care pathways working together with patients to secure their help, understanding, ownership and support of the needed changes 3 Commissioned services which have a sound evidence base 4 Provides greater equality of access to all Link to current strategic objectives 1 Prevent people from dying prematurely 2 Enhance the quality of life for people with long term conditions 3 Helping people to recover from episodes of ill health or following injury 4 Ensuring people have a positive experience of care 5 Ensuring people are treated and cared for in a safe environment and protected from avoidable harm To approve Yes To note Summary The Assurance Framework was developed by the Governing Body in conjunction with Mersey Internal Audit Agency and identifies key risks to NHS Wirral CCG’s Strategic Objectives.

When presented at Governing Body in June 2013, key controls and assurances were identified against each risk, with any gaps identified as requiring an action plan to address them. The Assurance Framework has been reviewed a number of times since then (see Report History), with the latest review being at the Informal Governing Body session held on 6th November October 2015 . Changes made at that meeting are highlighted in red and are to be approved at today’s Governing Body. The detailed discussion points are captured in the accompanying Director of Corporate Affairs’ Report.

Comments No additional comments Next Steps Adopt updated Assurance Framework

What are the implications for the following (if not applicable please state why):

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GOVERNING BODY BOARD REPORT COVER SHEET

Financial Does the report consider financial impact? YES

Part of Assurance Framework refers to the financial duties of the CCG and identifies risks related to QIPP delivery and the economy wide financial challenge

Value For Money Does the report consider value for money? No

Not applicable

Risk Is there a documented risk assessment? YES

The Assurance Framework allows the Governing Body to consider the risks that may hamper the Clinical Commissioning Group from delivering its statutory duties and functions – these are the strategically significant risks facing the Clinical Commissioning Group. The Framework also outlines how the Governing Body is provided with assurance that these risks are being effectively managed and, as such, acts as a documented risk assessment. Legal Are there any legal implications and has legal advice been obtained? YES

All NHS organisations are required to develop and maintain an Assurance Framework in accordance with the governance regulations applied to the NHS. Legal advice was not deemed necessary for this paper. Patient and Public Does the report provide evidence whether there could be a positive or Involvement (PPI) negative impact on patients and public? YES

The Assurance Framework details risks related to patient and public engagement

Equality & Human Does the report provide evidence of whether there could be a positive or Rights negative impact on protected groups (statutory duty for new / changes to services) YES

The Assurance Framework highlights reducing inequalities as a key strategic objective

Workforce Does the report provide evidence of whether there could be a positive or negative impact on the CCG or other NHS staff? No

Not applicable

Partnership Working Does the report evidence a partnership working in its development? YES

The review of the Assurance Framework has been undertaken with input from Local Authority staff and Lay representation. Some of the risks identified are associated with Partnership Working and what measures are in place to strengthen this

Performance Does the report indicate any relevant performance indicators for this item? Indicators The risk scores and mitigation actions will be regularly assessed by the Governing Body.

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GOVERNING BODY BOARD REPORT COVER SHEET

Sustainability Does the report address economic, social and environmental sustainability (should be addressed for new / change projects)? No

Do you agree that this document can be published on the website?  (If not, please note that it may still be subject to disclosure under Freedom of Information - Freedom of Information Exemptions

This section gives details not only of where the actual paper has previously been submitted and what the outcome was but also of its development path i.e. other papers that are directly related to the current paper under discussion.

Report History/Development Path

Report Name Reference Submitted to Date Brief Summary of Outcome Assurance N/A Informal Governing 6th October Updated subject to ratification at Framework Body Session 2015 November 2015 Governing Body Assurance GB 15- Governing Body 7th July Approved Framework 16/0024 2015 Assurance GB 14- Governing Body 3rd March Approved Framework 15/0068 2.1 2015 Assurance Informal Governing 3rd February Agreed amendments Framework Body Session 2015 Assurance GB 14- Governing Body 5th August Approved Framework 15/0026 2.3 2014 Assurance Informal Governing 23rd July Agreed amendments Framework Body Session 2014 Assurance GB 13- Governing Body 4th February Approved Framework 14/062 2.2 2014 Assurance Informal Governing 6th January Agreed amendments Framework Body Session 2014 Assurance GB 13- Governing Body 3rd Approved Framework 14//033 4.3 September 2013 Assurance GB 13- Governing Body 4th June Approved Framework 14/014 2013

Assurance Informal Board 25th April Governing Body Members agreed risk Framework Session 2013 ratings and scores. Actions to be added to address gaps in Assurance and present to Governing Body

Private Business

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GOVERNING BODY BOARD REPORT COVER SHEET

The Board may exclude the public from a meeting whenever publicity (on the item under discussion) would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution. If this applied, items must be submitted to the private business section of the Board (Section 1 (2) Public Bodies (Admission to Meetings) Act 1960). The definition of “prejudicial” is where the information is of a type the publication of which may be inappropriate or damaging to an identifiable person or organisation or otherwise contrary to the public interest or which relates to the provision of legal advice (for example clinical care information or employment details of an identifiable individual or commercially confidential information relating to a private sector organisation).

If a report is deemed to be for private business, please note that the tick in the box, indicating whether it can be published on the website, must be changed to an x.

If you require any additional information please contact the Lead Officer.

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WIRRAL CLINICAL COMMISSIONING GROUP ASSURANCE FRAMEWORK FOR 2015-16 FOR CONSIDERATION AT THE GOVERNING BODY MEETING - OCTOBER 2015 Workstream / Task Descriptions and Strategically Significant risks are detailed against the Strategic Aims: A To improve the health of all Wirral Citizens

B To target inequalities in health expereinces and outcomes amongst sections of our population.

C Deliver needs based healthcare of the highest quality to all our resident poulation.

D Promote maximum self care by involving and including our patients in all decisions made about them.

E To reduce waste, inefficiency and duplication within the patient journey and between partners.

F To be a high perfromance, high reputation organsiation with ambition.

2014-15 Assurance Framework (September 2015) Wirral Clinical Commissioning Group Page 1 Document produced by Wirral Clinical Commissioning Group Governing Body by:

Paul Edwards DIrector of Corporate Affairs Old Market House Hamilton Street Birkenhead Merseyside CH41 5AL.

2014-15 Assurance Framework (September 2015) Wirral Clinical Commissioning Group Page 2 A BRIEF GUIDE TO THE ASSURANCE FRAMEWORK Introduction 1 All NHS organisations are required to develop and maintain an Assurance Framework in accordance with the governance regulations applied to the NHS. The Assurance Framework allows the Governing Body to consider the risks that may hamper the Clinical Commisisoning Group from delivering its statutory duties and functions – these are the strategically significant risks facing the Clinical Commisisoning Group. The Framework also outlines how the Governing Body is provided with assurance that these risks are being effectively managed 2 Identification of a risk does not mean that it will occur. The Assurance Framework is a self-assessment process which allows the Governing Body to identify where it may need to prioritise the use of resources to improve services and internal processes.

Identifying Corporate Aims / Objectives 3 Each year the Clinical Commissioning Group's Governing body agrees a set of corporate objectives which define what has to delivered in the coming year (in this case from ). The corporate aims for 2013/14 can be seen on the front cover of this Assurance Framework. These are underpoinned by a number of objectives and work streams

Identifying and Scoring Risks 5 The Clinical Commisioning Group next considers those factors which may stop it from delivering each of these workstreams - these are the risks to delivery (Column 4), each of which is numbered (Column 1). Risks are considered in two stages, each of which is given a score in line with the Clinical Commissioning Group's Risk Management Strategy. a) The Clinical Commissioning Group considers what would be the effect upon the organisation should the risk, as described, actually occur. An impact rating score is then assigned based upon the impact on the Clinical Commissioning Group should the described risk occur - with a score of 5 meaning the risk occurring would be 'catastrophic' to the organisation and 1 having an 'insignificant' impact on delivering. The impact rating is shown in Column 5.

2014-15 Assurance Framework (September 2015) Wirral Clinical Commissioning Group Page 3 b) once a risk has been identified, the Clinical Commisisoning Group has to consider what controls are in place staff, training, financial resources, systems, controls and processes to mitigate the possibility of the risk from occurring. By having these key controls the Clinical Commisioning Group attempts to reduce the likelihood of a risk actually occurring .A likelihood rating score is used to show how effective the Clinical Commissioning Group rates these key controls in mitigating the possibility of the risk occurring - with a score of 5 meaning a risk is 'certain' to occur and 1 meaning the chances are 'remote'. The likelihood rating is shown in Column 8.

6 A risk score is then calculated by multiplying the impact rating by the likelihood rating (Column 9). Using the matrix below, each risk is then assigned a risk rating (Column 10). Both the risk score and the risk rating are used by the Clinical Commissioning Group to help it prioritise the use of resources and development of action plans. Level Descriptor Examples Frequency Consequenc 1 2 3 4 5 / e Occurrenc Likelihood e 1 Rare Difficult to believe that Annually 1 1 2 3 4 5 this will ever happen/ happen again 2 Unlikely Do not expect it to Bi-annually 2 2 4 6 8 10 happen/happen again, but it may 3 Possible It is possible that it Monthly 3 3 6 9 12 15 may occur/recur

4 Likely Is likely to occur/recur Weekly 4 4 8 12 16 20 but is not a persistent issue 5 Almost Will almost certainly Daily 5 5 10 15 20 25 certain occur/recur and could be a persistent issue

7 When considering the most appropriate impact and likelihood rating scores for a risk the GP Consortium will consider the following definitions Impact Measures

2014-15 Assurance Framework (September 2015) Wirral Clinical Commissioning Group Page 4 Level Descriptor Example, something that involves 1 Negligible No or minimal impact/ breach of stat duty/ financial loss/ business interuption Minor adverse publicity/ reduced performance/ business interruption <8 hours, small financial 2 Minor loss Reduction in public confidence, slippage in business objectives, financial loss < 0.5% budget, 3 Moderate Service interruption > 1 day Improvement notices, critical media coverage, major slippage in business objectives delivery, 4 Major financial loss up to 1% of budget. Severly critical performance rating, adverse national media coverage, loss of public 5 Catastrophic confidence, failure to meet statutory duties. Likelihood Measures Level Descriptor Example, something that involves 1 Rare an event that may only happen in exceptional circumstances/ Difficult to believe this would happen 2 unlikely an event that could occur (recur) at some time/ Do not expect it to happen 3 Posible an event that may well occur (recur) at some time 4 Highly likely an event will occur (recur) in most circumstances 5 Almost Certain an event is expected to occur (recur) in most circumstances

8 Risk scores are under constant review by the Clinical Commisisoning Group. Column 11, with the use of arrows, simply showing if their have been any changes to a risk score since the Assurance Framework was discussed at the last Governing Body Meeting. Providing Assurance to the Governing Body 9 One of the roles of the CCG Governing Body is to assure itself that the CCG has robust systems and processes in place which do what they say they will do. The Assurance Framework therefore maps out to the Governing Body where they can obtain that assurance for those risks that have been identified. This assurance takes 2 main forms:

a) Assurance (Column 7)- the Governing Body receives assurance from its own Committees, Members and Managers on the effectiveness of internal systems and controls. For example this can take the form of reports, perfromance data and minutes of meetings demonstrating that the key controls (identified in Column 6) are in place and operating effectively.

2014-15 Assurance Framework (September 2015) Wirral Clinical Commissioning Group Page 5 b) The CCG may also receive assurance on the effectiveness of internal systems and controls from other organisations. For example this includes assessments / reports from Mersey Internal Audit Agency (our internal auditor), Grant Thornton (our external auditor), NHS England, Care Quality Commission and other regulatory / statutory organisations. Gaps in Control and Assurance 10 By identifying those risks that may stop the CCG from undertaking its duties together with the key controls which mitigate these risks, the organisation may identify gaps where it either has ineffective controls in place or cannot provide sufficient assurance to the Governing Body. Column 12 identifies these gaps in control and assurance. Where a gap has been identified, the action necessary to address it is recorde in a detailed Action Plan. This should be monitored by the Director of Corporate Affairs

2014-15 Assurance Framework (September 2015) Wirral Clinical Commissioning Group Page 6 Wirral CCG

Controls Assurances Priority Gaps

Risk Impact Likelihood Risk Risk Sponsor Risk Owner/ Lead Status No Risk Description Rating Key Controls Assurance on Controls Rating Score Rating Gaps in Control and Assurance Action plan

What are the principal risks that could prevent the CCG from achieving this Evidence that the controls are operating and the Detail of gaps where the controls / systems / assurances What actions are in place to close What controls / systems does the CCG have in place to aim/ objective e.g types of risk - CCG is reasonably managing its risks with aims/ have either not yet been put in place or are yet to be fully the gaps in the controls and manage the risk clinical, financial, reputational, objectives being delivered effective. What needs to be done assurance statutory,

1 2 3 4 5 6 7 8 9 10 11 12 13

Strategic Aim A To improve the health of all wirral citizens

JSNA development and re-fresh, Health and Review Clinical Senate, Wellbeing Board (HWB), Membership of Membership Council and Governing Body includes Public Health, Local New CCG clinical and managerial strucutres Provider Forum authority and lay member representation, QPF Committee monitoring and minutes. resulting from 'Capability and Governance Review' Quater 3 2015/16 formation of Clinical Senate, Integrated planning Healthy Wirral minutes. Joint Strategic are still being implemented and and will not be Lead: Medical Director The local health economy fails to processes. Joint Strategic Commissioning Group Commissioning minutes. Reports to Health fullly consolidated until Quarter 3 A1 work together and becomes 4 established. New Healthy Wirral governance and and Well Being Board. Plan sign off by HWB. 3 12 ↔ Develop new Engagement and Safety fragmented. meeting arrangements developed. Results of 360 review and feedback, due to New engagement and experience strategy for Experience Strategy Representatives of Healtheatch and LMC are be next undertaken in March 2016. Collation member practies and patients will be needed in Quarter 3 2015/16 Accountable Officer members of the Governing Body. New of themes from pracitce visits light of move away from consortia arrangements Lead: Director of Quality/Head engagement structrures as part of CCG Redesign. following the 'Capability and Governance Review' of Direct Commissioning Introduction of Think Phamarcy and Consultant Connect initiatives. Practice Visits commenced Medical Director/Director of Quality and Patient

CCG Strategy and Plan, Health & Wellbeing Plan alignment will result from Strategy, Contractual Quality and Performance Health Wirral yprogramme JSNA and public health data and reports. requirements, patient engagement, public health Quarter 3 2015/16 QPF committee minutes. Governing Body. support and reports, QPF Committeee monitoring Lead: Chief Officer New 2013-2018 Strategic Plan has been Outcomes for patients don’t and reporting. Quarterly Assurance visits from Plan alignment to ensure local commissioining A2 4 submitted. Shared measures via the Better 3 12 ↔ improve or deteriorate. Area Team. In the future, will also incorporate and provider plans. Review Terms of Reference of Care Fund External CCG Assurance Outcomes Outcomes Framework and Quality Premium. New Joint Commissioning Strategy Framework. Minutes of SI Review received at

Accountable Officer Governing Body Reporting Format. Healthy Wirral Group Quality, Performance and Finance Committee partners to produce plan. Serious Incident Review Quarter 2 2015/16

Head of Strategic Planning and process in place. Lead: Chief Officer

CCG Strategic Plan, NHS England performance monitoring, Patient Feedback, Patient Practice Performance reports to Governing Body, QPF Fail to deliver agreed health A3 3 Groups, Quality and Performance Contract Committee minutes. External CCG 3 9 ↔ No gaps indentified priorities and objectives. Officer meetings, QPF Monitoring. Refreshed Strategic Assurance Framework Director of Accountable

Commissioning Plan. Health & Wellbeing Board, Public Health and CCG to develop Social Care representation on CCG Governing Health and Wellbeing Board, QPF Committee decommissioning guide that Social factors may impact more Body, public health intelligence, CCG Strategic minutes Healthy Wirral minutes. Joint Lack of awareness re Social Value Act, particularly covers social value A4 greatly than health improvement 3 Plan, Integrated Commissioning. Integrated Strategic Commissioing minutes. Reports to 4 12 ↔ in regard to decommissioning Quarter 3 2015/16 investments can address. planning processes. Joint Strategic Health and Well Being Board. Plan sign off Lead: Head of Delivery and Commissioning Group establishe. Healthy Wirral by HWB. JSNA evidence.

Accountable Officer Contracts

Chief Financial Officer programme

Health and Wellbeing Board, QPF Committee QIPP Strategy and plans, DASS membership on minutes. Healthy Wirral SLG minutes. Joint Plan alignment will result from CCG Governing Body, Health & Wellbeing Board, Plan alignment to ensure local commissioining Strategic Commissioing minutes. Reports to Health Wirrral programme Reducing financial resource QPF Committee monitoring. Integrated planning and provider plans. Health and Well Being Board. Pooling Quarter 3 2015/16 A5 available across health and social 4 processes. Joint Strategic Commissioning Group 5 20 arrangements for Better Care Fund. External ↔ Lead: Chief Officer care. established. Healthy Wirral finance workstream. Assurance re: provider ability to deliver Cost CCG Assurance Framework. Monitoring of New Governing Body Reporting Format. Improvement Plans

Accountable Officer Financial Recovery Plan through 'Confirm and

Chief Financial Officer Development of Financial Recovery Plan Challenge' Group

Strategic Aim B 1 To reduce health inequalities within our local population

Page 7 Wirral CCG

Controls Assurances Priority Gaps

Risk Impact Likelihood Risk Risk Sponsor Risk Owner/ Lead Status No Risk Description Rating Key Controls Assurance on Controls Rating Score Rating Gaps in Control and Assurance Action plan Inability to measure outcomes/ improvements Chief Financial B1 due to poor/ inaccurate data 3 Risk Removed July 2015 Officer Officer and data collection Accountable mechanisms

Public Health Communications Campaigns, Public Health workers. Diversity in delivery of health messages, i.e attendance at shopping/ community Develop new Engagement and New engagement strategy for public and patients Failure to engage general public centres. . Links with VCAW. New Engagement QPF Minutes and reports, Governing Body Experience Strategy will be needed in light of move away from B2 in change, difficultly in engaging 3 Strategy to be developed. Stakeholder database. minutes and reports. Feedback from Expo 4 12 ↔ Quarter 4 2015/16

Safety consortia arrangements following the 'Capability with hard to reach groups. Healthy Wirral workstream promoting self care. event Lead: Director of Quality/Head and Governance Review' New Governing Body Reporting Format. Expo of Direct Commissioning Accountable Officer Event set up for November to engage with wider public Director of Quality and Patient

Strategic Aim B 2 To target differences in perceived/ real outcomes between the population utilising our services

Failure to understand Director of Risk Removed October 2015 as BI team and B3 population due to lack of 3 Commissioning data flows in place data or inadequate data Accountable Officer

PALS, Complaints management, website New engagement strategy for member practies feedback mechanisms, Communications support QPF Minutes and reports, BME worker and patients will be needed in light of move away Develop new Engagement and systems provided by CSU, QPF Committee quarterly report. GB minutes. CCG fails to understand people's from consortia arrangements following the Experience Strategy monitoring. Patient Engagement Reports to CCG Communications, Engagement and B4 health experiences due to lack of 3 4 12 ↔ 'Capability and Governance Review' Quarter 4 2015/16 Governing Body. CQC relationship, Quality Experience Group minutes, Quality engagement. Lead: Director of Quality/Head Surveillance Group, Complaints Monitoring. Surveillance Group minutes. Healthwatch Ensure data from engagement activities is of Direct Commissioning

Accountable Officer Healthwatch. Quarterly aggregated reported to member on GB. Quality & Safety Group. understood and utilised QPF. New Governing Body Reporting Format Director of Quality and Patient Safety

Strategic Aim C Deliver needs based healthcare of the highest quality to all our resident population

Friends and Family test, Quality Impact meetings. QPF Committee receives regular reports from Monitoring of CQUINS. Implementation of Datix providers which include an agreed set of HR risk management system. Hospital visits & walk metrics indicating adequate levels and Providers fail to deliver high arounds. Quarterly aggregated reports to QPF. C1 4 competencies of staffing. Friends and Family 3 12 ↔ No gaps indentified quality services New Lay Member for Quality as part of new test result. Monitoring of patient complaints. structure. New Head of Contacting and Delivery Safe staffing levels now reported. External

Accountable Officer in post. New Director of Commissioning appointed. CCG Assurance Framework New Governing Body Reporting Format Director of Quality and Patient Safety

Page 8 Wirral CCG

Controls Assurances Priority Gaps

Risk Impact Likelihood Risk Risk Sponsor Risk Owner/ Lead Status No Risk Description Rating Key Controls Assurance on Controls Rating Score Rating Gaps in Control and Assurance Action plan

Lack of sound intelligence C2 and systems for performance Risk Removed March 2015 monitoring and reporting. Performance Head of Quality and and Quality of Head Chief ClinicalChief Officer

Regular reports to GB and Healthy Wirral Full engagement with the Health and Wellbeing SLG evidences consensus agreement Board to drive our high level strategic between organisations on Wirral-wide needs, understanding of the needs of the patch. strategies and approaches.This demonstrates Collaborative work led at HWB which engages that the CCG is not working within a health C3 Ineffective partnership working 4 Providers, LA Executives and CCG leaders 3 12 ↔ No gaps indentified silo. Healthy Wirral SLG minutes. Joint working together. Integrated planning processes. Strategic Commissioing minutes. Reports to Better Care Fund planning, Joint Strategic

Accountable Officer Health and Well Being Board. Better Care Commissioining Group. Healthy Wirral

Accountable Officer /Chair Fund Plan sign off by HWB. Healthwatch programme member of GB.

CCG Strategic Plan, QIPP Plan with measurable outcome targets, QPF Committee monitoring and, Indicators of success/ failure in demand management and action plans as needed. QSG. BCF plan delivery, Systems CQUINS monitoring. QPF. Clinically led Resilience Plan Delivery, workstreams. 2 year plan in place & refocus of introducton of new Local Inabiliy to manage rising demand commissioning intentions. New Governing Body QPF Committee monitoring of QIPP. Enhanced Service approach and reducing capacity in a Systeme Resilience Group now in place to Formalise and monitor range of initiatives in Quarter 4 C4 4 Reporting Format. Financial Recovery plan 4 16 ↔ constrained financial developed address economy wide pressures. Governing 2015/16 that address system pressures Lead: Chief Officer environment. Body minutes

Accountable Officer Financial Recovery Plan Chief Financial Officer Quarter 3 Lead: Chief Financial Officer

Continuing work with community partners in voluntary, community and faith sectors plus QPF Committee reports on shifting local representatives of individuals with protected Develop new Engagement and demographies and take up of services by Organisations fail to put the characteristics to ensure their full representation in Experience Strategy diverse populations. Friends and Family Test C5 patient at the heart of everything 4 our commissioning plans . Friends and Family 2 8 No gaps indentified Quarter 4 2015/16 results. PPG forum agendas & minutes. ↔ they do. Test. Public Health intelligence. Analysis of Lead: Director of Quality/Head Quarterly aggregated complaints reports to Patient Safety provider organisations complaints. PPGs. New of Direct Commissioning

Accountable Officer QPF. Incidents reported and reviewed.

Director of Quality and Head of Communications and Engagement to be recruited

Strategic Aim D Promote maximum self care by involving and including our patients in all decisions made about them

CCG Strategic Plan, Comms & Engagment Plan, JSNA, HWB membership and Plan, Patient Groups and Forums, Lay member for Patient Develop new Engagement and Engagement, Public Health inclusion on CCG Patient Group/ Practice feedback, Public Socio demographic changes (e.g. New engagement strategy will be needed in light Experience Strategy GB.Engagement events and activities. Patient Health Reports. GB minutes. D1 ageing populatoin, migrant 3 3 9 ↔ of move away from consortia arrangements Quarter 4 2015/16 Engagement Reports to CCG Governing Body. Communications, Engagement and population) prevent inclusion. following the 'Capability and Governance Review' Lead: Director of Quality/Head Triangulation as part of Communications, Experience Group minutes. of Direct Commissioning

Accountable Officer Engagement and Experience Group. Healthwatch member at GB. NHS constitution. Vanguard Group re self care & prevention. Director of Quality and Patient Safety

Page 9 Wirral CCG

Controls Assurances Priority Gaps

Risk Impact Likelihood Risk Risk Sponsor Risk Owner/ Lead Status No Risk Description Rating Key Controls Assurance on Controls Rating Score Rating Gaps in Control and Assurance Action plan

Comms and Engagement Plan, Communications Support from CSU, Website development, Use of social media, Engagement events and activities, Develop new Engagement and Patient and public feedback, feedback/ Failure to engage widely means Public CCG GB meetings. Patient Engagement New engagement strategy will be needed in light Experience Strategy interaction with public at engagement events. D2 that decisions may be skewed by 3 Reports to CCG Governing Body. Triangulation as 3 9 ↔ of move away from consortia arrangements Quarter 4 2015/16

Safety GB minutes. Communications, Engagement particular interest groups. part of Communications, Engagement and following the 'Capability and Governance Review' Lead: Director of Quality/Head and Experience Group minutes Experience Group. Links to Healthwatch New of Direct Commissioning Accountable Officer Head of Communications and Engagement to be recruited Director of Quality and Patient

CCG Strategic Plan, Comms & Engagement Plan, Investment in multicultural services to promote Develop new Engagement and care with Long Term Conditions. Focus on self Cultural and attitudinal issues New engagement strategy will be needed in light Experience Strategy care via the Integration Boad. Healthy Wirral Monitor services invested in via QPF. D3 skew expectations against self 3 3 9 ↔ of move away from consortia arrangements Quarter 4 2015/16

Safety Engagement workstream. Integration team work re Integration Board minutes. care. following the 'Capability and Governance Review' Lead: Director of Quality/Head patient care. Healthy Wirral workstream re self of Direct Commissioning

Accountable Officer care and prevention. New Head of Communications and Engagement to be recruited Director of Quality and Patient

Comms & Engagement Plan, Communications CCG fails to get information Support from CSU, Website development, Choose Patient and public feedback, feedback/ across in a way that engages the Review of the use of language for minutes of Well/ Public Health campaigns, Some use of interaction with public at engagement events, D4 public and is understandable to 3 2 6 ↔ meetings on website to ensure are clear and Ongoing

Affairs social media. Patient Engagement Reports to PALS/ Complaints reporting through QPF them (allowing for differing levels understandable CCG Governing Body. New Head of Committee. GB minutes. of understanding).

Accountable Officer Communications and Engagement to be recruited Director of Corporate

Stategic Aim E To reduce waste, inefficiency and duplication within the patient journey and between partners New CCG structures enable clinical involvement New CCG clinical and managerial strucutres through the Clinical Senate, Provider Forum and resulting from 'Capability and Governance Review' Review Clinical Senate, Membership Council as well as clinical QPF Committee meetings and reports, QIPP are still being implemented and and will not be Membership Council and Ineffective engagement from E1 4 membership of other committees and GB New Plan monitoing and reporting, Clinical Senate 3 12 ↔ fullly consolidated until Quarter 3 Provider Forum

Chair clinicians Governing Body Reporting Format. Consultant minutes Quater 3 2015/16 Connect established, cycle of Practice Visits Further direct practice engagement by visits and Lead: Medical Director Accountable Officer established, Expo planned for November events

JSNA and HWB Strategy and Board, Contract Contract management meetings and minutes, management arrangements, development of QPF Monitoring and reporting, QIPP Team service specifications which require collaborative minutes, Social Care updates to CCG GB. Providers/ Health and Social approach, Joint CQUIN development, Social Care Healhty Wirral SLG minutes. Joint Strategic E2 Care fail to work together in 4 2 8 ↔ No gaps indentified represnentation on CCG GB and QIPP teams. Commissioing minutes. Reports to Health partnership Integrated planning processes. Joint Strategic and Well Being Board. Better Care Fund

Accountable Officer Commissioning Group established. Better Care Plan sign off by HWB and pooled budget

Accountable Officer /Chair Fund.Healthy Wirral SLG arrangements

Public consultation, Engagement through Wirral CCG to develop Voice/PPGs, CSU support, Use different comms Adverse public reaction to Patient group feedback, web site feedback. decommissioning process mechansims e.g local press. Patient E3 decommissioning or reduction in 3 GB minutes. Communications, Engagement 4 12 Lack of formal decommissioning process Quarter 3 2015/16 Engagement Reports to CCG Governing Body. ↔ Officer access and Experience Group minutes Lead: Head of Delivery and Director or

Accountable New Head of Communications and Engagement

Commissioning Contracts to be recruited Consortia don’t work together and share E3 Risk Removed March 2015

Chief commisisoning ideas/ Officer Officers Consortia Consortia direction of travel Chief ClinicalChief

Strategic Aim F To be a high performance, high reputation organisation with ambition

Page 10 Wirral CCG

Controls Assurances Priority Gaps

Risk Impact Likelihood Risk Risk Sponsor Risk Owner/ Lead Status No Risk Description Rating Key Controls Assurance on Controls Rating Score Rating Gaps in Control and Assurance Action plan

Develop staff to focus on innovation Develop Organisaional Development plan AQUA/HIPP and other membership/subscriptions. Quarter 4 2015/16 QIPP/Commissioning Plan/Urgent Care/Strategic Lead: Director of Corporate Plan and Healthy Wirral programme all require CCG fails to be innovative and Approvals Committee minutes, GB minutes. Affairs innovation to change to system. Staff trained in F1 deliver sufficient appropriate 4 CCG plans. Clinical Senate minutes. Award 3 12 ↔ New CCG clinical and managerial strucutres

Affairs Experience Lead Commissioning. Development of change won by BI team resulting from 'Capability and Governance Review' Review Clinical Senate, Clinical Senate to drive clinical innovation. are still being implemented and and will not be Membership Council and

Accountable Officer Examples of innovation include Think Pharmacy, fullly consolidated until Quarter 3 2015/16 Provider Forum OPAT, Single Front Door, Conultant Connect Quater 3 2015/16 Lead: Medical Director Medical Director/ Director of Corporate

CCG has effective oversight of poor 4 Risk Removed March 2015 Chief Chief Chief Chief Clinical Clinical Head of of Head provider performance. Quality and Performanc F2 e/Consortia

CCG Comms and Engagement Plan, Regular communications with local politicians as Councillors, MPs plus regular, open, transparent communication with local media. Staff and community newsletters from CCG , Regular Develop new Engagement and briefings of encouragement to the voluntary, New engagement strategy will be needed in light Experience Strategy Failure to be proactive with 3 community and faith sectors, Healthwatch and GB minutes. . Healthy Wirral SLG minutes 2 6 of move away from consortia arrangements Quarter 4 2015/16 opinion makers. ↔ other local community representatives through following the 'Capability and Governance Review' Lead: Director of Quality/Head area fora etc. Patient Engagement Reports to of Direct Commissioning Accountable Officer CCG Governing Body. Triangulation as part of Director of Corporate Affairs Corporate of Director Communications, Engagement and Experience Group. Communications and Engagement staff now in place. Health y Wirral F3 Involvement in Clinical Senates; use of benchmarking analyses when undertakng needs Failure to adequately benchmark assessments. Joint work on reshaping the health Quality dashboard, Right Care data, minutes 3 2 6 ↔ No gaps indentified with peers. provider economy with neighbouring CCGs. CLRN of CWW Chairs and Chief Officers. Director of of Director meetings. AQUA/HIPP and other Commissioning

F4 Accountable Officer membership/subscription

Page 11

Report Title Quality and Patient Safety Report Lead Officer Lorna Quigley Director of Quality and Patient Safety

Recommendations • Note progress in report • Review issues and concerns highlighted and identify any further actions.

INTRODUCTION

This report is to provide information to the Governing Body on the quality of services commissioned by NHS Wirral CCG.

KEY ISSUES / MESSAGES

WIRRAL UNIVERSITY TEACHING HOSPITAL

The Care Quality Commission has undertaken a comprehensive inspection of all services in September, as part of this programme a series of patient listening events was undertaken facilitated by CQC. The outcome of the inspection is awaited

There have been twelve serious incidents that have been reported onto the national reporting system in September and eight in October. In accordance with the serious incident reporting a root cause analysis will be undertaken.

There have been 2 never events reported in September and October. One relating to wrong site surgery and one wrong route administration.

The Trust receives patient feedback via the Friends and Family Test which is assessed in A&E (minors unit), inpatient services, and maternity service over 4 touch points. The data presented is performance in August.

WIRRAL COMMUNITY TRUST

There have been eleven serious incidents reported on the national reporting system for September, and seven in October. In accordance with the serious incident reporting a root cause analysis will be undertaken.

Since January 2015, The Trust has undertaken the Friends and Family test for Community services.

CHESHIRE AND WIRRAL PARTNERSHIP TRUST

The Care Quality Commission has undertaken a comprehensive inspection of services provided by CWP in August. This report has not been published.

There has been four serious incident have reported to the national reporting system in September, and three in October. In accordance with the serious incident reporting a root cause analysis will be undertaken.

Friends and Family Test for Mental Health services at CWP are detailed below.

ONE TO ONE MIDWIFEREY SERVICE

The Care Quality Commission have undertaken an unannounced focussed inspection in April 2015.This was due to a number of concerns raised about the care of women at the service and to follow up the compliance actions issued at our previous inspection in September 2014. This report has been published on 16th October 2015. http://www.cqc.org.uk/sites/default/files/new_reports/AAAD0562.pdf

Overall the provider showed some improvement in governance since the last inspection. However there was a continued issue re the management of governance in the organisation. CQC where not assured that risk was being managed effectively across the organisation to provide a safe environment for mothers and unborn babies.

Practice had now ceased in relation to Controlled Drugs, and an action plan has been submitted to CQC and shared with the CCG following the inspection. The CCG will continue to monitor the organisation as part of their contract requirements with the CCG as the Lead commissioner with Warrington and Liverpool CCG’s.

Action GB to note: Since the publication of this report, there has been local Media interest.

NURSING AND RESIDENTIAL HOMES

The CCG continues to work collaboratively with Local Authority colleagues to ensure that quality and safety in nursing homes is maintained. The following CQC reports have been published

Ryecroft Residential Home. This was rated inadequate by CQC following their inspection in May and reported in September. This is no longer registered with the CQC. The full report can be accessed using the link below. http://www.cqc.org.uk/location/1-120691341

Heathermount residential Home was inspected in July. The report has been published in September and has been rated as requires improvement. http://www.cqc.org.uk/location/1-115774761

*Penkett Lodge; This nursing home was inspected in April and the report published in September. This has been rated as requires improvement

http://www.cqc.org.uk/location/1-118280109

*Pensby Hall Residential Home: An unannounced inspection was undertaken in August, and has been rated as inadequate. This report was published in September. http://www.cqc.org.uk/location/1-118243727

Hoylake Cottage Hospital; This home has nursing facilities, intermediate care beds and day care dementia services. An unannounced inspection was undertaken in August by CQC who have rated the home as inadequate. The report was published in October. http://www.cqc.org.uk/location/1-110278022

Action GB to note: *Penkett Lodge and Pensby Hall are managed by the same company. The publication of these reports from some of these homes have been of interest to the local media

QUALITY IN PRIMARY CARE

A System for reporting near misses and serious incidents has been implemented within Primary Care; this system gives Primary Care the ability to report quality concerns about providers to the CCG in addition to self-report which improves quality. The table shows the number of GP reported incidents. The largest theme for reporting relates to the discharge process and access/appointments.

Action: GB to Note: The majority of reporting relates to other providers, and not self - reporting

CQC have commenced their programme of inspections in Primary Care which includes both GPs and Dental Surgeries. It is the intention that these visits will be undertaken over the next 12 months.

The Friends and Family test (FFT) have been performed in GP practices since January 2105. There is a variance in response rates across practices. Practices will need to look at innovative ways to improve response rates. The net promoter score for Wirral Practices are more favourable than those across Merseyside and Cheshire.

Action GB to Note: There has been a drop in the number of response rates from 661 in June.

SAFEGUARDING CHILDREN AND VULNERABLE ADULTS

The safeguarding team continue to ensure that there are robust processes in place across commissioned services to ensure that children and vulnerable adults are protected. Level 3 safeguarding training for GPs took place in October, this was attended by 35 GP’s. he session has been evaluated as excellent. The role of the Named GP for Safeguarding Adults has been filled, however there is a vacancy for the Named GP for Safeguarding Children. This has been advertised nationally, and there have been no applicants for this role. Subsequently a local GP has shown interest in the role. This is a risk to the CCG with regard to compliance against the safeguarding assurance framework. This risk is on the CCG risk register

Action: GB to note: The risk highlighted within the safeguarding team.

CONTINUING HEALTH CARE (CHC)

From summer 2014, CCGs across Cheshire and Wirral have been working together on the delivery of continuing healthcare, funded nursing and complex care services. A Joint Committee of CCGs and Local Authorities has been set up with delegated responsibilities around continuing healthcare, funded nursing and complex care (approved by GB Nov/Dec 2014)). The strategic Joint Committee is underpinned by an Operational Group and various task and finish groups. Following transition into the CCG the priority for the service was, transition and stabilisation whilst engaging staff, people who use services and their families and wider stakeholders in a process of redesign for transformation.

As part of the transformation agenda, work went on to develop a new service model which was presented in a detailed business case at the CHC Joint Committee in August 2015. This was followed by an intensive confirm and challenge process for Cheshire and Wirral CCGs and Local Authorities in September 2015. From this the joint committee has agreed to extend the timelines due to risks and issues identified from this process.

Previously Unassessed Periods of Care (PUPOC)

The Department of Health introduced deadlines for appeals for people who think they may have been eligible for NHS continuing healthcare funding between 1 April 2004 and 31 March 2012 but who did not have a continuing healthcare assessment at that time, this is known as Retrospective CHC -Previously unassessed periods of care, (PUPoC). Below is the plan set and the actual cases that have been undertaken. This work is being undertaken by the Northwest Commissioning Support Unit, because of the concerns raised regarding the delivery and quality issues across Merseyside and Cheshire, a Single Item Quality Surveillance Group (QSG) was held in September. CHC has been identified on the CCGs risk register.

Action: GB to note the changes in timeline with regard to the transformation and note the performance and risks to delivery with regard to PUPOCs.

QUALITY PERFORMANCE INDICATORS

The table below shows the number of serious incidents in month.

The biggest area for reporting remains Pressure Ulcers,

Number of SI's Reported in Month 45 40 35 30 25 20 15 10 5 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

OTHER PERFORMANCE AGAINST THE NHS CONSTITUIONAL STANDARDS

Achievement against the 4hour standard remains a challenge for the Trust and the Health and Social Care economy. Some improvement had been seen in the latter half of June and July; however this has not been sustained. The Systems Resilience Group continues to meet monthly to hold the system to account. An economy escalation plan has been developed and its robustness is being tested. The Economy is in Phase 1 of the Emergency Care Improvement Project (ECIP) which is a project being run by NHSE for the most “challenged” economies.

Due to the change in focus on looking at all patients who have been waiting (incomplete pathways), the patients being treated within 18 weeks has deteriorated across the providers. Pressures remain at subspecialty level, eg community paedatircs. This is being monitored by the CGG as part of the contractual process. There have been no patients waiting over 52 weeks.

Action: GB to Note the change in the focus of reporting.

The amount of time patients waiting for an appointment with a suspected cancer (2 week rule) and those waiting for cancer treatment (62 day wait) remain a focus for the CCG. The System Resilience Group (SRG) is responsible for the reviewing of patients who breached the 62 day pathway to ensure that future breaches are prevented.

There have been four breaches in in the delivery of the same sex accommodation in September. This is an increase on previous months. All breaches where in the critical care area at Wirral University Teaching Hospitals. The CCG will be managing this through the contractual process.

Action: GB to note the approach that the CCG are adopting with regard to single sex accommodation breaches.

The ceiling set for the CCG in 2015/16 in relation to Clostridium Difficile was 75. The year to date position is 31, with 6 new cases reported in September . These have been attributed to: • 5 Wirral University Teaching Hospital • 1 Royal Liverpool and Broadgreen Hospitals

A detailed review of all cases is undertaken to see if the cases where avoidable, and see if there is a pattern to the cases. Public Health have appointed tot eh substantive post for Health Protection. The post holder commenced in role in October, this will support the IPC agenda.

There have been no new MRSA Cases reported in September 2015. Cumulatively there have been 3 cases to date.

CONCLUSION

Governing Body is asked to note the report.

Report Title Medical Director Report Lead Officer Nesta Hawker Director of Commissioning

Recommendations 1. Note progress in report

1. INTRODUCTION

1.1 This paper provides Governing Body with a report on the key strategic and operational issues related to the delegated duties of the Director of Commissioning.

2. STRATEGY DEVELOPMENT AND REFORM IMPLEMENTATION

2.1 Policy development A draft commissioning decision policy and process for the CCG has been developed and is now on the CCG website for consultation with the public. 2.2 Recovery plan Detailed project plans with agreed metrics to monitor progress have been developed as part of the recovery plan for 2015/16 and for 2016/17. Progress against each of the project plans are reviewed in detail at Delivery Plan Confirm and Challenge meetings and outline progress shared at the Operational meeting on a weekly basis. 2.3 Review of urgent care model. Following consultation the potential model for urgent care delivery will be refined and the final model will be recommissioned during 2016/17. 2.4 Single Front door. Agreement reached that this scheme of implementing nurse triage at ED at Arrowe Park to sign post patients to the appropriate care setting will start 1st December 2015. 2.5 Primary Care Quality Scheme. The PCQS has been launched and operational from 1st October 2015. Support has been offered individually for practices which have been taken up. The BI web portal has been launched and is being used by practices. All 56 practices have signed up to deliver PCQS. A small number of practices have shared their plans which have been uploaded onto the CCG members section of the website to share good ideas and practice. 2.6 Primary Care Risk Stratification The tool has been developed and launched and 51 out of 56 practices have signed the data sharing agreement, and it is felt that this may increase by a further two over the next week or so. Two practices are developing their own model, and one practice has refused to sign the agreement. 2.7 Co-Commissioning. • Primary care. A paper is attached which outlines the proposed way forward for co- commissioning. An engagement strategy is being developed in order to explore next steps with members, which will be in place by December 2015. • Local Authority. Agreement reached to undertake a review of joint funded packages of care and develop a strategy and action plan for future joint commissioning arrangements. To include involvement of Cheshire and Wirral Partnership in the review of learning disability services and community mental health packages of care. 2.8 Crises Care Concordat. The team have presented to the AQUA collaborative on progress achieved with the crisis care concordat. 2.9 Improving Access to Psychological Therapies (IAPT) CCG successful in bid for IAPT monies to support clearing the waiting list backlog inherited from the previous contract. 2.10 CAMHS and Eating Disorder Service A bid has been submitted to NHS England for £500k for CAMHS and £200k for eating disorders. The CAMHS bid will focus on early intervention and prevention and develop a single point of access for patients, families and professionals. 2.11 Better Care Fund – highlights of progress of the schemes as at September:- • Reduction of non-elective activity target (-2.25%) has been achieved for quarter 1 and on track to achieve for quarter 2. • Winter preparation a) 100 intermediate and transitional beds available from 1st September with a plan to increase to 110 in December. b) 4 adapted flats (which will support people waiting for adaptions to their own property) available. c) 24 planned and unplanned respite beds (including 3 bariatric) available. d) Rapid Community service which offers support in a person’s own home such as overnight support, domiciliary and reablement support. e) Rapid Community team which is being increased to offer a 7 day core response to ensure discharge 7 days and also rapid community response 7 days supporting the IMC beds and in the persons own home.

3 OPERATIONAL DEVELOPMENTS

3.1Procurement update

• Case Loading Maternity. The procurement went live on 12th October 2015. The deadline for receipt of PQQ (pre-qualifying questionnaire) is 12th November 2015. New contracts will commence on 1st June 2016 • Direct Access Diagnostics. The procurement process is underway. The September provider event highlighted potential challenges for NHS providers to construct their sub-contractors within the provisional procurement timeline for the Prime Provider model (NHS Trusts are subject to different statutory and legal obligations than non-NHS providers). The procurement timeline is being re-drafted to ensure no providers are disadvantaged. • Physiotherapy and Podiatry. Procurement processes were separately planned for these services with new contracts to commence on 1st September 2016 and 1st August 2016 accordingly. The CCG has since reconsidered its approach and is developing a new integrated pathway for MSK (Muscular Skeletal) incorporating physiotherapy and podiatry. The procurement timeline is to be determined. In the meantime both contracts will be subject to negotiation on price, waiting times and first to follow up ratios (where appropriate). • Audiology The current service specification is to be reviewed and consulted upon prior to formal procurement process beginning. New contracts to commence 1st August 2016.

3.2 Contract negotiation and reviews

Contracts with Wirral Community Trust, Cheshire and Wirral Partnership and Wirral University Teaching Hospital NHS FT are all signed.

4 ENGAGEMENT

4.2 Wirral Patient Voice. All three consortia Patient Forums have now been merged into one larger “Wirral Patient Voice Group” who have met a number of times and are currently going through an election process for Chair and Vice-Chair and are finalising Terms of Reference for the group. The group is supported by the Direct Commissioing Team and have established a process for receiving and requesting information from the CCG. 4.3 Member engagement • Monthly meetings have taken place with GPs, Practice Managers and Practice Nurses. Members and Provider Forums have taken place, these have been opened up to Practice Managers and Practice Nurses. A number of Protected Learning Time events and ad hoc training sessions have also taken place. • A GP Chair has been voted in place to Chair the Members meetings • Primary Care Communications funnelled through Direct Commissioing Team with weekly CCG bulletin and ad hoc communications which has received positive feedback. 4.4 Urgent care review The initial consultation has now finished with 443 respondents. Further engagement with community groups planned during October and wider public consultation on the refined proposed model for the urgent care system to be undertaken during December – February 2016. 4.5 Learning Disabilities. An engagement event with the Local Authority has been held to seek the views of parents/carers of children with a learning disability approaching transition to adulthood on how we can improve the experience during transition.

5 CONCLUSION

5.1Governing Body is asked to note progress and agree next steps regarding co- commissioning of primary care.

Please see appendices below:

Co-commissioning_joi nt_commissioning_app

GOVERNING BODY BOARD REPORT

Report Title Co-commissioning - Joint Commissioning Application Proposal Lead Officer Iain Stewart, Head of Direct Commissioning

Recommendations 1. Submit application for Joint Commissioning to be operational from April 2016 2. Membership Engagement – recommendation to establish a transition working group to support the transition period 3. Delegated Commissioning Status April 2017

1. INTRODUCTION

1.2 In May 2014 NHS England invited CCGs to come forward with an expression of interest to take on an increased role in the commissioning of GP services. The intention was to give CCGs more influence over the wider NHS budget and enable local health commissioning arrangements that can deliver improved, integrated care for local people in and out of hospital.

There are 3 co-commissioning models that CCGs can take forward:

1. Greater involvement in GP commissioning decisions 2. Joint commissioning responsibility with NHS England 3. Full delegated responsibility for commissioning the majority of GP services

Primary care co-commissioning is one of a series of changes set out in the five year forward view. The purpose of primary care co-commissioning is to enable clinically led, optimal local solutions in response to local Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies. This will be done by delegating functions and decision making to the local level.

2. KEY ISSUES / MESSAGES

2.1 A meeting with the CCG’s clinical leads, NHS England representatives, Direct Commissioning team members and the Director of Commissioning and Contracting was held on 20th October to discuss the options around co-commissioning and timescales for application. It was agreed during this meeting that the CCG’s intention would be to submit an application for joint commissioning status (level 2) in February 2016 with the view to become a joint commissioning CCG from April 2016 (for the duration of the 2016/17 financial year). This allows time for thorough engagement with our membership practices around the transition and operation of this agreement. There is a further intention to submit an application November 2016 for fully delegated co-commissioning status from April 2017 (for the duration of the 2017/18 financial year).

3. IMPLICATIONS

3.1 The CCG would be required to complete a joint commissioning checklist ahead of submitting the application, this includes:

GOVERNING BODY BOARD REPORT

• Ensuring that the CCG has complied with statutory duties regarding the involvement of members and other key stakeholders in the development of joint commissioning arrangements • Ensuring that the CCG has involved its members in the development of joint commissioning arrangements and the governing body has ratified the proposed governance changes • Ensuring that the CCG has set out clearly defined objectives and benefits of the arrangement • Ensuring that the CCG Constitution or proposed constitutional amendment has been updated in line with the guidance and this has also been approved by the NHS England regional office and sent to [email protected] • Ensuring the governance documentation has been updated in line with the Next Steps guidance (joint committee terms of reference incorporating scheme of delegation) • Ensuring the CCG has reviewed its conflicts of interest policy in line with the statutory managing conflicts of interest guidance • Ensure the CCG IG Toolkit meets level 2 criteria as a minimum

The list below sets out a brief overview of the functions the CCG can expect to acquire under joint commissioning status:

• GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing breach/remedial notices and removing a contract) • Newly designed enhanced services (Local Enhanced Services and Directed Enhanced Services) • Design of local incentive schemes as an alternative to the Quality of Outcomes Framework (QOF) • The ability to establish new GP practices in an area • Approving practice mergers • Making decisions on ‘discretionary’ payments (e.g. returner/retainer schemes)

In joint commissioning arrangements, CCGs and NHS England remain accountable for meeting their own statutory duties. Therefore NHS England retains accountability for the discharge of its statutory duties in relation to primary care commissioning.

3.2 In order to manage the process for co-commissioning, the CCG will need to produce a terms of reference for joint commissioning arrangements, including a scheme of delegation. The CCG will also need to form a Primary Care Committee. In the interests of transparency, and mitigation of conflicts of interest, a local Health Watch representative and a local authority representative from the local Health and Wellbeing board will have the right to join the committee as non-voting attendees. Clinical leadership will also need to be retained in the committee arrangement. It is recommended that the Primary Care Committee must have a lay and executive majority and have a lay chair.

3.3 The CCG and area team can consider implementing a pooled fund agreement under joint commissioning arrangements as per section 13V of Chapter A1 of the NHS Act 2006 (as amended by the Health and Social Care Act 2012). Although NHS England can create a pooled fund which a CCG can contribute to, the CCG’s contribution must relate to its own functions and so could not relate to core primary medical service. The CCG will have the

GOVERNING BODY BOARD REPORT

opportunity to discuss the current financial position for all local primary care services with their area team. NHS England will provide the organisation with an analysis of our baseline expenditure broken down between GP services and other primary care services.

3.4 CCGs are advised to have a conversation with their area team regarding accessing support through the existing primary care team. A regional steering group has been formed with CCGs in the local area to discuss the distribution and potential collaboration of resource. It is advised that a senior representative of the CCG attends these bi-monthly meetings to involve the CCG in these discussions. CCGs are advised to discuss options for sharing administrative resource to support commissioning of primary care services.

3.5 NHS England have advised for both joint commissioning and delegated arrangements the CCG will need to take a strengthened approach to managing conflicts of interest; co- commissioning could significantly increase the frequency and range of potential conflicts of interest. A framework from NHS England for conflict interest management with clear minimum expectations for CCGs has been developed. This guidance has regard to any statutory guidance issued by Monitor, and continues to facilitate clinically-led decision making as far as possible within the important constraint of the effective management of conflicts of interest. The guidance also provides a framework to a strengthened approach to the public register of conflict of interest – this will include information on the nature of the conflict and details of the conflicted parties. The register will form an obligatory part of the annual accounts and be signed off by external auditors. The CCG will also be required to maintain and publish, on a regular basis, a register of procurement decisions.

3.6 Between now and January 2016 we have the opportunity to engage with our members to discuss the proposal and further shape it with their involvement. This process will start at the earliest opportunity to maximise potential. A members meeting is scheduled for Wednesday 4th November with an agenda item devoted to Primary Care development. Co-commissioning will be re-introduced as a concept to our members and this will be an opportunity for them to get involved and ask questions. A requirement of the application is the CCG has involved its members in the development of co-commissioning arrangements. Therefore, in addition to protected agenda items at the Wirral wide members meetings; each membership practice has also been offered a practice visit from the senior clinical and management team. Each of these visits will include an agenda item on co-commissioning. Neighbouring CCGs have also established a transition working group to support the change to joint commissioning. This is a concept for engagement which needs to be considered by the Governing Body. The establishment of a transition working group is an opportunity to form a multi-disciplinary team with clinicians and lay members to discuss the co-commissioning strategy and develop a feedback/engagement strategy with members.

3.7 Co-commissioning is an opportunity to ensure that local arrangements maximise the benefits for the local patient population. This concept can be shared with the established Patient Voice group; there is also scope to share information and involve patients virtually via email communications. In establishing the Primary Care Committee it is obligatory to have a lay and executive majority, with a lay chair.

GOVERNING BODY BOARD REPORT

4. CONCLUSION

Following approval an engagement strategy for members will be drafted by November 2015, this will include: • Regular agenda slots at Wirral wide members meetings on co-commissioning • Practice Visits to include an agenda item on co-commissioning By January 2016 we will seek a majority approval from members ahead of the application submission.

This document seeks approval from Governing Body for the CCG to proceed, following engagement with members, to submit an application to NHS England in February 2016 to commence level 2 co-commissioning (joint commissioning) from April 2016. The intention is to submit a further application in November 2016 for delegated status from April 2017. This decision will be brought again to Governing Body and will be dependant on a review of the actual experience of joint commissioning from April 2016.

5. APPENDICES (Must be copied below or available on request – do not embed)

No. Title of Appendix

Report Title Governing Body Report regarding Financial Govern- ance / Management – October 2015 Lead Officer Mark Bakewell – Chief Financial Officer Recommendations a) Financial Performance

The Governing Body is asked to consider the CCG position regarding the associated financial risks and ability to deliver the NHS England Business Planning rules within the 2015/16 financial year.

An assessment should be made in conjunction with the CCG Risk Management Policy and current as- sessment within the Governing Body risk register in respect of criteria for impact and likelihood.

c) Note the Development of the Financial Recovery Plan (8 Impact Areas detailed project plans in Ap- pendix One)

e) Note the Developments within the LPF and dele- gated authority to Chief Officer following completion of process to place contract

g) note the Information Governance developments as part of ‘Healthy Wirral’ programme and Infor- mation Sharing Agreement within Appendix Two

INTRODUCTION

This report is produced in line with revised reporting arrangements to the CCG Governing Body and in accordance with Assurance Framework alignment for 2015/16.

The areas for reporting are as per the table below.

Governing Body Report CCG Assurance Component

Chief Financial a) Financial and Activity Financial Manage- Performance ment Officer b) Financial Planning c) QIPP d) Final Accounts e) Commissioning Support f) ICT g) Information Governance h) Estate

Page 1 of 109 Information Sharing Agreement Healthy Wirral WCR - November 2015

Details will be reported on an exceptional basis and will complement discus- sions held at Quality, Performance and Finance Committee with regards to the appropriate actions. a) Financial Performance

This report sets out the financial position for NHS Wirral Clinical Commission- ing Group (Wirral CCG) as at the end of September (Month 6) within the 2015/16 financial year and the performance against the measures outlined in the CCG Assurance Framework 2015/16.

1. PERFORMANCE INDICATORS

1.1 Wirral CCG’s assessment of its performance against these indicators is set out in the table below with commentary:

Financial performance Primary / Self Assessment Self Assessment Self Assessment No. Indicator Supporting Month 4 Month 5 Month 6 Indicator (July 2015) (Aug 2015) (Sept 2015)

1 Underlying recurrent surplus Primary Green Green Green 2 Surplus - year to date performance Primary Amber / Red Red Red 3 Surplus - full year forecast Primary Green Red Red 4 Management of 1% NR funds within agreed processes Supporting Green Green Green 5 QIPP ** - year to date delivery Primary Amber / Red Amber / Red Amber / Red 6 QIPP ** - full year forecast Primary Amber / Red Amber / Red Amber / Red No Formal No Formal No Formal Indicator Indicator Indicator 7 Activity trends - year to date Supporting Available Available Available No Formal No Formal No Formal Indicator Indicator Indicator 8 Activity trends - full year forecast Supporting Available Available Available

9 Running costs Primary Green Green Green Clear identification of risks against financial delivery and 10 Primary Amber / Red Amber / Red Amber / Red mitigations This covers internal and external audit opinions, and an 11 Supporting Green Green Green assessment of the timeliness and quality of returns Balance sheet indicators including cash management and 12 Supporting Green Green Green BPCC Financial plan meets the 2015 surplus planning 13 Supporting Green Amber / Red Amber / Red requirement

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Year to date and Forecast Financial Performance (Indicator no 2 & 3)

1.2 As at the end of September (Month 6) the year to date operational per- formance position for Wirral CCG is an over spend of £2.32m before surplus, as shown in the variance table below. M6 M5

Movement Month 6 YTD variance YTD variance £'000 £'000 £000 Programme expenditure 2,357 1,889 467

Admin expenditure (34) 18 (52) Subtotal 2,323 1,907 415 (operational performance) Surplus (2,411) (2,010) (402)

CCG YTD overall performance (89) (102) 14

1.3 There remains to be a continued deterioration in the year to date posi- tion, this is a continuation of previous month trends overperformance against planned levels of activity (across both NHS / NON-NHS provid- ers) and prescribing.

1.4 In line with the assessment of the month 6 position, across all areas of expenditure and considering expected forecast trajectories, the forecast outturn surplus position remains revised at £0.37 million. This is a devia- tion away from the CCG’s ability to deliver the planned surplus level (1% - £4.8 million) as per NHS England Business Rules.

Recurrent Non-Recurrent Total £m £m £m Resource 478.38 5.16 483.54

Expenditure 475.38 7.78 483.17

Revised (Surplus) / Deficit (3.00) 2.62 (0.38)

1.5 This change in the forecast outturn position has led to a financial recov- ery plan written by the CCG which is currently being reviewed by NHS England

1.6 Due to the CCGs financial position and as part of its recovery plan the CCG has identified 8 high impact areas as stated below: 1. Urgent Care Recovery including Single Front Door 2. Statutory Duties / Packages of Care 3. New Models of Care - Respiratory 4. New Models of Care - Diabetes 5. Primary Care Quality 6. Contract Conditions 7. Risk Strat / ICCH

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8. Prescribing

Activity Trends (Indicator no. 7 & 8)

1.7 The CCG continues to develop a robust activity monitoring system via its Business Intelligence team and delivery through its web portal.

1.8 The below tables are extracts from the portal of performance information and sources of appropriate data providing a snapshot of activity perfor- mance against all provider contracts:

CCG Activity Dashboard – Comparison against NHS England Plans (All Providers)

CCG Activity Dashboard – Comparison against Last Year (All Pro- viders)

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GP Referrals (General & Acute Specialties)

Other Referrals (General & Acute Specialties)

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Financial Risks (Indicator no. 10)

1.9 A number of risks are still being highlighted by the CCG in the month 6 reporting to NHS England, as outlined below in section 3 but are sum- marised by:

• Secondary Care activity and coding • QIPP delivery • Better Care Fund • Continuing Healthcare/ Joint Funded packages

Balance Sheet and Cash Management (Indicator no. 12)

1.10 Balance sheet indicators and other performance metrics regarding cash management and Better Payments Practice Code (BPPC) is reported below.

1.11 The BPPC monitors public sector organisations on the timeliness of its financial payments in terms of both volume and value. Guidance rec- ommends 95% of payments within 30 days.

1.12 The table below shows performance for all invoices (NHS and non NHS) within the system as at month 6:

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1.13 The CCG cash balance at the end of September was £22k. This is in line with current NHSE guidance that CCGs aim towards 1.25% month end cash balance of the drawdown.

1.14 There are no significant aged debtors or creditors to highlight as at Sep- tember, although there are a range of on-going queries with regards to expenditure in relation to packages of care with Wirral DASS.

2. DETAILED PERFORMANCE ANALYSIS

2.1 The month 6 year to date operational performance detail breakdown is shown in the variance table below:

M6 M5

Movement YTD variance YTD variance £'000s £'000 £'000 NHS 181 459 (278) Non NHS 1,118 1,014 104 Prescribing 544 157 387 Commissioned out of Hospital 228 344 (117) 3rd Sector (2) (1) () Better Care Fund 0 0 0 Other (incl reserves) 288 (84) 371 Running costs (34) 18 (52) Operational performance 2,323 1,907 415

2.2 Performance improvements in month for NHS contracts and commis- sioned out of hospital services have been offset by prescribing and re- serves.

NHS Contracts

2.3 Monthly information relating to contract performance is regularly being received by all providers. The reporting position reflects August data

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(M5) where received and has been used to inform the month 6 financial reporting position.

2.4 NHS contracts reports an over spend against plan of £181k as at month 6.

2.5 This is a favourable in month movement of £278k mainly due to the ex- penditure alignment with the Better Care Fund and the Royal Liverpool and Broadgreen Hospital Trust contract (critical care/non elec- tive/outpatient follow-ups all lower than plan).

2.6 Areas of contract performance pressures reported and highlighted at month 6 are: • Aintree Hospital £238k - in relation to elective activity and excluded drugs • Alder Hey Children’s Hospital £158k – mainly day case and non-elective activity, • Countess of Chester Hospital £73k – vascular and bariatric, and • St Helens & Knowsley Hospital £64k – day case, elective activity and non-elective excess bed days.(areas include breast reconstruction and burns)

NHS Contracts – Wirral University Teaching Hospital Foundation Trust (WUTH)

2.7 The year to date performance at WUTH shows £264k underperformance against plan, a detailed analysis is shown in the table below:

Full Year Plan YTD Actual YTD Variance YTD WUTH Summary Plan (M5) (M5) (M5) £000's £000's £000's £000's DC and Elective (including XBDs) 42,008 17,472 17,002 (469) A&E 9,494 4,106 4,022 (85) Non Elective (including XBDs) 65,050 26,918 27,113 195 Non Elective Non Emergency (including XBDs) 7,973 3,280 3,139 (140) Outpatients 31,180 12,860 12,955 96 Unbundled Diagnostic Imaging 2,143 878 883 6 Maternity 4,848 2,001 2,136 135 Non-PbR 55,278 23,018 23,034 16 CCC Diagnostics 219 91 88 (3) Bilateral Patient Charges 59 25 11 (13) Total Contract £218,253 £90,648 £90,384 (£264)

2.8 It is important to consider the issue of potential increases in elective ac- tivity given the increase in GP referral numbers as per the activity sec- tion of this report and the potential impact that has upon the current posi- tion for future months activity

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Non NHS Contracts

2.9 Month 5 activity has been received for the majority of non NHS contracts and is used to inform the year to date position. The position at month 6 shows over performance against plan of £1.12 million. (month 5 £1.01 million over)

2.10 Spire Murrayfield is £325k over planned levels of spend as at month 6 which is a favourable in month movement of £42k due to lower than planned activity in month. The over performance is due to an increase in referrals and orthopedic activity from WUTH and general surgery.

2.11 Locally commissioned services shows a year to date over spend against plan of £674k, this predominantly remains in relation to physio activity, as shown in the table below:

movement Month 6 Annual Budget YTD variance from M5 £'000 £'000 £'000 AQP Physio 985 473 107 AQP Radiology 327 104 24 AQP Audiology 387 67 8 AQP Ophthalmology 433 32 15 Bridgewater 78 (2) () Total 2,210 674 154

2.12 The CCGs overall year to date position in relation to physio performance is illustrated by provider in the table below:

Plan YTD YTD Variance movement Physio Provider £'000 £'000 YTD £'000 from M5 WUTH 630 583 (47) (75) WCT 1,934 2,223 289 30 Peninsula 188 200 12 (5) AQP Premier Health 210 297 86 22 AQP Injury Care Clinic 277 607 330 36 AQP Spire Healthcare 6 12 6 4 Total 3,245 3,921 677 11

Prescribing

2.13 Four months prescribing actual data has been received to date with es- timates included for August and September. The year to date perfor- mance position reported for prescribing is £544k overspend.

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2.14 This detail breakdown is shown in the table below:

M6 YTD Movement from variance M5 £'000 £'000 Practice Prescribing 508 378 Amber (15) 12 Centrally Charged Drugs 33 3 Air Liquide 18 (6) Total Prescribing 544 387

2.15 The movement in month is partly due to known annual tends in prescrib- ing. For the last 3 years in succession, prescribing has increased in cost during July, followed by a decrease in August. The CCG is mirroring the national trend for monthly cost and have decreased its % growth against national from 1.9% to 1.8% for this year to date against 2014/15 figures.

2.16 Work continues with the CCGs prescribing lead, primary care lead and the CSU Medicines Management team. The development and roll out of a mitigation plan is in progress to manage potential pressure areas in prescribing, working with outlying practices/proposed pilot following pre- scribing reviews, looking at script switch rejections and develop further QIPP schemes/rebate schemes.

Better Care Fund (BCF)

2.17 Work continues with regards to the development of the pooled budget arrangements for the Better Care Fund and the governance arrange- ments regarding the performance monitoring of the Section 75 agree- ment.

2.18 There still remains however an amount of financial and performance risk to the CCG as a result of the minimum top-slice to the pooled budget. This has seen further mitigating actions taking place in order to minimise the financial impact however there does remain a gap of around £4.4m which will need to be managed through the Better Care Fund Board and further CCG mitigating actions.

2.19 A full review is being conducted as part of the month 6 closedown. Fur- ther information and evaluation will be made available in the month 7 re- port.

Other & Reserves

2.20 The pressure shown in reserves of £0.84 million is consistent with the release of 6/12ths of the contingency and the current unmitigated QIPP gap as per table below:

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Full Year Impact YTD £'000 £'000

Un-identified QIPP (4.09) (2.05) Contingency 2.41 1.20 Total Mitigations (1.69) (0.84)

3. IMPLICATIONS

Forecast Outturn/ Risks and Mitigations:

3.1 The CCG is required to declare in its monthly returns to NHSE the risks and mitigation plans with regards to the CCG achieving financial balance at year end.

3.2 Given the continued challenging year to date position in the financial year, the CCG maintains its reported revised financial surplus of £0.37 million. This was a movement in month 5 from the planned 1% surplus of £4.8 million.

3.3 This resulted in the CCG writing a financial recovery plan in month 6 which is currently under review by NHS England and the CCG awaiting feedback.

3.4 With respect to mitigation of the risks in particular the unidentified QIPP element and the BCF planning gap, the CCG has collectively identified a number of mitigations which are outlined in the recovery plan.

3.5 The anticipated impact of the recovery plan mitigations in 2015/16 is £3.75 million, as illustrated in the QIPP Section below:

3.6 If the CCG continued on a trajectory towards the year end with no miti- gations in place then the potential forecast outturn position “likely case” would be a deficit of £1.4 million:

Pre – Recovery Plan Mitigation Like- Best Worst Case Scenario Analysis ly Case £ 000 £ 000 £ 000 (370) (1,370) Current FOT Surplus at Month 6 (370) * Potential WUTH - Contract Risks - 1,000 500 Elective (above current FOT) Potential WUTH - Contract Risks - 1,600 800 Non-Elective (above current FOT) Additional Non-WUTH Risks 946 473 Potential Deficit / (Surplus) 3,176 1,403 (1,370) Pre Mitigation Gap to Planned Surplus (£4.823m) 7,999 6,226 3,453

* Impact of non recovery plan mitigation measures

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For the range of scenarios:

3.7 Worst Case is considered to be full impact of coding & counting, contract growth for remainder of financial year and other outturn risks are trans- lated into position. Only 25% of demand management and cash releas- ing savings have subsequent impact upon the Worst Case Scenario

3.8 Likely Case (pre recovery plan mitigation) suggests 50% of above finan- cial risk converting within year end position and current CCG mitigations hold any potential variation to anticipated levels included within above. Only 50% of demand management and cash releasing savings have subsequent impact upon the Worst Case Scenario

3.9 Best Case scenario considers that 0% of the risks translate and that CCG mitigations have additional impact upon the year to date position. Also assumes that 100% of demand management and cash releasing savings have subsequent impact upon the Worst Case Scenario.

3.10 The table below shows the scenario analysis post recovery plan mitiga- tions. The CCG’s potential forecast outturn position likely case would be a surplus of £0.47 million.

Post – Recovery Plan Mitigation Worst Case Likely Best Case Scenario Analysis

£ 000 £ 000 £ 000

Current FOT Surplus at Month 6 (370) (370) (1,370)

Potential WUTH - Contract Risks - Elective (above current 1,000 500 FOT)

Potential WUTH - Contract Risks - Non-Elective (above cur- 1,600 800 rent FOT)

Additional Non-WUTH Risks 946 473

Potential Deficit Pre Mitigation 3,176 1403 (1,370)

Demand Management and Main- (674) (1,349) * tain Current Outturn

Cash Releasing (264) (528) (1,056)

Revised Deficit / (Surplus) Posi- 2,238 (474) (2,426) tion

* Demand Management maintains outturn position

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3.11 Activity performance and use of appropriate levers within contracts is paramount to the ability to be able to deliver the planned surplus for the financial year and therefore will need to be closely monitored / actioned as appropriate over the duration of the financial year in particular regards to the risks relating to community and secondary care activity.

3.12 A revised assessment of QIPP / BCF (£4.4m) gap is on-going in con- junction with an assessment of the ability to deliver the revised surplus position. b) Financial Planning

There are no exceptional issues to report, the CCG Financial Plan is currently being refreshed for Quarter two 2015/16 recurrent adjustments and in respect of in-year requirements regarding non-recurrent expenditure (headroom), Bet- ter Care Fund / Section 75 agreement and long term planning assumptions as appropriate.

The CCG understands that planning guidance may not be released until Early January but with early signals leading to multiple year allocations but with a requirement for a system wide transformation plan and alignment of provider / commissioner plans.

The CCG Financial Recovery Plan includes an indicative assessment of po- tential scenarios within the 2016/17 financial year regarding potential planning / QIPP gaps based on the planning assumptions c) QIPP & Effective, Efficient Services

The CCG had established a ‘QIPP’ plan of circa £6.9m QIPP following an up- date to the 2015/16 financial plan. This consisted up of £2.3m in identified schemes and £4.6m in unidentified schemes.

Due to the Financial Performance Position, the CCG has prepared a Financial Recovery Plan which is currently under review by NHS England and now forms the basis of the QIPP requirements going forwards.

The Financial Recovery Plan supports both 2015/16 and 2016/17 financial performance with the identification of 8 Impact areas (Appendix One)in sup- port of delivery of the revised forecast outturn position for 2015/16 and helping to support additional improvements in the longer term with a plan to return to business planning rules in 2016/17.

The key impact areas are as per the table below

Clinical Clinical Dept Director Leads Support Heads Urgent Care Recov- Paula Andrew 1 ery inc Single Front Nesta Hawker Cowan Cooper Door

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Statutory Duties / Sian Peter Christine 2 Nesta Hawker Packages of Care Stokes Arthur Campbell New Models of Care Sian Kathy Andrew 3 Nesta Hawker - Respiratory Stokes Fegan Cooper New Models of Care Sian Lesley Andrew 4 Nesta Hawker - Diabetes Stokes Hodgson Cooper Simon Iain 5 Primary Care Quality Paul Edwards Delane Stewart y Trish 6 Contract Conditions Mark Bakewell Clitheroe Sue Iain 7 Risk Strat / DES Nesta Hawker Wells Stewart Simon Saket Iain 8 Prescribing Lorna Quigley Delane Jalan Stewart y

The anticipated impact of the recovery plan mitigations in 2015/16 is as fol- lows (Appendix One)

Demand Manage- Cash Re- Anticipated ment and leasing Impact 15/16 Maintain and Miti- Current gate Risks Outturn Urgent Care Recovery inc 1 £1,759,872 Yes Single Front Door Statutory Duties / Packages 2 £496,660 Yes of Care New Models of Care - Res- 3 £58,500 Yes piratory New Models of Care - Diabe- 4 Nil assumed tes 5 Primary Care Quality £376,000 Yes 6 Contract Conditions £500,000 Yes

7 Risk Strat / ICCH £503,000 Yes Yes 8 Prescribing £60,000

£3,754,032 £2,697,372 £1,056,660

Detailed Project Plans are being prepared regarding 8 impact areas and are included as part of Appendix One

d) Final Accounts

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No Exceptional issues to report, CCG Finance team are implementing rec- ommendations / feedback from 2014/15 year end process in order to improve approach.

Early planning is underway for Annual Accounts / Annual Governance State- ment report production in line with requirements and release of national guid- ance. Timetable has been brought forward a further week from 2014/15 and will result in additional pressures in order to meet required deadline

Transition planning process currently underway with regards to Financial Ser- vices Arrangements back from NWCSU (to new shared service between Wir- ral, Western Cheshire (Host) and Warrington CCG’s) will are vital to smooth Year end / Final Accounts process. e) Commissioning Support

Background

NHS Wirral Clinical Commissioning Group current holds a contract with North West Commissioning Support Unit (NWSCU) for a range of commissioning support services. NHS England announced in February 2015 organisations that had been approved to join the new Commissioning Support Lead Provid- er Framework (LPF).

NWCSU were not on the approved lists of organisation’s who had been ap- proved in order to deliver the support services to Clinical Commissioning Groups (CCGs) and such CCG’s have had to establish a process in order to transfer the services it currently commissions to either

• one of the providers on the framework in each of the respective lots • provision of services in-house or on a shared basis (requiring ap- proval of NHS England on a business case basis).

The current configuration of the LPF / alternative approaches is as per below table

Component Decision LPF Lot

Data Management Separate Process (DSCRO) Shared Service (Wirral (Host) & Contracting & Quality West Cheshire) Process / Governance EPRR LPF Lot 1 E&D LPF Lot 1 IG Advisory LPF Lot 1

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IFRs LPF Lot 2b Medicines Management LPF Lot 2a Communication & En- LPF Lot 1 gagement Procurement LPF Lot 1 Shared Service (West Cheshire Finance (Host) , Warrington & Wirral) HR/OD LPF Lot 1 ICT LPF Lot 1 UCAT Separate Process CHC PUPOC LPF Lot 2b

The current status / timeline of the LPF process is as follows

1 bid 1 bid 2 bids 2 bids Lot 1 End to End Lot 1 ICT Lot 2A Lot 2B • Business Intel- • GP IT • Medicines • CHC Previous- ligence • CCG Corporate Management ly Unassessed • Comms ICT Periods of Care • HR & OD • Trust ICT (PuPOC) • Governance • Individual &Risk Funding Re- quest s (IFRs)

The CCG Governing Body will be updated on progress as per below timetable

The CCG Chief Officer will be required to approve the award of contract to each of the respective providers following completion of the above process and will be in line with the CCG’s Scheme of Delegation / Standing Orders.

Stage Date Description Status 13/07/15 (soft launch) Pre Procurement Complete 1 Work Complete and 27/07/15 (final launch) onto Portal Complete 30/09/15 – 14/10/15 Evaluation Work underway and on track 05/10/16 – 07/10/15 Interviews Work underway and on track 2 27/10/15 - 05/11/15 Standstill Period Work underway 16/11/15 Award of Contracts Work Underway 3 17/11/15 – 01/03/16 Mobilisation Not yet commenced Shall not exceed 4 Business as Usual Not yet commenced 01/03/16

It is anticipated that subject to above timelines and final details this will be agreed during November with award notification to governing body as appro- priate upon agreement.

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f) ICT

No Exceptional items to report on CCG operational matters other than subject to 2.5 above re LPF procurement will be subject to transition.

General Practice Information Technology (GPIT) services in Cheshire are cur- rently provided by Northwest Commissioning Support Unit (NWCSU) man- aged via delegated NHS England budget to the CCG, however subject to 2.5 above re LPF procurement will be subject to transition.

LPF decision will also have impact upon Technical Infrastructure issues as per below and have been identified as potential risks

The CCG currently sit on Wirral NHS Community Trust (CT) infrastructure and utilise the CT IP Telephony solution. This includes a number of network con- nections, servers and storage area network (SAN) and the CT invoice the CCG direct for related services, maintenance and support contracts

3 GP practices at Victoria central Health Centre - Liscard, Central Park and Mill Lane sit on CT infrastructure and utilise the Wirral health economy N3 connections, 2 of these use the CT IP Telephony solution

2 practices at St Catherine’s Health Centre - Greenway Park and Victoria Park sit on CT infrastructure and utilise the Wirral health economy N3 connections, 2 of these use the CT IP Telephony solution.

The Community trust has signaled that administrative access to the infrastruc- ture will not be given to external parties. g) Information Governance (IG)

There are no exceptional issues to report regarding CCG IG activities and a detailed review / assurance is discussed at Quality, Performance & Finance Committee.

There are a range of work plan activities being progressed in order to com- plete milestones for IG Toolkit submission in Quarter Four of 2015/16 financial year

However, a significant amount of work is currently being undertaken with re- gards to Information Governance Areas in relation to the Health Wirral pro- gramme due to the work on the Wirral Care Record and development of regis- tries.

This has included development of Privacy Impact Assessment and Data Shar- ing Agreements across the Wirral Partners Organisation in order to support the development of the Wirral Care Record and Registries as part of the Value Proposition. Draft Versions of these documents are included in Appendix Two and subject to further development as part of the ongoing proces

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This has included input from the Caldicott Guardian (Dr Sue Wells), Senior Information Risk Owner (SIRO) Mark Bakewell and Chief Officer (Jon Devel- ing) in order to ensure documentation and approach is in line with Information Governance Requirements.

In line with the appropriate roles and responsibilities and in line with the Standing Orders of the organisation, these documents require approval by the CCG (through the delegated authority to the Chief Officer and recommenda- tions of the SIRO and Caldicott Guardian Roles) and other partners within the Healthy Wirral Programme

The development of the agreement with Cerner as part of the Healthy Wirral is dependant upon the development and agreement of these key IG documents and further versions will be required as the development of the platforms con- tinue over the next few phase. h) Estate

On-going discussions regarding base accommodation for NHS Wirral Clinical Commissioning Group. The lease extended for Old Market House until March 2016 pending further review and business case development between health and social care partners.

Mark Bakewell Chief Financial Officer NHS Wirral Clinical Commissioning Group

16th October 2015

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Appendix One - 2015/16 Impact Areas as part of CCG Financial Recovery Plan

Project Plans

1 Urgent Care Recovery / Single Front Door scheme

Key Lines of Enquiry Actions Timescale Reduction in ED attend- Commences Novem- 1 Single Front Door ances ber 15 Reduction in non-elective Commenced Early Supported Discharge excess bed days COPD commences 2 General Reduced 30 day readmis- October 15 Fractured Neck of Femur sions COPD

% patients not conveyed Commenced to hospital 3 Green Car Reduction in ED attend- ances Reduction in ED attend- Commenced 4 Acute Visiting Scheme ances Reduction in non-elective Commenced admissions

Reduction in ED attend- 5 OPAT ances

Reduction in non-elective excess bed days Reduction in non-elective Commenced admissions

Reduction in readmissions 6 Older people's services (5 pathways) Reduction in ED attend- ances

Reduction in ED attend- In progress ances 7 Street triage Reduction in non-elective admissions Reduction in non-elective Commences October 8 Rapid community service and ICCHs admissions 15 Sustained 4 hour perfor- Commenced 9 ED 4 hour recovery plan mance above 95%

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Assumed Financial Impact (compared to Month 6 position), these will be a combina- tion of demand management / avoidance initiatives that will secure the forecast out- turn position as reported against the main acute / unplanned care contract assump- tions within the month 6 forecast outturn assumptions

Impact Contract Anticipated Impact (Finance) type Expenditure

Demand WUTH Mgt & De- 1 Single Front Door £114,048 liver Current FOT

Early Supported Discharge WUTH Demand

Mgt & De- General 2 £175,500 liver Current Fractured Neck of Femur FOT (See respiratory section below for ESD

for COPD)

Demand WUTH Mgt & De- 3 Green Car £32,700 liver Current FOT

Demand WUTH Mgt & De- 4 Acute Visiting Scheme £38,304 liver Current FOT

Demand WUTH Mgt & De- 5 OPAT £269,100 liver Current FOT

Demand WUTH Mgt & De- 6 Older people's services (5 pathways) £403,650 liver Current FOT

Demand WUTH Mgt & De- 7 Street triage £26,910 liver Current FOT

Demand WUTH Mgt & De- 8 Rapid community service and ICCHs £699,660 liver Current FOT

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9 ED 4 hour recovery plan N/A N/A

£1,759,872

2 Statutory Responsibilities / Commissioned Out of Hospital Care

The CCG is to review the range of current expenditure within plans for 2015-16 with regards to its statutory responsibilities particularly with regards to commissioned out of hospital care (care packages of joint / fully funded nature).

It is anticipated that the CCG will be able to make in year savings as a result of re- verting to its statutory obligations in certain areas, however this may have an adverse impact on other partners (e.g. local authority) and will need to be considered appro- priately as part of the impact assessment process

A summary of specific actions being taken with regards to this area are as per the below table

Actions Key Lines of Enquiry Timescale

1 Develop schedule for bringing all Community Treatment Or- October - March 2016 CTOs back to panel to ensure that the ders CCG is funding assessed health needs

2 Issue credit notes for all financial que- Resolved queries October - December ries outstanding 2015

3 Develop schedule of 100% Health Review of 100% Health October - March 2016 funded packages and bring back to funded LD packages panel for review, with a view to ensur- ing the CCG is funding assessed health needs 4 Develop schedule of 50% Health Review of 50:50 LD pack- October - March 2016 funded packages and bring back to ages panel for review, with a view to ensur- ing the CCG is funding assessed health needs 5 Develop list of all packages where Implementation of Re- From October on- patient has moved out of area, where sponsible Commissioner wards Wirral CCG is no longer the Respon- Guidance sible Commissioner, and hand pack- age over to Responsible Commis- sioner

Assumed Financial Impact (compared to Month 6 position)

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Impact type Contract Expendi- Anticipated Impact (Finance) ture Develop schedule for bringing all CTOs Commissioned Out back to panel to ensure that the CCG is Cash Re- of Hospital Expendi- funding assessed health needs. Plan is leasing ture – Funded 1 £125,660 to bring all CTOs back to panel to shift Packages of Care to 50 - 50 funding, with a quarter's im- pact. 2 Resolve for all financial queries out- £171,000 standing Develop schedule of 100% Health funded packages and bring back to 3 panel for review, with a view to ensuring £75,000 the CCG is funding assessed health needs Develop schedule of 50% Health fund- 4 ed packages and bring back to panel for review, with a view to ensuring the CCG is funding assessed health needs £125,000 Develop list of all packages where pa- tient has moved out of area, where Wir- 5 ral CCG is no longer the Responsible Commissioner, and hand package over to Responsible Commissioner £496,660

3 / 4 New Models of Care – focus areas inc Respiratory & Diabetes

As part of the Healthy Wirral transformation process and redesign of end to end pathways in certain disease areas, it is anticipated that with the additional ‘Vanguard’ investment to pump prime the service development in these areas there will be an improvement to activity based contract position according for both planned (outpa- tient) and unplanned (non-elective admissions) activity within the financial year.

The transformation progress in these areas is supported through improved care pathway development and more services being provided in the community setting but also through the innovative use of information technology and single care records to improve patient care, improving efficiency.

Actions Key Lines of Enquiry Timescale

Reduce Unplanned Ad- Pump Priming of enhanced communi- missions (reduction in hy- Recruitment Q3, Ser- ty service provision (following release 1 per / hypo for diabetes and vice Implementation of resource from New Models of Care) copd exacerbations in during Q4 in Diabetes / Respiratory Models respiratory)

Rollout of Health In- Development of Wirral Care Record More Effective Care Path- formation Exchange 2 (HIE) and Registries as part of New way through information Q3&4 (as pre-cursor Care Models sharing , early intervention to Wirral Care Rec- ord)

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Impact Contract Ex- Anticipated Impact (Finance) type penditure 6 month PYE

Assumes 50% of pa- Pump Priming of enhanced commu- tients would nity service provision (following re- exceed trim 1 lease of resource from New Models £58,500 WUTH point and of Care) in Diabetes / Respiratory attract av- Models erage of 2 non- elective ex- cess bed days"

5 Primary Care Quality Scheme

NHS Wirral CCG has recently launched a Primary Care Quality scheme with its membership with the objective of having a significant impact upon areas of activity related expenditure in 3 key cost driver areas for the CCG.

The target areas are across elective / non-elective and prescribing expenditure where GP behaviour through referrals or system behaviour has a key controlling as- pect to the resulting expenditure.

It is anticipated that this will reduce the expenditure within the CCG’s activity based contracts and also on its relating prescribing expenditure

A summary of specific actions being taken with regards to this area are as per the below table

Actions Key Lines of Enquiry Timescale

1 Consider a "referral management cen- 1st October 2015 till tre" approach to filter out inappropri- 31st March 2016 ate referrals and direct to the most Demand Management, appropriate settings. See NHS Ker- reduce variation in refer- now (Cornwall) rals, ensure appropriate- / for http://rms.kernowccg.nhs.uk ness Demand Management website as a

resource for local GPs and patients

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2 Explore further development of Ser- Start now - ongoing vice Index to include integrated refer- development with in- ral forms and improved functionality creased functions and local guidelines

3 Consider further development of refer- Now and on-going ral guidelines to improve quality of referral letters following on from feed- back at WUTH discussions

4 Consider implementing standardised By 31st March 2016 system of clinical triage and assess- ment via peer review in-practice 5 Host referral management work- January/February shop directed at both clinicians and 2016 non-clinicians to ensure wider circula- tion of any learnings/shared good practice 6 Develop referral guidelines for areas By March 2015 of particularly high spend and make them easily accessible to GP's via CCG website or BI portal

7 Consider Warrington Referral Assis- By 31st December tance Gateway (WRAG) model to 2015 manage referral process, including Choose & Book/DBS element

Demand Management, 8 Procedures of Low Clinical Priority reduce variation in refer- Now - 31st March (PLCP) analysis - targeted approach rals, ensure appropriate- 2016 via BI portal to practices who continue ness to refer in order to raise awareness.

9 Consider directing practices to Map of By 30th November Medicine as a referral management 2015 aid

Impact Contract Ex- Anticipated Impact (Finance) type penditure Average referral cost £900, The average cost of Reduced a first is £150 and a follow Elective All Elective Activity 5 referrals per month per practice, up £85. 1,600 avoided re- Activity Contracts, in total 1,600 referrals over 6 1 -9 ferrals equates to £240k (WUTH, Other months costed at £150 (just a NHS Providers,

first), £376k costed at Spire, AQP) £235 (a first and a follow up)

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6 Contract Conditions

The CCG has a number of areas of contract over performance which through man- agement of appropriate contractual levers will look to reduce expenditure on a pro- active basis.

A summary of specific actions being taken with regards to this area are as per the below table

Actions Key Lines of Enquiry Timescale

Review & identify contract levers and 1 opportunities to influence activity of 1st-31st Oct 2015 AQP and Non-PBR services

Consult with clinicians & patients Reduce tariff 2 1st - 31st Oct 2015 where required during review period Increase waiting times Decrease follow up ratios Agree next steps with Operational 3 Capacity management 3rd Nov 2015 Group Disinvestment

Engage & negotiate with providers as 4th Nov - 18th Nov 4 appropriate 2015

Implement new contract conditions 5 1st Dec 2015 where appropriate

Monitor activity and spend against 6 Monthly ongoing contract plan

Impact type Contract Ex- Anticipated Impact (Finance) penditure Greatest opportunity in year lies with physio contracts: reduce tariff to lowest quartile/lowest CCG tariff; introduce minimum wait; reduce Reduce tariff Manage first to follow up ratios Increase waiting times Contract Per- Decrease follow up ratios formance, 1 -6 AQP Activity, ▪ DAD - no minimum wait set there- Capacity management Tariff, Ca- fore current capacity in AQPs may Disinvestment pacity Man- have neglible impact in 15/16 how- agement ever greater impact via prime pro- vider model in late 16/17

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A number of delivery risks have been identified as part of the process

• Where a contract is not up for renewal any permissible variations require pro- vider agreement • AQP contracts have no contract levers to manage capacity or cap referrals • Current/increased referral rates

7 Risk Stratification / DES

As part of the integrated care agenda, Wirral CCG has successfully developed a risk stratification tool for use of clinicians in order to identify and manage patients at most risk of unplanned admissions into hospital. The risk stratification tool has recently been rolled out to a number of Gp practices following completion of the appropriate information governance elements and is now being used proactively in order to iden- tify and prevent costly unplanned activity and escalation of patients through the sys- tem.

The risk stratification tool is developed in conjunction with the integrated community care hub service model across health and social care in order to provide efficiencies along the care pathway

A summary of specific actions being taken with regards to this area are as per the below table

Actions Key Lines of Enquiry Timescale

1 Continually promote use of BI portal By 31st March 2016 via weekly comms

2 Offer support to practices to ensure By 31st March 2016 they can get full use and functionality of the BI portal (to include 1:1 where necessary) 3 Monitor login and use of portal and By 31st March 2016 Reduce unplanned admis- offer targeted support to those prac- sions tices not using it

4 Promote drop in sessions to ensure By 31st March 2016 practice staff are upskilled in portal functions

5 Invite ICCT teams to GP members to By 31st October 2015 promote service and encourage refer- rals via risk stratification identification

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6 Consider automatic referral of top 2% By 30th November risk stratified patients to ICCTs 2015

7 Regular promotion of ICCTs in weekly Now and on-going comms

8 Promote daily review of gateway Now and on-going email account for A&E admissions and utilise in conjunction with Avoid- ing Unplanned Admission DES

Impact Contract Ex- Anticipated Impact (Finance) type penditure Reduce 1 emergency admission £503k based on £1,495 Reduced per month, per practice per epidose per practice Non- 1 -8 WUTH per month. Elective Activity

8 Prescribing

Targeted measures to improve prescribing expenditure over and above planned measures will be developed with medicines management team support in order to reduce variation away from planned performance and to further identify areas for im- provement. The table below provides information on appropriate leads, impact area and suggested areas of measurements with regards to the 8 impact areas

A summary of specific actions being taken with regards to this area are as per the below table

Actions Key Lines of Enquiry Timescale

1 Reintroduce “Drug of the Month” to By 31st March 2016 heighten awareness around alterna- tives and script switch options

2 Campaign and literature on rational- By 31st March 2016 Reduce prescribing ex- ising prescription ordering, “only or- penditure costs der if you need it” 3 Target pharmacies who order pre- By 31st March 2016 scriptions on patient’s behalf, (pa- tients report getting items they don’t want as pharmacies order for them).

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4 Publicity on ensuring certain items By 31st March 2016 are on prescriptions as acute items to avoid reordering E.g. PRN pain relief and not as repeat items which result in over ordering and wastage.

5 Care Homes - use of Practice Phar- By 31st March 2016 macists to support improvements in repeat prescribing behaviour

6 Produce CCG recommendation for By 30th November guidance to cease prescribing of 2015 Over The Counter medicines

7 Maximise offers of industry rebate By 31st March 2016 schemes

8 Utilise BI portal medicines tab for By 31st March 2016 targeted approach/practice specific support on key prescribing areas

9 Establish regular weekly communi- By 31st March 2016 cation, if not already in place, be- tween Practice Pharmacists and Practice Prescribing Leads and Practice Managers

10 Utilise practice visits to reinforce key By 31st March 2016 messages and analyse trends

Impact Contract Ex- Anticipated Impact (Finance) type penditure 1 - Demand Management, manage- Reduced 6, ment to Forecast Outturn Perfor- As per Primary Care Qual- Prescribing Prescribing 8- mance ity Scheme Costs 10 CCG rebate schemes x 4 Reduced Maximise offers of industry rebate 7 £60k savings Prescribing Prescribing schemes Costs

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Appendix Two

HealthyWirral

Wirral Care Record

Information Sharing Agreement

INFORMATION SHARING CODE OF PRACTICE (Tier Two) Operational Guidance for Staff

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Name and designation of policy au- Suzanne Crutchley Senior Governance Manager (Information Governance) thor(s) North West Commissioning Support Unit (NWCSU)

Agreed by (committee, group, man- HealthyWirral Information Governance Task & Finish Group ager) Approved by (committee, group, Healthy Wirral IT & Information Governance Work Stream manager) Approving signatures See Section 8

Adopted By All organisations whose signatures appear in Section 8 Date approved November 2015 Review date November 2017 Review period Every Two Years Target audience All Healthy Wirral Partner Organisations Links to other strategies, policies, This Tiered Information Sharing Code of Practice is required for the Information Governance Toolkit. procedures

It is part of a three-tiered set of documents, agreed for use across Cheshire and Merseyside.

Protective Marking Classification N/A

Version History:

Date Version Author name and designation Summary of main changes August 1.0 Suzanne Crutchley First draft for the: Healthy Wirral - Wirral Care 2015 Senior Governance Manager (Infor- Record (WCR) mation Governance) North West Commissioning Support Unit (NWCSU) August - 2.1 Suzanne Crutchley Amendments through the Healthy Wirral – September 2.2 Senior Governance Manager (IG) IG Task and Finish Group meetings: 2015 2.3 NWCSU 13/08/15; 27/08/15; 10/09/15; 24/09/15; 2.4 08/09/15, 08/10/15 2.5 2.6 9th October Latest draft (2.5) to IT and IG Meeting - Wir- 2015 ral CCG: 9th October 2015

November Suzanne Crutchley Final draft for approval to Healthy Wirral – 2015 Senior Governance Manager (IG) Health and Well Being Board NWCSU November Final Suzanne Crutchley Final approved version 2015 Senior Governance Manager (IG) NWCSU

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Contents

Contents ...... 31 1. Background to the Tiered Framework of the Information Sharing Code of Practice ...... 33 1.1 Tier Zero ...... 34 1.2 Tier One ...... 34 1.3 Tier Two ...... 34 2. Background to Healthy Wirral ...... 35 2.1 Shared Vision and Principles ...... 35 2.2 Overview ...... 36 2.3 Vanguard Governance Structure ...... 43 3. Healthy Wirral IT & Information Governance Work Stream ...... 45 3.1 Extract from the Healthy Wirral Terms of Reference ...... 45 3.2 Principles ...... 46 3.3 Governance and Accountability ...... 46 3.4 Fairness and transparency ...... 46 3.5 Information Standards and Assurance ...... 47 3.6 Review ...... 48 3.7 Complaints ...... 48 3.8 Non Compliance and Partner Disagreement ...... 48 3.9 Checklist for Information Sharing Agreement ...... 50 4. Overview and General Principles to Sharing Information for the WCR ... 58 4.1 Summary...... 58 4.2 Context and Background ...... 60 4.3 Aim and Objectives ...... 60 4.4 General Principles of the Information Sharing Agreement ...... 60 4.5 Fairness and Transparency ...... 61 4.6 Caldicott Principles ...... 62 4.7 The Use of Person Identifiable Data (PID) ...... 63 5. Legitimate Purposes for Sharing Information for the WCR...... 64 5.1 Legitimate Purposes ...... 64 5.2 Setting Parameters and Review ...... 67 5.3 HM Government Advice and Safeguarding ...... 67 5.4 Data Protection Act 1998 ...... 67 5.5 Schedule 2, Data Protection Act 1998 ...... 73 5.6 Schedule 3, Data Protection Act 1998 ...... 74 5.7 Clinical Codes Excluded from the WCR ...... 74 6. Description of Arrangements and Security Procedures for the WCR ...... 76 6.1 WCR Structure ...... 76 6.2 Hosting Arrangements for the WCR ...... 76 6.3 WUTH’s specific obligations as Host ...... 76 6.4 Sub-contracting ...... 78 6.5 Legal Basis to Operate Within ...... 78 6.6 Definition of Data Controller in Common ...... 78 6.7 Creation of a New Record/Entity- Wirral Care Record ...... 80 6.8 Opt Out Process for Patients ...... 80 6.9 Population Record ...... 80 6.10 Privacy Impact Assessment ...... 80 6.11 Openness and Transparency ...... 81 6.12 Confidentiality and Vetting ...... 81 6.13 Compliance ...... 82 6.14 Non Compliance and Partner Disagreement ...... 82 6.15 Liability and Indemnity...... 82 6.16 Consequences of Termination ...... 83

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6.17 Sanctions ...... 83 6.18 Security of Shared Information ...... 83 6.19 Staff Training and Awareness ...... 84 6.20 Movement of Information ...... 84 6.21 Data Retention ...... 84 6.22 Retention of Shared Information ...... 84 6.23 Storage of Papers ...... 86 6.24 Disposal of Electronic Information...... 86 6.25 Disposal of Papers ...... 86 6.26 Subject Access Requests ...... 86 6.27 Freedom of Information Requests ...... 86 7. Legislation and Further Guidance ...... 88 7.1 Information Governance and Technical Definitions ...... 88 7.2 Key Information Law ...... 88 7.3 Web links to further legislation and guidance ...... 89 8. Signatories to Abide by this Agreement ...... 90 8.1 NHS Wirral Clinical Commissioning Group ...... 91 8.2 Wirral University Teaching Hospital NHS Foundation Trust ...... 93 8.3 Cheshire and Wirral Partnership NHS Foundation Trust ...... 95 8.4 Wirral Community NHS Trust ...... 97 8.5 Wirral Metropolitan Borough Council ...... 99 8.6 All Wirral GP Practices ...... 101 8.7 Data Protection Registration ...... 102 8.8 Information Governance Toolkit Status ...... 106

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Cheshire and Merseyside

Tier Two

Information Sharing Code of Practice

Operational Guidance for Staff

1. Background to the Tiered Framework of the Information Sharing Code of Practice

This Overarching Standard for Information Sharing is designed to be used in con- junction with a set of documents within a Tiered Structure. The structure is designed to provide a framework for the secure and confidential sharing of information be- tween the partner organisations that contribute to the wellbeing of residents and en- suring disclosure is in line with statutory requirements.

The Government understands that it is most important that people remain confident that their personal information is kept safe and secure and that practitioners maintain the privacy of the individual, whilst sharing information to deliver better services. It is therefore important that practitioners can share information appropriately as part of their day-to-day practice and do so confidently.

The Data Protection Act 1998 is not a barrier to sharing information but provides a framework to ensure that personal information is shared appropriately.

SOLACE (Society of Local Authority Chief Executives) advice states:

• Keep information safe and accurate - prevent leakages, respect the citizen's preferences for how it is used and retain sound and appropriate records. • Share and exploit information - exploit for better services, adopt new practic- es, share information with partners, gain value for money and continuous im- provements against targets.

This template contains general guidance and descriptions of what an Information Sharing Protocol needs to cover.

It is advised that you look at the other Tiers in the framework, as a substantial amount of information is included in the other documents.

Prior to implementing any joint working arrangement it may also be necessary to complete a short Privacy Impact Assessment (PIA).

Information may be stored in many different formats such as, physical, electronic, audio or video.

There are 3 main Tiers to the structure.-

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1.1 Tier Zero

• This is a document signed by a Chief Executive of an organisation agreeing in principle to share information responsibly. The names of all agencies in agree- ment are listed and can be added to as more agencies became involved. Organ- isations should, if possible, place copies of Tier Zero and Tier One, and a list of partner organisations, on their internet sites to reassure the public of their com- mitment to sharing responsibly. If not this Tier Zero document, a document simi- lar to a Tier Zero document must be signed by the Chief Executive/equivalent of all organisations wishing to take part. Only one Tier Zero document need be signed by the Chief Executive for any number of Tier Two documents agreed be- neath it.

1.2 Tier One

• This is an overarching standard outlining the agreed procedures for sharing in- formation. It is this document which sets the standards for obtaining, recording, holding, using and sharing of information. It also outlines the supporting legisla- tion, guidelines and documents which govern information sharing between part- ner organisations.

1.3 Tier Two

• This gives guidance to operational practitioners on the production of a protocol for the safe sharing of information. These protocols should show what information should be shared and how and under what circumstances and by whom, and should be tailored to individual partners. This document will require authorisation of the participating partner organisations.

A copy of this document should be logged with the Information Governance Lead for each participating partner organisation.

Guidance would suggest that the following sections are included:

o Fair processing notices, o Consent leaflets, o Social Care Record Guarantee, o Confidentiality statement, o Subject access o Privacy Impact Assessment

This Code of Practice is designed to simplify and strengthen the sharing of infor- mation between partner organisations across Cheshire and Mersey, along with other partners which border the geographical area and with whom we may share infor- mation.

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Healthy Wirral - Wirral Care Record

INFORMATION SHARING AGREEMENT

2. Background to Healthy Wirral

1The NHS Five Year Forward View, published in October 2014, described the need for the NHS to adapt to take advantage of the opportunities that science and technol- ogy offer and to evolve to meet new challenges as people live longer with complex health issues.

Wirral’s successful Vanguard application has built on the progress of Vision 2018 to develop the Healthy Wirral programme which intends to implement the New Care Models described in the 5 Year Forward View. The emphasis of the new model is to enable people to live well and stay well for longer, create a person-centred integrated system that will respond quickly, safely and appropriately when needed, and drive technology to enable proactive approaches to integrated care. The model aims to meet the needs of the whole population of Wirral using different approaches to meet their needs.

In order to take forward a population health approach, it is essential that information is available across the health and social care system to enable a joined-up approach to care and deliver services that are truly integrated. However, it is absolutely essen- tial that information is used in an appropriate manner. This task and finish group has therefore been established to develop supporting data agreements and processes in order to provide assurance to the ‘Healthy Wirral’ Informatics Group and Wirral Part- ners’ Board.

2.1 Shared Vision and Principles

2Vision: “To ensure the residents of Wirral enjoy the best quality of life possible, be- ing supported to make informed choices about their own care, and being assured of the highest quality services”.

To achieve this we commit to the following principles:

• Our strategy will promote good health and wellbeing and seek to reduce ine- qualities.

• Everything we do is aimed at improving outcomes and the experiences of the population of Wirral, and of the people who use our services, their families and carers.

• We will engage with the people who use our services as partners, establish- ing a new and equal relationship with our professional staff in co-designing and continually improving services.

1 Extract from the HealthyWirral Terms of Reference 2 Extract from the HealthyWirral Terms of Reference

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2.2 Overview

Below you will find a general explanation of why health and social care information needs to be shared for the Healthy Wirral - Wirral Care Record (WCR).

a. The organisations who are party to the Information Sharing Agreement

The following organisations are involved and have a number of work streams being coordinated by the Project Management Office (PMO):

 NHS Wirral Clinical Commissioning Group*  Wirral University Teaching Hospital NHS Foundation Trust  Cheshire and Wirral Partnership NHS Foundation Trust  Wirral Community NHS Trust  Wirral Metropolitan Borough Council  All Wirral GP Practices

For reference, please note that this Information Sharing Code of Practice is hearafter referred to as the Information Sharing Agreement (ISA)

*The CCG will not have access to the WCR. However, they are required to sign up to this Information Sharing Agreement as the lead commissioner of the NHS provider organisations party to this Agreement.

The list can be amended to add or remove partner organisations with the agreement of the Healthy Wirral – Health and Well Being Board.

b. Purpose of information sharing

Healthy Wirral has prompted the health and social care services across the Wirral.to reconfigure.

All the partner provider organisations have agreed to share information about their patients, service users and clients (who for convenience are all referred to in this agreement as patients) to establish an electronic Wirral Care Record (WCR) for the purpose of caring for patients in common.

Each partner organisation confirms that its Caldicott Guardian or SIRO has reviewed and agrees with the provisions of this ISA.

c. The benefits of sharing information

The primary benefit of the sharing is anticipated to be better access for clinicians to a patient's health and social care history at the point of care, leading to better and more well-informed care for that patient.

The programme is to run for a minimum of 5 years, between all partner organisa- tions. The Programme will implement the Wirral Care Record (WCR) as a solution, which will be held at Person Identifiable Data (PID) level.

The partner organisations have agreed to appoint Wirral University Teaching Hospital NHS Foundation Trust (WUTH) as the host of the WCR, and WUTH has agreed to fulfil that role. WUTH shall enter into the Software Contract with the Software Provid-

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er, under which the Software Provider shall provide the Software for the WCR. WUTH shall host that Software, and shall provide a first line support service to the partner organisations. Second line technical support shall be provided by the Soft- ware Provider.

This agreement therefore regulates the sharing of specific Personal Confidential Data (PCD) between the parties for the delivery of Direct Care to the partner organisations' patients. This includes the care provided by the Local Authority Social Services. It also regulates the processing of Personal Data by WUTH as the host on behalf of the partner organisations. This is a legally binding agreement.

Each Partner Organisation agrees that it is party to this agreement as a data control- ler in respect of personal data that it discloses, and as a data controller in common in respect of any information that it accesses in the WCR. WUTH in its capacity as host is a data processor of personal data shared by any of the other partner organisations. See Section 6.6 for further information concerning data controllers.

Summary of Benefits of Data Sharing for the Wirral Care Record

Safety 'Warnings' should be highlighted. High level of audit trail. Prevents mistakes in prescribing requests. Most errors are made due to lack of up to date information; this system would cer- tainly help reduce these. It would help reduce prescribing errors, and also the risk of allergic reactions.

Governance – Data Protection Act 1998 FIRST PRINCIPLE Personal data shall be processed fairly and lawfully. Viewing the WCR will be lawful as the Data Protection Act 1998 Schedule 3 Condi- tions on which to rely are: 1. The data subject has given his explicit consent to the processing of the personal data. and/or 8 (1) The processing is necessary for medical purposes and is undertaken by— (a) a health professional, or (b) a person who in the circumstances owes a duty of confidentiality which is equiva- lent to that which would arise if that person were a health professional. This includes Social Services. SECOND PRINCIPLE Personal data shall be obtained only for one or more specified and lawful purpose(s), and shall not be further processed in any manner incompatible with that purpose or those purposes. The data viewed in the WCR will be processed for medical & social care purposes only. THIRD PRINCIPLE Personal data shall be adequate, relevant and not excessive in relation to the pur- pose or purposes for which they are processed. The WCR will provide the health professional with greater information to manage the patient. FOURTH PRINCIPLE Personal data shall be accurate and, where necessary, kept up to date. The data will help the health professional to update their records more accurately.

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FIFTH PRINCIPLE Personal data processed for any purpose or purposes shall not be kept for longer than is necessary for that purpose or those purposes. The WCR will be kept in line with the Records Management: NHS Code of Prac- tice, available at: https://www.gov.uk/government/publications/records-management-nhs-code-of- practice SIXTH PRINCIPLE Personal data shall be processed in accordance with the rights of data subjects un- der this Act. The Data Protection Act 1998 Part II Rights of data subjects and others will be met. The necessary Schedule 2 and Schedule 3 conditions are also met. SEVENTH PRINCIPLE Appropriate technical and organisational measures shall be taken against unauthor- ised or unlawful processing of personal data and against accidental loss or destruc- tion of, or damage to, personal data. A Privacy Impact Assessment was completed for the WCR, to ensure that all appro- priate technical and organisational measures are current and remain adequate. EIGHTH PRINCIPLE Personal data shall not be transferred to a country or territory outside the European Economic Area, unless that country or territory ensures an adequate level of protec- tion for the rights and freedoms of data subjects in relation to the processing of per- sonal data. No part or function to the WCR will be transferred outside of the UK. Improved patient care. More clinical information such as up to date medication, investigation results available to therapy staff. Correct up to date information. Allows greater accuracy in diagnoses across services if all available infor- mation is at our finger tips. Local plus one additional system to log in to, to access the WCR. No errors. Allows fuller understanding of a Professionals position re a given patient. Reduced confusion as to what one person said and advice is replicated and reinforced therefore 'sing of same hymn sheet'. Moves us towards One record for Patient not numerous conflicting records. Patient does not have to repeat key information e.g. medications, allergies etc. Ability to obtain reports /X-rays/Bloods /scans /etc without delay and unneces- sary paper chasing. If a patient queries about a service not receiving a referral, we would be able to check if a referral has been made, follow it up, and reduce patient frustration/ improve patient experience. Investigations would be seen in a timely way, with no need for duplication. This would benefit patients, and save money. Invaluable in situations where patients are unable to give an account of their past medical history. It would allow clinicians to each see what other treatment patients were under- going which may impact on planning their future care.

Efficient working. Reduced time wasted phoning GP secretaries etc. for information they would be able to view at the click of a button. Reduced time wasted for Patients if test results are known and shared. Reduce Cost for health economy if tests are not duplicated. The patient record can be updated at the point of care and shared with col-

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leagues across health and social care. Reduce duplication – staff are currently in some instances logging in to several systems. This would reduce to the local system plus one additional system, to access the WCR. Information sharing between partner organisations will help to avoid delayed care, and will enhance streamlined care.

Other Analysis of anonymised data allows targeting of services appropriately so the correct services are placed in the correct geographical area. Partner organisations can all contribute to improving data quality. Enhance commissioning, ensuring the right services are planned and procured as necessary.

d. What information will be shared

The Healthy Wirral WCR will be shared.

Each partner organisation shall share the agreed Personal Confidential Data (PCD) extracted from each partner organisation's patient records to establish the WCR.

The WCR shall contain Sensitive Personal Data and Personal Data including, but not limited to, medication records, diagnostic results and reports, procedure details, clini- cal letters, medications, summaries and assessments, appointment/event details, summary social care records and alerts to provide an integrated record for each pa- tient.

The Core Data Set and Registries will allow for the following:

It should be noted by all partner organisations that all PCD held on the WCR is only to be used for the purpose that they were created for Healthy Wirral WCR.

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No individual partner organisation can take all or part of the WCR, and use it for something unrelated to the Healthy Wirral Programme. Please see section 3.8 below on Non Compliance and Partner Disagreement.

e. Statutory duties to share, and restrictions on sharing

The Healthy Wirral WCR will be subject to the Data Protection Act 1998, Section 7 Right of access to personal data – referred to in this ISP as Subject Access Requests (SARs).

The Healthy Wirral Programme documents will be subject to the Freedom of Infor- mation Act 2000.

Both will be subject to the NHS Code of Practice on Records Management.

Individuals within any partner organisation who provide Direct Care for a patient shall be able to access that patient's record electronically at the point of care if appointed access by their partner organisation. The WCR shall provide a view only, integrated care record for each individual patient, amalgamated from each partner organisa- tion's source systems. This view only functionality shall not allow editing of the source data.

f. Confidential and sensitive information

The Healthy Wirral WCR is intended to be shared amongst all partner organisations.

In general terms, each partner organisation shall:

 comply with the Data Protection Legislation and all applicable laws;  maintain its registration with the Information Commissioner under the Data Protection Act 1998;  ensure the accurate, timely, secure and confidential sharing of information where such information sharing is essential for the purposes of this agree- ment;  ensure that information shared pursuant to this agreement is used solely for the purposes set out in this agreement, and is not shared with any other or- ganisation without the prior consent of the relevant Data Controller and/or pa- tient;  respect an individual's right to object to the sharing of Personal Confidential Data about them;  provide staff with training on the principles and legal requirements for infor- mation sharing and the appropriate tools to enable them to comply with the obligations under this agreement;  comply with the Information Governance Toolkit (IGT) Requirements, at Level 2, of the current IGT as appropriate to its organisation type.  adhere to robust information governance management and accountability ar- rangements, including effective security event reporting and management.  make it a condition of employment that all employees, agents or contractors who may access the WCR shall abide by the rules and policies of that partner organisation in relation to information governance.  have documented policies and procedures to ensure compliance with the na- tional requirements for data protection, information security and confidentiality and be committed to ensuring that any information is shared in accordance

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with its legal, statutory and common law duties, and, that it meets the re- quirements of any additional guidance.  Each partner organisation warrants that the use of information it shares under this agreement in accordance with this agreement shall not cause the user to infringe any third party’s intellectual property rights in such information.  accept responsibility for independently or jointly auditing its own compliance with this agreement at least annually.

g. Access to the WCR

Each Partner Organisation shall strictly restrict internal organisational access to the WCR for each patient record to those personnel/staff who are providing Direct Care to the relevant patient for that record and who are under written obligations to respect and maintain the confidentiality and security of the Personal Confidential Data and have been properly trained to discharge any relevant obligations in accordance with this agreement.

Each Partner Organisation shall use user authentication mechanisms to ensure that all instances of access to the WCR are auditable against an individual, including the following information:

• Job role and name of staff member accessing the system; • Organisation name; • What actions were performed; and • The date and time the information was viewed.

h. Consequences of not sharing information

Without the WCR, the problems experienced would be:

• Constant risk of information breaches when regularly transferring information as currently. • Frequent update emails containing large amounts of PID and attachments to multiple distribution lists being sent across partner organisations. The large amount of data being sent could cause issues for senders and recipients. • Recipients needing to send back updates which are difficult to manage across several emails. • It is difficult to make sure everyone is viewing the latest PID. • Decisions based on partial information could lead to mistakes being made.

i. Who will be affected by the ISA

The following partners will be affected by the ISA:

 NHS Wirral Clinical Commissioning Group  Wirral University Teaching Hospital NHS Foundation Trust  Cheshire and Wirral Partnership NHS Foundation Trust  Wirral Community NHS Trust  Wirral Metropolitan Borough Council  All Wirral GP Practices

j. Processes and procedures relating to the Healthy Wirral programme

Under the Information technology and interoperability workstream Wirral Partners is developing a population health management tool which will amalgamate information

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from the clinical records of the Partner organisations to create a NEW shared care record.

The catalysts for rapid change can be seen in the diagram below:

k. Outside contractors to be used

Wirral University Teaching Hospital NHS Foundation Trust (WUTH) will maintain overall responsibility for the Healthy Wirral WCR.

The WCR will be held at Person Identifiable Data (PID) level.

WUTH will use an outside contractor to host the WCR. Cerner will host the WCR in its UK Data Centre.

Wirral Partners are intending to bring other organisations electronic clinical records into the Wirral shared record. This project will be subject to due diligence.

Please note that the table below is subject to change, until HWP agrees scope. HWP with the designated Data Controller will instruct Cerner as the Data Processer.

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Proposed phasing for the development of registries to support Wirral Partners New Care Model

Phase Record Comments Anticipated date reg- istry to commence 1a Longitudinal Rec- WUTH (Millennium) April 2016 ord & 56 Primary Care GP Practices data feeds (scope to be defined) Phase Registries Comments Anticipated date reg- istry to commence 1a Asthma - adult April 2016

1a Asthma - child To include transition into April 2016 adult asthma services at 19 years. 1a COPD April 2016

1a Diabetes - adult April 2016

1a Diabetes - child To include transition into April 2016 adult diabetes services at 19 years. 1b Depression Requires first analytics October-December 2016 investigations to identify population, measures and users workflows whole system analytics. Requires whole system analytics to understand workflow for data gov- ernance on sensitive da- ta process. 1b Clinical Wellness Requires discussions October-December 2016 - adult whether starting > 40 years of age. 1b Clinical wellness - 0-19 years of age October-December 2016 child 1b Social wellness - Requires first analytics Dependent upon identi- adult investigations to identify fied population group population, measures and users workflows 1b Social wellness - Requires first analytics Dependent upon identi- child investigations to identify fied population group population, measures and users workflows

All the above workstreams to commence summer 2015.

2.3 Vanguard Governance Structure

Please see the diagram below:

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3. Healthy Wirral IT & Information Governance Work Stream

The following governance arrangements are referenced here for assurance purpos- es, for the wider WCR programme.

3.1 Extract from the Healthy Wirral Terms of Reference

The Group will ensure that the strategy covers:

a) Sharing information across organisational boundaries in order to improve the day to day care of patients. This may include, test results, images discharge summaries etc.

b) The ability to have shared information and workflows across organisational boundaries. This may include the development of multi-agency care plans etc.

c) The use of modern technology to support innovative service delivery models, such as tele-health and tele-care, including the potential to connect medical and consumer devices (such as monitoring equipment, weighing scales or web cams).

d) The use of common place technologies, such as home telephones and mo- bile text messages to support patients’ independence in their own homes.

e) The use of “Big Data” to risk assess patients to ensure that care is given at the optimum time, reducing the need for higher intensity treatment at a later stage.

f) The on-going development of Wirral wide technical infrastructure that enables staff to provide care across the health economy.

g) The ability for patients to be engaged and positively play their part in their health care by giving them access to their health and social care records and the ability as appropriate to contribute to them.

h) The ability to trigger alerts to ensure that all relevant parties are aware that a key piece of information has changed.

i) Development of standard principles for contracting for systems that are capa- ble of interoperating to support integrated care.

j) Keeping in touch with national best practice.

k) Put in place health economy wide systems and procedures that protect pa- tient and service user confidential data from inappropriate use and disclosure, whilst at the same time recognising that the duty to share personal confiden- tial data can be as important as the duty to respect service user confidentiali- ty.

l) Make and support joint bids for appropriate funding to support innovative working and use of technology.

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m) Benefits realisation.

n) Review the implications and opportunities of new legislation, for example the Care Bill.

3.2 Principles

The suggested core principles of the IT & Information Governance work stream are based on:

• A shared vision to create a seamless journey for the patient or client

• Collective and shared goals that address the challenges outlined in ‘A Call to Action’

• Understanding each other’s perspective and not about protectionism

• Mutual respect

• Support and offer to help each other

• Handling difficulty together

• Effective communication with honest constructive dialogue

• Transparency

• Evidence based decision making

• Patient focused approach

• Maximising value for money, quality and outcomes

• Innovation and learning from national best practice

3.3 Governance and Accountability

The Informatics work stream will be chaired by the Director of Informatics from WUTH and will report its progress to the Healthy Wirral Programme on a monthly ba- sis.

3.4 Fairness and transparency

Healthy Wirral WCR will be available over time amongst all partner organisations.

Other than the steps that will be taken to tell the public about the Healthy Wirral Pro- gramme, all other Programme information will be available through formal Freedom of Information Act 2000 requests, subject to the usual exemptions that may apply.

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Extensive consultation and engagement is already underway on the developing pro- posals with key stakeholder groups. Information about the Shared Care Record has been distributed to:

• Patients; through existing networks and also via email to over 40,000 ad- dresses, GP surgeries and other health and social care facilities • GPs, clinicians and health and social care staff; through existing email and postal networks • Partners; through the Vanguard board and Wirral Partnership arrangements • MPs and Elected Members; through stakeholder briefings

Based on information provided in the initial proposal, people were invited to provide their views through a questionnaire. The results of this feedback will be used on an ongoing basis to inform the design of the Shared Care record system.

The engagement methods vary for each stakeholder and during the timeline, howev- er in principle there are three stages of engagement:

Phase 1 (August - October 2015) Initiation: a range publicity materials including an online survey has been issued to all stakeholders. The feedback from this will inform the development of the registries and information governance documentation.

Phase 2 ( October - December 2015) Design: the outputs from phase 1 engagement will also inform a series of events and more detailed publicity for stakeholders in which insights will be shared along with case studies detailing what this means to them and give the opportunity for questions and further informing the development.

Phase 3 (January - March 2016) Mobilisation: In advance of the implementation of the registries all stakeholders will be informed of how they and or their patients can opt out of the Wirral Care Record and be given the opportunity to discuss any con- cerns or raise any questions.

3.5 Information Standards and Assurance

It is important that a partnership makes a commitment to maintaining quality infor- mation. Therefore, the following will apply to all partner organisations:

a. Information Quality – quality assurance checks on data and information pro- duced. b. Recording Information – by which organisation and by whom. c. Data Controller – the Data Controller will be the organisation who produced each document.

Each Partner Organisation shall:

 take all reasonable steps to ensure the accuracy of the Personal Confidential Data (correct, complete and up-to-date) which it is sharing under this agree- ment and shall have in place appropriate systems to update any information if subsequently discovered to be inaccurate;  if it becomes aware of a material inaccuracy or omission in Personal Confi- dential Data that it shares under this agreement: o inform the recipient of that inaccuracy or omission and take immediate steps to correct or annotate to show the patient disagrees or that it is in accurate. Nothing is removed, because if clinical decisions have

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been made on inaccurate information then there needs to be a clear audit trail; and o consider whether to inform the data subject, if the data subject is not already aware of the inaccuracy or omission;  establish a procedure to ensure that only authorised persons access the WCR and ensure that such access is controlled by secure logins and associ- ated audit trails; and  ensure that Personal Confidential Data for which it is data controller is re- tained in accordance with its own data retention policy.

3.6 Review

All partners will formally review the Information Sharing Protocol Tier Two document 6 months after the commencement of this protocol, and thereafter at least once a year or earlier if requested in writing by any party.

3.7 Complaints

With regards to the Healthy Wirral WCR, there should be a standard approach on how each partner organisation is to handle complaints which may be made against members of the partner organisations.

Each partner organisation will deal with any such complaints in accordance with their own procedures which will ensure that:

• WCR staff users are aware that they can complain and of how to go about it; • complaints are resolved at first contact if possible; • complaints are acknowledged promptly in writing; • the complaint is investigated fairly and thoroughly; • WCR staff users are given an appropriate written response; • if appropriate the appeals procedure is explained to the WCR user.

Named contacts for general advice on making complaints by each partner organisa- tion will already be in place.

3.8 Non Compliance and Partner Disagreement

In the event of a suspected failure within their organisation to comply with this Infor- mation Sharing Agreement, partner organisations will ensure that an adequate inves- tigation is carried out and recorded. If the partner organisation finds there has been a failure it will ensure that:

• necessary remedial action is taken promptly; • WCR partner organisation users affected by the failure are notified of it, the likely consequences, and any remedial action;

If one partner organisation believes another has failed to comply with this Agreement it should notify the other partner organisations in writing giving full details. The other partner organisations should then investigate the alleged failure. If they find there was a failure, they should take the steps set out above. If they find there was no fail- ure they should notify the first partner organisation in writing giving their reasons.

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Partner organisations will make every effort to resolve disagreements between them about information use and sharing. When doing so they should refer to the Tiered Agreements and Associated Documents.

However, all partner organisations recognise that ultimately each organisation must exercise its own discretion in interpreting and applying this Agreement in line with guidance from the Information Commissioner.

Nominated representatives should ensure they are notified at an early stage of any suspected or alleged failures in compliance or partner disagreements relating to their partner organisation.

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3.9 Checklist for Information Sharing Agreement

Section Question Answer 1a Who are the organisations who are party to the Agreement?  NHS Wirral Clinical Commissioning Group  Wirral University Teaching Hospital NHS Foundation Trust  Cheshire and Wirral Partnership NHS Foundation Trust  Wirral Community NHS Trust  Wirral Metropolitan Borough Council  All Wirral GP Practices b Why do you want to share? What is the Purpose of Information Healthy Wirral has prompted the health and social care services Sharing? across the Wirral to reconfigure how data is shared.

Wirral Partners want to develop a shared care record which enables Wirral to integrate care and optimise care pathways across the whole health and social care economy, to enable the population to live well and stay well for longer.

Does the purpose comply with the Data Protection Act and other Yes key legislation listed in Tier One c What will the benefits of sharing be? The programme is to run for a minimum of 5 years and the amount of documentation generated will increase significantly over this time, between all partner organisations.

The Programme will implement WCR as a shared health and social record solution.

Also, see list of benefits in section 2.2.c The benefits of sharing in- formation.

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d Are there Statutory duties to share this information? Yes e Is it a partnership as a direct result of legislation or a government Yes initiative?

Are there any restrictions on sharing this information? Yes, the Healthy Wirral WCR will be subject to the Data Protection Act 1998. Legal, commercial. Also, the NHS Code of Practice on Records Management. f What information do you need to share? Healthy Wirral WCR will be shared.

Is confidential or sensitive information to be shared? Yes

List specifically what data is intended to be shared Healthy Wirral WCR. g Are there any alternatives to sharing personal information? No, PID has to be used in the WCR, for those involved in the health and social care, to benefit the patient. Can the information be anonymised? h What are the consequences of not sharing information? With no central file repository in place, the problems experienced would be:

• Frequent update emails containing large attachments to mul- tiple distribution lists being sent by the PMO. The large amount of data being sent causes issues for senders and re- cipients. • Recipients needing to send back updates which are difficult to manage by the PMO. • It is difficult to make sure everyone is viewing the latest ver- sion of documents. • There is no library of documents to reference.

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i Who will be affected by the Agreement? e.g. Children, older peo- Patients registered with a Wirral GP Practice, attending: ple, people living in a particular area, specific groups  Wirral University Teaching Hospital NHS Foundation Trust  Cheshire and Wirral Partnership NHS Foundation Trust  Wirral Community NHS Trust  Wirral Metropolitan Borough Council  All Wirral GP Practices

What are the risks in sharing the information? All of the Healthy Wirral WCR will be shared.

It should be noted by all partner organisations that PID held on the WCR is only to be used for the purpose that they were created for the Healthy Wirral Programme.

No individual partner organisation can take all or part of an entry held on the WCR, and use it for something unrelated to the Healthy Wirral Programme. Please see section 9 below on Non Compliance and Partner Disagreement.

Is any individual likely to be damaged or harmed by information No being shared?

Is any individual likely to object? No j What new processes or procedures will be required to enable WUTH have offered to host the Healthy Wirral WCR. information to be shared?

Will new or changed authentication checks be required that could No be intrusive?

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i.e. How will the information be obtained, who will access, when Data extracts from all partner organisations will upload their data to access necessary, audit trails, physical security and system se- the WCR. curity.

How will staff be trained in using the new process/procedure? Cerner will provide training using a train the trainer model, which will include the development of a standard user guide documented pro- cedure for staff to refer in to. k Are outside contractors to be used? WUTH will use an outside contractor to host the WCR. Cerner will host the WCR in its UK Data Centre. Contracts need to include confidentiality clause re Information Governance Security requirements. For partner organisations to access the WCR:

For EMIS & Millennium Electronic System Users they will have ac- cess to both the Longitudinal Record and Registries through a tab within that source record in Phase 1a.

For Community, Mental Health and Social Care (& other organisa- tions and service providers as deemed appropriate by the Data Con- troller) will have access via a weblink.

Authority for access remains with the Data Controller

2 How will the public be informed that their information will be Extensive consultation and engagement is already underway on the shared? developing proposals with key stakeholder groups. Information about the Shared Care Record has been distributed to: The public need to be told: • Patients; through existing networks and also via email to a What information will be shared? over 40,000 addresses, GP surgeries and other health and social care facilities b Who with, which staff/organisation will see it? • GPs, clinicians and health and social care staff; through ex- isting email and postal networks

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c When will information be shared? • Partners; through the Vanguard board and Wirral Partnership arrangements d Is a Fair Processing Notice required? • MPs and Elected Members; through stakeholder briefings e How will you distribute the fair processing information? See section 3.4 for further details. f Do the public know who to contact for enquiries? g How will consent be obtained to share the information? h What procedures will be in place to allow sharing without con- sent? Include risk assessments, documentation of decision

3a What quality assurance checks are in place to ensure recorded All partner organisations will be responsible to ensure all of these information is of an acceptable quality? points. b When will information be recorded, who will record the infor- mation? c Is the information collected relevant? Will all the information be needed? d How will the quality of the information be reviewed? 6 months after the commencement of this protocol, and thereafter at least once a year or earlier if requested in writing by any party. e Who will be the data controller?

4a What retention period has been agreed for the information? All Healthy Wirral WCR will be managed in accordance with the b What is the review period for the retention policy? NHS Code of Practice on Records Management (April 2006): c What are the legal requirements to retain or delete information? Download a PDF version of the Records Manage-

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Will the information be archived or deleted when no longer re- ment: NHS Code of Practice - Part 1 (PDF, 222.4kB) d quired? How will this be done? Download a PDF version of the Records Manage- Who will be responsible for holding the information? ment: NHS Code of Practice - Part 2 (PDF, 583.6kB) e (The Information Asset Owner for the information) The arrangements for who will review the PID held on the WCR will Who will be responsible for ensuring each organisation complies be led by WUTH. The WCR will be reviewed on an annual basis. f with the agreed retention policy and how will this be done? The WCR Registries will go through a yearly review cycle as part of the clinical safety and governance process, to ensure that content remains clinically relevant and continues to drive improvement in outcomes.

5 Who will be responsible for security of the system holding the in- WUTH formation? a Who will monitor access to the system and report breach- WUTH es/incidents? What process is in place to deal with inci- dents/breaches or staff non-compliance with procedures?

Who will be responsible for technical security? WUTH b (user access – issue of passwords, system restrictions, backup procedures for system) c Is there organisational security in place to prevent access to of- Yes fices, fax machines, computers or areas where personal infor- mation may be seen by the public?

Who is the data controller for the information? The Data Controller will be the organisation who produced each d document.

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6 Who will process Subject Access Requests and how will this be WUTH will manage any SARs in accordance with their own local done? procedures, for access to the WCR.

Subject Access Request = where service users have requested to see their personal information

i.e. Which organisation will process Subject Access Requests?

Do the public know how they can access their information?

7 What review period has been agreed for the Information Sharing 6 months after the commencement of this protocol, and thereafter at protocol? least once a year or earlier if requested in writing by any party.

Need to check that the sharing of information is still achieving its objectives, still appropriate and the safeguards still meet the risks.

Who will undertake the review?

8 What is the process for dealing with complaints from service us- Each partner organisation will deal with any such complaints in ac- ers? cordance with their own procedures.

Who will process them? How will they be reported to partner or- ganisations?

9 Detail process for resolution of a dispute between partner organi- Each partner organisation will deal with any such disputes in ac- sations. cordance with their own procedures

Nominated officers for dealing with dispute, Investigations, find- ings, remedial action, consequences, notification of affected ser- vice users and organisation.

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10 Include a list of lead officers involved in agreeing this Information See Section 8: Sharing Protocol. Signatories To Abide by this Agreement: Obtain signatures from lead officers when they have agreed and ensure copies of signed Information Sharing Protocol given to all INFORMATION SHARING AGREEMENT- parties including the Information Governance Team for the organ- SIGNATURE SHEETS isation.

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4. Overview and General Principles to Sharing Information for the WCR

This Information Sharing Agreement has been developed in relation to the WCR. The following sections provide an overview and some general principles to sharing information across organisations.

4.1 Summary

Who are the organisations who are party to the Agreement?

The signatories to this Agreement will represent the following agencies/bodies:

 GP Practice members of the NHS Wirral Clinical Commissioning Group

 Wirral University Teaching Hospital NHS Foundation Trust

 Wirral Community NHS Trust

 Cheshire and Wirral Partnership NHS Foundation Trust

 Wirral Borough Council

In time, it may expand to include:

 Clatterbridge Cancer Centre NHS Foundation Trust

 Wirral Hospice – St Johns

 Pharmacists

 Dentists

 Optometrists

 Any Qualified Provider (AQP)

 Carers (LA)

Why do you want to share?

Please see the Core Data Set and Registries set out in the diagram in section 2.2 d.

Purpose of Information Sharing

The Data Protection Act 1998, along with the Caldicott Reports, and other infor- mation security legislation, imposes certain obligations on users of such information. It is necessary to ensure that the security and confidentiality of this data is safe- guarded and there is no unlawful disclosure. Therefore, an Information Sharing Agreement between each main party is required.

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What will be the benefits of sharing?

The benefits of effective sharing of information for the purposes set out in this Agreement are will be a direct benefit to Wirral residents in that their health and well- being will be improved.

What information do you need to share?

The information shared will include:

 Person identifiable data  Encounters  Allergies  Diagnostics  Procedures  Medications  Immunisations  Investigation Results

Statutory duties to share, restrictions on sharing - is this partnership as a direct result of legislation or Government initiative?

Sharing information is bound by various legislation and Government initiatives.

Is confidential and/or sensitive information to be shared?

Yes, confidential, personal and personal sensitive information will be shared.

Alternatives to sharing personal information

Personal and personal sensitive information will be shared, to assist in identifying and assessing the health and wellbeing of Wirral residents.

What are the consequences of not sharing information?

A child, young person or adult could suffer, and even die, as a consequence of their information not being shared as necessary.

Who will be affected by the Agreement?

All Wirral residents.

Are outside contractors to be used?

Yes, outside contractors are party to this Information Sharing Agreement: Cerner.

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4.2 Context and Background

The Government understands that it is most important that people remain confident that their personal information is kept safe and secure and that practitioners maintain the privacy of the individual, whilst sharing information to deliver better services. It is therefore important that practitioners can share information appropriately as part of their day-to-day practice and do so confidently.

It is important that PID transfers are handled to the highest, agreed standards and that the information will be used exclusively for legitimate purposes.

4.3 Aim and Objectives

There are many reasons or purposes why Person Identifiable Data (PID) may be shared within and between NHS organisations, Social Services, other Local Authority Departments, and also with non-statutory organisations, for the health and wellbeing of Wirral residents.

The following should be understood and agreed by all partner organisations to the WCR.

• To set parameters for the sharing of information between organisations within the WCR. • To define the purposes for holding personal information. • To define how that personal information should be held and who should have access to the information.

This Information Sharing Agreement is a sign of commitment and a demonstration to the public about how their information is used.

4.4 General Principles of the Information Sharing Agreement

This Information Sharing Agreement provides a framework for the establishment and regulation to share specified Person Identifiable Data (PID), for justified purposes. This Agreement covers information held which may be manual, verbal, visual or elec- tronic.

The presence of an Information Sharing Agreement does not, however, remove the need to inform patients that their data may be shared with other organisations.

All staff have a legal obligation to safeguard the confidentiality of personal infor- mation. In addition to this legal requirement, contracts of employment and profes- sional codes of conduct also make clear this responsibility.

Furthermore all staff are aware that a breach of confidentiality could result in discipli- nary action being taken and provides grounds for formal complaint against them and the organisation.

This Information Sharing Agreement assumes that the following are in place, across each partner organisation:

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• The organisations referred to in this Agreement have an appointed Caldicott Guardian (or similar) whose role it is to:

 Safeguard the confidentiality of PID  Review and monitor Information Sharing Agreements internally and across organisational boundaries  Ensure year on year improvement of performance in handling PID  Develop and maintain security and confidentiality policies  Advise on confidentiality issues at a strategic level  Arbiter in disputes around the sharing of personal information.

• Each organisation referred to in this Agreement has appropriate measures in place to comply with the requirements of the Data Protection Act 1998 (see sig- nature sheets also – which includes details of the ICO Registration and the Infor- mation Governance Toolkit status for each partner organisation).

• There will be an Information Governance / Data Protection Officer or equivalent senior post responsible for the overall management of information security issues specified above, in every organisation covered by this Agreement. Their advice should be sought where necessary.

• All standard ‘data flows’ to, between and from the organisations have been identi- fied, which ‘justify’ the sharing of each item of data to be shared for the pur- pose(s) agreed.

• Each organisation is committed to a regular reviewing practice with the aim of ensuring all exchanges of PID conform to the principles of this Agreement.

• Each organisation is committed to ensuring staff are familiar with and trained as appropriate in Data Protection and Caldicott requirements and procedures.

• All information systems are password protected and users do not divulge di- rectly or indirectly passwords or leave systems ‘open’ while unattended.

• Only authorised staff have access to personal information, the facilities where they are stored and the areas where these facilities are located.

• Electronic transfers in all formats will be encrypted and there is a robust and secure method of password authentication.

• Paper information transferred will be protected in a secure, sealed envelope and there will be an acknowledgement of receipt to the sender by the recipi- ent.

4.5 Fairness and Transparency

The following steps will be taken to tell the public:

o what type of information about them may be shared; o who it may be shared with; o the likely consequences of sharing.

This will be done by:

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a. Fair Processing Notices; b. Providing further information/dealing with enquiries; c. Obtaining consent to share the information, where appropriate; d. Providing details regarding circumstances when it may be necessary to share without people’s knowledge or consent.

4.6 Caldicott Principles

The Caldicott Committee Report on the Review of Patient Identifiable Information was published in 1997. Every flow of PID should be regularly reviewed against the Principals (see below) outlined in the Caldicott Report.

A second report Information to share or not to share, published April 2013, con- tains 26 recommendations and a revision of the previous Caldicott Principles.

The Information Governance Review is available at: https://www.gov.uk/government/publications/the-information-governance-review

The revised list of Caldicott Principles are:

1. Justify the purpose(s) Every proposed use or transfer of personal confidential data within or from an organi- sation should be clearly defined, scrutinised and documented, with continuing uses regularly reviewed, by an appropriate guardian.

2. Don’t use personal confidential data unless it is absolutely necessary Personal confidential data items should not be included unless it is essential for the specified purpose(s) of that flow. The need for patients to be identified should be considered at each stage of satisfying the purpose(s).

3. Use the minimum necessary personal confidential data Where use of personal confidential data is considered to be essential, the inclusion of each individual item of data should be considered and justified so that the minimum amount of personal confidential data is transferred or accessible as is necessary for a given function to be carried out.

4. Access to personal confidential data should be on a strict need-to-know ba- sis Only those individuals who need access to personal confidential data should have access to it, and they should only have access to the data items that they need to see. This may mean introducing access controls or splitting data flows where one data flow is used for several purposes.

5. Everyone with access to personal confidential data should be aware of their responsibilities Action should be taken to ensure that those handling personal confidential data — both clinical and non-clinical staff — are made fully aware of their responsibilities and obligations to respect patient confidentiality.

6. Comply with the law Every use of personal confidential data must be lawful. Someone in each organisa- tion handling personal confidential data should be responsible for ensuring that the organisation complies with legal requirements.

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7. The duty to share information can be as important as the duty to protect pa- tient confidentiality Health and social care professionals should have the confidence to share information in the best interests of their patients within the framework set out by these principles. They should be supported by the policies of their employers, regulators and profes- sional bodies.

4.7 The Use of Person Identifiable Data (PID)

PID refers to all personal information about individual members of the public held in any format (visual / verbal / paper / computer / microfilm / etc).

Person Identifiable Data includes:

Surname Forename Initials Date of Birth Address Postcode Other Dates (i.e. death, diagnosis) Sex Ethnic Group Occupation NHS Number National Insurance Number / Local Identifier (i.e. Hospital or GP Practice number)

Sensitive personal data includes:

Ethnic origin or race Health – mental or physical Political opinion Sexual life Religious beliefs Commission of any offence (or alleged) Trade Union membership Any court proceedings or findings

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5. Legitimate Purposes for Sharing Information for the WCR

5.1 Legitimate Purposes

The ranges of legitimate purposes for sharing information, agreed by the organisa- tions in this Agreement are:

Initial legitimate purposes

• Delivering personal care and treatment. • Maintaining and improving the quality of care and treatment. • Monitoring and protecting public health. • Managing safeguarding issues. • Managing and planning services.

Future legitimate purposes

• Clinical audit. • Auditing accounts and accounting for performance. • Commissioning services (anonymised/aggregate data only). • Statistical analysis (anonymised/aggregate data only). • Medical or health services research (with patient consent).

Each Partner Organisation has a Privacy Notice in place.

Partner Organisation Website link to Privacy Notice / Fair Processing Notice

NHS Wirral Clinical Commissioning https://www.wirralccg.nhs.uk/GPCC/About%20Us/Get%20Involved/privacy-policy.htm Group

Wirral University Teaching Hospital http://www.wuth.nhs.uk/patients-and-visitors/choose-us/for-care/how-we-use-your- NHS Foundation Trust information/

Cheshire and Wirral Partnership NHS http://www.cwp.nhs.uk/general-information-help-advice/335-protecting-and-sharing- Foundation Trust information-about-you-and-general-information-we-hold

Wirral Community NHS Trust http://www.wirralct.nhs.uk/you-and-your-health/health-records-prescriptions/accessing- your-health-records

All Wirral GP Practices The text below will be added to the NHS Wirral Clinical Commissioning Group website, in the section for the Wirral Care Record. Comment [SC1]: CCG to add to their website, to cover the GPs. Wirral Metropolitan Borough Council https://www.wirral.gov.uk/about-council/freedom-information-and-data-protection/fair- processing-notice

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Healthy Wirral - Wirral Care Record

Introduction

The information held in your record is important for your care. It is a record of your relationship with those caring for you. This relationship is based on mutual trust and confidence and we continue to do everything possible to protect that trust. Staff will ask for information about you and this notice will explain what information is collected and the reasons why it is needed.

Where the information will come from

Information from the following organisations will be used to create your Wirral Care Record:

 Wirral GP Practice members of the NHS Wirral Clinical Commissioning Group  Wirral University Teaching Hospital NHS Foundation Trust  Cheshire and Wirral Partnership NHS Foundation Trust  Wirral Community NHS Trust  Wirral Metropolitan Borough Council

Some of these organisations work jointly with Social Services and other health care providers. By working together in this way, we hope that everyone who uses these services will have clear and consistent advice about how we use and safeguard in- formation.

Why we collect information about you

We keep records about your health and social care and any treatment you receive to help ensure that you get the best possible service. Records also help us to investi- gate concerns if a complaint is raised.

It is important that the details you provided are accurate and you let us know of any changes, for example, if you change your address or GP.

How is your information stored?

Your Wirral Care Record will be held on computer, and may include:

 Person identifiable data  Encounters  Allergies  Diagnostics  Procedures  Medications  Immunisations  Investigation Results

Confidentiality

In accordance with the Care Record Guarantee, all staff have a legal duty to keep information about you confidential. The law strictly controls the sharing of some types of sensitive personal information.

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We will not disclose information without your consent unless there are exceptional circumstances, such as when the health or safety of others is at risk or if the law re- quires us to pass on information.

Access to your records is restricted to health and social care staff involved directly or indirectly in the delivery of your care. Access to the Wirral Care Record is very tightly controlled and monitored.

How your records can help others

We maintain your records to plan the services we provide.

Records are used to monitor the effectiveness of treatment and help to improve the level of care we give.

Some information is used for statistical purposes and we ensure individuals cannot be identified.

Accessing your Wirral Care Record

The Data Protection Act 1998 allows you to find out what information about you is held on computer and in relevant manual records, subject to certain conditions.

If you want to see, or obtain copies of, your Wirral Care Record, you need to make a written request to Wirral University Teaching Hospital NHS Foundation Trust, who host the Wirral Care Record.

Charges are often made for this information, and details will be given on application.

Your right to see some details in your records may be limited for your own interest or for another reason, such as the protection of others.

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5.2 Setting Parameters and Review

When making a request for personal information, individuals and organisations will be clearly identified as being authorised to receive such information and that the pur- poses of the request fall within the terms of this Agreement.

There will be a nominated senior professional within each organisation responsible for agreeing this Agreement and all subsequent amendments (see Section 8).

Local mechanisms will be in place to monitor the operation of the Agreement and en- sure compliance.

Each partner organisation will construct a regularly maintained register of individuals and organisations requiring access to personal information, and the defined purposes for which such information is required.

The partner organisations will formally review this Information Sharing Agreement six months after the commencement of this protocol, and thereafter at least once a year or earlier if requested in writing by any party.

5.3 HM Government Advice and Safeguarding

HM Government have recently published advice for safeguarding practitioners, which should be read in conjunction with this Agreement.

The document provides advice about information sharing, for people who provide safeguarding services to children, young people, parents and carers.

Information Sharing Advice for Safeguarding Practitioners 26 March 2015 https://www.gov.uk/government/publications/safeguarding-practitioners- information-sharing-advice

5.4 Data Protection Act 1998 http://www.legislation.gov.uk/ukpga/1998/29/contents

Advice from the Information Commissioners Office (ICO) is applicable to this Infor- mation Sharing Agreement: https://ico.org.uk/for-organisations/guide-to-data-protection/

The Data Protection Act 1998 identifies 8 key Principles in relation to the sharing of personal and sensitive data.

First DPA Principle:

Data must be processed lawfully and fairly

The Data Protection Act 1998 says:

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Personal data shall be processed fairly and lawfully and, in particular, shall not be processed unless – (a) at least one of the conditions in Schedule 2 is met, and (b) in the case of sensitive personal data, at least one of the conditions in Schedule 3 is also met.

Please see sections 5.5 and 5.6 for lists of the conditions met for the WCR.

A public authority must have a legal basis entitling it to process the information.

Some concerns regarding children where information will need to be shared under this Agreement will often fall below a statutory threshold of Section 47 or even Sec- tion 17 Children Act 1989. If they do however fall within these sections of the 1989 Act then these sections will be the main legal gateway.

Sections 10 and 11 of the Children Act 2004 place new obligations upon Local au- thorities, Police, clinical commission groups and the NHS Commissioning Board to co-operate with other relevant partners in promoting the welfare of children and also ensuring that their functions are discharged having regard to the need to safeguard and promote the welfare of children.

Section 10 and 11 of the Children Act 2004 create a ‘permissive gateway’ for infor- mation to be shared in a lawful manner. Such information sharing must take place in accordance with statutory requirements pertaining to the disclosure of information namely the Data Protection Act 1998, the Human Rights Act 1998 and the Common Law duty of confidentiality.

Section 29 of the Data Protection Act 1998 does not give a direct power to disclose information. It does however state ‘that if not disclosing information would prejudice the prevention/detection of crime and/or the apprehension/ prosecution of offenders, personal data can be disclosed’.

Under this Agreement, if not disclosing information to the MASH would prejudice the situations listed above, organisations are then exempt from the usual non-disclosure provisions and may provide the information requested / they wish to share proactive- ly.

All decisions to share or not share information must be decided on a case-by-case basis and recorded.

Duty of Confidence

A duty of confidence may be owed to both the holder of the data and to the data sub- ject.

Whilst always applying the tests of proportionality and necessity to the decision to share information, the protection of children or other vulnerable persons would clearly fulfil a public interest test when passing the information to a partner agency, whose work with the Police would facilitate this aim. All information shared with a partner agency must be relevant to the case in point.

Information held by other agencies that will be shared in the WCR may have been gathered where a duty of confidence is owed. Duty of confidence is not an absolute bar to disclosure, as information can be shared where consent has been provided or where there is a strong enough public interest to do so.

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Consent

The starting point in relation to sharing information is that practitioners will be open and honest with families and individuals from the outset about why, what, how and with whom information will or could be shared.

It may be necessary and desirable to deviate from the normal approach of seeking consent from a family in cases where practitioners have reasonable grounds for be- lieving that asking for consent would be unsafe or inappropriate. For example if there is an emergency situation or if seeking consent could create or increase a risk of harm.

There must be a proportionate reason for not seeking consent and the person mak- ing this decision must try to weigh up the important legal duty to seek consent and the damage that might be caused by the proposed information sharing on the one hand and balance that against whether any, and if so what type and amount of harm might be caused (or not prevented) by seeking consent.

There is no absolute requirement for agencies in the WCR to obtain consent before sharing information nor is there a blanket policy of never doing so. However, there is an obligation to consider on all occasions and on a case-by-case basis whether in- formation will be shared with or without consent. This determination by a practitioner should always be reasonable, necessary and proportionate. It should always be rec- orded together with the rationale for the decision.

The disclosure of personal information without consent is legally justifiable if it falls within one of the defined category of public interest:

The Public Interest Criteria include: i) The administration of justice; ii) Maintaining public safety; iii) The apprehension of offenders; iv) The prevention of crime and disorder; v) The detection of crime; vi) The protection of vulnerable members of the community.

When judging the public interest, it is necessary to consider the following: i) Is the intended disclosure proportionate3 to the intended aim? ii) What is the vulnerability of those who are at risk? iii) What is the impact of disclosure likely to be on the individual? iv) Is there another equally effective means of achieving the same aim? v) Is the disclosure necessary to prevent or detect crime and uphold the rights and freedoms of the public? vi) Is it necessary to disclose the information, to protect other vulnerable people?

As previously stated a proportionality test must be applied to ensure that a fair bal- ance is achieved between the public interest and the rights of the data subject. All disclosures must be relevant and proportionate4 to the intended aim of the disclo- sure.

3 “Proportionate” is the critical issue. 4 The implication here is that full records should not be routinely disclosed, as there will usual- ly be information that is not relevant.

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Privacy Notice

It is a requirement of the Data Protection Act 1998 that all organisations that process personal data should have what is now known as a ‘Privacy Notice’5, which will in- form individuals about how their personal data will be used by that organisation. This notice will cover:

i. The identity of the Data Controller ii. If the Data Controller has nominated a representative for the purposes of the Act, the identity of that representative iii. The purpose or purposes for which the data are intended to be pro- cessed. iv. Any further information which is necessary, taking into account the specific circumstances in which the data are or are to be processed, to enable processing in respect of the data subject to be fair.

Each partner organisation will publish a Privacy Notice, which specifically references the WCR within it. Comment [SC2]: All partner organisa- tions to do this, as the WCR goes live. Section 29 of the Data Protection Act 1998 allows agencies to share information if complying with the fair processing conditions i.e. telling individuals how their data will be processed/shared; would be likely to prejudice the purposes of the prevention or detection of crime and/or the apprehension and prosecution of offenders.

Other Legislation Engaged

Human Rights Act 1998 http://www.legislation.gov.uk/ukpga/1998/42/contents

The Human Rights Act must also be considered with the Data Protection Act.

HRA Article 8: The Right to Respect for Private and Family Life, Home and Corre- spondence

There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a dem- ocratic society in the interests of national security, public safety or the eco- nomic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.

Consent is relevant to the rights of those to whom confidential information relates, and thus to legal obligations such as the Human Rights Act 1998.

The sharing of information may engage Article 8. However, there will be no contra- vention provided that an exception within Article 8(2) applies.

5 Previously known as ‘fair processing’.

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The benefits of effective sharing of information for the purposes set out in this Agreement are to the direct benefit6 of the patient and so in the public interest.

Care Act 2014 http://www.legislation.gov.uk/ukpga/2014/23/contents

Section 3 concerns: Promoting integration of care and support with health services etc.

(1) A local authority must exercise its functions under this Part with a view to ensur- ing the integration of care and support provision with health provision and health- related provision where it considers that this would—

(a) promote the well-being of adults in its area with needs for care and support and the well-being of carers in its area,

(b) contribute to the prevention or delay of the development by adults in its area of needs for care and support or the development by carers in its area of needs for support, or

(c) improve the quality of care and support for adults, and of support for carers, pro- vided in its area (including the outcomes that are achieved from such provision). .

Second DPA Principle:

Personal data shall be obtained only for one or more specified and lawful pur- poses, and shall not be further processed in any manner incompatible with that purpose or those purposes.

The information exchanged under this Agreement will not be processed in any man- ner contradictory to the purposes set out in this Agreement.

All information will only be used within the WCR for the legitimate purposes it was originally collected.

Third DPA Principle:

Personal data shall be adequate, relevant and not excessive in relation to the purpose or purposes for which they are processed.

Any information that is shared into and within the WCR will be relevant to the aims of this Agreement. This will include a defined data set of information captured during GP and inpatient and outpatient hospital visits.

Examples of data that may be shared include;

6 Benefit does not always equate to real public interest, and when it does, it still has to be ‘proportionate’.

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• Name of subject (child, young person or adult) and other family members, their carers and other persons whose presence and/or relationship with the subject is relevant to identifying and assessing the risks to that person. • Age/date of birth of subject and other family members, carers, other persons detailed. • Ethnic origin of family members. • School and educational information (to include family members where appro- priate and relevant) • GP and health records (to include family members where appropriate and relevant) • Relevant data from any signatory to this Agreement • Housing and other partnership data relevant to the child and family which may affect the welfare of that child

Not all of the above information will be applicable in every case.

Fourth DPA Principle:

Personal data shall be accurate and, where necessary, kept up to date.

All the information supplied will be obtained from signatories’ computer systems or paper records and subject to their own organisations reviews, procedures and valida- tion. Any perceived inaccuracies should be reported to the contact at that partner or- ganisation for verification and any necessary action.

Whilst there will be regular sharing of information, the data itself will be ‘historical’ in nature. Specifically this means that the data fields exclusively relate to individual ac- tions or events that will have already occurred at the time of sharing. These are not categories of information that will substantially alter or require updating in the future. The exception to this will be that of the unborn child.

Fifth DPA Principle:

Personal data processed for any purpose or purposes shall not be kept for longer than is necessary for that purpose or those purposes.

The data will be kept in accordance with signatories’ file destruction policy (or equiva- lent procedure). It is acknowledged that there is a need to retain data for varying lengths of time depending on the purpose, and also in recognition of the importance of historical information for risk assessment purposes. However, once information is no longer needed, it should be confidentially destroyed.

Sixth DPA Principle:

Personal data shall be processed in accordance with the rights of data sub- jects under this Act.

Partners to this arrangement will respond to any notices from the Information Com- missioner that imposes requirements to cease or change the way in which data is processed.

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Partners will comply with Subject Access Requests (SARs) in compliance with the relevant legislation.

Seventh DPA Principle:

Appropriate technical and organisational measures shall be taken against un- authorised or unlawful processing of personal data and against accidental loss or destruction of, or damage to, personal data.

Measures to satisfy the Seventh Principle will be applicable to all partner organisa- tions.

Eighth DPA Principle:

Personal data shall not be transferred to a country or territory outside the Eu- ropean Economic Area, unless that country or territory ensures an adequate level of protection of the rights and freedoms of data subjects in relation to the processing of personal data

Under the terms of this Agreement no information will be passed outside of the Euro- pean Economic Area, unless specific requirements exist and the originating organisa- Comment [SC3]: Ask ICO at meeting tion makes that decision for a particular reason in relation to the safeguarding of a on 16 October e.g. fixing system from outside the EEA. child, young person or adult with a safeguarding need. Legal advice may be neces- sary in these cases.

5.5 Schedule 2, Data Protection Act 1998

In addition to the legal criteria set out above, the Information Sharing Agreement must satisfy at least one condition in Schedule 2 of the Data Protection Act in relation to personal data. For the WCR these will include and will be relevant to partner or- ganisations as appropriate:

1 The data subject has given his consent to the processing.

3 The processing is necessary for compliance with any legal obligation to which the data controller is subject, other than an obligation imposed by con- tract.

5 The processing is necessary— (b) for the exercise of any functions conferred on any person by or under any enactment.

6 (1) The processing is necessary for the purposes of legitimate interests pur- sued by the data controller or by the third party or parties to whom the data are disclosed, except where the processing is unwarranted in any particular case by reason of prejudice to the rights and freedoms or legitimate interests of the data subject.

------

Schedule 2 is satisfied in the case of this Agreement by Condition 5(b) (for the exer- cise of any functions conferred on any person by or under any enactment), as there

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is an implied gateway available for the sharing of information, which obliges the rele- vant agencies to ensure that its functions are discharged having regard to the health and wellbeing of Wirral residents.

5.6 Schedule 3, Data Protection Act 1998

If the information is “sensitive” (that is, where it relates to race, ethnic origin, political opinions, religion or belief system, membership of a trades union, physical/mental health or sexual life, the commission or alleged commission of any offence, proceed- ings relating to the offence) you must also satisfy at least one condition in Schedule 3. For the WCR these will include and will be relevant to partner organisations as appropriate:

1 The data subject has given his explicit consent to the processing of the per- sonal data.

7 (1) The processing is necessary— (b) for the exercise of any functions conferred on any person by or under an enactment, or

8 (1) The processing is necessary for medical purposes and is undertaken by— (a) a health professional, or (b) a person who in the circumstances owes a duty of confidentiality which is equivalent* to that which would arise if that person were a health professional. (2) In this paragraph “medical purposes” includes the purposes of preventa- tive medicine, medical diagnosis, medical research, the provision of care and treatment and the management of healthcare services.

* this includes registered Social Workers.

------

Schedule 3 is satisfied in the case of this Agreement by Condition 7 (the processing is necessary for the exercise of any functions conferred on any person by or under an enactment).

5.7 Clinical Codes Excluded from the WCR

Whilst recognising the importance of sharing information to support the care provided to individuals, the Information Sharing Agreement also identifies a series of exclu- sions which will not be included within the sharing model, unless explicitly stated, due to legal/statutory requirements and sensitivity concerns.

The Table below shows the heading areas along with some high level rational for ex- cluding this information from the sharing model (unless explicitly stated).

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Data field Reason

HIV and Aids AIDS (Control) Act 1987

Sexually Transmitted Diseases NHS (Venereal Diseases) Regulations 1974 NHS Act 1977 NHSTs & PCTs (STDs) Directions 2000

Termination of Pregnancy Sensitive data

IVF treatment Legal requirement - Human Fertilisation & Embryology (Disclosure of Information) Act 1992 imposes restrictions on the dis- closure of information about individuals

Complaints Could be perceived to prejudice care if known that patient was complaining about care

Convictions & imprisonment Sensitive data

Abuse Sensitive data

Gender Reassignment Legal requirement

Adoption Legal requirement

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6. Description of Arrangements and Security Procedures for the WCR

The following arrangements and procedures will be in place.

6.1 WCR Structure

The staff working for a number of organisations together form the WCR structure. It is vital for these staff to share information to manage the health and wellbeing of Wir- ral residents.

This should be explained to the residents, who should also be made aware of the people, the teams and the organisations that form WCR and their links to other statu- tory and non-statutory bodies.

6.2 Hosting Arrangements for the WCR

WUTH will use an outside contractor to host the WCR. This is Cerner, who will host the WCR in its UK Data Centre.

A Memorandum of Understanding will be in place before the WCR goes live. MoU Comment [SC4]: To include a brief MoU sentence here. Need advice from Mark Blakeman, All Signatories to this Agreement confirm that there are adequate security measures WUTH. on their electronic systems that information from partners may be transferred to. In- formation can only be accessed via username and password. Partners confirm that permission to access the WCR information held electronically by partners will be granted on a strict ‘need-to-know’ basis once it is contained within partners’ electron- ic systems.

6.3 WUTH’s specific obligations as Host

In its capacity as host, WUTH shall:

i. Enter into the Software Contract. WUTH shall manage and enforce the provi- sions of the Software Contract against the Software Provider. ii. Host the software required to use the WCR in accordance with the Software Contract. iii. Provide a first line technical support service for the WCR, and contract with the Software Provider for the Software Provider to provide a second line technical support service. iv. Work with the Software Provider to provide: o implementation and set-up assistance for the WCR; and o training for each Partner Organisations Trainers to enable cascade training to end users of the WCR. v. Comply with its obligations as a data processor, and specifically shall (and shall ensure that the Software Provider shall): o process the personal data only in accordance with instructions from WUTH, which may be specific instructions or instructions of a general nature as set out in this agreement or as otherwise notified by WUTH during the term of this agreement;

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o process the personal data only to the extent, and in such manner, as is necessary for the purposes of this agreement or as is required by law or any regulatory body; o take reasonable steps to ensure the reliability of any WUTH or Soft- ware Provider (as the case may be) personnel who have access to the personal data; o implement appropriate technical and organisational measures to pro- tect the personal data against unauthorised or unlawful processing and against accidental loss, destruction, damage, alteration or disclo- sure. These measures shall be appropriate to the harm which might result from any unauthorised or unlawful processing, accidental loss, destruction or damage to the personal data and having regard to the nature of the personal data which is to be protected; o obtain prior consent from the partner organisations before transferring any personal data to any sub-contractors; o ensure that all WUTH or Software Provider (as the case may be) per- sonnel required to access the personal data are informed of the confi- dential nature of the personal data and comply with the obligations set out in this ISA; o ensure that none of the WUTH or Software Provider (as the case may be) personnel publish, disclose or divulge any of the personal data to any third party unless directed in writing to do so by WUTH; o notify the relevant partner organisations within five working days if it receives: . a request from a data subject to have access to that person’s personal data; or . a complaint or request relating to WUTH’s obligations as host under the Data Protection Legislation; o provide the partner organisations with full cooperation and assistance in relation to any complaint or request made, including by: . providing full details of the complaint or request; . complying with a data access request within the relevant time- scales set out in the Data Protection Legislation and in accord- ance with the relevant partner organisation’s reasonable in- structions; . providing the relevant partner organisation with any personal data it holds in relation to a data subject (within the timescales reasonably required by the relevant Partner Organisation); and . providing the Governance Group or relevant partner organisa- tion with any information reasonably requested by the relevant partner organisation; o permit the partner organisations (subject to reasonable and appropri- ate confidentiality undertakings), to inspect and audit WUTH’s data processing activities and comply with all reasonable requests or direc- tions by the partner organisations to enable them to verify and/or pro- cure that WUTH in its capacity as host is in full compliance with its ob- ligations as host under this ISA; o provide a written description of the technical and organisational meth- ods employed for processing personal data (within the timescales rea- sonably required); and o not transfer any personal data outside the European Economic Area. vi. Not make any further copies of the personal data, except for back-up copies as necessary, and except where de-identified in accordance with this agree- ment or approved by all partner organisations.

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vii. Carry out its obligations under this agreement in compliance with Data Pro- tection Legislation. viii. Afford shared data the highest appropriate industry standards of storage in- cluding ensuring that hardware utilised for the purposes of this agreement is kept in a physically secure environment protected by a fully managed industry standard firewall. ix. Use, and ensure that the latest versions of anti-virus definitions and software available from an industry accepted anti-virus software vendor are used to check for, contain the spread of, and minimise the impact of malicious soft- ware. x. Maintain and implement a business continuity and disaster recovery plan to the reasonable satisfaction of the partner organisations. xi. Arrange for independent audits of the security and resilience of the software and physical and virtual systems, networks and hardware (including the non- technical management and organisational processes necessary to limit the accessibility of the virtual environment) in conjunction with the partner organi- sations. These should occur at least once in every three years. xii. Backup servers to the extent necessary to maintain the service and retain au- dit trails. xiii. Ensure that on the expiry or termination of this agreement, the Personal Con- fidential Data is returned to each partner organisation, destroyed, or migrated to an alternative software provider and shall ensure that no Personal Confi- dential Data is retained by the Software Provider.

6.4 Sub-contracting

The partner organisations may from time to time authorise WUTH to authorise a third party (sub-contractor) to process Personal Confidential Data on behalf of the partner organisations. At the date hereof, WUTH is hereby authorised to appoint the Soft- ware Provider as a sub-contractor.

6.5 Legal Basis to Operate Within

Please see the section on: Legitimate Purposes for Sharing Information for WCR.

6.6 Definition of Data Controller in Common

The identity of the data controllers for NHS patient data where IT systems support the sharing of data between some or many organisations, can appear difficult to de- termine. In part, this is because this sharing is often portrayed as organisations con- tributing to a single shared record relating to a unique patient, an example of the pa- tient being at the centre of care processes. Note that organisations do not have any legal right to access confidential patient data simply by virtue of being a data control- ler or data processor - consent or some statutory provision will still normally be re- quired.

It is important to clarify which bodies have responsibilities in respect of patient data and the means by which these responsibilities are discharged. The Data Protection Act 1998 sets out clear responsibilities that must be met by data controllers even though it may not always be straightforward to determine who they are. In general, bodies processing data about identifiable individuals will be either a data controller for that data or a data processor.

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Joint or Common Data Controllers

The determination of the purposes for which, and the manner in which, any personal data are, or are to be, processed does not need to be exclusive to one data control- ler. Authority to make such determinations may be shared with others. The DPA rec- ognises two models of shared authority:

i. joint data controllers, and ii. data controllers in common

“Joint” covers the situation where the determination is exercised by data controllers acting together, typically with written data controller agreements setting out the pur- poses for processing, the manner of processing and the means by which joint data controller responsibilities will be satisfied.

“Determination in common” is where data controllers share a pool of personal data, often disclosing data to each other but with each processing the data independently of the other(s). As with ‘joint’ arrangements, data controllers in common should have written agreements and processes for ensuring that all data controller responsibilities are satisfied. Each needs to exercise due diligence in ensuring that all parties in- volved are meeting the requirements of law.

Joint data controllers are actually very rare.

Fortunately, this is not how the current range of care sector shared record systems actually works, though there are several different models. These may be categorised as:

A single data controller: in this model, participating organisations disclose data to a single data controller who maintains and is responsible for the shared record envi- ronment. This is the model envisaged for the Summary Care Record.

Here, the data controllers are clearly identifiable.

Organisations participating in a model where they are data controllers in common need to be provided with clear guidance on their legal responsibilities and document- ed agreements covering all DPA requirements need to be developed and put in place.

Whilst it is important that pragmatism and efficient use of resources underpin these agreements, it is also important that every effort is made to ensure that the interests of patients are given appropriate priority. This might best be delivered through a data sharing agreement or memorandum of understanding.

The above is taken from:

Information Governance Alliance Data Controller Issues March 2015

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6.7 Creation of a New Record/Entity- Wirral Care Record

Personal data records held on the Solution will be overwritten every time a record is received (generally in an overnight batch) and matches an existing record using the NHS Number, but if activity on a record ceases and hence no new record arrives to overwrite the existing record, then the historic record will remain. It is noted that these feeds are routinely deleted once the data load is completed successfully. Batch HL7 transactional messages (inc. CCD, EDL, crawler data) from the partner Data Controller systems update the record and retain the history of all previous transac- tions.

6.8 Opt Out Process for Patients

If a patient chooses to opt out, the GP Partner Organisation can flag their record for exclusion and the data is purged from the system. If the patient opts back in then a new bulk upload for that patient occurs and adds any data from the date that the pa- tient was removed back into the delta feed. This provides flexibility to quickly rein- state the record if the patient should change their mind and opt back in.

6.9 Population Record

Wirral’s successful Vanguard application has built on the progress of Vision 2018 to develop the Healthy Wirral programme which intends to implement the New Care Models described in the 5 Year Forward View. The emphasis of the new model is to enable people to live well and stay well for longer, create a person-centred integrated system that will respond quickly, safely and appropriately when needed, and drive technology to enable proactive approaches to integrated care. The model aims to meet the needs of the whole population of Wirral using different approaches to meet their needs.

In order to take forward a population health approach, it is essential that information is available across the health and social care system to enable a joined-up approach to care and deliver services that are truly integrated. However, it is absolutely essen- tial that information is used in an appropriate manner.

Population selection OPTIONS: • People registered in Wirral at all EMIS practices only (therefore two practices patients will be excluded even if activity in WUTH & will have non Wirral resi- dents if at a Wirral GP practice) • People registered in Wirral at all EMIS practices and have a Wirral Postcode (therefore the two non EMIS practice patients with WUTH activity will be in- cluded in the population record and if have any of the 5 conditions against a WUTH episode BUT not GP data) • People registered in Wirral at all EMIS practices and have a identified Wirral Postcode only

6.10 Privacy Impact Assessment

WUTH has conducted a Privacy Impact Assessment (PIA) in relation to the WCR proposal, in accordance with the Privacy Impact Assessment Code of Practice pub-

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lished by the Information Commissioner's Office in February 2014. The PIA is insert- ed below for reference purposes. Comment [SC5]: Suzanne Crutchley, CSU, to insert the Privacy Impact As- sessment, when it is agreed.

Insert PIA

6.11 Openness and Transparency

Each partner organisations will:

° Ask for permission to access the patient’s information. ° Explain why they are using the patient’s information, and will only use it for those purposes. ° Explain who will see it and limit access to the patient’s information only to per- sons who need it. ° Collect minimum personal and sensitive information to meet the identified needs of the patient and not ask for information which is not relevant. ° Record and share patient’s needs with partner organisations as appropriate, on the organisations respective system. ° Keep information about the patients as accurate and up-to-date as possible – with the patient’s help. ° Respect patient’s rights under the Data Protection Act 1998 – including the pa- tient’s right to see the information which has been recorded about them. ° Protect patient’s information with the highest standards of security and confi- dentiality. ° Tell patients how they can get more information, including: How their personal information is safeguarded; How patients can check and correct any information held about them; How to raise a query or a complaint. ° Only keep the information for as long as needed or as required by statute. ° There may be occasions when information is shared without consent. In these cases the Data Protection Act 1998 or other legislation will apply.

6.12 Confidentiality and Vetting

The information to be shared under this Agreement is classified as ‘RESTRICTED’ under the Government Protective Marking System. Vetting is not mandatory to view this grade of information; however staff working within the WCR environment will ei- ther be vetted to CTC level or have an ‘Enhanced’ DBS check. What is required at ‘RESTRICTED’ level access is a strict ‘need-to-know’ the information, which all staff viewing shared information must have.

Signatories to this Agreement agree to seek the permission of the originating partner organisation if they wish to disseminate shared information outside of the WCR envi- ronment. Such permission will only be granted where proposed sharing is within the agreed principles.

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6.13 Compliance

All signatories to this Agreement accept responsibility for ensuring that all appropriate data security arrangements (physical and technical) are complied with. Any issues concerning compliance with security measures will form part of the annual review of this Agreement.

6.14 Non Compliance and Partner Disagreement

In the rare event that a dispute arises it should be clear what action should be taken.

In the event of a suspected failure within an organisation to comply with this Agree- ment, partner organisations will ensure that an adequate investigation is carried out and recorded. If the partner organisation finds there has been a failure it will ensure that:

• necessary remedial action is taken promptly; • service-users affected by the failure are notified of it, the likely consequences, and any remedial action; • Partner organisations affected by the failure are notified of it, the likely conse- quences, and any remedial action.

If one partner organisation believes another has failed to comply with this Agreement it should notify the other partner organisation in writing giving full details. The other partner organisation should then investigate the alleged failure. If it finds there was a failure, it should take the steps set out above. If it finds there was no failure it should notify the first partner organisation in writing giving its reasons.

Partner organisations will make every effort to resolve disagreements between them about personal information use and sharing. However, they recognise that ultimately each organisation must exercise its own discretion in interpreting and applying this Agreement in line with guidance from the Information Commissioner.

Nominated representatives should ensure they are notified at an early stage of any suspected or alleged failures in compliance or partner disagreements relating to their partner organisation.

6.15 Liability and Indemnity

Each Partner Organisation shall accept responsibility for its own acts and omissions.

WUTH’s liability, regarding the hosting arrangements of the WCR, in its capacity as host, shall be limited to £500,000.

Nothing in this Agreement shall limit liability for death or personal injury resulting from negligence or for fraud.

Each partner organisation warrants that in accessing the WCR it shall comply with the licence terms set out in the Software Contract.

Each partner organisation shall indemnify and keep indemnified WUTH (in its capaci- ty as host) from and against all costs, claims, demands, liabilities, expenses, damag- es or losses (including without limitation consequential losses and loss of profit, and

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all interest, penalties and legal and other professional costs and expenses) arising out of or in connection with:

• the use of shared data by the partner organisation; • personal injury caused by or arising from the partner organisation’s use of shared data; • the partner organisation’s failure to comply with the licence terms of the Soft- ware Contract; or • the partner organisation’s failure to comply with all applicable laws and regu- lations with respect to the shared data or the infringement of the rights of any third party arising out of the possession, processing or use of the shared data.

6.16 Consequences of Termination

Upon exiting this agreement (whether by leaving, or because the agreement has terminated or expired): Comment [SC6]: Mark Blackman, WUTH, to comment • the exiting partner organisation shall cease accessing the WCR immediately and securely return or destroy any shared information in its possession; • WUTH as host shall arrange for the cessation of the exiting partner organisa- tion’s access to the Software; and • WUTH as host shall ensure that Personal Confidential Data for which the exit- ing partner organisation is data controller is removed from the WCR at the next extract following the partner organisation’s exit. • Any former partner organisation shall have access to audit trails only on the written authority of the partner organisation(s) or as required by law.

6.17 Sanctions

Any unauthorised release of information or breach of conditions contained within this Agreement will be dealt with through the internal discipline procedures of the individ- ual partner organisation.

All partner organisations are aware that in extreme circumstances, non-compliance with the terms of this Agreement may result in the Agreement being suspended or terminated.

6.18 Security of Shared Information

As a general rule staff should only have access to personal information on a ‘need to know’ basis. All partner organisations will have sufficient levels of security in place, including the following:

• Physical and technical security of data and information systems. • Monitor access to data and information. • Provide security awareness and training to staff. • Security management. • Systems development. • Organisation specific information security policies. • Data Controller associated responsibilities to meet the requirements of the Data Protection Act 1998.

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When at all possible the patient will be informed at first contact of the purpose of col- lecting information and how it will be stored, used and shared. Consent to share should also be gained at the first suitable opportunity if possible and if appropriate.

All partner organisations should have sufficient levels of security in place to include:

a. The levels of security for monitoring access to the WCR b. Technical security arrangements, including passwords and system re- strictions c. Information will be stored in secured premises, e.g. not in areas where the public have access.

Security standards are further covered in the Tier One document of the Tiered Framework of the Information Sharing Code of Practice.

6.19 Staff Training and Awareness

All partner organisations will hold a copy of this Agreement. It is the responsibility of each partner organisation to ensure that all individuals likely to come in contact with the data shared under this Agreement are trained in the terms of this Agreement and their own responsibilities.

6.20 Movement of Information

Information will be sent and received electronically to ensure there is an audit trail of its movement.

Any e-mail communication will be by way of secure, encrypted, appropriate and ap- proved methods. The sharing of information must be done via secure email, meaning only the following email addresses will be used:

@nhs.net @pnn.police.uk @gcsx.gov.uk @cjsm.net @gsi.gov.uk

6.21 Data Retention

Each organisation must have a data retention policy that accords to the legitimate purposes of that.

The policy document will make clear the organisations approach to the retention, storage and disposal of records, only keeping information for as long as is necessary in relation to the original purpose(s) for which it was collected.

6.22 Retention of Shared Information

The Data Protection Act 1998 states that information should only be kept for as long as necessary so the following will need to be considered:

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a. Retention periods b. Reviewing a retention policy c. Legal requirements to retain or delete d. Deletion and archiving e. Retaining information supplied by another organisation f. Compliance with each individual organisation's policies

Where joint records are being created using shared information, the retention period must be the longer of the retention periods as required by the legislation governing each agency.

The WCR will be managed in accordance with the NHS Code of Practice on Records Management (April 2006):

Download a PDF version of the Records Management: NHS Code of Practice - Part 1 (PDF, 222.4kB)

Download a PDF version of the Records Management: NHS Code of Practice - Part 2 (PDF, 583.6kB)

The arrangements for who will review the PID held on the WCR will be led by WUTH. The WCR will be reviewed on an annual basis.

The WCR Registries will go through a yearly review cycle as part of the clinical safety and governance process, to ensure that content remains clinically relevant and con- tinues to drive improvement in outcomes.

If a patient chooses to opt out, the GP Partner Organisation can flag their record for exclusion and the data is purged from the system. If the patient opts back in then a new bulk upload for that patient occurs and adds any data from the date that the pa- tient was removed back into the delta feed. This provides flexibility to quickly rein- state the record if the patient should change their mind and opt back in.

If a data controller ceases to participate in the WCR that data controller’s data is re- moved at the next extract.

Data that is stored and generated within the WCR, including audit trails, access logs, etc, are retained in accordance with General Medical Council and British Medical As- sociation guidance and the NHS Records Management Code of Practice.

The audit log will be retained for ten years.

Personal data records held on the Solution will be overwritten every time a record is received (generally in an overnight batch) and matches an existing record using the NHS Number, but if activity on a record ceases and hence no new record arrives to overwrite the existing record, then the historic record will remain. It is noted that these feeds are routinely deleted once the data load is completed successfully. Batch HL7 transactional messages (inc. CCD, EDL, crawler data) from the partner Data Controller systems update the record and retain the history of all previous transac- tions.

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6.23 Storage of Papers

It is not the intention of this Agreement that WCR information will be produced in a hard format.

However, if required for legal cases reports can be pulled from the back end. And then it will be the partner’s responsibility to keep the information secure by measures such as storing documents in a locked container when not in use. Access to printed documents must be limited only to those with a valid ‘need to know’ that information. There should also be a clear desk policy in place, and particular information from any partner organisation is only assessed when needed and stored correctly and secure- ly when not in use.

6.24 Disposal of Electronic Information

Information will be held in electronic systems until the information is no longer re- quired. Information provided as part of this Agreement will be the subject of review by the partner organisations. Information will be destroyed in accordance with each agencies code of practice in the safe handling and disposing of information, and with regards to their responsibilities under the Data Protection Act 1998.

If information is stored by partners electronically on their systems, information must be overwritten using an appropriate software utility.

6.25 Disposal of Papers

As mentioned previously, it is not the intention of this Agreement that information will be produced in a hard format. If information is printed off an electronic system, it will be the partner’s responsibility to dispose of the information in an appropriate secure manner i.e. shredding or through a ‘RESTRICTED’ waste system, once it is no longer needed.

6.26 Subject Access Requests

The Healthy Wirral WCR will hold copies of data downloaded from all partner organi- sations.

Data Subjects are entitled to know what information is held about them. If any of their details are wrong, they should inform the organisation so that they can be corrected.

WUTH will manage any SARs in accordance with their own local procedures, for ac- cess to the WCR.

If data subjects would like access to their WCR they should make a Subject Access Request (SAR) by applying in writing to WUTH.

Each organisation should let patients know how they can gain access to their WCR.

6.27 Freedom of Information Requests

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This document and the arrangements it details will be disclosable for the purposes of the Freedom of Information Act 2000 and so will be published within the signatories’ Publication Schemes.

Any requests for information made under the Act that relates to the operation of this Agreement should, where applicable, be dealt with in accordance with the Code of Practices under the Freedom of Information Act 2000.

The Lord Chancellor has issued two Codes of Practice under the Act.

• The section 45 Code sets out good practice in handling requests for infor- mation. It also includes a section on Freedom of Information and public sector contracts.

http://webarchive.nationalarchives.gov.uk/20150730125042/http://www.justice .gov.uk/downloads/information-access-rights/foi/foi-section45-code-of- practice.pdf

• The section 46 Code is in two parts:

o part I sets out good practice in records management and applies to all FOI authorities and other bodies subject to the Public Records Act 1958 or the Public Records Act (Northern Ireland) 1923

o part II applies only to bodies subject to the Public Records Act 1958 or the Public Records Act (Northern Ireland) 1923 and sets out how records should be transferred to records offices

http://webarchive.nationalarchives.gov.uk/20150730125042/http://www.justice .gov.uk/downloads/information-access-rights/foi/foi-section-46-code-of- practice.pdf

The Section 45 Code contains provisions relating to consultation with others who are likely to be affected by the disclosure (or non-disclosure) of the information request- ed. The Code also relates to the process by which one authority may also transfer all or part of a request to another authority if it relates to information they do not hold.

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7. Legislation and Further Guidance

Various definitions have been used throughout this Information Sharing Agreement, and the associated Privacy Impact Assessment.

7.1 Information Governance and Technical Definitions

Information Governance Toolkit

NHS and various other Organisations are required to adopt the Information Govern- ance Toolkit which is a knowledge base and assessment framework. The toolkit brings together in one place information and activities to support the provision of high quality care. It promotes the effective and appropriate use of information with an in- creased importance of data sharing and partnerships. Link to Department of Health Information Governance Toolkit website: https://nww.igt.hscic.gov.uk/

The following document is extracted directly from the HSCIC IG Toolkit Glossary of Terms.

HSCIC IGT Information Governan

7.2 Key Information Law

The Data Protection Act 1998 This Act represents the key legislation governing the protection and use of personal data about living, identifiable people. This legislation requires organisations to ensure any ‘processing’ of personal data complies with the Principles of the Act. This in- cludes the implications of any information sharing arrangements; with particular re- gard for the purpose(s) information is shared.

Further guidance on the implementation of this Act can be found from the Information Commissioner’s Office website: https://ico.org.uk/

The Common Law Duty of Confidence When considering personal information that has been provided ’in confidence’, then all staff of any organisation with access to such information are subject to the Com- mon Law Duty of Confidence. This duty is recognition, in law, of the need to ensure that the information remains confidential. All health information so provided, within any of the partner organisations, imposes such a duty on staff who have access to the information.

The Human Rights Act 1998 states (in Article 8.1) that ‘everyone has the right to respect for his private and family life, his home and his correspondence’. Agencies entering into information sharing must be aware of the implications of the rights granted to individuals by this legislation.

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7.3 Web links to further legislation and guidance

The Data Protection Act 1998 http://www.legislation.gov.uk/ukpga/1998/29/contents

The common law duty of confidentiality http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publicationsandstatisti cs/publications/publicationspolicyandguidance/browsable/DH_5803173

The Human Rights Act article 8 http://www.legislation.gov.uk/ukpga/1998/42/schedule/1/part/I/chapter/7

Mental Capacity Act 2005 http://www.opsi.gov.uk/ACTS/acts2005/ukpga_20050009_en_1

Criminal Justice and Immigration Act 2008 http://www.opsi.gov.uk/acts/acts2008/ukpga_20080004_en_1

NHS Act 2006 http://www.opsi.gov.uk/Acts/acts2006/ukpga_20060041_en_1

Health and Social Care Act 2012 http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted

The NHS Care Record Guarantee for England http://systems.hscic.gov.uk/rasmartcards/strategy/nhscrg

The Social Care Record Guarantee for England http://webarchive.nationalarchives.gov.uk/20130513181011/http://www.nigb.nhs.uk/b ookletlr.pdf

The Summary Care Record http://systems.hscic.gov.uk/scr

The international information security standard: ISO/IEC 27002: 2005 http://www.iso.org/iso/catalogue_detail?csnumber=50297

The Confidentiality NHS Code of Practice: http://www.ecric.nhs.uk/docs/nhs_conf_code.pdf

The Information Security NHS Code of Practice: http://systems.hscic.gov.uk/infogov/codes/securitycode.pdf

The Records Management NHS Code of Practice: https://www.gov.uk/government/publications/records-management-nhs-code-of- practice

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8. Signatories to Abide by this Agreement

HEALTHY WIRRAL WCR

INFORMATION SHARING AGREEMENT

SIGNATURE SHEETS

A Signature Sheet is needed for each partner organisation:

 NHS Wirral Clinical Commissioning Group*  Wirral University Teaching Hospital NHS Foundation Trust  Cheshire and Wirral Partnership NHS Foundation Trust  Wirral Community NHS Trust  Wirral Metropolitan Borough Council  All Wirral GP Practices

*The CCG will not have access to the WCR. However, they are required to sign up to this Information Sharing Agreement as the lead commissioner of the NHS provider organisations party to this Agreement.

The partner organisations signing this Agreement accept that the procedures laid down in this document provide a secure framework for the sharing of information be- tween their agencies in a manner compliant with their statutory and professional re- sponsibilities.

As such they undertake to:

. Implement and adhere to the procedures and structures set out in this Agreement.

. Ensure that where these procedures are complied with, then no restriction will be placed on the sharing of information other than those specified within this Agreement.

. Engage in a review of this Agreement with partners annually.

By signing this partners are signing to the whole of the Cheshire and Merseyside In- formation Sharing Code of Practice, and must agree to the Overarching Standard for Information Sharing, designed to be used in conjunction with a set of documents within a Tiered Structure.

We the undersigned agree that each partner organisations that we represent will adopt and adhere to this Information Sharing Agreement:

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8.1 NHS Wirral Clinical Commissioning Group

HEALTHY WIRRAL WCR

INFORMATION SHARING AGREEMENT

NAME OF ORGANISATION: NHS Wirral Clinical Commissioning Group http://www.wirralccg.nhs.uk

ADDRESS: Old Market House, Birkenhead, Merseyside, CH41 5AL

Data Protection Registration Registration Number: Z3597206 Date Registered: 14 March 2013 Registration Expires: 13 March 2016

Information Governance Toolkit status

Assessment Stage Level Level Level Level Not Total Overall Self- Reviewed Reason 0 1 2 3 Relevant Req'ts Score assessed for Grade Change Grade of Grade

Version Published 0 0 24 0 4 28 66% Satisfactory n/a n/a 12 (2014- 2015)

Chief Executive: Jonathan Develing

Job Title: Chief Officer

Email address: [email protected]

Signature:

Date:

Caldicott Guardian: Dr Sue Wells

Job Title: Medical Director & Caldicott Guardian

Email address: [email protected]

Signature:

Date:

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Information Governance Lead: Mark Bakewell

Job Title: Chief Financial Officer

Email address: [email protected]

Signature:

Date:

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8.2 Wirral University Teaching Hospital NHS Foundation Trust

HEALTHY WIRRAL WCR

INFORMATION SHARING AGREEMENT

NAME OF ORGANISATION: Wirral University Teaching Hospital NHS Foundation Trust http://www.wuth.nhs.uk/patients-and-visitors/

ADDRESS: Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral, Merseyside, CH49 5PE

Data Protection Registration Registration Number: Z1092834 Date Registered: 26 November 2007 Registration Expires: 25 November 2015

Information Governance Toolkit status

Assessment Stage Level Level Level Level Total Overall Self- Reviewed Reason for 0 1 2 3 Req'ts Score assessed Change of Grade Grade Grade

Version 12 Published 0 0 35 10 45 74% Satisfactory n/a n/a (2014-2015)

Chief Executive: David Allison

Job Title: Chief Executive

Email address: [email protected]

Signature:

Date:

Caldicott Guardian: Dr Melanie Maxwell

Job Title: Associate Medical Director for Quality and Safety

Email address: [email protected]

Signature:

Date:

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Information Governance Lead: Lin Snow

Job Title: Information Governance/Records Manager

Email address: [email protected]

Signature:

Date:

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8.3 Cheshire and Wirral Partnership NHS Foundation Trust

HEALTHY WIRRAL WCR

INFORMATION SHARING AGREEMENT

NAME OF ORGANISATION: Cheshire and Wirral Partnership NHS Foundation Trust http://www.cwp.nhs.uk/

ADDRESS: Trust Headquarters, Redesmere, Countess of Chester Health Park, Liverpool Road, Chester, CH2 1BQ

Data Protection Registration Registration Number: Z5225526 Date Registered: 22 January 2001 Registration Expires: 21 January 2016

Information Governance Toolkit status

Assessment Stage Level Level Level Level Total Overall Self-assessed Reviewed Reason 0 1 2 3 Req'ts Score for Grade Grade Change of Grade

Version 12 Published 0 1 6 38 45 94% Not Satisfac- n/a n/a (2014-2015) tory

N.B. level 1 for Requirement 514 – audit of clinical coding (just for secondary diagnosis – missed being com- pliant in audit by 1%.

Chief Executive: Sheena Cumiskey

Job Title: Chief Executive

Email address: [email protected]

Signature:

Date:

Caldicott Guardian: Dr Faouzi Alam

Job Title: Medical Director

Email address: [email protected]

Signature:

Date:

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Information Governance Lead: Gill Monteith

Job Title: Trust Records Manager/Data Protection Officer

Email address: [email protected]

Signature:

Date:

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8.4 Wirral Community NHS Trust

HEALTHY WIRRAL WCR

INFORMATION SHARING AGREEMENT

NAME OF ORGANISATION: Wirral Community NHS Trust http://www.wirralct.nhs.uk/

ADDRESS: Wirral Community NHS Trust St Catherines Health Centre Derby Road, Birkenhead Wirral. CH42 0LQ Data Protection Registration Registration Number: Z2567487 Date Registered: 28th March 2011 Registration Expires: 27th March 2016

Information Governance Toolkit status

Assessment Stage Level Level Level Level Not Total Overall Self- Reviewed Reason 0 1 2 3 Relevant Req'ts Score assessed Grade for Change Grade of Grade

Version 12 Published 0 0 29 9 1 39 74% Satisfactory n/a n/a (2014-2015)

Chief Executive: Karen Howell

Job Title: Chief Executive

Email address: [email protected]

Signature:

Date:

Caldicott Guardian: Dr Ewen Sim

Job Title: Medical Director

Email address: [email protected]

Signature:

Date:

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Information Governance Lead: Claire Wedge

Job Title: Head of Governance and Patient Safety

Email address: [email protected]

Signature:

Date:

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8.5 Wirral Metropolitan Borough Council

HEALTHY WIRRAL WCR

INFORMATION SHARING AGREEMENT

NAME OF ORGANISATION: Wirral Metropolitan Borough Council http://www.wirral.gov.uk/

ADDRESS: Council Chamber, Wallasey Town Hall Brighton Street, Wallasey, Wirral, CH44 8ED

Data Protection Registration Registration Number: Z5881449 Date Registered: 26 October 2001 Registration Expires: 25 October 2015

Information Governance Toolkit status

Assessment Stage Level Level Level Level Exempt Total Overall Self- Reviewed Reason 0 1 2 3 Req'ts Score assessed for Grade Change Grade of Grade

Version 12 Published 0 0 25 2 1 28 69% Satisfactory Satisfactory n/a (2014-2015)

Chief Executive: Eric Robinson

Job Title: Chief Executive

Email address:

Signature:

Date:

Caldicott Guardian: Simon Garner

Job Title: Corporate Safeguarding Manager and Caldicott Guardian

Email address: [email protected]

Signature:

Date:

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Information Governance Lead: Mike Zammit

Job Title:

Email address: [email protected]

Signature:

Date:

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8.6 All Wirral GP Practices

N.B. one signature sheet for each GP Practice

NAME OF GP PRACTICE:

ADDRESS:

Data Protection Registration See below

Information Governance See below Toolkit Status

Information Governance Lead:

Job Title:

Email address:

Signature:

Date:

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8.7 Data Protection Registration

WIRRAL WIDE – GP PRACTICES

WIRRAL WIDE – GP PRACTICES

PRACTICE REGISTRATION DETAILS Allport Surgery Registration Number: Z5014547 N85003 Date Registered: 16/11/00 Registration Expires: 15/11/15 Blackheath Medical Centre Registration Number: Z7416512 N85648 Date Registered: 13/02/03 Registration Expires: 12/02/16 Cavendish Medical Centre Registration Number: Z6932616 N85017 Date Registered: 09/08/02 Registration Expires: 08/08/16 Central Park Medical Centre Registration Number: Z685961X N85027 Date Registered: 11/07/02 Registration Expires: 10/07/16 Church Road Medical Practice Registration Number: Z5617026 N85633 Date Registered: 16/08/01 Registration Expires: 15/08/16 Civic Medical Centre Registration Number: Z6926733 N85006 Date Registered: 31/07/02 Registration Expires: 30/07/16 Claughton Medical Centre Registration Number: Z7042970 N85044 Date Registered: 15/08/02 Registration Expires: 14/08/16 Commonfield Road Surgery Registration Number: Z7200277 N85009 Date Registered: 14/03/03 Registration Expires: 13/03/16 Devaney Medical Centre Registration Number: Z750916X N85015 Date Registered: 17/02/03 Registration Expires: 16/02/16 Earlston & Seabank Medical Centre Registration Number: Z2761322 N85619 Date Registered: 12/08/11 Registration Expires: 11/08/16

Eastham Group Practice Registration Number: Z5104810 N85005 Date Registered: 04/05/01 Registration Expires: 03/05/16 Egremont Medical Centre Registration Number: Z7420257 N85629 Date Registered: 29/11/02 Registration Expires: 28/11/15 Fender Way Health Centre Registration Number: Z7440476 N85029 Date Registered: 31/01/03 Registration Expires: 30/01/16 Field Road Health Centre Registration Number: Z6747109 N85053 Date Registered: 23/07/02 Registration Expires: 22/07/16 Gladstone Medical Centre Registration Number: Z5469039 N85031 Date Registered: 23/07/01 Registration Expires: 22/07/16 Greasby Group Practice Registration Number: Z4733607 N85032 Date Registered: 17/05/01

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PRACTICE REGISTRATION DETAILS Registration Expires: 16/05/16 Greenway Surgery Registration Number: Z7345095 N85041 Date Registered: 11/11/02 Registration Expires: 10/11/15 Grove Road Surgery Registration Number: Z7520709 N85052 Date Registered: 12/02/03 Registration Expires: 11/02/16 Hamilton Medical Centre Registration Number: Z8097825 N85021 Date Registered: 07/08/03 Registration Expires: 06/08/16 Heatherlands Medical Centre Registration Number: Z4833774 N85037 Date Registered: 05/07/00 Registration Expires: 04/07/16 Heswall & Pensby Group Practice Registration Number: Z4793272 N85007 Date Registered: 18/05/00 Registration Expires: 17/05/16 Holmlands Medical Centre Registration Number: Z6902253 N85022 Date Registered: 05/08/02 Registration Expires: 04/08/16 Hoylake & Meols Medical Centre Registration Number: Z6525253 N85059 Date Registered: 17/07/06 Registration Expires: 16/07/16 Hoylake Road Medical Centre Registration Number: Z1007604 N85046 Date Registered: 01/10/07 Registration Expires: 30/09/15 Kings Lane Medical Practice Registration Number: Z732216X N85054 Date Registered: 11/12/02 Registration Expires: 10/12/15 Leasowe Primary Care Centre Registration Number: N85640 Date Registered: Registration Expires: Liscard Group Practice Registration Number: Z6262233 N85616 Date Registered: 19/02/02 Registration Expires: 18/02/16 Manor Health Centre Registration Number: Z6652421 N85023 Date Registered: 16/04/02 Registration Expires: 15/04/16 Marine Lake Medical Practice Registration Number: Z3595131 N85002 Date Registered: 12/03/13 Registration Expires: 11/03/16 Miriam Medical Centre Registration Number: Z5554765 N85625 Date Registered: 31/05/01 Registration Expires: 30/05/16 Moreton Cross Group Practice Registration Number: Z6046593 N85028 Date Registered: 07/12/01 Registration Expires: 06/12/15 Moreton Health Clinic Registration Number: Z7224820 N85040 Date Registered: 01/11/02 Registration Expires: 31/10/15 Moreton Medical Centre Registration Number: Z6977559 N85048 Date Registered: 22/08/02 Registration Expires: 21/0/16 Parkfield Medical Centre Registration Number: Z6353109 N85034 Date Registered: 18/02/02 Registration Expires: 17/02/16 Prenton Medical Centre Registration Number: ZA009752 N85643 Date Registered: 05/08/13

Page 103 of 109 Information Sharing Agreement Healthy Wirral WCR - November 2015

PRACTICE REGISTRATION DETAILS Registration Expires: 04/08/16 Riverside Surgery Registration Number: Z69291268 N85016 Date Registered: 07/02/02 Registration Expires: 06/02/16 Silverdale Medical Centre Registration Number: Z6396077 N85058 Date Registered: 31/01/02 Registration Expires: 30/01/16 Somerville Medical Centre Registration Number: Z9540938 N85024 Date Registered: 17/07/16 Registration Expires: 16/07/16 Spital Surgery Registration Number: Z5170753 N85617 Date Registered: 05/02/01 Registration Expires: 04/02/16 St George’s Medical Centre Registration Number: Z6182088 N85012 Date Registered: 24/04/02 Registration Expires: 23/04/16 St Hilary Group Practice Registration Number: Z4761758 N85025 Date Registered: 02/06/00 Registration Expires: 01/06/16 Sunlight Group Practice Registration Number: Z733408X N85051 Date Registered: 23/12/02 Registration Expires: 22/12/15 Teehey Lane Medical Centre Registration Number: Z6766796 N85057 Date Registered: 20/05/02 Registration Expires: 19/05/16 TG Medical Centre Registration Number: Z3214210 N85001 Date Registered: 08/06/12 Registration Expires: 07/06/16 The Orchard Surgery Registration Number: Z55801X N85047 Date Registered: 19/07/01 Registration Expires: 18/07/16 The Villa Medical Centre Registration Number: Z7059395 N85018 Date Registered: 26/09/02 Registration Expires: 25/09/16 The Village Medical Centre Registration Number: Z7836500 N85620 Date Registered: 28/04/03 Registration Expires: 27/04/16 Townfield Health Centre Registration Number: N85014 Date Registered: Registration Expires: Upton Group Practice Registration Number: Z5390810 N85013 Date Registered: 31/05/01 Registration Expires: 30/05/16 Victoria Park Practice Registration Number: Z6960949 N85020 Date Registered: 05/08/02 Registration Expires: 04/08/16 Vittoria Medical Centre Registration Number: Z5456741 N85038 Date Registered: 15/06/01 Registration Expires: 14/06/16 Vittoria Medical Centre Registration Number: Z5535862 N85634 Date Registered: 30/01/02 Registration Expires: 29/01/16 West Wirral Group Practice Registration Number: Z9544713 N85008 Date Registered: 20/07/06 Registration Expires: 19/07/16 Whetstone Medical Centre Registration Number: Z6275711 N85019 Date Registered: 04/02/02

Page 104 of 109 Information Sharing Agreement Healthy Wirral WCR - November 2015

PRACTICE REGISTRATION DETAILS Registration Expires: 03/02/16 Woodchurch Medical Centre Registration Number: Y02162 Date Registered: Registration Expires:

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8.8 Information Governance Toolkit Status

WIRRAL WIDE – GP PRACTICES

Total Code Name Status Date (%) Allport Surgery - Walton H (N85003) N85003 Published 26/03/2015 88 Blackheath Medical Centre - Quinn B N E N85648 (N85648) Published 20/03/2015 100 Cavendish Medical Centre - Melville J A N85017 (N85017) Published 09/02/2015 100 Central Park Group Practice - Mukherjee S K N85027 (N85027) Published 24/03/2015 94 Church Road Medical Practice (N85633) N85633 Published 25/03/2015 74 Civic Medical Centre - Pillow S J (N85006) N85006 Published 12/03/2015 87 Claughton Medical Centre - Renwick J A N85044 (N85044) Published 24/03/2015 97 Commonfield Road Surgery - Brodbin C N85009 (N85009) Published 09/03/2015 87 Devaney Medical Centre - Bates J W N85015 (N85015) Published 05/02/2015 66 Earlston and Seabank Medical Centre N85619 (N85619) Published 19/03/2015 100 Eastham Group Practice - Bush K J (N85005) N85005 Published 17/03/2015 94 Egremont Medical Centre - Hickey J J M N85629 (N85629) Published 19/03/2015 94 Fender Way Health Centre - Ream J E N85029 (N85029) Published 18/03/2015 66 Field Road Health Centre - Downward D C N85053 (N85053) Published 11/03/2015 66 Gladstone Medical Centre - Salahuddin M N85031 (N85031) Published 30/03/2015 92

Page 106 of 109 Information Sharing Agreement Healthy Wirral WCR - November 2015

Greasby Group Practice_coppock PJ N85032 (N85032) Published 03/03/2015 66 Greenway Road Surgery - Dow SC (N85041) N85041 Published 13/03/2015 69 Grove Medical Centre - Roberts A (N85620) N85620 Published 11/03/2015 66 Grove Road Surgery - Tandon R (N85052) N85052 Published 25/03/2015 66 Hamilton Medical Centre - Jayaprakasan C A N85021 (N85021) Published 19/03/2015 92 Heatherlands Medical Centre - Camphor I A N85037 (N85037) Published 18/02/2015 100 Heswall Health Centre - Nicholas K S N85007 (N85007) Published 18/03/2015 87 Holmlands Med Centre - Dr Srivastava N85022 N85022 Published 26/02/2015 100 Hoylake & Meols Medical Centre - Burgess M N85059 B (N85059) Published 05/02/2015 100 Hoylake Road Medical Centre - Sharma V N85046 (N85046) Published 02/02/2015 66 Kings Lane Medical Centre - Kershaw D N85054 (N85054) Published 16/03/2015 92 Leasowe Primary Care Centre - Swift N D Not An- N85640 (N85640) swered 0 Liscard Group Practice - Staples B (N85616) N85616 Published 09/02/2015 84 Manor Health Centre - Magennis S P M N85023 (N85023) Published 02/03/2015 89 Marine Lake Medical Practice (N85002) N85002 Published 26/03/2015 79 Mill Lane Surgery - Dr S Kidd (N85635) Not An- N85635 swered 0 Miriam Medical Centre - Mantgani A B N85625 (N85625) Published 17/02/2015 71 Moreton Cross Group Practice - Richmond I M N85028 (N85028) Published 30/03/2015 100 Moreton Health Clinic - Janikiewicz S M J S N85040 (N85040) Published 31/03/2015 87

Page 107 of 109 Information Sharing Agreement Healthy Wirral WCR - November 2015

Moreton Medical Centre (N85048) - A Pereira N85048 Published 26/03/2015 92 Not An- Y02569 NHS Wirral Pcac (Y02569) swered 0 Orchard Surgery - Lannigan BG (N85047) N85047 Published 16/02/2015 66 Parkfield Medical Centre - Hawthornthwaite E N85034 M (N85034) Published 16/03/2015 97 Parkfield Medical Centre (N85051) N85051 Published 10/03/2015 94 Prenton Medical Centre - Dr Murugesh V N85643 Published 26/03/2015 97 Riverside Surgery (Williams RM) (N85016) N85016 Published 16/02/2015 66 Silverdale Medical Centre (Hennessy T D) N85058 (N85058) Published 10/03/2015 100 Somerville Medical Centre - Cheridjian VE N85024 (N85024) Published 18/03/2015 66 Spital Surgery (Francis G G) (N85617) N85617 Published 19/03/2015 92 St George's Medical Centre - Rudnick S N85012 (N85012) Published 30/03/2015 92 St Hilary Brow Group Practice - Kingsland JP N85025 (N85025) Published 20/03/2015 92 Teehey Lane Surgery (N85057) N85057 Published 30/03/2015 87 TG Medical Centre (Dr. Alam) (N85001) N85001 Published 18/09/2014 100 Townfield Health Centre - Lee A (N85014) N85014 Published 16/02/2015 100 Upton Group Practice_pickin RB (N85013) N85013 Published 26/02/2015 84 Victoria Park Health Centre - Freeman M J N85020 (N85020) Published 04/12/2014 100 Villa Medical Centre - Cookson Dr N M P N85018 (N85018) Published 23/03/2015 100 Vittoria Medical Centre - Grant P J (N85038) N85038 Published 20/02/2015 66

Page 108 of 109 Information Sharing Agreement Healthy Wirral WCR - November 2015

Vittoria Medical Centre - Murty K S (N85634) N85634 Published 10/03/2015 100 Wallasey Village Group Practice - Cameron E Not An- N85056 F (N85056) swered 0 West Wirral Group Practice - Wright J A N85008 (N85008) Published 23/03/2015 97 Whetstone Lane Medical Centre - Pleasance N85019 C M (N85019) Published 31/03/2015 100 Woodchurch Medical Centre (Y02162) Y02162 Published 01/04/2015 100

Page 109 of 109 Information Sharing Agreement Healthy Wirral WCR - November 2015

Report Title Medical Director Report November Governing Body 2015 Lead Officer Sue Wells Medical Director

Recommendations 1. Note progress in report

1. INTRODUCTION

1.1 This paper provides Governing Body with a report on the delegated duties of the Medical Director.

2. Clinical Engagement

• URGENT CARE ACTIVITY NHS 111 commenced October 2015. Being carefully monitored OPAT ( out-patient antibiotic therapy) referral simplified to encourage increased use by GPs Single Front Door project 8 High Impact Areas Think Pharmacy continuing Blood Transfusion access Hypoglycaemia admissions from nursing homes – educational project Rapid community service launched.

• PLANNED CARE ACTIVITY Consultant Connect – encouraging increased clinical dialogue with consultants regarding individual patient care- 4 areas in use. Excellent feedback from GPs and hospital colleagues . Call numbers increasing and last week 55% of the calls resulted in a patient not being referred or admitted to hospital

Direct Access Diagnostics- rationalization of current provision being discussed at the same time as procurement proceeds for new tender. Physiotherapy- delivery plan options under discussion Musculoskeletal care

• LONG TERM CONDITIONS Diabetes pathway including foot care- integrated pathway under development Elderly Care including 5 new pathways of care in association with Community Geriatricians active Respiratory Care Joint work with Public Health regarding Alcohol, Ageing well and Diabetes prevention Hypertension Summit held jointly with Public Health end of September

• PRIMARY CARE Primary Care Quality Scheme. Every practice has signed up . Service Index appropriate for use by GP in consultation available on the webportal Primary Care prescribing being closely monitored. Pilot planned for deep dive into practices whose figures suggest greatest need of support Co-commissioning of Primary Care to be considered and further engagement to occur Risk Stratification active in 50practices Use of the webportal increasing every week, encouraged by regular ‘drop-in’sessions

CLINICAL SENATE September meeting regarding Diabetes Registries October meeting regarding respiratory registries Good multi- disciplinary attendance at each. Further refinement of both registries will take place at the November meeting

• ENGAGEMENT Membership Council well attended in October . Important discussion regarding the ‘voice of Primary care’ Joint meeting of all GPs and Consultants in Wirral being planned for early November to discuss the Wirral Care Record. Practice Engagement Visits ( Listening and Quality Visits) are planned for all practices and have commenced. Learning from these visits will be shared Wirral Patient Voice quarterly meeting took place.

• RESEARCH Currently 50 practices are involved in research Many are involved through the Me and My COPD project Research Champion and Medical Director intend to encourage practice to continue to be research active following this study. Project regarding demand for antibiotics is considered and a practice involvement with research project on surveillance of some influenza vaccines has been approved.

• CALDICOTT GUARDIAN Female Genital Mutilation registration is required for all practices from October. This has been undertaken on behalf of all practices by the Safeguarding Team Considerable work with current Healthy Wirral Information Governance Task and Finish Group to take forward the Wirral Care Record. ( See other report by Mark Blakewell) Advice regarding confidentiality issues. Reminder to all practices regarding ongoing need for vigilance in this area

3. CONCLUSION

3.1 Governing Body is asked to note progress.

Audit Committee Chair’s Summary Report: 24 September 2015

In continuing the tradition established by James Kay during his chairmanship of the Audit Committee, I am summarising below the main issues discussed at the last meeting of the committee on 24 September, ahead of circulation of the formal approved minutes of the meeting.

We had a full agenda with 14 substantive items, and good attendance at the meeting.

1. Review Assurance Framework The report summarised progress made in developing the Assurance Framework to take account of recommendations made by MIAA following a review during 2014/15. It is intended that the Governing Body be involved in developing revised key objectives to ensure that the framework more closely aligns with the current strategic priorities of the CCG, including the Healthy Wirral partnership agenda and its importance to secure the financial resilience of the Wirral health and social care economy.

It was agreed that in future all closed risks will be shown on the framework, so that their ongoing status may be regularly reviewed. The Governing Body will be asked to consider the risk appetite of the CCG in deciding on what risks it is prepared to accept.

2. Review Risk Management Strategy and Policy The committee endorsed minor cosmetic changes to the document, which make it consistent with the revised CCG governance structure.

3. Note Business of other committees and review their relationships The committee noted the completed implementation of the revised committee structure, including the role of the Clinical Senate. The cycle of planned attendance of committee chairs at the Audit Committee will begin at the next meeting on 12 November.

4. Review other sources of assurance This was an information item, with a diagram showing the major organisations that are responsible for overseeing the work of the CCG.

5. Delegated functions – Self Certification NHS England requires all CCGs to sign a self-assessment declaration of assurance regarding the governance of delegated functions, particularly co-commissioning of Primary Care services. This is virtually a ‘NIL’ return for the CCG. The committee supported the signing of the declaration by the Accountable Officer and the Audit Committee chair.

6. Review Risks and Controls around Financial Management This is a very detailed return from NHS England seeking self-assessment of a variety of measures of the financial systems and controls to indicate the quality of the CCG’s financial management arrangements. The CFO had liaised closely with the Audit Committee Chair in completing the return by the end of August. NHS England reviewed the assessment and reassuringly there were not significant variations in their assessment compared to the CCG’s. Where there were differences they were mainly driven by the recent deterioration in the financial position, which is interpreted as representing failure to deliver the financial plan. The next steps are to seek Governing Body approval of the assessment, following review at the Audit Committee, and the formulation of an action plan to address those areas with weaker scores.

The committee acknowledged the additional burden which this process had placed on the CFO and his team.

7. Losses and special payments There were none to report for the relevant period.

8. Changes to Standing Financial Instructions The committee discussed in some detail a proposal to set a delegated limit of £100,000 to the Drugs and Therapeutics Committee for the addition of new drugs to the formulary. The committee was reassured that this will be a very infrequently used delegation, and primarily relates to NICE approved drugs. There is an effective monitoring system in place to review actual expenditure against estimates, and to highlight and address inconsistent prescribing patterns at individual practice level.

9. Internal Audit Reports A review of the Complaints Management system has recently been completed by MIAA, with a ‘Limited Assurance’ outcome. Actions to address weaknesses, including the reporting of KPIs to demonstrate the CCG’s performance are being introduced. In mitigation, it was agreed that the audit review was completed very soon after the CCG has assumed responsibility for this function.

10. External Audit Report It was confirmed that all of the accounts sign off processes for 2014/15 had been completed within the Department of Health deadline, with unqualified opinions except for the Value For Money opinion, which was qualified following the outcome of the CCG governance review conducted by NHS England.

The external audit fees will be reduced in the current year without detriment to the quality or timeliness of the service.

11. Safe Staffing Levels This report from the Director of Quality and Patient Safety described the 10 expectations which NHS organisations should deliver, which will assure boards that there are safe staffing levels in patient services. The report was noted, including the actions taken by the CCG to secure appropriate assurances from provider organisations.

12. Counter fraud Report The report summarised the CCG’s compliance, based on self-assessment, with ‘Standards for Commissioners: Fraud, Bribery and Corruption’. The RAG ratings indicate GREEN assessment for 22 of the 29 standards, 4 AMBER and 3 RED. Action plans have been set to address the standards not at GREEN.

13. Audit Tracker There are no actions arising from Audit recommendations that are overdue for completion, and good progress is being made on all those due for completion in the future.

14. Private Discussions with Internal and External Auditors I summarised the main issues discussed with the auditors before the start of the Audit Committee. They were mainly around concerns with the risks of the current CSU procurement process, and the value of Service Auditor Reports as a source of assurance.

15. Any Other Business i. The Accountable Officer offered to provide the Audit Committee with a presentation of the “Healthy Wirral Programme” at an extra meeting of the committee. ii. The Accountable Officer reported the establishment of a Programme Office to oversee implementation of the Vanguard work streams. The current CCG CFO will be seconded as CFO to the Programme Office and a replacement is being recruited. iii. The Accountable Officer reported recent high compliance levels of staff completing training on Counter Fraud. This was important in view of recent media coverage of fraud in the NHS.

Alan Whittle

Lay Member (Audit and Governance)

30 September 2015.

Clinical Senate Meeting

Tuesday 29th September 3.00pm Nightingale Room, Old Market House

Present:

Sue Wells (SW) Medical Director Wirral CCG Ewen Sim (ES) Medical Director CT Paula Cowan (PC) GP Lead- Unplanned Care Sian Stokes (SS) GP Lead- Long Term Conditions Lax Ariaraj (LA) GP Lead- Planned Care Jane Harvey (JH) Consultant in Public Health Evan Moore Medical Director WUTH Melanie Carroll (MC) Chief Officer Community Pharmacy Cheshire and Wirral Anna Rigby Programme Manager- Strategic Planning and Outcomes Brenda Light (BL) Pediatric Diabetes Specialist Jude Joseph (JJ) Core Pediatric Diabetes Faouzi Alam (FA) Medical Director CWP Helen Hackett (HH) Advanced Dietitian WCT Fred Howard (FH) Lead Optometrist Anne Cartwright (AC) Integrated Care Co-Ordinated Team Manager Phil Clow (PC) Director of Strategy WCT Mike McColgan (MM) Podiatrist King Sun Leong (KSL)Consultant in Diabetes Lesley Hodgson (LH) Diabetic lead and GP Val McGee (VMc) Director Integrate and Partners Jo Goodfellow (JG) Programme Director Chelsea Worthington (CW) Corporate Support Admin Assistant

Apologies: Simon Delaney (SD) GP Lead – Primary Care Lorna Quigley (LQ) Director of Quality and Patient Safety Amanda Bennett (AB) Consultant at WUTH Natalie Smale (NS) North West Influencing Manager Richard Williams (RW) Chair at LMC Arpan Gahu (AG) Associate Medical Director – Royal Liverpool Hospital Mark Doyle (MD) Clinical Director Surgery – Women’s and Children Julia Collier (JC) Diabetes Dietitian

Item No. Agenda Items Action

Page 1 of 4

PRELIMINARY BUSINESS 1.1 Welcome and introductions:

SW welcomed all members to the meeting and each member introduced themselves. It was clarified that the role of the meeting is to give multidisciplinary clinical advice and is not a decision making body. As such it is acceptable when a member is unable to attend for a suitable clinical representative to attend in their place.

SW gave a brief description of the purpose of the meeting and why it has formed. 1.2 Conflicts of Interest

No conflicts of interest were declared

1.3 Minutes and Actions from Previous meeting

The minutes of the previous meeting held on 14th July 2015 were agreed as a true and accurate record.

1.4 Matters Arising:

Group noted that Consultant Connect is now in place for Practices

2.1 Diabetes Registry and Pathway - Adults

The timings for this work are tight for all to be in place by 1st April 2016. Any amendments discussed at the meeting will be made and an amended version will be brought back to the group at the next meeting.

JG presented to the group a presentation on Registry Development Wirral Partners New Models of Care.

The development and implementation of the registries is one of the key deliverables of our 2015-16 New Care Model programme. We have identified COPD, asthma and diabetes as priority care pathways in phase 1a of our New Care Model and registries will be created to support these. In July 2015, local specialists in these areas met with local informatics colleagues and Cerner to share their knowledge and understanding of the care pathways and data flows that currently exist to support them. An Information Governance Task and Finish group has been established to develop a data sharing agreement to support the Wirral care record which is led by Dr Melanie Maxwell.

Workshops have recently taken place on the 16th and 17th September to enable local specialist and Cerner colleagues to agree metrics that will

Page 2 of 4

support the care pathways so the phase 1a registries can be built.

The first draft of diabetes metrics and service model is brought to the Clinical Senate to note the content.

Members noted that a registry is a tool to enable providers of services to deliver an agreed standard of care to the entire population. This is based on Local, National and International best practice.

Members noted which systems and data would feed into the Healthy Wirral Record. By April 2016 the Emis System at Practices and the Millennium System at the hospital will be accessible through the Healthy Wirral Record, this will follow on with the Mental Health, Social Care and Community record by September 2015.

The registry will be developed as a tool that supports local care pathway design for COPD, Asthma and Diabetes. It will be used as a standard approach as we design future pathways of care. It will support high quality, evidence based, standardised care which can be replicated as part of the Healthy Wirral Programme.

LH went on to advise the group of where we are today with the diabetes pathway. Currently this is a draft service specification for the adult’s treatment and care pathway by what was formally known as the Diabetes QIPP group. The next steps are to use the outcomes from the workshop to update the draft service specification and to bring to the Clinical Senate.

KSL went through the headings line by line for Adult Diabetes. It was discussed which of the yellow headings can be more accessible and re- evaluated to be under a green heading.

The hypothesis of the Healthy Wirral Record is so that when a patient visits any of the wider Health Services, the GP, and Consultant will get a pop up reminder of what is outstanding on their record.

VMc and JG have captured the groups concerns and amendments to take back to Cerner. The group will receive an amended copy as soon as available.

2.2 Diabetes Registry - Children

LH displayed a number of diagrams to show the breakdown of age’s groups and months within the year were diabetes admissions are at its peak.

In 2014/15 there were 5781 emergency admissions in Wirral for people with diagnosis code linked to diabetes. The number of diabetes related admissions in March 15 were slightly lower than the beginning of the year from 486 to 437. The linear trend line indicates a slight decline in admissions during the year.

There has been a rise in diabetes admissions for 0- 18 age group with a slight Page 3 of 4

decline for 18+ for the year.

Wirral had a higher QOF prevalence of Diabetes than both the NHS North of England region and England overall. Diagnosed Diabetes increased in prevalence in both the North of England and England but decreased in Wirral between 2012/13 and 2013/4. Trends indicate that both number of prescriptions and cost has increased between April 14 to March 15 Wirral CCG spends approximately 4% more of their total diabetes spends than the national average on Oral Antidiabetic Drugs.

Members discussed each measure line by line under the pediatric diabetes registry. Dr Jude Joseph gave a brief explanation of why each heading is on the list.

Group agreed that the 3 separate educations: dietary and exercise, substance abuse and tobacco and smoking should all be under the same heading.

Members expressed that it would be easier to read if these could be collated into further themes. Action- VMc and JG to follow up with Cerner.

The aim for the future is for patients to have full access to their health record for them themselves to be able to take ownership of their conditions and medication.

It was agreed by all group members that a separate discussion outside of the meeting should take place between both GPs and Pediatricians.

JG mentioned to the group that Cerner are looking for a total of 4 people to be able to take ownership from meetings to feedback to them on any comments/actions that may arise.

ANY OTHER BUSINESS

3.1 Hold the date – Mortality

Group noted for Information the hold the date re Mortality.

DATE AND TIME OF NEXT MEETING

The next meeting will be held on:

13th October 2015, 3pm – 4.30pm, Room 510, Old Market House. Please forward apologies / agenda papers to [email protected] ALL

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WIRRAL CLINICAL COMMISSIONING GROUP Quality Performance and Finance meeting

Notes & Actions of Meeting

Tuesday 29th September 2015 1pm Room 539, 5th Floor, Old Market House

Present: Dr P Naylor (PN) Chair of WCCG (Chair) Paul Edwards (PE) Director of Corporate Affairs Dr Sue Wells (SWe) Medical Director WCCG (Deputy Chair) Laura Wentworth (LW) Corporate Affairs Manager Nesta Hawker (NH) Director of Commissioning Alan Whittle (AW) Lay member – Audit & Governance Alastair Cannon (AC) Lay member – Quality & Outcomes

Guest Speakers: Kerry Hogan (KH) Programme Manager Louise Morris (LM) Senior Finance Accountant

Board Support Allison Hayes (AJH) WCCG Corporate Officer – Corporate Affairs

In attendance Jordan Lane (JL) Corporate Officer

Ref No. Minute QPF15- 1.0 Standing Agenda Items 16/0031 1.1 Apologies for absence

Apologies were received from: Lorna Quigley, Mark Bakewell, Susan Smith, and Jon Develing. It is to be noted that in line with the QPF Terms of Reference the meeting was not quorate due to the absence of the Director of Quality and Patient Safety, but Chair suggested the meeting proceeded on the basis that any decisions would be either deferred or on an ‘in principle’ basis and ratified at the next meeting. 1.2 Declarations of Interest

PN and SQ declared an interest in the Prescribing papers, but the group agreed that there was no conflict as the paper was a summary report for noting. 1.3 Minutes of Previous meeting from 25th August

The minutes from the previous meeting held on 25th August were agreed as true and accurate record.

Action - AJH to send ratified minutes from August to GB in September/October.

Actions

Members discussed the outstanding actions from previous meetings and informed members of work in progress items.

Matters Arising

AC asked for an update on the Homeopathy Review and PE provided members with an update, clarifying the timescales of the review and contractual status of the current provider

Minutes of the WCCG QPF Meeting –29.09.2015 Page 1 of 9

Ref No. Minute whilst the review took place. QPF15- 2.0 Items for approval 16/0032 2.1 Update re CHC

CC gave an update regarding the progress of Continuing Health Care, Funded Nursing and Complex Care services.

CC explained that Since early Summer 2014, Clinical Commissioning Groups across Cheshire and Wirral have been working together on the delivery of continuing healthcare, funded nursing and complex care services. A Joint Committee of Clinical Commissioning Groups and Local Authorities has been set up with delegated responsibilities around continuing healthcare, funded nursing and complex care and this is underpinned by an Operational Group and various task and finish groups.

With the support of external consultancy Integral Health Solutions and external interim clinical and management capacity, the service has been on a journey of identification and diagnosis, transition and stabilisation whilst engaging staff, people who use services and their families and wider stakeholders in a process of redesign for transformation.

The purpose of the paper was to give a short overview of the process and progress to date, highlight key points of the proposed future model under consideration and finally to give an update on current position and proposed next steps.

The QPF committee were asked to note:

• The work that has been undertaken over the last 16 months on the identification, diagnosis, transition, initial stabilisation and transformation of the continuing healthcare, funded nursing and complex care service. • the delivery to the delegated Joint Committee in August of a comprehensive and fully costed business case to inform the implementation of the future model and the resultant confirm and challenge session in September. • That further work will continue on the stabilisation and transformation plan for the service, final agreement will be sought on key elements of the future model before a further detailed paper comes back to governing bodies across Cheshire and Wirral in order to agree the timescale and process for the implementation of the future model.

AC sought further clarity around when the proposal will be taken to Governing Body and CC clarified the progress to date with regards to the programme. Members agreed that regular updates should continue to be presented at QPF.

PE asked CC if the progress outlined in the report would affect the scoring of CHC risks as outlined in the Risk Register. CC stated that this might be more appropriate for review once additional staff had been recruited and been embedded into the service.

Members noted the reported presented today and thanked CC for her work.

2.2 Serious Incident Policy

LW provided an overview of the Serious Incidents Policy on behalf of Lorna Quigley and asked the committee to review and approve the changes to the Serious Incidents Management Policy, following the implementation of the amended Serious Incident Framework in April 2015. This revised Serious Incident Policy has been developed in collaboration with Cheshire CCG’s in order to comply with the 2015 “NHS England Serious Incident Framework” and ensure consistency in Serious Incident reporting, management and monitoring across Wirral

Minutes of the WCCG QPF Meeting –29.09.2015 Page 2 of 9

Ref No. Minute and Cheshire CCG’s. This reflects the revised frameworks recommendations that commissioners must work collaboratively to agree how best to manage Serious Incidents that occur in their services.

Subject to formal ratification at the next meeting when quorate, the committee members noted and approved the Serious Incidents Policy presented at today’s meeting.

2.3 Update re 3rd Sector (The Lantern Project)

KH introduced an update paper regarding the lantern Project. A report was taken to the Quality, Performance and Finance (QPF) Committee meeting held on the 25th August 2015, which outlined concerns raised to Wirral CCG on both the 30th June and 1st July 2015 in relation to The Lantern Project (a service commissioned by the CCG to provide specialist counselling and support to survivors of sexual abuse). The concerns have been treated as a whistleblowing incident and as a result of some of those concerns (and others that had emerged) that had been upheld, referrals into the service had been suspended pending satisfactory assurance and evidence being provided.

Whilst not present, the Director of Quality and Patient Safety, had provided an email outlining her view that the assurances provided by the provider were insufficient to provide the level of assurance the CCG had asked for, particularly around Safeguarding (especially given the nature of the client group).

With that in mind, the group considered the assurances and evidence that had been provided and felt that all the concerns had not been fully addressed and hence did not feel the suspension could be removed. The group agreed that a letter would be issued by NH and KH to the provider informing them of this and that they must inform current patients of the position. AW asked if there was a case to be made around also suspending the service for current service users given the serious concerns, and SW and PN said that clinically, it would be more prudent not to stop patients already in the receipt of therapy, as this could potentially present a risk to those who had already established a relationship with the therapist. Since all current patients and their GPs are to be informed of the suspension and concerns should they chose to withdraw from this provider and seek referral to an alternative they will be in a position to make an informed choice.

In addition, it was noted that Governing Body has identified additional concerns at the wider service review concerning the therapeutic approach Lantern use and it was reiterated that, in parallel, it has been agreed that Lantern would be asked to attend a meeting with members of the Governing Body to examine more closely the evidence base and effectiveness of their approach.

The group also asked NH to review the contractual arrangements of the Project to ensure the service was compliant with the terms of its contract.

Action – NH/KH to write to the Lantern Project to inform them that the suspension would remain in place as insufficient assurance had been received. NH/KH to also provide an MP briefing

Action – KH to write GP practices to notify them of the continued suspension.

Action – NH to investigate contractual compliance

Action – Meeting with Lantern and key GB members to be finalised.

Minutes of the WCCG QPF Meeting –29.09.2015 Page 3 of 9

Ref No. Minute 2.4 New Medicines via Wirral Drug and Therapeutics Panel

The paper outlined the proposed governance arrangements related to the Wirral Drugs and Therapeutic Panel that would ensure the CCG had a robust process in place to minimise challenge.

Key elements of the process were described as:

• The agreed delegated limit for Prescribing Lead GP is up to an annual cost of £100K per application. (This is excluding drugs with a positive NICE TAG) • Above this limit WDTP application to be taken to Clinical Operational Group for approval by CCG • Summary Paper with WDTP decisions to be presented to QPF for noting (within delegated limit or positive NICE TAG). • WDTP minutes to be presented to QPF for noting. • All WDTP application forms submitted by primary care below delegated limit to be signed by Prescribing Lead GP prior to submission to WDTP. All WDTP application forms submitted by primary care above the delegated limit to be signed by Medical Director. • After pre D&T a list of drugs and indications will be sent to the Medical Director to ensure they are aware of all new drug applications and can become involved if they affect any new pathway developments in the CCG. • WDTP Appeals Panel Composition – independent GP from the CCG to sit on the WDTP Appeals Panel on an ad-hoc basis in the event of a clinician appealing against a decision made by WDTP. Will be either the Clinical Lead for the relevant Clinical Area e.g. respiratory or one of the CCG Clinical Lead GPs. • Approval of drugs from Cheshire and Wirral Partnership Trust (CWP) – to follow the same process as WDTP. After the CWP Medicines Management Group Meeting – Mental Health Clinical Lead GP to discuss items below delegated limit with Prescribing Lead GP for authorisation. Items above delegated limit to be taken to Clinical Operational Group for CCG approval. As per flow chart in appendix 2. • Approval of drugs from Out of Area Trusts – Wirral CCG are happy to adopt these drugs onto the Wirral formulary provided they have been through an appropriate D&T or APC process in the requesting area.

Members approved the paper subject to formal ratification at the next QPF meeting. QPF15- 3.0 Items for Discussion 16/0033 3.1 Performance Reports

NH presented the performance figures for July against the standards within the NHS Constitution and the actions that are being taken in order to improve performance where needed.

Areas included:

• A&E waiting times • Ambulance handover times • Cancer waiting times • Delivering same sex accommodation • Reducing healthcare acquired infections • Referral to treatment (RTT - 18 weeks) • Excessive waiters (incomplete) • Diagnostic testing • Friends and family tests including staff and GP surgeries

Minutes of the WCCG QPF Meeting –29.09.2015 Page 4 of 9

Ref No. Minute The Quality Performance and Finance Committee were asked to:

• Note the performance for July against the standards within the NHS Constitution and the actions that are being taken in order to improve performance where needed.

3.2 Finance Reports

LM presented a report detailing the CCGs financial plan and financial performance against budgeted allocation for 2015/16 financial year as at Month 5 August 2015, on behalf of Mark Bakewell. The report sets out the financial position for WCCG as at the end of August (Month 5) within the 2015/16 financial year and the performance against the measures outlined in the CCG Assurance Framework 2015/16.

Areas included:

• Headline Plan Deliverables • Resources • Surplus requirements • Planned expenditure • QIPP • Prescribing – year to date position reported for prescribing is £123k overspend • Forecast Outturn Assumptions • Contract Values • Non recurrent resources • Non elective admissions • Other commissioning expenditure • Better Care Fund (BCF)/Third sector – a gap of £4.4m remains • Financial Risks & Mitigations • Debtors and Creditors

Discussions took place around the current year to date position and MB (MB arrived at the meeting at 14:50pm) explained the month on month reporting processes and gave a rational around the current trends, activities, risks and mitigations.

Members were asked to note:

• The CCG financial position as at the end of August 2015 • The performance against indicators based on the information available • The associated financial risks within the declared position including the impact of potential resource allocation issues.

Members noted the finance report presented at today’s meeting.

QPF15- 4.0 Items for Information 16/0034 4.1 Contracting issues

There were no updates.

4.2 Complaints Update

LW provided an update regarding the CCGs current complaints. The purpose of this monthly update is to provide assurance to the Quality, Performance & Finance Committee of

Minutes of the WCCG QPF Meeting –29.09.2015 Page 5 of 9

Ref No. Minute complaints received (including those escalated to the Parliamentary & Health Service Ombudsman) & MP enquiries received by NHS Wirral CCG as at 29th September 2015.

The QPF Committee were asked to:

• Review and note the contents of the report.

New complaints Within the period of 14th August 2015 to 21st September 2015; 16 new complaints were received. 12 of which were acknowledged within 3 days of the complaint. Of the remaining complaints received; 1 complaint was forwarded to NHS England for their investigation and response and 3 were directed to the complaints team at Wirral University Teaching Hospital NHS Foundation Trust (WUTH) to be investigated and responded to directly.

Closed complaints Within the period of 14th August to 21st September 2015; 11 complaints have been closed (some of which were received in the previous reporting period)

On-going complaints There are currently 14 further cases with on-going investigations (some of which were received in the previous reporting period)

Reopened Complaints There were 2 complaints reopened during this period.

New MP enquiries There were 3 new MP enquiries received within this reporting period.

On-going MP enquiries There are currently 2 MP enquiries which is being investigated

Closed MP enquiries There were 5 MP enquiries closed during this period

Patient Enquiries / Concerns There were also 7 patient enquiries / concerns received during this period

Parliamentary & Health Service Ombudsman There was 1 complaint escalated to the Ombudsman during this period

Trends and Themes

The majority of complaints received continue to relate to Continuing Healthcare (CHC), however, there continues to be a high number of complaints received regarding provider organisations including Wirral University Teaching Hospital NHS Foundation Trust, Wirral Community NHS Trust and Cheshire and Wirral Partnership NHS Foundation Trust.

Members noted the contents of the Complaints Report.

4.3 Freedom of Information Update

LW presented a monthly report regarding Freedom of Information requests. The purpose of the report is to provide assurance to the group of FOI’s received and responded to within August 2015.

Minutes of the WCCG QPF Meeting –29.09.2015 Page 6 of 9

Ref No. Minute This report details the number of FOI requests received and closed during the reporting period of August 2015. This report also provides a brief description of each request, details the type of applicant, the average response time and reasons for delay, if applicable.

In the month of August 2015; 27 requests were received which is an increase of 1 from the previous reporting period of June 2015. During this period, the subjects of the FOI requests received are detailed below:

• CCG Commissioning - 2 • CCG Strategy - 1 • CCG Structure - 1 • Continuing Healthcare (CHC) - 4 • Contracts & Procurement - 3 • Finance & Expenditure - 5 • Other - 2 • HR - 1 • ICT - 1 • Medicines Management - 3 • Mental Health - 1 • Primary Care - 3

All FOI requests received during this period were responded to within 20 working days and the average response time was 4 working days. 9 requests remained open at the time of writing this report, with 2 of these requests awaiting further information in order to complete.

Conclusion

All FOI queries and responses are published on the CCG’s public facing website, as per the publication scheme.

This update report will continue to be presented at this committee on a monthly basis going forward.

The QPF Committee were asked to review and note the contents of the Freedom of Information report.

4.4 Serious Incidents Update

LW presented the Serious Incidents update report for August 2015.

The QPF Committee is asked to note the 39 new serious incidents reported to the Strategic Executive Information System relating to:

21 Wirral University Teaching Hospital Trust. 5 Cheshire and Wirral Partnership NHS Foundation Trust 11 Wirral Community NHS Trust 1 Clatterbridge Cancer Care NHS Foundation Trust 1 Countess of Chester Hospital NHS Foundation Trust

The Quality Performance and Finance committee are asked to note the Serious Incidents reported onto the StEIS system in August 2015. All Serious Incidents will be managed via the serious incident review group to ensure: • the incident has been adequately investigated • the root causes and contributory factors have been identified Minutes of the WCCG QPF Meeting –29.09.2015 Page 7 of 9

Ref No. Minute • the recommendations and action plan adequately address the root causes and contributory factors • the action plan has been completed in a timely manner • All lessons learnt are shared appropriately

4.5 CQC Inspection Reports

Members were asked to note the Summary Of CQC Inspection Reports relating to Wirral Autistic Society and Claire House Children’s Hospice.

The QPF committee noted the contents of the reports, both of which were positive and PN suggested that he wrote to Claire House to commend them on their ‘outstanding’ rating

4.6 Prescribing Incentive Scheme Review

This report details an analysis of the outcomes of the Wirral CCG 2014/15 Prescribing Incentive Scheme and highlights the achievements at practice level. The report also illustrated how the scheme met Mersey Internal Audit Agency (MIAA) recommendations following the review of the 2013/14 Prescribing Incentive Scheme.

Members noted the contents of the report.

4.7 Prescribing Expenditure Analysis

This report set out a detailed analysis of the prescribing expenditure for Wirral CCG for the financial year 2014/15 and explains factors contributing to the £1.8 million outturn. This paper also highlighted the agreed work-streams and timescales to mitigate the 2014/15 prescribing cost growth and to maximise QIPP outputs for the current financial year.

Members noted the contents of the report. QPF15- 5.0 Items for Noting 16/0035 5.1 Sub groups for noting

• SI Review Group of 7th August 2015 – Noted

Members noted the sub groups ratified minutes as detailed above. QPF15- 6.0 Risk Register 16/0036 6.1 Risk Register

Members discussed the current risk register and all items were reviewed and noted accordingly.

Action - PE is to update the current risk register to reflect the outcome of discussion and provide a report detailing the recommendations made by the QPF committee to the Governing Body. This will be an on-going action from all QPF meetings. 7.0 Any other items of Business 7.1 AOB - there were no items of other business. Date and Time of next meeting The date and time of the next QPF meeting is scheduled for: Tuesday 27th October at 1pm in Room 539 OMH Please forward any apologies to [email protected]

Minutes of the WCCG QPF Meeting –29.09.2015 Page 8 of 9

The meeting ended at: 15:02pm.

Minutes of the WCCG QPF Meeting –29.09.2015 Page 9 of 9

NHS WIRRAL CCG

CORPORATE RISK REGISTER

To be reviewed at Governing Body on 3rd November 2015

Consequence Likelihood 1 2 3 4 5 1 1 2 3 4 5 2 2 4 6 8 10 3 3 6 9 12 15 4 4 8 12 16 20 5 5 10 15 20 25

Page 1 of 4 Master 14-15

Risk ID Date added Source Division Risk Description Organisational Consequ Likelihoo Matrix Key Control Established Key Gaps in Control Assurance on Controls Gaps in Assurance Consequ Likelihoo Previous Owner Date of next Date of last review Last review Objectives (reference ence d Score (reference to evidence) (reference to evidence) (reference to evidence) ence d Risk Rating review to detail) 12-13 A 12-13 CCG Gov Body Impact of 111 Quality / Patient Access 3 2 6.00 Current provision of primary Unknown impact of 111 Monitoring of Primary Timely impact on 3 3 9.00 Governing November October 15 QPF To be reviewed at September QPF. Financial Year Implementation and Various care / urgent care services - Service Provision. Care/ urgent care activity monitoring of primary care Body - 111 15 QPF Updated AP reviewed at September QPF, next due for review Activity Impacts across ability to absorb additional Increased costs for and performance of activity Implementatio at December QPF. AP reviewed, next due at January QPF primary / community and activity clinical input NHS111 through n Team upon completion. A&E Attendances. information flows Reviewed at Jan QPF and noted that a review of the host Increased demand for mobilisation is underway. Agreed for next review at June QPF clinical input and lack of with a full risk assessment due in October 15. influence of national specification Updated AP received from PB - for review at June QPF.

Reviewed at June QPF and agreed to reduce the likelihood to 2, next due for review at September 15 QPF.

Reviewed at September QPF and updates noted - Next due for review at October QPF, when NHS will be live.

Updated AP reviewed at October QPF and noted that there have been issues since 'go live' date - Due for next review at N b QPF 14-15G Jun-14 CCG Gov Body A&E 4 hour Target, including Quality / Financial / 4 4 16.00 On-going monitoring Target not being met by Target continues to not be 4 5 20.00 LQ November October 15 QPF New risk discussed at June GB. To be monitored at quality of care & standards Patient Safety Wirral economy & rated met. 15 QPF Governing Body. Action plan to be agreed with lead. provided to patients high risk by NHS England and Monitor Reviewed at Jan QPF & agreed for likelihood to be amended to 5. Action plan for further review at March GB. Reviewed at March GB & agreed for further review at May QPF.

AP reviewed at May QPF and noted further update due in June 15 - Therefore due for next review at June QPF.

Updated AP received from LQ - for review at June QPF.

Reviewed at June 15 QPF - next due for review at July QPF. LQ apols noted for July QPF, therefore due for review at August QPF.

Action plan reveiewed at August QPF and agreed monthly review going forward.

Action plan reviewed at September QPF and agreed to continue to monitoring on a monthly basis.

Updated action plan reviewed at October QPF - Wirral economy is part of phase 1 ECIP and first meeting took place on 20th October 2015. Next due for review at QPF in November 15.

14-15I Jul-14 CCG Gov Body Supreme Court Judgement Quality / Patient Safety 4 2 8.00 To work with Provider Understanding the local Work continues with Currently awaiting national 4 3 12.00 LQ November September 15 QPF New risk discussed at July QPF/ Action plan to be agreed with Deprivation of Liberty Organisations. impact to Wirral based on Provider Organisations guidance. 15 GB lead. To be brought back to August QPF. AP reviewed at Safeguards (DoLS) the Supreme Court and the Local Authority August QPF and due back for further review upon completion Judgement Deprivation of at December GB meeting. AP reviewed at Jan QPF & it was To work with Local Authority Liberty safeguards (DoLS) noted that processes and training are in place to manage the to assess the impact fully. risk. Noted that Supreme Court Judgement has not yet been received. For further review of AP at May QPF.

Provider Organisations to AP reviewed at May QPF & members requested further ensure that this is on their information regarding what has been done so far & what work Risk register also. is being done with Provider Organisations and Local Authority - Further update to be included within action plans for July QPF.

LQ apols noted for July QPF, therefore due for review at August QPF.

Action plan reviewed at August QPF and agreed for the likelihood to be reduced to 2 from 3.Action plan nexy due for review at September 15 QPF.

Completed action plan reviewed at September QPF with recommendation to remove risk from register - To be ratified at GB in November 15.

14-15K August QPF CCG Gov Body Continuing Healthcare issues Quality / Patient Safety 5 3 15.00 Action plan in place and on- Reliance on shared CCG CSU monitored monthly 5 3 15.00 CC November September 15 QPF New risk discussed at August QPF. AP to be completed by re the service provided, the going monitoring of service arrangements for against PUPoC target; 15 QPF IS. For noting at September GB & AP to be reviewed at CHC process followed, performance via QPF. aspects of delivery and action plan to address December GB - awaiting AP from lead. Still awaiting AP from general performance & CHC joint committee reliance on CSU for contract gaps in place and lead - Dec 14. quality. Gaps in contracts established to oversee delivery of PUPoC minutes of joint committee AP requested from CC as part of new work plan / structure. with providers and delivery service tranistion targets. Lack of contracts and QPF AP due for review at May 15 QPF. against Previously with provides Unassessed Periods of Care AP reviewed at May QPF & members requested for further (PUPoC) trajectories details to be included within the AP, for further review at June QPF.

Further information to be included in AP for review at July QPF following update, in line with timescales.

Reviewed at July QPF and added additional risks in relation to contracts and PUPoCs.

Reviewed at September 15 QPF and agreed that the mitigation can be amended when the new CHC teams are in place, but to remain the same at present. Due for next review at November QPF.

14-15N December CCG QPF Quality of care provided to Quality / Patient Safety / 3 3 9.00 Quality Surveillence Group Minutes of the QSG To review further in 6 4 3 12.00 LQ January October 15 QPF New risk discussed at December QPF. Scoring to be agreed QPF patients at Wirral University Financial (QSG) meeting held on meetings & WUTH Quality months 2016 QPF & action plan to be completed by LQ. Teaching Hospital NHS 13th February , follow up & Clinical Risk committee Foundation Trust meeting to be arranged in 6 Scoring to be agreed at January QPF. months time. Outputs from QSG to be monitored Reviewed at Jan QPF & agreed for the risk description to be through WUTH Quality & amended to reflect concerns regarding the quality of care Clinical Risk committee. being provided. It was agreed that this risk would be scored at the next GB to be held in Feb 15.

Reviewed & scored at Feb GB, and agreed for further review at March GB. Reviewed at March Gb & agreed for further review at May 15 QPF.

Action plan being reviewed at QSG meeting and also being monitored through WUTH Quality and Clinical Risk Committee.

Reviewed at August QPF and as WUTH surveillence has been reduced agreed to amend the likelihood to 3 from 4. Next due review September QPF.

Action plan continues to be reviewed at QSG meeting and also being monitored through WUTH Quality and Clinical Risk Committee. Due for further reiview / update at October 15 QPF.

Reviewed at October 15 QPF and agreed for the consequence to be reduced to 3 from 4 as this is now at normal surveillance level and has been stepped down - Due for next review at QPF in January 2016.

14-15P January QPF CCG QPF Financial risk to CCG Financial 4 4 16.00 Regular financial reporting Ability to influence activity Minutes & monitoring of Timliness of reporting / MB November August 15 QPF New overall financial risk agreed to be added at Jan QPF to through QPF & GB. Further trends. GB / QPF ability ti implement action 15 GB replace existing financial risks (1415C,D&F) - Further detailed monitoring of plans directly. description, key controls & scoring to be agreed at Feb GB. contractual prescribing & other commissioning Unable to score at Feb GB as CFO not present - Therefore expenditure areas as agreed to score at March GB. appropriate. Scoring agreed at Feb QPF.

May 15 - Financial assumptions are currently being tested against contract values - This is currently being fianlised and once completed will review planning and then be brought back to QPF and GB in June.

Financial plan was reviewed at QPF in June. The risk remains the same at present. The financial plan will continue to be monitored via QPF and Governing Body. Next due for review at July QPF.

Worsening positoin based on month 3 data discussed at July QPF and Chief Financial Officer will brief Governing Body at August meetingwith a view to reviewing this risk at August QPF.

Reviewed at August QPF and agreed for further review and discussion at GB to be held in November 15.

14-15Q February GB CCG GB Risk to services bought from CCG organisational 3 3 9.00 Transistion Board Transition plan, though this Minutes from the Stabiltity arrangements PE/LQ/MB November September 15 QPF New risk identified at Feb GB - Scoring to be agreed at Feb North West CSU following delivery established and two staff is expected to be Transition Board and during transition and risk of 15 QPF QPF. failure of CSU to secure appointed from CSU to developed once regular newsletters on staff loss Scoring agreed as appropriate at Feb GB. place on the Lead Provider oversee transition to new procuement begins progress Framework. providers or in-housing. May 15 - Scoring agred but action plan for resolution is being Agreed service co-ordinated by NHS England with CCG's joiintly, for further specifications review at July 15 QPF.

July 15 QPF - Update from MB to advise that transition arrangements are progressing and specifications accross Cheshire & Merseyside are being finalised. In house business cases have been informally approved. Support may be required for assessment process in September Further update due for review at September 2015.

Aug 15 - Update from CFO to advise that the position remains as above (July 15). However, there continues to be outstanding issues in relation to stranded costs / exit costs / transfer / SLA payments. Transition timetable provided by NWCSU detailing key milestones and dates for completion. Next due for review in November 15 following the contracts being awarded (in line with timetable).

14-15R Jun-15 CCG GB Impact of Vacant Named GP Quality / Patient Safety 3 3 9.00 Designated Nurse Capacity of Designated Designated Nurse Until appointment made, LQ November October 15 QPF New risk forwarded to Corporate Affairs Manager via email Safegarding Children post. providing some essential Nurse. Main functions of monitoring activity. NHS continue to be non 15 QPF from Safeguarding Team. Non compliance with functions. Proactive Named GP not England may assist in compliant with Accountability & Assurance attempts at recruitment. undertaken. Adverse recruitment process. requirements. For noting at June QPF & for scoring to be agreed. Action Framework & CQC impact on risk to 14-15B Plan also provided, for review at June QPF. standards. Scoring agreed at June QPF as consequence - 3 and likelihood - 3. Next due for review ay July 15 QPF.

July QPF noted that role being advertised more widely in NHS Jobs and agreed to readvertise with local practices.

Action plan reviewed at August 15 QPF and updated that the role is currently live on NHS jobs. Due for next review at September 15 QPF.

Reviewed at Septemner 15 QPF and noted that role has been readvertised on NHS jobs - To be reviewed and further update to be provided at October 15 QPF.

Update provided at October 15 QPF and LQ is currently investigating an application received . Due for next review at November 15 QPF. 14-15S Sep-15 CCG QPF Suspension of Lantern Quality / Patient Safety / 4 3 12.00 Meeting held with Provider Next meeting with Safeguarding policies are NH November October 15 QPF New risk highlighted and agreed to be added at September 15 Project following Contracts to discuss suspension and Provider due to be held on not compliant with 15 QPF QPF. whistleblowing incident and address the conditions. 20/10/15 as a single item safeguarding toolkit, concerns raised in relation to Meeting held with CCG QSG. provision of the new Next meeting with Provider due to be held on 20/10/15 as a both safeguarding policies Deisgnated Nurse for dashboard and MDS single item QSG - Further update to be provided at October and breach of confidentiality. Safeguarding Children to requirements to evidence QPF. It was agreed by QPF that work through the avtivity delivery by the the service should be Safeguarding Audit Tool service, p[rovision of Update provided at October 15 QPF to state that a meeting suspended with immediate and Safeguarding outcomes data to was held with Lantern Project and Governing Body members effect (on 25/08/15) with no Assurance Framework evidence improvements in October 2015 and a letter is to be issued regarding the nre referrals to be accepted Dashboard tobe submitted delivered by the service, future funding of the service. Further review due at November and with no payment to be to CCG. Provider to submit attendance at an Evidence 15 QPF. made to the prohect during a Confidentiality Policy to and Quality Review the period of suspension. the CCG to address the meeting breach in confidentiality, which is to be reviewed by CCG Caldicott Guardian, CCG Senior Information Risk Owner and CCG Information Governance Lead.

Insert Rows Above This Line Only

Impact Values Negligible 1 Minor 2 Moderate 3 Major 4 Catastrophic 5

Probability Values

Rare 1 Unlikely 2 Possible 3 Likely 4 Almost Certain 5

Green/Yellow/Red Threshold Values Green - maximum score 4 Yellow - minimum score 5 Yellow - maximum score 12 Red - minimum score 15

Page 2 of 4 Process

Risk Register Process Before QPF Meeting E-mail to be sent to QPF members to request any new risks. Risk added to Register by Laura Wentworth.

At QPF Meeting: New Risks and corresponding action plan to be considered for inclusion - either keep or decision escalated to risk owner. Current risks to be reviewed in line with action plan progression.

After QPF Meeting Laura Wentworth to update Monitoring column with decisions made at group. Laura Wentworth to amend residual risk rating in line with actions.

At Governing Body Review new and escalated risks Agree to include or de-escalate risks

After Governing Body Laura Wentworth to update Monitoring column with decisions made at group. Laura Wentworth to amend residual risk rating in line with actions. Add removed risks to the Removed risks Tab. Save and copy for next reveiw.

Page 3 of 4 GB Governing Body QPF Quality, Performance and Finance Committee PCMH Primary Care Mental Health DNA Did not Attend KPI Key Performance Indicator SLA Service Level Agreement NWCSU North West Commissioning Support Unit MD Managing Director DMIC Data Managerment Information Centre OOH Out of Hours NHSD NHS Direct DOS Directory of Services CCG Clinical Commissioning Group AT Area Team