Governing Body Meeting in Public

Thursday 25 March 2021 10:40 – 11:45 Video Conferencing Etiquette

1. Be on time to attend the meeting When you're connecting in to a video conference, it's especially important to be on time. Being late is far more visible in a video conference, as late people suddenly appear on everyone’s device unannounced.

2. Check your technology in advance, Check your device in advance, including power cables, your camera, speakers and microphone. External peripherals such as headsets of earphones will improve quality as they capture your voice better if you naturally move when you speak.

3. Video conference from home When conferencing from home, consider who else may by using your broadband/internet connection, if saturated, this will impact performance. If possible limit broadband usage during video conferences.

4. Avoid using VPN services There is no need to be connected to the corporate VPN service during video conferences. Having VPN connection will only reduce performance quality, as it competes for scarce network bandwidth for your device.

5. Reduce the number of open applications Reducing the number of open/active applications on your device will free up processing capacity, improve network bandwidth and limit opportunity for personal distraction.

6. Mute yourself when you are not speaking Even though you may not be speaking and think you're being quiet, most microphones can pick up minor background noises, like coughs, sneezes, typing, etc. These sounds can easily distract other video conferencing participants and potentially cause annoyance.

7. Frame your camera correctly When you're on video, make sure you frame your camera in a way that feels natural to you and allows you to look directly at the camera. Make sure that you are at the centre the frame and that there are no distracting objects behind you.

8. Display participants in grid format This will enable you to view all participants on your screen, making the meeting more inclusive.

9. Keep your self-view on your screen This is so that you can see how you are presented to other participants. What you can see in your self-view is what others can see.

10. Have the right lighting Think about lighting in the room. Poor lighting conditions have an enormous effect on the video quality that you send. You'll want to make sure that there is enough light in the room you're in so that your video isn't grainy and unwatchable.

11. Address the Camera When speaking, directly face the camera and minimise your physical movement. Looking down or away from the camera will distort your voice quality to the audience.

Hertfordshire, Bedfordshire and Luton ICT Shared Services is hosted by NHS East & North Hertfordshire CCG Page 1 of 1 Governing Body Meeting in Public Thursday 25 March 2021, 10:40–11:45 Microsoft Teams

AGENDA

Item Time Subject Report Action

1. 10:40 Welcome and Apologies for Absence Chair Note Verbal

2. Declarations of Interests . To receive any new declarations of interest or Chair Note Enclosed declarations relating to matters on the Agenda. . To reconfirm current declarations on the Register of Interests are accurate and up-to-date. . To confirm that all offers of Gifts and Hospitality received in the last 28 days have been registered with the Governance and Corporate Affairs Team.

3. 10:45 Questions from members of the Public Chair Discuss Verbal

4. 10:50 Minutes of the Previous Meeting Held on Thursday 26 November 2020 and Matters Arising Chair Approve Enclosed

5. Action Tracker Chair Discuss Enclosed

6. 10:55 Managing Directors Report Managing Discuss Enclosed Director

7. 11:10 Governance Report Chief Finance Approve Enclosed Officer

8. 11:20 Integrated Performance and Quality Report Interim Note Enclosed Director of Operations

Page 1 of 2 Item Time Subject Report Action

9. 11:30 East and North Hertfordshire Integrated Care Partnership Update Development Note Enclosed Director (ENH ICP)

10. 11:40 Any Other Urgent Business To consider any other matters which, in the opinion of All Discuss Verbal the Chair, should be considered as a matter of urgency.

11. 11:45 Date of Next Meeting: Chair Note Verbal Thursday 27 May 2021

Resolution to exclude members of the press and public The Governing Body of the Clinical Commissioning Group resolves that representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity of which would be prejudicial to the public interest, in accordance with the Public Bodies (Admissions to Meetings) Act 1960.

Page 2 of 2 Agenda Item No: 2

Date of Meeting: 25 March 2021

Governing Body Meeting in Public

Paper Title: Declarations of Interest

Decision or Approval Discussion Information

Report author: Leon Adeleye, Corporate Governance Manager & DPO

Report signed off by: N/A

Executive Summary: The purpose of this paper is to receive any new declarations of interest or declarations relating to matters on the Agenda.

Members to reconfirm their current declarations on the Declarations of Interests Register are accurate and up-to-date.

Members are also asked to confirm that all offers of Gifts and Hospitality received in the last 28 days have been registered with the Governance and Corporate Affairs Team.

Recommendations . To review the Register of Interests of the Governing Body or to the members: relevant committee membership, and highlight any potential conflicts, which the Chair needs to manage: http://www.enhertsccg.nhs.uk/declarations-interest

. To declare those interests at the start of the meeting. . To complete a declaration form available from the Company Secretary. This will be recorded in the Minutes of the meeting. . To confirm that all offers of Gifts and Hospitality received in the last 28 days have been registered with the Governance and Corporate Affairs Team.

Conflicts of Interest . There are none identified. involved:

Page | 1 Conflict of Interest Definitions

The following table describes the sub-classifications of interests:

Type Description Financial Interests This is where an individual may get direct financial benefits from the consequences of a commissioning decision. Non-Financial This is where an individual may obtain a non-financial professional Professional benefit from the consequences of a commissioning decision, such Interests as increasing their professional reputation or status or promoting their professional career. Non-Financial This is where an individual may benefit personally in ways which are Personal Interests not directly linked to their professional career and do not give rise to a direct financial benefit. Indirect Interests This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision.

Page | 2 Declarations of Interest Register 2020-21 18/03/2021, 13:16

Full Names Type of interest: Date of Interest:

Categories Sub categories Locality PCN GP Surgery (If appropriate) First Name Last Name Current position(s) held in the CCG Declared Interest Financial Non-financial Non-financial Indirect interest Is the interest Nature of Interest From: To: Action taken to mitigate risk Date most i.e. Governing Body member; (Name of the organisation and professional personal direct or recent update Committee member; Member nature of business) indirect? (inc. leaver, new practice; CCG employee or other DOI/No Change Form) was received GB Members Governing Body GPs North Herts Hitchin & PORTMILL SURGERY Tara Belcher GP Governing Body Member 12 Point Care Ltd (company number y Direct The Portmill Surgery has a share in the local 25/09/2014 Ongoing Will declare before relevant 06/02/2020 Whitwell PCN representing North Herts Locality 09214266) Federation, 12 Point Care Ltd which may discussions. Kingston Smith LLP provide bid for services commissioned by the Orbital House, 20 Eastern Road, CCG Romford, Essex RM1 3PJ

GB Members Governing Body GPs North Herts Hitchin & PORTMILL SURGERY Tara Belcher GP Governing Body Member Health Education England (Eastern y Direct GP Trainer (Health Education England) 03/10/2012 Ongoing Declaration 06/02/2020 Whitwell PCN representing North Herts Locality Deanery)

GB Members Governing Body GPs North Herts Hitchin & PORTMILL SURGERY Tara Belcher GP Governing Body Member Portmill Surgery y Direct The Portmill Surgery holds the contract for the 01/04/2017 Ongoing Declaration 06/02/2020 Whitwell PCN representing North Herts Locality Special Allocation Scheme for ENHerts and Herts Valleys CCGs.

GB Members Governing Body GPs North Herts Hitchin & PORTMILL SURGERY Tara Belcher GP Governing Body Member Mills and Reeve LLP (company number y Indirect Spouse Christopher Belcher is a Partner at 01/10/2009 Ongoing Declaration 06/02/2020 Whitwell PCN representing North Herts Locality OC326165) Mills & Reeve LLP who have a contract with Abstain from any discussion / votes in 4th Floor, Monument Place, 24 ENHerts CCG and may bid for other legal work which Mills and Reeve have a financial Monument Street, London EC3R 8AJ from this and other CCGs and Hospital Trusts. interest

GB Members Governing Body GPs North Herts Hitchin & PORTMILL SURGERY Tara Belcher GP Governing Body Member Hitchin & Whitwell Primary Care y Direct Clinical Director of Hitchin & Whitwell Primary 11/09/2019 Ongoing Declaration 06/02/2020 Whitwell PCN representing North Herts Locality Network (PCN) Care Network

GB Members Governing Body GPs North Herts Hitchin & PORTMILL SURGERY Tara Belcher GP Governing Body Member The Portmill Surgery y Direct GP Partner providing commissioned services 01/04/2007 Ongoing Declaration 06/02/2020 Whitwell PCN representing North Herts Locality 114 Queen Street, Hitchin, Herts SG4 Mitigation embedded in GGC 9TH processes for all GP GB members.

GB Members Directors N/A Joanne Burlingham Interim Director of Operations Nil N/A N/A N/A N/A N/A N/A N/A N/A N/A 15/06/2020

GB Members Lay Members Dianne Desmulie Lay Member - Co-Commissioning Pieve Solutions Ltd Company No, y Direct & Indirect Director of my own company: Pieve Solutions Nov-14 Ongoing Provide new declaration of interest in 03/03/2020 (Freedom to Speak-up Guardian)) 5600186. Registered address: Orchard Ltd. I have worked through this company as a event of either myself or my husband House, Park Lane, REIGATE, Surrey, freelance Management Consultant. entering into a consultancy contract RH2 8JX. Nature of business: I have My husband, Robert Pinkham, is a freelance with a supplier to the CCG worked through this company as a management consultant and also a director of freelance Management Consultant. this company

GB Members Lay Members Dianne Desmulie Lay Member - Co-Commissioning Hoddesdon Carers' Support Hub y Direct I am the Volunteer Hub Lead for the Feb-16 Ongoing Declare non financial personal interest 03/03/2020 Hoddesdon Carers' Support Hub. This is part of at any meeting where contract or Carers in Hertfordshire, a charity which performance of CinH (Carers in contracts with Herts County Council and the Hertfordshire) is to be discussed CCG and NHS locally. This particular project is funded by the Big Lottery.

GB Members Lay Members Dianne Desmulie Lay Member - Co-Commissioning Hanscombe House Patient Participation y Direct I am a practice patient and a Member of Nov-14 Ongoing Declare non financial personal interest 03/03/2020 Core Group Hanscombe House Patient Participation Core where funding or performance of Group. I am acting secretary for the group. Hanscombe House practice is to be discussed

GB Members Governing Body GPs Stort Valley & villages Stort Valley & SOUTH STREET SURGERY Sarah Dixon GP Governing Body Member South Street Surgery y Direct GP Partner, South Street Surgery. Apr-18 Ongoing Declare conflict at meetings when 13/02/2020 Villages representing Stort Valley and Villages necessary

GB Members Governing Body GPs Stort Valley & villages Stort Valley & SOUTH STREET SURGERY Sarah Dixon GP Governing Body Member Stort Valley and Villages (SVV) Locality y Direct GP Workforce and Education Lead for Stort Apr-18 Ongoing Declare conflict at meetings when 13/02/2020 Villages representing Stort Valley and Villages Valley and Villages (SVV) necessary

GB Members Governing Body GPs Stort Valley & villages Stort Valley & SOUTH STREET SURGERY Sarah Dixon GP Governing Body Member STORT VALLEY HEALTHCARE y Direct South Street Surgery Practice is a member of Apr-18 Ongoing Declare conflict at meetings when 13/02/2020 Villages representing Stort Valley and Villages LIMITED Locality Federation. necessary Registered office address - C/O GP Partner Dr Kwasi Appiah is a Federation Parsonage Surgery Hertfordshire & Director Essex Community Hospital, Cavell Drive, Bishops Stortford, Hertfordshire, United Kingdom, CM23 5JH Company number 09489615 (Locality Federation) GB Members Governing Body GPs Stort Valley & villages Stort Valley & SOUTH STREET SURGERY Sarah Dixon GP Governing Body Member STORT VALLEY HEALTHCARE y Direct Federation Director for Stort Valley Health Feb-20 Ongoing Declare conflict at meetings when 13/02/2020 Villages representing Stort Valley and Villages LIMITED Federation necessary Registered office address - C/O STORT VALLEY HEALTHCARE LIMITED Parsonage Surgery Hertfordshire & Registered office address - C/O Parsonage Essex Community Hospital, Cavell Surgery Hertfordshire & Essex Community Drive, Bishops Stortford, Hertfordshire, Hospital, Cavell Drive, Bishops Stortford, United Kingdom, CM23 5JH Hertfordshire, United Kingdom, CM23 5JH Company number 09489615 (Locality Company number 09489615 (Locality Federation) Federation) GB Members Governing Body GPs Stort Valley & villages Stort Valley & SOUTH STREET SURGERY Sarah Dixon GP Governing Body Member STORT VALLEY HEALTHCARE y Direct Practice Lead for Stort Valley and Villages PCN Jul-20 Ongoing Declare conflict at meetings when 13/02/2020 Villages representing Stort Valley and Villages LIMITED necessary Registered office address - C/O Parsonage Surgery Hertfordshire & Essex Community Hospital, Cavell Drive, Bishops Stortford, Hertfordshire, United Kingdom, CM23 5JH Company number 09489615 (Locality Federation) GB Members Governing Body GPs Stort Valley & villages Stort Valley & SOUTH STREET SURGERY Sarah Dixon GP Governing Body Member West Essex Vocational Training y Direct GP Trainer West Essex Vocational Training Apr-18 Ongoing Declare conflict at meetings when 13/02/2020 Villages representing Stort Valley and Villages Scheme Scheme and Princess Alexandra Hospital necessary and Foundation Programme Princess Alexandra Hospital Foundation Programme

GB Members Governing Body GPs Stort Valley & villages Stort Valley & SOUTH STREET SURGERY Sarah Dixon GP Governing Body Member NHS England – Midlands and East y Direct GP Appraiser for NHS England – Midlands and Apr-18 Ongoing Declare conflict at meetings when 13/02/2020 Villages representing Stort Valley and Villages East necessary

GB Members Directors N/A Sharn Elton Managing Director Nil N/A N/A N/A N/A N/A N/A N/A N/A N/A 04/06/2020

GB Members Lay Members Linda Farrant Lay Member, Governance and Audit Non-Executive Board Member, y Direct Non-Executive Board Member, Parliamentary Feb-20 Ongoing As appropriate to situation 02/01/2020 (Conflicts of Interest Guardian) Parliamentary and health Service and health Service Ombudsman (PHSO) Ombudsman (PHSO)

GB Members Lay Members N/A Alison Gardner Lay Member for Public and Patient Herts Valleys CCG y Member of HVCCG Board (Lay Member – Aug-19 Ongonig Full transparancy with both 19/05/2020 Engagement Public and Patient Engagement) organisations on both roles

GB Members Lay Members Alison Gardner Lay Member for Public and Patient InvoDirector Alison Gardner Ltd y Aug-19 Ongonig 19/05/2020 Don’t pursue contracts in Hertfordshire. Coaching clients are outside Hertfordshire and outside NHS. If potential opportunity arose within NHS and/or Hertfordshire would consult with Chair and CEO.

Lay Member (PPI) of Governing Body GB Members Lay Members Alison Gardner Lay Member for Public and Patient InvoAssociate Consultant Royal College of y Aug-19 Ongonig 19/05/2020 Nursing

Don’t bid for RCN projects in Hertfordshire and would not accept RCN offers of work in Hertfordshire.

Lay Member (PPI) of Governing Body GB Members Governing Body GPs Stevenage Stevenage north CHELLS SURGERY Russell Hall GP Board Member / Locality Co-Chair GP Practice, Chells Way, Stevenage, y Direct GP Partner, Chells Way Surgery. GP Partner May-99 Ongoing Declare at meetings 06/07/2020 PCN Stevenage SG2 0NH and Provider - GMS Services.

GB Members Governing Body GPs Stevenage Stevenage north CHELLS SURGERY Russell Hall GP Board Member / Locality Co-Chair Stevenage Health Ltd (Stevenage y Direct Chells Practice is a member of Stevenage Jul-15 Ongoing Declare at meetings 06/07/2020 PCN Stevenage Federation) Federation, a private company.

GB Members Accountable Officer N/A Jane Halpin Accountable Officer Nil N/A N/A N/A N/A N/A N/A N/A N/A N/A 09/06/2020

GB Members Directors N/A Rachel Joyce Director of Clinical and Professional Spire Harpenden Hospital and Pinehill y y Direct/ Married to Ear, Nose and Throat Surgeon who 2000 Ongoing Will declare any 04/03/2020 Services Ramsay Hospital In Hitchin, One Indirect works at these hospitals. Income from Private potential interest at Herts & West Essex ICS & CCGs Hatfield Hospital (Private Hospitals) Practice is shared. the start of any Locally. relevant meeting, to allow the Chair to manage the conflict. Will not be on any procurement panels for this specialty.

1 of 2 Declarations of Interest Register 2020-21 18/03/2021, 13:16

Full Names Type of interest: Date of Interest:

Categories Sub categories Locality PCN GP Surgery (If appropriate) First Name Last Name Current position(s) held in the CCG Declared Interest Financial Non-financial Non-financial Indirect interest Is the interest Nature of Interest From: To: Action taken to mitigate risk Date most i.e. Governing Body member; (Name of the organisation and professional personal direct or recent update Committee member; Member nature of business) indirect? (inc. leaver, new practice; CCG employee or other DOI/No Change Form) was received GB Members Directors N/A Rachel Joyce Director of Clinical and Professional Herts and West Essex Sustainability y Direct Clinical and Professional Director of the Herts Apr-19 Mar-20 Will declare any potential interest with 04/03/2020 Services and Tranformation Partnership (STP) and West Essex STP any relevant agenda items Herts & West Essex ICS & CCGs

GB Members Directors N/A Jane Kinniburgh Director of Nursing and Quality Nil N/A N/A N/A N/A N/A N/A N/A N/A N/A 04/09/2020

GB Members CCG Chair Pragasen Moodley Chair, East and North Herts CCG Stanmore Medical Group y Direct Principal GP Partner, 01/09/2018 Ongoing I declare this at meetings where 27/02/2020 5 Stanmore Road, Stevenage, SG1 Stanmore Medical Group relevant according to the statutory 3QA [Canterbury Way Surgery & St Nicholas Health guidelines. Centre have both fully merged with the Stanmore Medical Group] Both provider and commissioner

GB Members CCG Chair Pragasen Moodley Chair, East and North Herts CCG AVM Medical. Suite 3 Middlesex y Direct Director: AVM Medical 01/09/2018 Ongoing I declare this at meetings where 27/02/2020 House, Rutherford Close, Stevenage, relevant. Hertfordshire, United Kingdom, SG1 2EF. Company number 10507387 I use this company to carry out private medicals and nursing home ward rounds

GB Members CCG Chair Pragasen Moodley Chair, East and North Herts CCG Stevenage Health Limited, Dr. Raj Kaja, y Direct My Practice is part of the Federation. 01/09/2018 Ongoing I declare this at meetings where 27/02/2020 The Health Centre, Stanmore Road, Stevenage Health Limited. I am not directly relevant. Stevenage, Hertfordshire, England, involved. SG1 3QA. Company number 08877494

GB Members CCG Chair Pragasen Moodley Chair, East and North Herts CCG Dr Anindita Saha, known as Dr Rini y I am in a relationship with Dr Saha, who is a 01/09/2018 Ongoing Written declaration made. 27/02/2020 Saha GP in Stevenage and a GP Governing Body Member for Stevenage as of 01/10/2018.

GB Members Secondary Care Dermot O'Riordan Secondary Care Representative on West Suffolk NHS Foundation Trust y Direct Consultant Surgeon & Chief Clinical Sep-01 Ongoing Declare in line with conflict of interest 20/05/2020 Clinician the Governing Body Information Officer, West Suffolk NHS FT policy.

GB Members Secondary Care Dermot O'Riordan Secondary Care Representative on West Suffolk NHS Foundation Trust y Indirect My wife works for West Suffolk NHS Apr-19 Ongoing Declare in line with conflict of interest 20/05/2020 Clinician the Governing Body Foundation Trust as a consultant in learning policy. from deaths.

GB Members Directors North Herts N/A Alan Pond Chief Finance Officer, GP Partner in Herts Valleys CCG y y Indirect Partner (Corina Ciobanu) Aug-10 Ongoing If ENHCCG ever seeks to procure 11/02/2020 Upper Lea Valley Hertfordshire and West Essex ICS (Haverfield Surgery, Kings Langley) and services from GPs and/or GP Surgeries WelHat East and North Hertfordshire CCG Chair of Dacorum Locality outside the CCG, I will keep Herts Valleys CCG confidential any information I receive West Essex CCG that could be of benefit to Haverfield Surgery and/or Corina Ciobanu. Should Haverfield Surgery and/or Corina Ciobanu submit a proposal to undertake any work for ENHCCG I will GB Members Directors North Herts N/A Alan Pond Chief Finance Officer, Director of Assemble Community y Direct These companies form the LIFT (Local Jul-08 Ongoing Myd role l onthi the i t Board t of d the ill LIFT t t k 11/02/2020 Upper Lea Valley Hertfordshire and West Essex ICS Partnership Ltd (Company Number Improvement Finance Trust) for South East Company Group is to represent the WelHat East and North Hertfordshire CCG 06471276) and associated companies Midlands which was created to develop interests of the local public sector, Herts Valleys CCG Assemble Fundco 2 Ltd (Company community premises for the NHS. The shares provide insight, but also to oversee the West Essex CCG Number 08309498) in the companies are held by Guildhouse Ltd financial and governance arrangements Assemble Holdco 2 Ltd (Company and Community Health Partnership, the latter of the companies. Number 08309495) being a company wholly owned by the The Group of Companies was created Wolverton Holdings (Company Number Department of Health. to provide benefits to the NHS locally 08307564) The directorship is unpaid, nominated by and a conflict is highly unlikely to occur. GB Members Governing Body GPs Stevenage Stevenage South KING GEORGES SURGERY Anindita (Rini) Saha GP Governing Body Member, KingW l George t F Surgery d 1 Ltd (C y Direct GPC Partner, it HKind lth George P t Surgery hi since d Oct-18 Ongoing DeclareSh ld all interests fli t at f i meetings t t iwhere I 14/02/2020 PCN Stevenage Locality 2007/08 relevant and follow statutory guidelines. Both commissioner and provider

GB Members Governing Body GPs Stevenage Stevenage South KING GEORGES SURGERY Anindita (Rini) Saha GP Governing Body Member, MENTAL HEALTH AND LERANING y N/A MENTAL HEALTH AND LEARNING Mar-20 Ongoing Declare all interests at meetings where 29/06/2020 PCN Stevenage Locality DISABILITY LEAD FOR ENHCCG DISABILITY LEAD FOR ENHCCG relevant and follow statutory guidelines.

GB Members Governing Body GPs Stevenage Stevenage South KING GEORGES SURGERY Anindita (Rini) Saha GP Governing Body Member, Stevenage Health Limited, y Direct King George Surgery is a member of Oct-18 Ongoing Declare all interests at meetings where 14/02/2020 PCN Stevenage Locality Registered office address Stevenage Health Limited – which is the relevant and follow statutory guidelines. The Health Centre, Stanmore Road, Stevenage Locality Federation. I am not a Stevenage, Hertfordshire, England, director. I am not a direct shareholder SG1 3QA Company number 08877494

GB Members Governing Body GPs Stevenage Stevenage South KING GEORGES SURGERY Anindita (Rini) Saha GP Governing Body Member, Dr Prag Moodley, Chair of East and y Indirect I am in a relationship with Dr Prag Moodley, the Oct-18 Ongoing Written declaration made. 14/02/2020 PCN Stevenage Locality North Herts CCG Chair of East and North Herts CCG.

GB Members Governing Body GPs Upper Lea Valley Hertford and Rupal Shah GP Governing Body Member Hanscombe House Surgery, 52A St y Direct Salaried GP – Hanscombe House Surgery. May-19 Ongoing None perceived necessary as I am a 04/03/2020 Rural PCN Representing ULV Locality. Andrews Street, Hertford, SG14 1JA salaried GP and do not perceive a Locality Co-Chair: ULV Locality conflict

GB Members Governing Body GPs Upper Lea Valley Hertford and Rupal Shah GP Governing Body Member GENERATING HEALTHCARE y Direct Hanscombe House is a shareholder of May-19 Ongoing None perceived necessary as I am a 04/03/2020 Rural PCN Representing ULV Locality. LIMITED – Upper Lea Valley GENERATING HEALTHCARE LIMITED salaried GP and do not perceive a Locality Co-Chair: ULV Locality Company number 08830754 I am not a director or a shareholder conflict Registered office address 2 Tower House, Tower Centre, Hoddesdon, Hertfordshire, England, EN11 8UR.

GB Members Governing Body GPs Upper Lea Valley Hertford and Rupal Shah GP Governing Body Member Abhirush Limited. y Direct Director (Joined) of Abhirush Limited. May-19 Ongoing Any conflict arising out of discussions 04/03/2020 Rural PCN Representing ULV Locality. Company registered address regarding same at the meeting will be Locality Co-Chair ULV Locality 5 Chedburgh raised at the meeting. Welwyn Garden City AL7 2PU. Company No: 07998120 Nature of Business: I work as a locum GP via the limited company.

GB Members Governing Body GPs Upper Lea Valley Hertford and Rupal Shah GP Governing Body Member Upper Lea Valley Locality Provider y Direct I work as a GP Representative for Hertford on May-19 Ongoing Any conflict arising out of discussions 04/03/2020 Rural PCN Representing ULV Locality. Board the Provider Board at ULV Locality regarding same at the meeting will be Locality Co-Chair ULV Locality raised at the meeting.

GB Members Governing Body GPs Upper Lea Valley Hertford and Rupal Shah GP Governing Body Member Spouse y Indirect Spouse works as a GP in Hatfield and Deputy 01/05/2019 Ongoing Any conflict arising out of discussions 04/03/2020 Rural PCN Representing ULV Locality. Chair and Corporate GP Lead on ENHCCG regarding same at the meeting will be Locality Co-Chair ULV Locality Governing Body. raised at the meeting.

GB Members Governing Body GPs Welhat WRAFTON HOUSE SURGERY Ashish Shah Vice-Chair of ENHCCG. Wrafton House Surgery y Direct Principal GP and GP Trainer Nov-14 Ongoing Any conflict arising out of discussions 23/06/2020 GP Governing Body Member 9-11 Wellfield Road Wrafton House Surgery. Both provider and regarding same at meetings will be representing WelHat Locality. Locality Hatfield commissioner. raised at the meeting. Chair – WelHat Locality. AL1 OBS

GB Members Governing Body GPs Welhat WRAFTON HOUSE SURGERY Ashish Shah Vice-Chair of ENHCCG. Abhirush Limited. y Direct Director (Joined) of Abhirush Limited. I work Nov-14 Ongoing Any conflict arising out of discussions 23/06/2020 GP Governing Body Member Company registered address through the Limited Company as an Out of regarding same at meetings will be representing WelHat Locality. Locality 5 Chedburgh Hours GP at Herts Urgent Care. raised at the meeting. Chair – WelHat Locality. Welwyn Garden City AL7 2PU. Company No: 07998120 Nature of Business: I work through the Limited Company as an Out of Hours GP at Herts Urgent Care. GB Members Governing Body GPs Welhat WRAFTON HOUSE SURGERY Ashish Shah Vice-Chair of ENHCCG. Ephedra Healthcare Ltd, Suite 3, y Direct Principal GP at Wrafton House Surgery. Nov-14 Ongoing Any conflict arising out of discussions 23/06/2020 GP Governing Body Member Middlesex House, Rutherford Close, Practice is a Shareholder of Ephedra regarding same at meetings will be representing WelHat Locality. Locality Stevenage, Herts, SG1 2EF. Company Healthcare Limited, which is a local federation raised at the meeting. Chair – WelHat Locality. no: 06560722 for WelHat Locality. Ephedra Healthcare Ltd.

GB Members Governing Body GPs Welhat WRAFTON HOUSE SURGERY Ashish Shah Vice-Chair of ENHCCG. Locality Lead for Workforce Planning y Direct I Work as a Locality Lead for Workforce Jan-16 Ongoing Any conflict arising out of discussions 23/06/2020 GP Governing Body Member and Educational Network for Welwyn Planning and Educational Network for Welwyn regarding same at meetings will be representing WelHat Locality. Locality and Hatfield Locality and Hatfield Locality raised at the meeting. Chair – WelHat Locality.

GB Members Governing Body GPs Welhat WRAFTON HOUSE SURGERY Ashish Shah Vice-Chair of ENHCCG. Spouse y Indirect Spouse works a GP in Hertford and Corporate May-19 Ongoing Any conflict arising out of discussions 23/06/2020 GP Governing Body Member GP lead for ULV on ENHCCG Governing Body. regarding same at meetings will be representing WelHat Locality. Locality raised at the meeting. Chair – WelHat Locality.

GB Members Directors N/A Philip Turnock Chief Digital Officer Nil N/A N/A N/A N/A N/A N/A N/A N/A N/A 25/02/2020

2 of 2 Agenda Item No: 4

Date of Meeting: 25 March 2021

Governing Body Meeting in Public

Paper Title: Draft – Governing Body Minutes

Decision or Approval Discussion Information

Report author: Tracey Middleton, Governing Body Clerk

Report signed off by: Jas Dosanjh, Corporate Governance Manager

Executive Summary: Draft minutes of the Governing Body meeting in Public attached for approval.

Recommendations . To approve the Minutes. to the members:

Conflicts of Interest . There are none identified. involved:

Conflict of Interest Definitions

The following table describes the sub-classifications of interests:

Type Description Financial Interests This is where an individual may get direct financial benefits from the consequences of a commissioning decision. Non-Financial This is where an individual may obtain a non-financial professional benefit Professional Interests from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. Non-Financial This is where an individual may benefit personally in ways which are not Personal Interests directly linked to their professional career and do not give rise to a direct financial benefit. Indirect Interests This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non- financial personal interest in a commissioning decision.

Page | 1 Governing Body Meeting in Public Thursday 26 November 2020 Remotely via Webex

MINUTES Present: Tara Belcher GP Lead, North Herts. Jo Burlingham Interim Director of Operations Dianne Desmulie Lay Member, Primary Care Commissioning Sarah Dixon GP Lead, Stort Valley and Villages Sharn Elton Managing Director Alison Gardner Lay Member, Patient and Public Involvement

Russell Hall GP Lead, Stevenage Jane Halpin Joint Chief Executive Officer, Herts & West Essex ICS & CCGs Jane Kinniburgh Director of Nursing and Quality, Herts & West Essex ICS & CCGs Prag Moodley Chair Dermot O’Riordan Secondary Care Specialist Alan Pond Chief Finance Officer, Herts & West Essex ICS & CCGs Rini Saha GP Lead, Stevenage Rupal Shah GP Lead, Upper Lea Valley Phil Turnock Chief Digital Officer Vacant Director of Commissioning Vacant GP Lead, Lower Lea Valley x2 Vacant GP Lead, North Herts. Vacant GP Lead, Stort Valley and Villages Vacant GP Lead, Upper Lea Valley Vacant GP Lead, Welwyn and Hatfield IN ATTENDANCE Sunday Adeniyi Deputy Chief Finance Officer Peter Chapman Patient Representative Tracey Cooper Associate Director of Adult Safeguarding Jas Dosanjh Corporate Governance Manager Mary Emson Acting Associate Director Nursing/ Designated Nurse Safeguarding Children, Looked after Children & Care Leavers Stephanie Evis Adult Safeguarding Lead Nurse

Page 1 of 10 Sarah Feal Company Secretary Tracey Middleton Governing Body Clerk Nuala Milbourn Assistant Director, Communications and Engagement Jo O’Connor Acting Assistant Director of Performance Trudi Southam Associate Director – CCG Commissioning Lynn Stewart Head of Infection Prevention & Control (ENHCCG, HVCCG, WECCG) Sam Tappenden Development Director of East & North Herts ICP Michael Taylor Patient Representative – Healthwatch

Members of the Public in attendance: Ian Stimson

Page 2 of 10 Item

1. Welcome and Apologies for Absence The meeting opened at 09:00

1. The Chair welcomed all to the meeting.

2. Apologies were received from:

 Linda Farrant - Lay Member, Governance and Audit  Ashish Shah - Deputy Chair, GP Lead, Welwyn and Hatfield, Prescribing Lead  Rachel Joyce – Medical Director

The Chair declared that the meeting was quorate.

2. Declarations of Interests

1. The Chair invited members to declare any declarations relating to matters on the Agenda.

2. None declared.

3. The Chair invited the members to reconfirm their current declarations on the Register of Interests and advise of any new declarations.

4. All members confirmed their declarations were accurate and up-to-date.

5. Colleagues were reminded to declare any offers of gifts or hospitality received in the last 28 days to the Governance and Corporate Affairs Team.

3. Minutes of Previous Meeting and Matters Arising

The Minutes of the meetings held on 23.07.2020 were approved as an accurate record.

Page 3 of 10 Item

4. Action Tracker

The Action Tracker was reviewed and it was agreed that the following items are closed:

 Item 54  Item 55

ACTION: The Action Tracker to updated accordingly. S Feal

5. Chief Executive/Managing Director’s Report

The Chief Executive/Managing Director’s Report which was circulated in advance of the meeting was presented by the Managing Director.

1. The report provided information on activities being undertaken by the Clinical Commissioning Group 2. Colleagues acknowledged the significant achievement in the delivery of the MMR programme 3. Health Watch was acknowledged for the work undertaken and continued collaboration 4. It was questioned how people with learning difficulties are prioritised and the Governing Body was advised that a request has been submitted for this to be taken into account in the guidance

The Governing Body noted the Chief Executive/Managing Director’s Report.

6. Governance Report

The Governance Report which was circulated in advance of the meeting was introduced by the Chief Finance Officer.

The Governing Body: . noted and ratified the decisions made at the Governing Body Workshops, . noted the Report from the Governance and Audit Committee, . noted the Report from the Primary Care Commissioning Committee, . noted the completion of the Declaration of Interests Register

Page 4 of 10 Item

annual review exercise and individuals outstanding to provide them, . noted the Assurance Framework and Corporate Risk Register. The 3 identified risks were outlined and the impact including costs of drugs, capacity within the nursing teams, further debated, . noted the Annual Audit Letter from External Audit, . noted the the updates on governance and compliance activities.

7. Finance Report Month 7 2020/21

The Finance Report which was circulated in advance of the meeting was presented by the Chief Finance Officer.

1. This report provided details of the finance position at the end of October 2020, month 7 and is the year to date position. 2. In response to COVID-19, NHS England put in place a temporary financial regime to cover the period 1st April to – 30th September 2020. The changes are detailed in section 1. 3. A revised framework has been implemented for the period 1st October 2020 – 31st March 2021. The framework retains the simplified arrangements for payment and contracting but with a greater focus on system partnership and the restoration of elective services. 4. The financial position as at the end of October 2020 is an underspend of £0.468m. 5. The CCG historic underspend of £18.851m will be retained and carried forward to 2021/22. 6. The funding regarding the flu campaign and potential costs was reviewed by the Primary Care Team and is separate to the Covid vaccination campaign

The Governing Body noted the Finance Report.

AP left the meeting at 09.29

8. Integrated Performance and Quality Report (IPQR)

The report which was circulated in advance of the meeting was introduced by the Acting Assistant Director of Performance.

1. The Integrated Performance and Quality report provided an

Page 5 of 10 Item

update on the performance and quality of local NHS Trusts in relation to key national performance standards. It included quality and performance information at CCG level and also at provider level. 2. The performance and quality metrics included within the report are published information predominantly for the September position, A and E is October and the commentary is up to November. All metrics have been included with commentary for exceptions where performance standards have not been met. 3. The HPFT data regarding longest wait time was clarified. 4. Assurance was provided that the long waiters are monitored and reviewed noting that lack of patient engagement is followed up. 5. Activity levels and streaming requirements were outlined noting that pressure across acute trusts is high. Considerable pressure on moving patients within hospital settings and staff absence is impacting different areas. Confidence was expressed that the local Trusts are recovering elective and diagnostic work. The increased activity in Primary Care was acknowledged.

The Governing Body noted the Report.

9. Emergency Preparedness, Resilience and Response (EPRR) (Core Standards Assurance)

The report which was circulated in advance of the meeting was introduced by the Interim Director of Operations.

1. The paper forms part of the annual business cycle within East and North Hertfordshire Clinical Commissioning Group (ENHCCG) for EPRR and provides evidence of ENHCCG self-assessment against the NHS England EPRR Core Standards. 2. The paper provided a brief summary of the Urgent and Emergency Care (UEC) priorities for 2020/21 and the operational plans in place for the management of winter 2020/21. 3. The operational plans in place for the management of winter as part of ENHCCG annual assurance business cycle. JH left me meeting at 09.50 4. The guidance provided during 2 PCN outbreaks experienced recently was noted as helpful and the support provided by the

Page 6 of 10 Item

CCG acknowledged. 5. The enhanced service to Care Homes and clarity regarding change management were debated. J 6. ACTION: Details relating to health professionals visiting Burlingham care homes to be circulated

The Governing Body noted the work undertaken in the last 12 months and the self–assessment and sign off by NHSE/I as ‘Fully Compliant’ for 2020/21.

The Governing Body noted the report The meeting adjourned at 10.05-10.15

10. CCG Communications and Engagement Strategy

The report which was circulated in advance of the meeting was introduced by the Managing Director and Assistant Director, Communications and Engagement

1. The strategy sets out East and North Hertfordshire CCG’s approach to communications and engagement and the specific activities being undertaken to reach key audiences both within the CCG and externally. 2. The Governing Body discussed the CCG’s proposed Communications and Engagement strategy 2019 – 2021 at a workshop meeting in November 2019. As this meeting was held during the pre-election period, it was not possible at the time to share the strategy in a public meeting or to discuss it with patient participation group members. A decision was taken to bring the strategy to a future Governing Body meeting in public. 3. In the light of the COVID-19 pandemic response this year, the strategy has been updated and extended until September 2021. 4. The strategy is in alignment with the NHS Long Term Plan, the Integrated Care System (ICS) Long Term Plan and the ICS Communications and Engagement strategy. 5. Patient and public engagement across all areas including transformation has been maintained throughout was commended. 6. Sharing information via schools is in place e.g. Q&A Covid via the Hertfordshire County Council (HCC) link however it is dependent on the school circulating the information provided to parents and students. The GP Health Campaigns is being used to share resources as part of the Consolidated Funding

Page 7 of 10 Item

Framework (CFF). 7. The team received notification that the NHS oversight framework has confirmed a “green*” rating endorsing the feedback received.

The Governing Body approved the updated strategy for the communications and engagement team.

The Governing Body endorsed and supported the activity where possible.

11. Infection Prevention and Control Annual Report 2019-20

The report which was circulated in advance of the meeting was introduced by the Head of Infection Prevention & Control.

1. The report outlined the arrangements for Infection Prevention and Control (IPC) across the Hertfordshire and West Essex STP, as well as IPC achievements and local performance in relation to HCAIs during 2019-20. 2. It highlighted the key IPC challenges faced, and focusses on the priorities required to address these during 2020-21, whilst still continuing to respond to the COVID-19 related agenda. 3. More testing is taking place and outbreaks of COVID-19 across a variety of setting is being managed. A strong support network for individuals is in place across the system.

The Governing Body noted the report.

12. Safeguarding Adults Annual repot 2019-20

The report which was circulated in advance of the meeting was presented by the Adult Safeguarding Lead Nurse.

1. The annual report for 2019/20 assured the Governing Body of the progress the CCG has made in relation to adult safeguarding and to outline the priorities for 2020/21. 2. It provided assurance that the Associate Director of Adult Safeguarding and the Named Nurse are actively leading the delivery of ENCCG safeguarding adult objectives and will provide information on outcomes, gaps identified and the

Page 8 of 10 Item

measures being taken to address these.

The Governing Body noted the report.

13. Primary Care Commissioning Committee Minutes

The minutes of the public meetings dated 02 July 2020 and 10 September 2020 were introduced to the Governing Body.

The Governing Body noted the minutes.

14. Governance and Audit Committee Minutes

The minutes of the meeting dated 28 May 2020 were introduced to the Governing Body.

The Governing Body noted the minutes.

15. HBL ICT Stakeholder Board Minutes

The minutes of the meeting dated 20 January 2020, 18 February 2020, 20 June 2020 were introduced to the Governing Body.

The Governing Body noted the minutes.

16. Joint Commissioning and Partnership Programme Committee Minutes

The minutes of the meeting dated 18 June 2020 were introduced to the Governing Body.

The Governing Body noted the minutes.

17. Locality Commissioning Committee Minutes

The minutes of the following meetings were introduced to the

Page 9 of 10 Item

Governing Body.

1. Lower Lea Valley – 04 March 2020, 15 June 2020 2. North Hertfordshire – none to report 3. Stevenage – none to report 4. Stort Valley and Villages – 16 January 2020 5. Upper Lea Valley – none to report 6. Welwyn and Hatfield – 23 January 2020

The Governing Body noted the minutes.

18. Questions from Members of the Public

1. One member of the public was present at the meeting 2. No questions were raised

19. Any Other Business

1. Thanks, were extended to the Company Secretary for the commitment and contribution to the CCG during her tenure.

20. Date of Next Meeting:

Thursday 25 March 2021

The meeting closed at 10:40

Page 10 of 10 Agenda Item No: 5

Date of Meeting: 25 March 2021

Governing Body Meeting in Public

Paper Title: Action Tracker

Decision or Approval Discussion Information

Report author: Tracey Middleton, Governing Body Clerk

Report signed off by: Jas Dosanjh, Corporate Governance Manager

Executive Summary: The purpose of this paper is to discuss the Action Tracker.

Recommendations . To discuss the Action Tracker. to the members:

Conflicts of Interest . There are none identified. involved:

Conflict of Interest Definitions

The following table describes the sub-classifications of interests:

Type Description Financial Interests This is where an individual may get direct financial benefits from the consequences of a commissioning decision. Non-Financial This is where an individual may obtain a non-financial professional benefit Professional Interests from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. Non-Financial This is where an individual may benefit personally in ways which are not Personal Interests directly linked to their professional career and do not give rise to a direct financial benefit. Indirect Interests This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non- financial personal interest in a commissioning decision.

Page | 1 Governing Body Meeting in Public Action Tracker

No. Meeting Date Item No. and Title Action Responsible Past deadlines Deadline Current Position Status Status Manager (Since recommendati Revised) on

56 26/11/2020 9. Emergency Preparedness, Details relating to health professionals visiting care Interim Director of 04-Dec-20 12-Mar-21: Action complete, information re-circulated Complete 2021-03-25 Resilience and Response (Core homes to be circulated Operations 28-Nov-20: Process for health professionals accessing Covid tests to be closed Standards Assurance) prior to visiting care homes to be recirculated

57

Page 1 of 1 Agenda Item No: 6

Date of Meeting: 25 March 2021

Governing Body Meeting in Public

Paper Title: Chief Executive/Managing Director’s Report

Decision or Approval Discussion Information

Report author: Nakiya Jafferji, Corporate Governance Manager Steve Madden, Interim Associate Director for Strategy and Transformation Jo Burlingham, Interim Director of Operations Rosie Connolly, Acting Associate Director- Quality Improvement Report signed off by: Sharn Elton, Managing Director

Executive Summary: The purpose of this paper is to provide information on activities being undertaken by the Clinical Commissioning Group.

Recommendations To discuss the report. to the members: Conflicts of Interest There are none identified. involved:

Conflict of Interest Definitions The following table describes the sub-classifications of interests: Type Description Financial Interests This is where an individual may get direct financial benefits from the consequences of a commissioning decision. Non-Financial This is where an individual may obtain a non-financial professional Professional benefit from the consequences of a commissioning decision, such Interests as increasing their professional reputation or status or promoting their professional career. Non-Financial This is where an individual may benefit personally in ways which are Personal Interests not directly linked to their professional career and do not give rise to a direct financial benefit. Indirect Interests This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision.

Page 1 of 5 1. Executive Summary

The purpose of this paper is to provide information on activities being undertaken by the Clinical Commissioning Group (CCG).

2. Covid-19 Vaccination Programme

Throughout the roll-out of the COVID-19 vaccination programme, keeping our population and stakeholders informed has been a key priority. The CCG has worked closely with NHS England (NHSE/I), Public Health England and Public Health Hertfordshire, Local Resilience Forum member organisations and voluntary and community groups in Hertfordshire and West Essex to jointly plan and share information and guidance with local people, using a range of communications channels. In a rapidly changing situation, we have worked in alignment with national and locally designed behavioural science principles to:

 help people focus on positive actions to prevent the spread of the virus  provide clear and specific information so people know what they are being asked to do and when they need to do it  provide information about positive actions people can take to stay safe and well  maintain public confidence in the vaccinations available and organisations delivering them  design messages and services to make it as easy as possible for people to take them up.

The CCG Communications lead has an ICS-wide responsibility to work closely with the East of England region of NHSE/I to deliver NHS communications across Hertfordshire and West Essex. The CCG’s Communications and Engagement Team has played a significant role in supporting this work. Since the vaccination programme started, they have:

 worked to manage public and stakeholder expectations around the roll-out of the vaccination programme, providing regular updates on who is eligible and how they can take up the vaccination when it is their turn  created a new COVID microsite for ICS organisations, with information on vaccinations, including a regularly updated FAQ section.  updated MPs, councillors and other stakeholders about the dedicated work underway to deliver the vaccination programme, in weekly updates  produced twice-weekly GP bulletins through which we pass on essential information in a much more brief and digestible format than we receive it in  shared clear information in a range of formats and languages, and on a number of topics, with health and care staff and the public to help to manage their queries or concerns about the vaccination programme away from GP practices, when this is appropriate  supported the opening of large vaccination sites, working with our system partners, HCT, to ensure effective and timely communications

Page 2 of 5  supported Hertfordshire County Council (HCC), the Hertfordshire Care Providers Association (HCPA) and Primary Care Network (PCN) leads with communications specifically designed to encourage care home staff to take up the offer of COVID vaccinations. This include a letter sent to care home managers co-signed by Chris Badger (HCC) and Jane Halpin (Herts and west Essex ICS) giving an update on vaccine process and encouraging staff to take up the vaccine when invited.  supported the new HCPA website page on vaccination for managers and staff in the social care sector, including comprehensive FAQs  organised print runs of mandatory vaccination leaflets when the national printing and delivery system doesn’t keep up with demand  replied to MP and councillor queries about practices in individual PCN vaccination sites as well as local large scale vaccination sites  regularly supplied suggested messaging to GP practices for use on websites, answering machines and in patient information  supported a Ministerial visit to a GP-led vaccination site in Hatfield – providing briefing, an outline programme and key messages

Our priorities for this programme continue to focus on working with the public and stakeholders to ensure widespread take-up of the vaccination across the ICS, to ensure that no-one is left behind by the vaccination programme. A communications and engagement plan is being developed to support the ICS plan to tackle vaccine inequalities.

3. Recovery and Reset

The CCG are currently preparing for the next phase of the pandemic as pressure from the second wave begins to subside. The planning for the recovery phase (now known as Restoration, Reset and Resilience) has begun, whilst there has been no formal guidance or requests nationally or regionally it is anticipated that this will be in line with the phase 3 recovery plans and objectives that were developed in the autumn. The CCG cells are beginning to focus on recovery with each cell identifying priorities for recovery which include:

 Implementing the interim Consolidated Funding Framework (CFF) and developing the 2021-22 CFF -informed by population health management priorities  Continue to deliver COVID vaccination programme per national plans with support from the Communications team in delivery and take-up of across the ICS area and reducing health inequalities  Restart/increase provision of lower priority treatments in accordance with British Medical Association (BMA )/Royal College of General Practitioners (RCGP) guidance – focus on cervical screening rates and backlog routine Long Term Condition reviews  Reducing waiting lists - risk stratification of patients so that treatment is prioritised according to need. To support this Inter-hospital Mutual Aid for planned care and outpatients transformation including Patient Initiated Follow Up (PIFU)  Further development of long COVID/rehabilitation services.  Developing a Prevention of Admission (POA) Integrated Service model to include the current POA model, virtual wards and potentially expanding to cover a wider range of conditions and form a virtual hospital service

Page 3 of 5  To expand direct booking to Emergency Department and Same Day Emergency Care (SDEC) via 111 and 999  Proactive support to frail patients, including virtual frailty clinics, dementia diagnostic model, delivery of an enhanced community and primary care offer to support care homes and continuation of crisis-response end of life work  Responding to anticipated significant increases in MH demand across all ages, a focus on wellbeing, support, recruitment and retention of workforce  Delivering the Children and Young People Transformation Programme and reducing the Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder waiting times  Ensure contracts are in place for providers, where required, and arrangements agreed for contracts post 1st April 2021

The CCG are currently preparing for the next phase of the pandemic as pressure from the second wave begins to subside. The planning for the recovery phase (now known as Restoration, Reset and Resilience) has begun, whilst there has been no formal guidance or requests nationally or regionally it is anticipated that this will be in line with the phase 3 recovery plans and objectives that were developed in the autumn. The CCG cells are beginning to focus on recovery with each cell identifying priorities for recovery, however NHSE has confirmed that the NHS will remain on a level 4 incident which means that full command and control arrangements will remain in place for the foreseeable future. We will therefore retain the cell structure focus on the priorities outlined below whilst still be able to respond to any changes in demand and surge in activity:

4. Cambridge Cancer Research Hospital

Cambridge University Hospitals NHS Foundation Trust (CUH) submitted the Strategic Outline Case (SOC) to NHS England, the Department for Health and Social Care, and HM Treasury on 18 February 2021.

This is a major milestone in the development of Cambridge Cancer, and represents years of hard work by clinicians, researchers, patients and the project team. The SOC sets out our vision of how the hospital will support rewriting the story of cancer, transforming outcomes for our patients regionally, nationally and internationally.

Following The Prime Minister’s announcement on the 2nd October 2020 to include the Cambridge Cancer Research Hospital as part of the HIP 2/New Hospitals Programme, CUH is now moving rapidly towards the next phase of development – submission of an Outline Business Case (approx. May 2021) and a Full Business Case (approx. July 2022) with a view to this transformative new hospital opening its doors in 2025.

Page 4 of 5 5. Learning Disabilities: Digital Flag update

The NHSE/I Reasonable Adjustment Digital Flag programme has identified Hertfordshire as a suitable ‘early adopter’ site, and the programme is being supported by the CCG. Activity to implement the project across systems has commenced. The initial task has been to identify key stakeholders. An initial meeting with the Improving Health Outcomes Group (IHOG), who work collaboratively across all health and care systems has taken place. The role of IHOG is to address the health inequalities faced by people with a learning disability. Given the groups remit their commitment to participating in the project was crucial and met with enthusiasm. It has been identified that there are 3 key groups whereby further stakeholder engagement will take place;

1) People with a learning disability (LD) and their families to identify the types of reasonable adjustments that will be required 2) Identified champions from Primary Care (LD GP Leads); Hertfordshire Partnership University NHS Foundation Trust (HPFT); Hertfordshire Community Trust (HCT); East and North Hertfordshire NHS Trust (ENHHT); West Hertfordshire Hospitals NHS Trust (WHHT); Central London Community Healthcare NHS Trust (CLCH) and HCC. This group will be required to understand the role of the flag and consider the benefits, issues and barriers to implementation and use 3) Links to key IT Leads across each system.

Initially concentrating on stakeholder feedback from groups 1 and 2, a communication plan is currently being developed and further meetings are being arranged with key stakeholders. In addition, a series of national workshops and forums to share learning across the programme are taking place and attended by the Project Lead.

6. Issues

Not Applicable.

7. Options

Not Applicable.

8. Resources implications

There are none identified.

9. Risks/Mitigation Measures

Not Applicable.

10. Recommendations

The Governing Body is asked to note the report.

11. Next Steps

Not Applicable.

Page 5 of 5 Agenda Item No: 7

Date of Meeting: 25 March 2021

Governing Body Meeting in Public

Paper Title: Governance Report

Decision or Approval Discussion Information

Report author (s): . Jas Dosanjh, Corporate Governance Manager . Leon Adeleye, Corporate Governance Manager & DPO . Nakiya Jafferji, Corporate Governance Manager Report signed off by: Alan Pond, Chief Finance Officer

Executive Summary: This paper seeks the approval of the Governing Body to some matters, as required by the Clinical Commissioning Group’s (CCG) Constitution, that have been agreed at Governing Body Workshops, including matters approved that require reporting to the Governing Body Meeting in Public for ratification; and provides information on corporate governance activities being undertaken by the CCG.

Recommendations The Governing Body is asked to: to the members: . note and ratify the decisions made at the Governing Body Workshops, . note the report and minutes from the Governance and Audit Committee, . note the report and minutes from the Primary Care Commissioning Committee, . note the report from the Joint Commissioning and Partnership Programme Committee. . note the report and minutes from the HBLICT Stakeholder Board, . note the minutes from the Locality Commissioning Committees, . note the update regarding the Declaration of Interests annual review exercise, . receive Register of Gifts, Hospitality and Sponsorship reported in 2020-21, . note the actions to be taken for the Assurance Framework and Corporate Risk Register, . note the update regarding the Annual Constitution Review, . receive the updates on governance and compliance activities.

Page 1 of 7 Conflicts of Interest There are none identified. involved:

Conflict of Interest Definitions

The following table describes the sub-classifications of interests:

Type Description Financial Interests This is where an individual may get direct financial benefits from the consequences of a commissioning decision. Non-Financial This is where an individual may obtain a non-financial professional Professional benefit from the consequences of a commissioning decision, such Interests as increasing their professional reputation or status or promoting their professional career. Non-Financial This is where an individual may benefit personally in ways which are Personal Interests not directly linked to their professional career and do not give rise to a direct financial benefit. Indirect Interests This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision.

Page 2 of 7 1. Executive Summary This paper seeks the approval of the Governing Body to some matters, as required by the Clinical Commissioning Group’s (CCG) Constitution, that have been agreed at Governing Body Workshops, including matters approved that require reporting to the Governing Body Meeting in Public for ratification; and provides information on corporate governance activities being undertaken by the CCG.

2. Background

2.1 Introduction This paper provides information on corporate governance activities being undertaken by the Clinical Commissioning Group (CCG).

2.2 Governing Body Workshops Summarised below are key discussions and actions agreed from the Governing Body Workshop meetings held virtually.

2.2.1 17 December 2020 . Approved the Long Term Conditions Strategy, . Formally noted the virtual approval of the ‘Model NHS COVID-19 Primary Care Vaccine handling and management policy 2020-21’.

2.2.2 28 January 2021 . Approved the recommendations of the Hertfordshire Medicines Management Committee on: - mandatory National Institute for Health and Care Excellence (NICE) Technology Appraisal treatments, and - for treatments not included in the NICE work programme, . Approved the ‘Memorandum of Understanding – Safe Use of Controlled Drugs’ as recommended by the Primary Care Commissioning Committee

2.2.3 25 February 2021 . Approved the recommendations in relation to the Governing Body Tenure extensions and the inclusion of an addendum with the CCG’s Constitution.

2.2.4 Governing Body Committee Meeting in Common

The Boards of East and North Hertfordshire CCG, Herts Valleys CCG and West Essex CCG met together for the first time in January 2021. An outline of what was covered and what members and Chairs of all three CCGs discussed can be found on the CCG’s website at the following link: https://www.enhertsccg.nhs.uk/governing-body-meetings-in-public

Page 3 of 7 2.3 Governance and Audit Committee Meeting Summarised below are the items of business considered by the Governance and Audit Committee meetings held virtually, the final minutes are attached as Appendix 1:

2.3.1 11 December 2020 . Quality Assurance Report . Financial Risk Update 2020/21 . Final Account Timetable and Progress . Month 9 Interim Governance Statement . Internal Audit Progress Report . Local Counter Fraud Specialist Progress Report . External Audit - BDO Current Issues - New Code and Use of Resources 2021 . IG Forum Six Monthly Report . Legal Claims Report . Internal Audit Management Actions - Approved . Governance and Audit Committee Self-Assessment . Annual Cycle of Business 2020/21

2.3.2 12 February 2021 . Waivers of Standing Orders . Internal Audit Progress Report . Audit Plan for 2021/22 - approved . Anti-Fraud and Bribery Policy review – approved, subject to the minor amendments to Appendices D and E . Detailed Financial Policies review – approved, subject to the updating of terminology suggested by the Chair . Annual Cycle of Business 2020/21

The Governing Body is asked to note the report and minutes from the Governance and Audit Committee.

2.4 Primary Care Commissioning Committee Meeting Summarised below are items of business considered and actions agreed from the Primary Care Commissioning Committee public meeting held virtually, the final minutes are attached as Appendix 2:

2.4.1 14 January 2021 . Covid-19 Primary Care Cell update . STP HWE Primary Care Strategy . 2019/20 CFF Review . Finance update . Primary Medical Care Contracts and Primary Care Networks update . Primary Care Quality Report . Update on Wise Five Project

The Governing Body is asked to formally note the report and minutes from the Primary Care Commissioning Committee.

Page 4 of 7 2.5 Joint Commissioning and Partnership Programme Committee

Summarised below are items of business considered and actions agreed from the Joint Commissioning and Partnership Programme Committee meeting:

2.5.1 25 September 2020 . Integrated Health and Care Commissioning Team update, including IHCCT Exception Report, Transforming Care Programme update, Mental Health Phase 3 submission and demand modelling, and Autism Review Phase 2, . Integrated Care Programme Team update, including Better Care Fund update, . Special Educational Needs and Disability (SEND) gap analysis update, . Updates for information, including Hertfordshire Suicide Prevention Strategy for submission to Governing Body, and Complex Needs Service (Turning Point) contract.

The Governing Body is asked to formally note the report from the Joint Commissioning and Partnership Programme Committee.

2.6 HBLICT Stakeholder Board

The items of business considered and actions agreed from the HBLICT Stakeholder Board meetings held on 12 October 2020 and 25 January 2021 are summarised in Appendix 3.

The Governing Body is asked to formally note the report and minutes from the HBL ICT Stakeholder Board.

2.7 Locality Commissioning Committees

The items of business and actions agreed from the Locality Commissioning Committee meetings are included in the approved minutes attached as Appendix 4 as listed below:

 Lower Lea Valley – 15 July 2020  North Hertfordshire – 12 February 2020, 29 July 2020  Stevenage – 10 March 2020  Stort Valley and Villages – 25 August 2020  Upper Lea Valley – 02 July 2020  Welwyn and Hatfield – 30 July 2020, 01 October 2020

The Governing Body is asked to formally note the minutes from the Locality Commissioning Committees.

Page 5 of 7 2.8 Declarations of Interest The CCG received substantial assurance in the 2020/21 Internal Audit for implementing an effective process to manage conflict of interests.

There is an on-going workstream to align processes across the three CCGs – East and North Hertfordshire, West Essex and Herts Valleys to an Integrated Care System (ICS). To this, the 2021/22 annual exercise to refresh its declaration of interests will be carried out collaboratively across the three CCGs.

The Governing Body is asked to note the arrangement in agreed across the three CCGs for the annual refresh exercise.

2.9 Register of Gifts, Hospitality and Sponsorship The Register of Gifts, Hospitality and Sponsorship reported in 2020-21 is attached as Appendix 5.

The Governing Body is asked to receive the Register of Gifts, Hospitality and Sponsorship reported in 2020-21.

2.10 Risk Management A systematic review was conducted across the three CCGs as part of the workstreams to align and harmonised processes. This includes risk management vocabularies and management tools, risk register components, strategic objectives alignment and a single summary Board Assurance Framework for all three CCGs. Part of this alignment programme is exploring the use of DatixCloudIQ – a new Enterprise Risk Management, to accommodate the management of various risk functions across the CCGs with integration and scalability.

In light of this, the CCG’s Corporate Risk Register and Assurance Framework have been deferred to May 2021, and would reflect the approach undertaken across the three CCGs.

2.10.1 Assurance Framework The Assurance Framework aims to bring together relevant information on the progress with the Governing Body’s strategic objectives, mapping key workstreams and relevant high risks. The assurances of the risk controls are reported as part of the Corporate Risk Register. The CCG reviewed the components of the Assurance Framework, for an effective examination of the sources of assurance, level and quality of assurance. To this, there is an on-going refresh exercise to use the enhanced Assurance Mapping tool implemented on Datix.

2.10.2 Corporate Risk Register The corporate risks are discussed every two months at the Risk Review Group and reviewed monthly in line with its policy. The Executive Committee received a Risk Report on 14 December 2020 about the management of corporate risks. Due to the COVID-19 NHS preparedness and response – notification of return to Incident Level 4, the focus shifted to priority risks and was reported to the Organisation, Performance and Delivery (OPD) on 02 February 2021. These are corporate risks to Strategic Objective 9 – To maintain a system of internal control and respond as required by NHS England and NHS Improvement to ensure safe and effective services for patients during the pandemic.

Page 6 of 7 The Governing Body is asked to note the risk management update and the actions to be taken for the Assurance Framework and Corporate Risk Register.

2.11 Annual Constitution Review

Recommendations in relation to the Governing Body Tenure extensions and the inclusion of an addendum with the CCG’s Constitution – at the time of drafting this entry, the proposed addendum is currently with NHS England & Improvement for approval. This will not amend the Constitution, but sit alongside the document. Given release of the White Paper, and developing position regarding CCGs, no change to the CCGs Constitution is being proposed at this point.

The Governing Body is asked to note the update regarding the Annual Constitution Review.

3. Issues Not Applicable.

4. Options Not Applicable.

5. Resources implications Not Applicable.

6. Risks/Mitigation Measures Not Applicable.

7. Recommendations The Governing Body is asked to: . note and ratify the decisions made at the Governing Body Workshops, . note the report and minutes from the Governance and Audit Committee, . note the report and minutes from the Primary Care Commissioning Committee, . note the report from the Joint Commissioning and Partnership Programme Committee. . note the report and minutes from the HBLICT Stakeholder Board, . note the minutes from the Locality Commissioning Committees, . note the update regarding the Declaration of Interests annual review exercise, . receive Register of Gifts, Hospitality and Sponsorship reported in 2020-21, . note the actions to be taken for the Assurance Framework and Corporate Risk Register, . note the update regarding the Annual Constitution Review, . receive the updates on governance and compliance activities.

8. Next Steps Not Applicable.

Page 7 of 7 Appendix 1

Governance and Audit Committee Friday 11 December 2020 10:00 - 12:30, WebEx MINUTES

Present:

Linda Farrant [LF] Chair of Governance & Audit Committee Alison Gardner [AG] Lay Member, Public and Patient Engagement Ashish Shah [AS] Deputy Clinical Chair, GP lead, Prescribing Lead

In Attendance:

Leon Adeleye [LA] Corporate Governance Manager Sunday Adeniyi [SA] Deputy Chief Finance Officer Lisa Clampin [LC] BDO Audit Partner, Head of Public Sector Assurance Rosie Connolly [RC] Acting Associate Director of Quality Improvement Sarah Howe [SH] RSM Internal Audit, Client Manager Nakiya Jafferji [NJ] Corporate Governance Manager Tracey Middleton [TM] Minute Taker Alan Pond [AP] Chief Finance Officer Satbinder Sanghera [SS] Interim Strategic Governance Lead Bradley Vaughan [BV] RSM Counter Fraud, Manager Item Subject Action by

1. WELCOME AND APOLOGIES FOR ABSENCE

The meeting opened at 10.00

The Chair welcomed all to the meeting, especially SA and SS attending the meeting for the first time. There were no apologies, and the Chair declared that the meeting is quorate.

2. DECLARATIONS OF INTERESTS

The Chair invited committee members to confirm the accuracy of their declarations on the Register of Interests and advise whether they have new interests to declare. To which, all confirmed that their records were accurate and had nothing new to declare.

Page 1 of 8 Attendees were invited to declare any interest relating to the matters on the Agenda. To which, all confirmed that they had no declarations about matters on the Agenda.

3. MINUTES OF PREVIOUS MEETING AND MATTERS ARISING

The Minutes of the previous meeting held on 18 September 2020, were approved as an accurate record.

4. COMMITTEE ACTION TRACKER

The Action Tracker was reviewed by the Committee and it was agreed that all actions are closed.

The Committee noted the Action Tracker.

5. QUALITY ASSURANCE REPORT

The Acting Associate Director - Quality Improvement introduced the Quality Assurance Report, circulated in advance.

1. The Committee was advised that the Quality Committee (QC) met on the 17 September 2020 and reviewed matters pertinent to its delegated authority as defined within its Terms of Reference 2. Key risks and recommendations to be drawn to the attention of the Governing Body were detailed in the Report 3. Identified risks and details of risk mitigation were outlined for each provider organisation 4. The current pandemic and national vaccination programme are affecting all provider services. 5. Concerns identified from the ongoing review of East & North Herts NHS Trust - Organisational Risk Rating: Continues to be Red 6. Assurance regarding progress has been secured. Two never events have been reported and no harm to patients 7. Strategies to address targets were challenged, and the detailed steps to address Venous Thromboembolism (VTE) were outlined with March being the time frame to meet compliance. Sepsis requires similar actions depending on the medical setting (Emergency Department and Inpatient) 8. Concerns identified for Princess Alexandra Hospital Trust from the ongoing review - Organisational Risk Rating: Amber 9. Main issues are regarding the management of COVID outbreaks and impact of isolating staff. Assurance was provided that learning is being shared. Good progress is being made with the Care Quality Commission (CQC) actions 10. Challenges in maternity are being supported, including an external review and regular updates being provided

Page 2 of 8 (Outstanding rating to Requires Improvement rating over a two- year period). 11. The Trust recognises that leadership capacity following their previous Outstanding rating for maternity was spread too thinly across the operation which has been rectified 12. The follow-up review in relation to glaucoma patients was outlined, and the Committee was assured that learning had been shared with other specialities and an executive scrutiny panel was held. 13. Concerns identified from the on-going review of Hertfordshire Community NHS Trust - Organisational Risk Rating: Amber 14. Concerns identified from the on-going review of Barnet and Chase Farm Hospital (Royal Free Foundation Trust) - Organisational Risk Rating: Amber 15. Concerns identified from the on-going review of Hertfordshire Partnership Foundation Trust - Organisational Risk Rating: Green 16. Concerns identified from the on-going review of East of England Ambulance Trust - Organisational Risk Rating: Amber 17. The Committee noted the drop in the rating and that the CQC inspection has raised concerns with lack of progress. The Trust is in Special Measures and an Action Plan and significant support are in place 18. COVID-19, winter challenges and quality and safety concerns are impacting on outcomes – the host commissioner is Suffolk CCG, which will lead the region and regular updates will be provided. The next Report will reflect a red rating 19. Concerns identified from the on-going review of Ramsay, Pinehill Hospital - Organisational Risk Rating: Amber 20. Learning Disability Mortality Review (LeDeR) Deep Dive, Maternity Update, Infection Prevention and Control Annual Report 2019/20, Adult Safeguarding Annual Report 2019/20 were all noted.

The Committee noted the Quality Assurance Report.

RC left the meeting at 10.29

6. FINANCE

The Chief Finance Officer introduced the reports, circulated in advance of the meeting.

1. The relationship across the Integrated Care System (ICS) and impact of block contracts was debated at length, and it was noted that the system is working together 2. The impact of the national Covid pandemic and patients not accessing routine services was outlined. Occupancy levels became lower. Occupancy levels would have impacted on costs if it had not been a block contract. Designing services to address reducing risk, ensuring patient care and achieving the best value have been the priority. The impact on the next financial year was debated – increase in referrals from Primary Care and on-going

Page 3 of 8 patients currently in Secondary Care system. The resource to reduce waiting lists will be provided however the capacity to deliver will be challenging and the impact on Primary Care is acknowledged 3. The differences in the provision, approach taken, and charges of national Enhanced Services were discussed, and it was noted that local community and demographic requirements would be considered during the standardisation

Financial Risk Update 2020/21

1. The Report noted that for the second half of the year, the financial regime has changed with the CCG being issued a fixed allocation within which to manage all expenditure. 2. The CCG has submitted a financial plan for Months 7-12 to NHSE which will deliver a balanced financial position provided all published allocations are received. 3. The Committee noted the identified risks

Waivers of Standing Orders

1. The Committee noted that there was none to report

Financial Accounts Timetable and Progress

1. The Report noted that the “Annual Accounts Timetable” has not been issued by NHS England. We have no notified accounting policy changes to 2020/21 Annual Accounts. A draft “Final Accounts Timetable” will be issued in the first week of January 2021. IFRS 16 Leases (International Financial Reporting Standard) has been pushed back across the entire public sector. 2. The Chair thanked the authors of the Report

The Committee noted the finance updates.

7. MONTH 9 INTERIM GOVERNANCE STATEMENT

The Interim Strategic Governance Lead updated the Committee about the CCG mergers with a view on the Integrated Care System (ICS) paper from NHS England and Improvement (NHSE/I).

1. It was noted that, of the two options presented in the paper by NHSE/I, option 2 was encouraged – the creation of the ICS and all the commissioning functions of the CCG would be carried out through the ICS structure. 2. The expectation is for the CCG mergers to continue, and proposals are being developed to support merger and align governance structures, e.g., joint committees, committees in common 3. There has been board level engagement, and the conversation is being extended to member practices, PCNs (Primary Care

Page 4 of 8 Networks), LMCs (Local Medical Committees), and working with Lay Members to provide a challenge in relation to the governance arrangements 4. Response to the NHSE/I proposal is due by 8 January 2021, and the draft response would be ready for comments a few days before the response is submitted to NHSE/I 5. The Committee welcomed the coordination and leadership 6. The reality of the engagement and options were challenged and debated 7. It was noted that the CCG is expected to produce a month 9 governance statement for NHSE/I

The Committee noted the Report.

8. INTERNAL AUDIT

The RSM Internal Audit, Client Manager introduced the Progress Report, circulated in advance of the meeting.

1. The progress report provided an update on the delivery of the Internal Audit Plan. In line with the revised plan due to the impact of COVID-19 on the CCG reported to the May 2020 Governance and Audit Committee, the majority of the plan commenced in quarter three 2. The one final Report in relation to Provider Quality Assurance, which received Substantial Assurance, has been issued 3. The following audits are currently in progress:  Delivery of Local Digital Roadmap  Key Financial Controls and Payroll  Operational Resilience  Primary Care Networks  Primary Care Delegated Commissioning 4. The Committee acknowledged the progress made to date on the audits 5. Clarification was provided that the delay in the Governance Review was not due to COVID-19, but rather the upcomimg governance changes this year 6. The Committee gained the assurance and confirmation was given that continuing health care assessments have been recommenced nationally in two schemes

The Committee noted the Report.

9. LOCAL COUNTER FRAUD SPECIALIST PROGRESS REPORT

The RSM Counter Fraud, Manager introduced the Report, circulated in advance of the meeting.

1. The ‘LCFS work plan for 2020/2021’ was approved by the Audit Committee on 13 March 2020. This Report provided an update in respect of counter fraud work undertaken at the CCG and

Page 5 of 8 covers the reporting period 1 April 2020 to 24 November 2020 covering both proactive work as agreed in the annual work plan and any reactive investigation work 2. The Benchmarking Report will be circulated to the CCG and questions are invited by email 3. The interactive webinars have been attended and well-received 4. The fraud by false representation was clarified as being the Third-Party Commissioning team. The issue was explained, and it was agreed that a different approach to the investigation is taken with the Care Agency 5. ACTION: Letter to be drafted by BV and sent to AP to send BV to the provider

The Committee noted the Report. The meeting adjourned at 11.26 -11.35

10. EXTERNAL AUDIT

The BDO Audit Partner introduced the BDO Current Issues - New Code and Use of Resources 2021, circulated in advance of the meeting.

1. The Committee noted the National Audit Office (NAO) has issued a new Code of Audit Practice (the Code) to take effect from 15 October 2020 and is, therefore, relevant to the CCG’s 2020/21 audit 2. Assurance was provided that the time frame can be met 3. The Auditor noted that the CCG has an effective Audit Committee and good practice is demonstrated

The Committee noted the Report.

11. IG FORUM SIX MONTHLY REPORT

The Chief Finance Officer introduced the Report, circulated in advance of the meeting.

1. The paper provided the Committee with a review of the activities of the Information Governance Forum for the first six months of 2020/21 including: 2. A progress update against the consolidated Caldicott Guardian and Information Governance (IG) Work Plan for 2020/21 3. Latest update for the CCG Data Security and Protection Toolkit (DSPT) submission for 2019/20 and 2020/21 4. A review of personal data breaches and incident management undertaken by the CCG for the first six months of 2020/21 5. A summary of Freedom of Information (FoI) requests received during the first six months of 2020/21 was provided 7. An update on IG Training 8. Colleagues debated mitigating risks around policy review. Assurance was provided that the policies that have been reviewed have required minor changes 9. Homeworking has increased and required a focus on

Page 6 of 8 cybersecurity; Charter House is Covid secure and open to colleagues to work to address confidentiality concerns from multi-occupancy in households 10. The Committee acknowledged that a great deal of work had been done in this area 11. The Data Security and Protection toolkit will be commenced in January which will provide additional assurance

The Committee noted the Report.

12. LEGAL CLAIMS REPORT

The Corporate Governance Manager introduced the Report which was circulated in advance of the meeting.

1. An outline of the legal position for 2020 and an overview and log of legal cases for NHS East and North Hertfordshire Clinical Commissioning Group (ENHCCG) was provided 2. The following points were questioned - Paragraph 2.1 and 2.2 contributions was clarified; 2.4 refers to the policy being updated and the impact of Covid on patient discharge from hospital

The Committee noted the Report.

13. AUDIT RECOMMENDATIONS TRACKER

The Corporate Governance Manager introduced the Report which was circulated in advance of the meeting.

1. The recommendations were considered, and it was noted that the open historic ones had been carried forward again. 2. ACTION: To contact the audit sponsors with a view to establishing if sufficient progress has been made to close LA the outstanding actions or whether they have been superseded for continuing health care and personal health budget. 3. Assurance was provided that collaborating with other CCGs is taking place and Personal Health Budgets could be driven as a separate project across the 3 CCGs with dedicated time and support 4. The participation and engagement outstanding actions were discussed, and it was noted that a recent new assessment has been undertaken by NHSE/I resulting in a Green Star Plus 5. ACTION: To contact the audit sponsor with a view to LA closing the outstanding participation and engagement actions if they have been superseded by the new assessment.

The Committee noted and approved the tracker.

Page 7 of 8 14. GOVERNANCE AND AUDIT COMMITTEE

The Chair introduced the report, which was circulated in advance of the meeting.

1. Members and attendees of the Committee self-evaluated on their effectiveness and considered the questions set out in the questionnaire 2. It was agreed that standardisation of policies would be helpful in maximising synergies and effective governance across the 3 organisations 3. The current Governance and Audit Committee allows for better quality and purposeful discussions around governance and risk, and it was agreed that the Terms of Reference are effective. The agenda is well planned, timed and facilitated to allow for a depth of discussion. The expectation for preparation and contribution is clear 4. Committee agreed that the Assurance Mapping was very useful to understand the quality and level of assurance received against risk controls 5. ACTION: To bring the Assurance Mapping to the Committee’s meeting in March 2021 LA

The Committee noted the report.

15. ANNUAL CYCLE OF BUSINESS

The Chair introduced the Annual Cycle of Business for 2020/21, which was circulated in advance.

The Committee approved the Annual Cycle of Business 2020/21.

16. ANY OTHER BUSINESS

None

17. DATE OF NEXT MEETING:

Friday 12 February 2021 10:00am - 12:30pm Virtual Meeting The meeting closed at 12.30

Page 8 of 8 Governance and Audit Committee Friday, 12 February 2021 10:00 – 11.30, MS Teams MINUTES Present:

Linda Farrant [LF] Lay-member for Governance and Audit [Chair]

Alison Gardner [AG] Lay-member, Public and Patient Engagement Ashish Shah [AS] Deputy Clinical Chair, GP lead, Prescribing Lead

In Attendance:

Leon Adeleye [LA] Corporate Governance Manager & Data Protection Officer Lisa Clampin [LC] BDO Audit Partner, Head of Public Sector Assurance Sarah Howe [SH] RSM Internal Audit, Client Manager Clive Makombera [CM] Risk Assurance Director, RSM Tracey Norris [TN] Minute Taker Alan Pond [AP] Chief Finance Officer

Item Subject Action by

1. WELCOME AND APOLOGIES FOR ABSENCE

1. The Chair welcomed all to the meeting. There were no apologies. 2. The Chair declared that the meeting was quorate

2. DECLARATIONS OF INTERESTS

1. The Chair invited the members to reconfirm their current declarations on the Register of Interests and advised of any new declarations 2. All members confirmed that their declarations were accurate and up-to-date 3. The Chair invited members to declare any interest relating to matters on the Agenda. All members confirmed that they have no declarations of interest concerning matters on the Agenda

3. MINUTES OF PREVIOUS MEETING AND MATTERS ARISING

Page 1 of 7 Item Subject Action by 1. The Minutes of the meeting held on 11 December 2020 were approved as an accurate record of the meeting.

4. COMMITTEE ACTION TRACKER

1. The contents of the Action Tracker were discussed, and the following actions were agreed to be closed:  Action: 20/21-13  Action: 20/21-14 2. It was noted that the updates provided for each of these actions needed to be transposed 3. The following updates were provided:  Action: 20/21-12 is outstanding, and a draft letter would be prepared by March  Action: 20/21-15 should remain open. The Chair discussed the need to reduce the administrative burden on staff across the CCG and agreed that this matter should be deferred until May 4. ACTION: to be updated to reflect the updates LA

The Committee noted the Action Tracker.

5. FINANCE UPDATE

The Chief Finance Officer introduced the reports, circulated in advance of the meeting.

5.1 Waivers of Standing Orders

1. The Committee gained assurance that the CCG is happy with the service provided by BDO 2. The feedback from the finance team was positive 3. Due to the anticipated structural changes of the CCG, there was little value in beginning a procurement process for new auditors 4. The proposal was to extend the current contract by two years 5. Clarification was provided on the values given; these were annual 6. The mental health investment standard was a one-year cost; the 2019/20 audit is being completed and would be published by 28 February 2021. 7. The Chair had attended a BDO technical workshop on 11 February 2021 and queried whether the proposed costs included the additional technical resources that might be required for the new use of resources. 8. Confirmation was provided that any changes in scope which might result in additional specialist input would need to be negotiated at the time.

Page 2 of 7 Item Subject Action by 9. The Chair queried whether there was a waiver for the extension of the RSM contract 10. It was agreed that a waiver would be prepared for 2021/22 and that there is a standing letter of engagement in place, providing adequate assurances around internal audit arrangements. This includes Counter Fraud Services. 11. ACTION: to put in place a waiver for RSM extension for AP 2021/22

The Committee noted the proposal to extend the contract of the external audit service by two years.

6. INTERNAL AUDIT

The Client Manager introduced the Progress Report, and the Risk Assurance Director introduced the Audit Plan for 2021/22 circulated in advance of the meeting.

6.1 Internal Audit Progress Report:

1. The following final reports were issued with positive assurance:  Delivery of Local Digital Roadmap  Conflicts of interest  Delegated Primary Care Commissioning (Finance Function) 2. Draft reports have been issued for Primary Care Networks, and there is progress with Key Financial Controls and Risk Management 3. Two audits are remaining on the 2020/21 Plan, and a follow-up audit review to commence the following week 4. The Data Protection and Security Toolkit has a later start date because the national deadline has been extended 5. The Committee discussed the reasonable assurance issued with the Delivery of Local Digital Roadmap. The medium action was about ensuring that there is a formal digital strategy in place and low action about ensuring that the Asset Register is updated 6. The Conflicts of interest was issued with substantial assurance with one low management action around the annual refresh. The CCG is compliant with national guidance for decision-making staff, and the action is to ensure that there is a consistency of process for staff with lower Agenda for Change bandings 7. The Delegated Primary Care Commissioning (Finance Function) was issued with substantial assurance with no actions. 8. The Committee gained assurance around the physical assets with GP surgeries as a result of COVID to ensure information security:  The ownership of assets: all devices in GP surgeries belonged to NHS England. The purchase, replacement and management of these devices are by CCGs, which HBLICT

Page 3 of 7 Item Subject Action by Shared Services is responsible for on behalf of the CCGs  The CCG policy does not capitalise on assets within the CCGs - individual laptops or PCs with a value below £5,000. However, these devices have value and need to be tracked, and information stored on them need to be secure 9. The HBLICT Shared Services maintains a register of all these devices and the software installed on them. As well as produce returns annually to the likes of Microsoft. This also ensures compliance with the software licence and terms and conditions 10. It was agreed that asset tags and serial numbers on devices on individual devices would address the low management action on the Delivery of Local Digital Roadmap audit. 11. The Chair was encouraged by the positive audit outcomes and commended LA around the conflict of interest outcome but questioned the necessity of the action identified for declarations of interest; if all staff members with decision-making responsibilities were compliant with national guidelines on declarations 12. The explanation provided was that there is a robust process in place for decision-makers as found during the audit; however, the action relates to junior staff members, particularly with Continuing Healthcare, who might have input in the decision-making process, potentially exposing the CCG to residual risk 13. It was noted that the CCG’s approach was that declarations were by exception and grades below Band 8D were not a requirement, i.e., declaration of interests was to be made upon appointment and at any change in circumstances. The CCG then went further to carry out an annual refresh to remind staff to reconfirm their declaration, thereby capturing changes that might have been omitted. This is over and above the requirement in the statutory guidance, which should be accepted. 14. It was suggested that, in light of audit action, staff could be targeted differently by requesting heads of department to identify who within their team may be required to make decisions to be included in the positive request for conflict of interests 15. Clarification was provided that the audit had received the highest assurance and that the action identified is a minor point of housekeeping to avoid potential risk. 16. The Chair was assured that there were no issues with the CCG’s current process; therefore, no change is required and noted that LA had agreed to the recommendation and would target a section of staff who might have more influence as suggested by AP

6.2 Audit Plans for 2021/22

1. The Committee noted that the plan had drawn following consultation with various stakeholders, including the Chair, Chief Finance Officer and the Executive Team for input in the process 2. The audit plans are driven by the COVID challenge and CCGs format in the future, i.e., structure, management, and business as

Page 4 of 7 Item Subject Action by usual 3. The Operational Resilience audit was queried as it was initially on the 2020/21 plan, deferred to 2021/22, which has been invoiced 4. It was confirmed that the CCG would not be charged twice for this audit 5. The Chair felt the plan was comprehensive but questioned whether it was necessary to have another full audit of conflicts of interest. This area has received substantive assurances for the last two years, therefore to consider the merits of a light touch audit and re-align resources 6. CM suggested that it was likely that the absorption of the CCG into the ICS would create new relationships which were not currently covered in the existing declarations of conflicts, and the audit would focus more on what was needed in the future. The emerging risk would be on new relationships and arrangements. The 2021/22 audit would not be backwards-looking 7. The use of internal audit for providing assurance on the use of resources would be critical moving forward 8. The Chair thanked RSM staff for their adaptability during the last 12 months

The Committee noted the Internal Audit Progress Report and approved the Audit Plan for 2021/22.

7. POLICIES AND PROCEDURES

The Chief Finance Officer introduced the policies, circulated in advance of the meeting.

7.1. Anti-Fraud Policy

1. The Committee noted that the policies had been reviewed by Becky Goodchild (counter fraud specialist), and he noted the Committee’s thanks for the quick turnaround of this policy. 2. There were no material changes to the policy 3. The Committee debated the merits of each of the three CCGs using the same policy 4. It was agreed that any work on standardising policies should be delayed until ICS boundaries had been confirmed 5. It was noted that Appendices D and E of this policy required a date change 6. ACTION: to update appendices D and E of the Anti-Fraud BG Policy

7.2 Detailed Financial Policies

7. The detailed financial policies have been reviewed, and proposed

Page 5 of 7 Item Subject Action by changes were tracked 8. The main change has been to add authorisation limits for continuing health care placements and increase the value that can be authorised from within the team 9. Many of these policies were enshrined in the CCG’s constitution. 10. The Chair noted that there was some inconsistently in the terminology used in the policies, for example: 11. NHS Protect rather than NHS Counter Fraud 12. ‘Manpower’ rather than the workforce 13. Commissioning Plan rather than strategic and operational plans 14. The main changes were noted on page 20, paragraph 13.12. re continuing health care placements 15. The Committee was assured that the appropriate members of staff were aware of these decision-making thresholds: 16. Up to £1,500 per week: clinical and operational leads made a joint decision 17. Above £2,000 per week: Continuing Healthcare Director (i.e., whichever Director with Continuing Healthcare in their portfolio) 18. Above £5,000 per week: Chief Financial Officer Chair 19. ACTION:Chair to send her track changed version of the Detailed Financial Policies to LA AP 20. ACTION: to circulate the final draft of the Detailed Financial Policies to the Chair.

The Committee approved the Anti-Fraud Policy, subject to the minor amendments to Appendices D and E. It approved the Detailed Financial Policies subject to the updating of terminology suggested by the Chair.

8 ANNUAL CYCLE OF BUSINESS UPDATE

The Chair introduced the draft Annual Cycle of Business 2020/21, and the following were raised in discussion:

1. The corporate risk register and assurance framework have been deferred to May 2021 2. Members debated the necessity of a full effectiveness review of Internal Audit with only one year remaining. 3. It was agreed that a light touch approach would be undertaken with the Chair seeking views from staff and committee members who had had regular interactions with Internal Auditors and prepare a brief report for the March Committee. 4. The Raising Concerns (Whistleblowing) Policy would be brought to the March meeting. It was noted that the policy would be reviewed at the Policy Forum by the HR business partner 5. ACTION: To seek feedback concerning Internal Audit Chair Effectiveness and report to the March meeting

The Committee approved the Annual Cycle of Business.

Page 6 of 7 Item Subject Action by

9 ANY OTHER BUSINESS

1. LC confirmed that the following members of the BDO audit team for this year, while the substantive audit manager was on maternity leave, are:  Audit Manager: Kirsty Slater  Audit Senior: Gerald Chanduru 2. AP sought assurance that the mental health audit would be completed on time (deadline 28 February). 3. A discussion was held on the timing of the finalisation of the BDO audit report to the Audit Committee and the Governing Body meetings 4. The meeting deadlines were confirmed as:  Governance and Audit Committee meeting: 21 May 2021. This had already been moved from 14 May 2021  Governing Body Meeting: 27 May 2021  Annual report publication: 15 June 2021 5. LC expressed her best endeavours to meet these deadlines but noted that BDO was experiencing difficulties in resources and were facing challenges in maintaining timetables during this time. The local government audits have overrun, which might have a knock-on impact 6. It was agreed that the Committee members would hold 10 June 2021 as a further backup meeting date. LA would block this time out (CM and SH would not be required for this meeting) 7. ACTION: to book in a reserve meeting date of 10 June at 9am LA for the Committee to receive BDO’s final audit report if necessary.

10 DATE OF NEXT MEETING

Friday, 12 March 2021 09:00 – 11:30 (please note earlier start time). Virtual meeting

Page 7 of 7 Appendix 2

Primary Care Commissioning Committee Public Meeting Thursday 14th January 2021: 09:00 – 11.00 Via Webex Present: Fahim Chowdhury [FC] Independent GP Dianne Desmulie [DD] Chair, Lay Member for Primary Care Commissioning Sharn Elton [SE] Managing Director Linda Farrant [LF] Lay Member, Governance and Audit Alison Gardener [AG] Lay Member, Public and Patient Engagement Russell Hall [RH] GP Lead, Stevenage Jane Kinniburgh [JK] Director of Nursing and Quality Alan Pond [AP] Chief Finance Officer Avni Shah [AS] Director of Primary Care Transformation Ashish Shah [SH] GP Lead, Welwyn Hatfield Rupal Shah [RH] GP Lead, Upper Lea Valley

In Attendance: Cathy Calione [CG] Senior Contracts Manager Ozlem Cholak [OC] Head of Primary Care and Community Contracts Lynn Dalton [LD] Director of Primary Care Commissioning & Contracting Sue Fogden [SFo] Assistant Director – Premises Veronica Fraser [VF] Patient Representative James Gleed [JG] Associate Director of Commissioning Primary Care Nakiya Jafferji [NJ] Corporate Governance Manager Tracey Middleton [TM] Governing Body Clerk Michael Taylor [MT] Healthwatch, Hertfordshire Andrew Tarry [AT] Head of Primary Care Development Kelly Young [KY] Primary Care Quality Manager Renna Bharania [RB] Programme Manager – Planned Care Phil O’Meara Senior Finance Manager Nicky Williams Bedfordshire & Hertfordshire Local Medical Committee Phil Turnock Chief Digital Officer Mark Sandler [MS] Wise 5 Clinical Lead - ICS Training Hub team Gerry Moir Associate Director Primary Care Support Robin Christie [RC] Clinical Lead, ENHCCG Training Hub Richard Freeman [RF] Primary Care Workforce Programme Manager

1 | P a g e Stacey Golding [SG] Lead Pharmaceutical Advisor Julia Taddeo [JT] Graduate – Programme Manager Apologies received: Tara Belcher [TB] PCN Clinical Director representative Rosie Connolly [RC] Acting Associate Director- Quality Improvement Holly Fairhurst [HF] Assistant Director of Contracts

2 | P a g e MINUTES Subject Action by

1. WELCOME AND APOLOGIES FOR ABSENCE The meeting opened at: 09.00am. The Chair welcomed all to the meeting in particular Avni Shah and Lynn Dalton to the Committee.

Apologies were received as above.

The agenda order will be organised according to attendance.

The Chair declared that the meeting was quorate.

2. DECLARATIONS OF INTERESTS

The Chair invited the members to reconfirm their current declarations on the Register of Interests and to advise of any new declarations.

All members confirmed their declarations were accurate and up-to-date with the following update. RS is the Prescribing Lead for Upper Lea Valley.

The Chair invited members to declare any declarations relating to matters on the Agenda. None were declared.

ACTION: Declaration form to be sent to RS to update and register NJ to be updated accordingly

3. MINUTES OF PREVIOUS MEETING AND MATTERS ARISING

The Minutes of the meeting held on 05 November 2020 were approved as an accurate record

4. ACTION TRACKER

The contents of the Action Tracker which had been circulated in advance of the meeting were reviewed.

The following items were agreed to be closed

. Item 85

ACTION: Action Tracker to be updated accordingly NJ

3 | P a g e Subject Action by

8. PRIMARY CARE DEVOLVED COMMISSIONING FINANCE REPORT MONTH 8 2020/21

The Chief Finance Officer introduced the report which had been circulated in advance of the meeting.

1. The paper provided details of the Primary Care Devolved Commissioning finance position at the end of November 2020 2. In response to COVID-19, NHSE/I put in place a temporary financial regime for the first half of the year and a revised framework has been implemented for the second half of the year. For the period October to March 20/21 an allocation of £39.198m was provided for Primary Care Devolved Commissioning. This brings the total baseline allocation for the year 2020/21 to £77.297m. An additional non-recurrent allocation of £531k has been received to date bringing total funding available for the year to £77.828m. 3. Effectively, the CCG Devolved Commissioning allocation has been reduced in 2020/21 by £1.099m compared to the originally published allocation because it is based on 2019/20 April to February expenditure. The potential financial risk relates to increase expenditure due to increase funding and roles from 2019/20 to 2020/21 that is more than allowed for by NHSE/I regarding PCN Additional Roles Reimbursement Scheme. 4. As at the end of November 2020, Primary Care Devolved Commissioning reported an overspend of £147k largely due to provision of additional funding to support the flu campaign. 5. A question was raised around whether the NHSE allocation will be provided. The process of reimbursement for the first 6 months was explained. The core budget spend was less as there were fewer additional roles in PCNs in place

The Committee noted the month 8 position.

9. OVERVIEW OF PRIMARY MEDICAL CARE CONTRACTS AND PRIMARY CARE NETWORKS

The Head of Primary Care and Community Contracts introduced the report which had been circulated in advance of the meeting.

1. The paper provided an update on list closures, APMS contracts, contract changes, primary care networks and other contractual items for practices in East and North Hertfordshire. 2. Sollershott and Spring House Surgeries APMS contracts were set up for an initial 3 years with the option to extend for a further 2 years. The Spring House Surgery contract has been

4 | P a g e Subject Action by extended for the two-year period, as mutually agreed by ENHCCG and Spring House Surgery. 3. The Limes was an initial two-year contract with the option to extend for 2 years and then a further 1 year. ENHCCG agreed to extend this contract for the 2 years.

The Committee approved the report.

5. COVID-19 – PRIMARY CARE CELL UPDATE

The Associate Director Commissioning Primary Care introduced the report which had been circulated in advance of the meeting.

1. The paper summarised the key workstreams of the Primary Care Cell and updates on key activity since the last PCCC paper; Communications; Contracts and Finance; 111 Direct Booking; PCN updates; SOP/Pathways; IT; Shielded Patient List; Infection Protection and Control 2. Key actions included: 3. Review of general practice patient messaging, practice websites and telephone messaging, to ensure this is as clear as possible. 4. General Practice COVID-19 Capacity Expansion Fund, specific monitoring is not required but some aspects of this require further CCG input, notably the establishment of the simple COVID-19 oximetry@home model. 5. Ensure that all practices provide confirmation of the acceptance of the QOF protected income plan. 6. Review weekly Direct Booking data report and work with any practices where issues are highlighted. 7. Work with HCT and PCNs to support/facilitate full delivery of the EHCH service, including effective mobilisation of the community element of the specification. 8. Work with PCNs once the national PCN Dashboard is launched to enable PCNs to maximise performance under the Investment and Impact Fund (IIF). 9. Further review PCN winter respiratory/hot site plans to ensure sufficient and appropriate capacity is available to effectively deal with COVID-19 suspected patients. 10. Liaise with Clinical Directors to develop a potential approach to implement General Practice Pressure Reporting. 11. Work with practices to gain assurance of appropriate review of children and young people on the practice’s Shielding Patient List. 12. Continue to support practices in increasing the utilisation of online consultation technology for patient benefit and as appropriate to patient need.

5 | P a g e Subject Action by 13. Colleagues were thanked for the comprehensive paper

The Committee noted the update.

6. STP HWE PRIMARY CARE STRATEGY

The Director of Primary Care Transformation gave a verbal update.

1. A refresh of the strategy is being undertaken informed by learning from the pandemic period, achievements to date and feedback from stakeholders 2. The plan will be circulated in due course 3. It is planned that this will outline the strategic ICS direction for General Practice and the wider Primary Care scope in order to provide a strategic framework and become embedded in local plans

The Committee noted the update.

7. 2019-20 CFF REPORT

The Programme Manager – Planned Care and Graduate Project Manager introduced the report which had been circulated in advance of the meeting.

1. The paper detailed that the Consolidated Funding Framework (CFF) is an investment of nearly £6m into primary care and general practice by the CCG. Its main objective is to give primary care additional capacity to operate in an integrated and collaborative way in order to address health needs within the local population and to progress CCG priorities. The CFF has been developed jointly by the CCG’s PMO team and clinical leads, with each element having a clinical basis and shown with strong evidence to improve patient care/outcomes. While the CFF has been in place since 2017, this review marks the first formal evaluation of the metrics. The analysis shows that some of the CFF metrics have had a positive impact on patient outcomes, in particular non-elective hospital admissions. However, for other metrics we could not conclusively determine benefit without more data. To provide a comprehensive analysis in future, several things are required (1) proper coding and standardised data entry to understand patient needs and the care delivered; (2) the ability to identify the point in time when a patient received an intervention to enable time/event analysis; and (3) the embedding of evaluation at the very start of each metric to facilitate data collection. The anticipation is

6 | P a g e Subject Action by that as the data systems develop within ENHCCG, we will be better placed to understand through outcomes monitoring the links between the populations of interest, the care they receive and the impact this is having. 2. The analysis undertaken was acknowledged. Further debate included: The financial allocations demonstrate that 25% of the activity is undertaken in March. Care planning was not conclusive in terms of effectiveness due to the lack of information. The collection of the data at an individual level is resource intensive and the value of this was challenged 3. A question was raised as to what will make a difference and how can value for money be assured by practices. The lack of value of the CFF by practices is acknowledged hence the work undertaken. Ardens should be able to support this in next year’s CFF. Each metric and how it is spent can be considered next year however the calculations this year were based on last year 4. Long term conditions and population management were noted for planning. An overview of the patient assessment and implementation of the universal model will also provide a framework 5. Assurance was given that the impact of the reporting is being considered to ensure that managing our patients is optimised 6. Thanks were extended to colleagues for the work undertaken to date

The Committee noted the update and supported the case for embedding data collection and evaluation at the start of CGG activity.

10. PRIMARY CARE QUALITY REPORT

The Primary Care Quality Manager introduced the report which had been circulated in advance of the meeting.

1. The report reviewed the latest information available for a number of quality indicators relating to GP Practices in ENHCCG, it highlighted the themes identified through the Care Quality Commission (CQC) visits that have already taken place to ENHCCG practices and outlined some of the actions taken to support practices to address these. 2. The national Primary Care questionnaire will be undertaken this year

The Committee noted the report. The Committee noted the current CQC updates. The Committee supported the course of action proposed for supporting the CQC rated ‘Requires Improvement’ practice and CQC rated Extended Access services.

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11. WISE FIVE PROJECT

1. It was noted that the project feeds into the workforce programme and retired GPs have returned to support the vaccine roll out and building on this is under consideration in terms of securing the support required at the appropriate time 2. The value of retaining the experience of retired GPs was acknowledged and it was noted that engagement of locums who provide a valuable service would be welcomed 3. Assurance was provided that there is a strong group of Locums engaging with the LMC and webinars are taking place to maximise opportunities for engagement

The Committee noted the report.

12. ANNUAL CYCLE OF BUSINESS

The Committee noted the annual cycle of business.

13. QUESTIONS FROM MEMBERS OF THE PUBLIC

There were no members of public in attendance

14. ANY OTHER BUSINESS

1. None

15. DATE OF NEXT MEETING

Thursday 18 March 2021 at 9am – 11am

The meeting closed at:10.00

8 | P a g e Appendix 3

Committees-in-Common - Summary of the HBL Stakeholder Board

Date: 5th March 2021 Action Required: For Information

Detailed below are the summarised headlines and outputs of the quarterly HBL Stakeholder Boards for October 2020 and January 2021. The minutes from the January Board are still in draft and will be approved at the next scheduled Stakeholder Board in April 2021.

HBL Stakeholder Board – 12th October 2020

All member organisations were represented at the Board.

1. Minutes from Stakeholder Board on 20th July were approved

2. HBL Finance Report for periods 5 & 6 - Presented and recorded by the Board

3. Activity Based Costing – The Board agreed to move towards an ABC costing methodology, but this would be delayed until the start of the new fiscal year. HBL to provide a service charges paper detailing the prosed service charges for 2021/22.

4. HBL Service Performance Report Sept– Presented and discussed. The Board agreed that the overall performance of HBL was good and very supportive towards the digital aspirations of the member organisations in their responses to COVID19.

5. Network Refresh Options Paper – Options paper presented and the recommendation to migrate to an SDWAN network solution was agreed by all member organisations. Funding from HCT & HPFT will be sourced from their respective capital funding schemes.

6. Microsoft N365 Enterprise Support – Discussion paper presented to the Board to debate the gain approval in principle to support the new N365 platform from the HBL Shared Service. This was agreed in principle pending a formal proposition Paper.

7. HBL Corporate Governance  High Level Partnership Risk Register reported  Quarterly Cyber Security Report provided  Results of GPIT Network Penetration Test presented and noted the ‘Substantial’ assurance level achieved.

Hertfordshire, Bedfordshire and Luton ICT Shared Services is hosted by NHS East & North Hertfordshire CCG Page 1 of 2 HBL Stakeholder Board – 25th January 2021

All member organisations were represented at the Board.

1. Minutes from Stakeholder Board on 12th October were approved

2. HBL Finance Report for period 9 - Presented and recorded by the Board, on target to meet annual control total.

3. HBL Service Performance Report December 2020 – Presented and discussed. The Board agreed that the overall performance of HBL and endorsed the service provided. In addition, the HBL Annual Report for 2020 was provided for dissemination to member organisations.

4. Partnership Service Charges for 2021 – proposed service charges using ABC costing was presented and agreed by the Board. However, due to the expected covid financial regime (Block Contracts) to continue, into the first quarter of 2021/22, it was agreed that the new service charges would take effect from July 2021.

5. West Essex CCG membership of HBL – Due to the Government white paper regarding constitutional changes to CCG’s and ICS’s, it was agreed that due diligence activities relating to the WECCG move to HBL should be suspected pending further clarity regarding the said White paper.

6. Microsoft Extended Support for Win7 Operating System – as with the majority of NHS organisations the migration to Win10 has been hindered by Covid 19, therefore NHSD has negotiated and extension support agreement for devices still to be migrated from Win7. Across the HBL Partnership there are 850 devices still to be migrated as of January representing 10% of the total device estate. The Stakeholder Board agreed to sign-off the prosed extended support package costing £31k and £12k to HPFT and HCT respectively.

7. Microsoft O365 (N365) Enterprise Support – proposition paper presented to Board was agreed including the establishment of a small early life support team during the deployment and migration of O365. Initially resources for 3 FTE will be sources from within HBL at no cost, but if additional support resources are required, this will tabled at future Boards for approval.

8. HBL Corporate Governance  High Level Partnership Risk Register reported  Quarterly Cyber Security Report provided

Phil Turnock Chief Digital Officer

Hertfordshire, Bedfordshire and Luton ICT Shared Services is hosted by NHS East & North Hertfordshire CCG Page 2 of 2 Appendix 4

Lower Lea Valley, Locality Commissioning Committee Wednesday 15th July 2020 12:30 – 1:30pm Virtual – MS Teams MINUTES

Present:

Name Job Title Alan Pond (DB) Chief Finance Officer - ENHCCG Dr Russell Hall (RH) GP, Chair, & GP Partner Chells Surgery, Stevenage Dr Mo Hossain (MH) GP, Stanhope Surgery Dr Alison Jackson (AJ) GP, The Maples & PCN Clinical Director Broxbourne Alliance Dr Nikunj Malde (NM) GP, Cromwell & Wormley Medical Centre Dr Bill Neville (BN) GP, Abbey Road Surgery Dr Raza Rashid (RN) GP, Warden Lodge Medical Practice Dr Pauline Taylor (PT) GP, Cuffley and Goffs Oak Dr Navina Sullivan (NS) GP, Stockwell Lodge Medical Centre Dr Aneela Sattar (AS) GP, High Street Surgery & PCN Clinical Director LVH

In Attendance:

Name Job Title Claire Arno (CA) PM, The Maples Verinder Bhoombla (VB) LLV CCG Finance Lead - ENHCCG Paul Brown (PB) Transformation Manager, (as an observer) - HCT Teresa Bird (TB) PM, Cuffley & Goffs Oak Helen Hemmingfield (HH) Team Administrator – ENHCCG Faisal Ijaz (FI) PM, Cromwell Medical Centre Deena Keefe (DK) Primary Care Support Manager, ENHCCG Richard Moore (RM) CEO – Lea Valley Health Federation Helen Moth (HM) PM, Warden Lodge Medical Practice Dr A Ndukwe (AN) GP, Stanhope Surgery Linda Patrick (LP) Programme Support Officer LLV PCN Natalee Pringle (NP) Asst PM, Stockwell Lodge Medical Centre Sharon Turner (ST) PM, High Street Tony Wood (TW) PM, Stanhope Surgery Emma Ross (ER) Nurse, The Maples

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Item Subject Action by

1. WELCOME AND APOLOGIES FOR ABSENCE The Chair welcomed all to the meeting and carried out individual introductions, as it was the first meeting that he had attended and chaired for LLV. This was the first LLV Locality Commissioning Committee Meeting since lockdown began in late March, Chair confirmed that the constitution requires the locality to meet 4 times in the financial year, and one of these will be the Council of Members on 3rd September 2020. The Chair declared that the meeting was quorate.

DECLARATIONS OF INTERESTS The Chair invited the members to reconfirm their current declarations on the Register of Interests and advise of any new declarations. As there have been some recent changes including the split into 2 PCNS, the declarations of interest form will be recirculated in order

that people can update their entries. Action: HH to share the DOI and all to update their sections.

The Chair invited members to declare any declarations relating to matters on the Agenda. All members confirmed they have no declarations in relation to matters on the Agenda.

2. MINUTES OF PREVIOUS MEETING AND MATTERS ARISING

The Minutes of the meeting held 4th March 2020 were virtually approved as an accurate record. No matters arising.

2. ACTION TRACKER The following actions were closed: 50, 51, 52, 53, 54, 55, 56, 57, 58, 62, 63

All agreed to close these actions.

3. GB UPDATE – RH and AP The Governing Body have been continuing to meet remotely, proposals that the 3 merging CCG’s and Governing Body will merge into one is doubtful by April 2021.

There have been a few organisational changes within the CCG.  Beverley Flowers is no longer the Chief Executive for the CCG she is now the Interim Director of Transformation for

the Integrated Care System (ICS)

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Item Subject Action by

 Dr Jane Halpin is now the Joint Chief Executive for the three CCGs and Integrated Care System (ICS)  Alan Pond is now the Chief Finance Officer of Hertfordshire and West Essex CCGs  Jane Kinniburgh is now the newly appointed Director of Nursing and Quality who came from West Essex  Denise Boardman the Director of Primary Care has now retired, we are waiting for the post to be filled, currently Gerry Moir and James Gleed are covering the work.

The number of GP Board members has been reduced from 13, down to six with a Chair as per the February 2020 vote.

Each of the CCGs will be working as a partnership – the three CCGs are West Essex, Herts Valleys and East and North Herts CCG.

The Integrated Care Partnership (ICP) has been set up and will start discussions.

The aim of the partnership working is to start discussions with the providers, PCN to decide who attends which meetings, and representation at each of the partnership boards. There are

opportunities for all PCNs to represent each other, so not all need to attend all meetings. Dr S Dixon (GP lead for SVV) has previously indicated that she is happy to have these discussions with PAH and the E&NH Trust.

This could be through conferences shared with the PCN Clinical Directors across the patch or with the CCG; this is about getting the right people around the table so that they can discuss the right care for the patients.

AP updated the group on the current governance structure of the 3 CCG’s and informed that interviews were still in progress and joint teams were being created.

There are three new Managing Directors, Sharn Elton for East and North Hertfordshire, Peter Wightman for West Essex and David Evans for Herts Valleys. It is also likely there will be a new post for a Director of Digital Transformation.

Discussions were held regarding how LLV Locality would get

representation in the hospitals that are outside of the CCG and the need for someone to represent the locality views ie: at North London CCG.

It was confirmed that each board may need a variety of GP representatives at each partnership to get the best way of working,

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Item Subject Action by

especially when developing pathways. LLV faces another CCG rather than the 3 that are merging.

DK shared the ENH ICP Governance Slide, showing how the localities feed into the ICBD and upwards, this is the draft framework for E&NH.

The Quoracy of the LCC was confirmed as per the vote and change in February 2020. Not all Practices need to attend the LCC meetings, only the GP lead, two PCN Clinical Directors, one Executive from the CCG with 50% of them in attendance plus the Primary Care Support Manager, all others are welcome to attend the meeting.

4. THE COUNCIL OF MEMBERS MEETING - RH Just a reminder that the Council of Members meeting will be held on 3rd September, invites will be sent out soon.

No plans for TARGET days and no capacity from HUC to cover for the foreseeable future.

AOB It was mentioned at the Practice Managers meeting that some PCNs were not receiving feedback from their PCN Clinical Director from the weekly Thursday Webex meetings, a request has been made to the Clinical Directors to forward any relevant information. LLV were not one that was mentioned.

LLV GP Nurse bank project - TW is now leading on the project and is keen to go ahead. Discussions to be held with the locality. Action: TW to liaise with the locality and feedback, as keen to progress this.

There was a training session today at 1pm for the FFP3 hoods and how to use them, which the locality missed, so DK will forward the details on and another date can be arranged with the trainer. Action: DK will forward the FFP3 training details to the CDs and they can arrange another date with the trainer.

DATE OF NEXT MEETING: Council of 3rd Sept 2020 Thurs 1:00 – 17:00 To be confirmed Members

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North Herts Locality Locality Committee Commissioning Meeting Wednesday 12th February 2020 Letchworth Centre for Healthy Living, Hitchin Road, Letchworth, Hertfordshire, SG6 3NA

MINUTES Present: Name Job Title

Dr Tara Belcher GP Portmill Surgery Dr Matthew Calcasola GP Portmill Surgery Dr Jeremy Cox Bancroft Medical Centre Dr Victoria Fraser GP Regal Chambers Dr Rob Graham GP Birchwood Surgery Dr Matt Jarvis GP Ashwell Surgery Dr Mel Lacy GP Nevells Road Surgery Dr Rajpreet Millan GP Whitwell Surgery Dr Richard Stanley GP The Baldock Surgery Dr Adrian Wood GP Garden City Surgery

In Attendance: Name Job Title

Claire Brown Practice Manager Whitwell Surgery Anthony Deitsch Locality Manager E&N Herts CCG Dr Simon Chatfield GP (part meeting) Melanie Felgate Practice Manager Portmill Surgery Anne Hegarty Practice Manager, Garden City Surgery David Mann Assistant Practice Manager Nevells Road Surgery Hayley Marshall Practice Manager Regal Chambers Phil O’Meara Senior Finance Manager ENHCCG Sima Parikh Prescribing Adviser Mark Pilling Practice Manager Ashwell Surgery Dr Tim Ramsbottom Senior Partner Nevells Road David Roberts Practice Manager Bancroft Medical Centre Lynda Rumble Team Administrator E&N Herts CCG Michael Sissens Practice Manager, The Baldock Surgery Zoe Smith Practice Manager, Birchwood Surgery Carrie Walsh Practice Manager, Sollershott Surgery

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Item Subject Action by

1. WELCOME AND APOLOGIES FOR ABSENCE The Chair welcomed all to the meeting. Apologies were received from:

Alan Pond Dr Agnieszka Rzadzinska-Prosser

The Chair declared that the meeting is quorate.

2. DECLARATIONS OF INTERESTS The Chair invited the members to reconfirm their current declarations on the Register of Interests and to advise of any new declarations.

Members confirmed their declarations were accurate and up-to-date.

The Chair invited members to declare any conflicts of interest in relation to matters on the Agenda.

All members, and those in attendance, confirmed they had no conflicts of interests in relation to matters on the Agenda.

3. MINUTES OF PREVIOUS MEETING AND MATTERS ARISING

The Minutes of the meeting held on 11th December 2019 were virtually approved as an accurate record.

The following actions were carried forward TB/AD • 36: Follow up with Melanie Bedoya regarding referrals ACTION – TB/AD SC • 38: Forward email to Rachel Joyce on Monovette to TB ACTION - SC TB • 40: Check with Mary Ann Gregory if Nurses can use GP Liaison Service ACTION - TB TB • 48: Send out Transgender form ACTION - TB TB • 52: Request agenda item at Delivery Board on Sexual Health Clinic Access in Herts ACTION - TB

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Item Subject Action by

4. CFF 55p HIGH INTENSITY USER UPDATE - SC • SC provided an update on the review of high intensity user practice. This covers people using A&E excessively and high frequency users in the twelve months to December 2019. SystmOne is being reviewed for themes before a review at each Practice. • Similar work in Norfolk morphed into a review of frequent admission to secondary care users. There was a large cohort of frequent users going to A&E out of hours.

• High intensity users are expensive; much of behaviour is due

to social, psychological, familial and financial factors. It has

been found that enforcement actions are generally not effective, a top down approach doesn’t usually work longer term, and action needs to be empathetic and patient centred. Other similar projects have been successful and have led to a 90% reduction in high user’s use of ambulances and A&E. • SC will share the lists for review with each Practice shortly, and offered to coordinate/ chair meetings or liaise to do care PMs reviews. Practices should let SC have forthcoming MDT dates or arrange a separate date before the end of March. • Funding will be discussed as timing has slipped due to IT issues so, a request to carry funding forward will be made as AD this work needs to be completed and should contribute to reducing non-elective overspend.

Tara thanked Simon for his contribution to the North Herts LCC over the past few years as Co Locality Chair.

5. UPDATED LIP – TB • The headline is that there is still an overspend, largely on non- elective admissions. • PO’M stated that Month 7 to 8 overspend has stagnated and is at steady state. More information on patient activity will be available in Month 9. • Nevells Road found that there were coding issues on COPD. Practices need to check how data has been coded by the Trust. • PO’M advised there are no issues to report on enhanced services and that £1 a patient is being utilised.

6. REVIEW ICDB - TB • A Healthy Hub is being set up. It will be partly an on-line offer advertising Healthy Hub pop-up locations. Timing is to be confirmed. • There was a Respiratory deep dive presentation at ICDB and coding was discussed. • The next Delivery board will look into mental health. The CAMS waiting list has been reduced, and the Contracts team

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Item Subject Action by

are currently liaising with mental health regarding service provisions. • PO’M was asked to feedback to CCG that GPs are being PO’M advised they should refer to Secondary health not Primary Care. • Frailty clinics: HCT have put bid in to have 3 Frailty Clinics in North Herts, it is proposed for Rockwood 6s to go to a Clinic and Rockwood 7 and 8s to go to hospice or Hawthorne Clinic.

The aim is to get a Frailty Hub set up and to link with HCT

Spa.

• There was no baseline work before Clinics started, so HCT are trying to show some evidence that is impacting on admissions and GP appointments. Increased Physio and OT should hopefully help reduce falls. • HCT are looking at Diabetes capacity. The Ernest Gardener Centre can only see 3 new patients a week. • HCT need to follow the same Pathways. ACTION TB to flag TB

7. PHLEBOTOMY • TB reported that negotiations on the contract and ongoing.

8. NON ELECTIVE OVERSPEND • Covered in discussion on the next item - Draft CFF.

9. DRAFT CFF • There was a discussion on the Draft CFF which had just been released for comments. • Concern was expressed that the time allowed for discussion and to provide comments did not meet the agreed 28 day window for turnaround of requests. • It was felt that some of the proposed changes to how funding is distributed via PCNs could destabilise Practices as they will have employed people based on funding for areas established over previous years.

• Areas of concern included:

o Payment for Care plans taken out and replaced with

bonus payment ‘if meet all metrics’ o When will CCG provide KPIs/metrics on how additional appointments will be measured and the baseline figures? AD ACTION AD to enquire o The requirement for Peer review of ALL new proposals to secondary care was felt to be impractical and that it could delay two week wait referrals TB

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Item Subject Action by

ACTION TB to feedback suggestions on peer reviews • The revised reimbursement levels for additional roles were felt to be a positive change.

10. CARE HOME PAPER • The Care Home paper and changes to funding were discussed. • Various models to provide care were explored including additional ward rounds; weekly Nurse led ward rounds, more triaging, GPs covering acute work. • AW noted that the current CCG funding doesn’t cover costs per bed, especially where there are multiple admissions in same bed. • It was felt that additional Nursing should be put into Care Homes.

• It was noted that the Bedfordshire model is to have more

Nurses looking after care home patients and to involve GPs less

ACTION TB will put a proposal together and circulate for TB comments ACTION AD to circulate paper from Gill (note paper not formally AD agreed)

11. PGP WAVE 11 • Group Based Learning dates have been confirmed (3pm to 6pm): o 15th April 2020 o 30th April 2020 th o 10 June 2020 th o 14 July 2020 • HUC cover has been booked and TARGET meetings will be arranged to coincide with one or two of these dates.

• A video was shown with a presentation overview on the

Productive GP Quick Start Programme

• The final PGP Wave 11 Delivery Plan will be circulated. AD ACTION AD (completed)

ACTION AD and PO’M to discuss funding for meetings/ AD/PO’M management funds with Alan Pond

12. PROPOSED CONSTITUTION CHANGES • Voting will take place in February on three proposals: Membership of CCG Governing Body, Locality Structure and Housekeeping of Constitution.

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Item Subject Action by

13. PCNs (PRIMARY CARE NETWORKS)

• Feedback on the recent PCN Conference was positive. • Additional role reimbursement will now be 100% not 70% (excluding management costs) for defined roles and the costs will then be part of baseline for GP contract after 5 years.

14. ANY OTHER URGENT BUSINESS

• MEETINGS – Funding LCC/PCN/TARGET events There will be four TARGET events, with at least one in-house to be scheduled covering Group Based Learning. More Locality input on the agenda was requested and to rotate days.

• AMBULANCE SERVICE There are still significant issues, especially with response times and raising the issues through the Hotline has not had any effect. It was felt that this needs to be fed back to the CCG. ACTION TB TB

• AVIS Emergency Practitioners dispense from stock so have been asking patient’s GP to prescribe other items. It was agreed that they should contact the AVIS GP. TB ACTION TB to raise

DATE OF NEXT LCC MEETING TBC 2020 - 12.30 – 2.30pm Letchworth Centre for Healthy Living, Hitchin Road, Letchworth, Hertfordshire SG6 3NA

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ACTION TRACKER

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North Herts Locality Locality Committee Commissioning Meeting Wednesday 29th July 2020 Microsoft Teams Meeting

MINUTES Present: Name Job Title

Dr Tara Belcher (TB) North Herts CCG Board Member (Chair) Dr Jeremy Cox (JC) Bancroft Medical Centre Dr Victoria Fraser (VF) GP Regal Chambers Dr Rob Graham (RB) GP Birchwood Surgery Dr Matt Jarvis (MJ) GP Ashwell Surgery Dr Mel Lacy (ML) GP Nevells Road Surgery Dr Rajpreet Millan (RM) GP Whitwell Surgery Dr Richard Stanley (RS) GP The Baldock Surgery Dr Adrian Wood (AW) GP Garden City Surgery Dr Agnieszka Rzadinska-Prosser (AR) GP Sollershott Surgery Dr Matthew Calcasola (MC) GP Portmill Surgery Bernadette Millwood (BW) CD Icknield PCN

In Attendance: Name Job Title

Alan Pond (AP) Chief Finance Officer E&N Herts CCG Anthony (Tony) Deitsch (TD) Locality Manager E&N Herts CCG Hayley Marshall (HM) Practice Manager, Regal Chambers Anne Hegarty (AH) Practice Manager, Garden City Surgery Phil O’Meara (POM) Senior Finance Manager ENHCCG Sima Parikh (SP) Prescribing Adviser Claire Brown (CB) Practice Manager, Whitwell Surgery Yulia Baker (YB) Business Manager, Portmill Surgery Gill Wilcox (GW) Practice Manager, Nevells Road Surgery Mark Pilling (MP) Practice Manager, Ashwell Surgery David Roberts (DR) Practice Manager, Bancroft Medical Centre Michael Sissens (MS) Practice Manager, The Baldock Surgery Zoe Smith (ZS) Practice Manager, Birchwood Surgery Carrie Walsh (CW) Practice Manager, Sollershott Surgery Jenny Walsh (JW) Business Manager, 12 Point Care

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Item Subject Action by

1. WELCOME AND APOLOGIES FOR ABSENCE The Chair welcomed all to the meeting. Apologies were received from:

The Chair declared that the meeting is quorate.

2. DECLARATIONS OF INTERESTS The Chair invited the members to reconfirm their current declarations on the Register of Interests and to advise of any new declarations.

Members confirmed their declarations were accurate and up-to-date.

The Chair invited members to declare any conflicts of interest in relation to matters on the Agenda.

All members, and those in attendance, confirmed they had no conflicts of interests in relation to matters on the Agenda.

3. PCN DES Care homes – GPFV Money to be used for FN until Dec. No issue with contract. GHH employed them and took them on as permanent roles (PO’M) ARR – Pharmacists. 12PC recruiting new pharmacists. First Point Physio recruiting and should be starting imminently. Unenthusiastic sign up to PCN DES. Icknield not adding any more to existing combination currently. HWPCN recruiting care coordinators. Looking for ones with HCA TB qualifications. Job description available for sharing (TB). Can be used for coordinating MDT for Care Homes. Will be employed by Portmill and used across practices. Schedule 5 incorporated. AP - Responsibility is on community services. Rachel Joyce and Anna Makepeace working through this detail. What is in the DES is insufficient. There is an increase in the community services provision. What FN do is in line with what they expect community series to do in care homes. Seeking to commission this work from the CCG. CFF Financial Balance – AP/TB: NH was significantly overspent and have asked the CCG why this was the case. Trusts across the country had debts wiped out and if this was debt then why would this not be wiped out? Government realised that it was not appropriate to take out loans to remove debts. Over 7-year period not every locality has been awarded payments. NH and Stevenage missed this year. AP – not a fair approach when other localities have not received the payment previously. JC: Expecting CCG to look at other examples

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Item Subject Action by

around resource envelope to award payments in light of the last 4 months. AP: every element of CFF had relaxed criteria due to COVID. NH and Stevenage were more than 0.5% overspent at month 10 so missed the payment. AP to send TB information regarding referral rates. Financial reports are provided each month to outline spends. TB: if referrals had not gone up and were being charged more, then overspend was not accurate. Secondary care is producing the charges. Alan’s team is investigating. AP: Payment by result should be scrapped. Pathway for patients should be what the hospital is paid for

ICP/ICS

4. PHLEBOTOMY  £2.22 per bleeding of a patient available until March. If one available then claim the funds.  LES is now out with details.  Start date for this funding is not retrospective. Funding under COVID has covered a variety of costs. These costs should have been claimed already.

5. ANTICOAG  Ashwell no longer offering services.  BMC looking into it.  HCT have been asked if they are interested. Looking to implement more widely across the CCG.  Ashwell have evidence of non-engagement around concerns with the current model. Shrinking demographic with change of medication. o AP encouraged all practices to speak to him directly. A service breakdown from a lack of communication is not appropriate.  Possibility to share service with Icknield 6. BLUE STREAM  Paid previously from £1pp funds. £1pp can be devolved to PCNs  Possibility to be funded from PCN development funds. Benefit is to align training and work across sites.  AW: Concern if paid from PCN funds that money will not be available if not signing up to PCN DES in future. Preference to £1pp rather than PCN funds  Each CCG spends more in Primary Care than funds provided. Questions raised about PCN funds and how they can release it to pay for other things. 21/22 costs will likely be more than expected due to recovery needs.

7. FINANCE £1PP

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Item Subject Action by

Management Funds - £40,000 TARGET – Virtual can be done. Bernadette and Richard to organise. COVID rehab teaching could be incorporated. Funds will be far less  Fund GP Care Home Lead post?  Fiona Sinclair does training. Dedicated time could set up a hub and have dedicated time to sort out inductions etc. Question around workload.  Icknield training requirements are different than HWPCN but RS encourages HWPCN to follow same training hub guidance/format. RS applying for PCN to be training organisation. Lead roles should still be funded. Money can go to PCNs to pay for other lead roles. Still goes to localities as they stayed in constitution. Can be used for Lead Roles. Each PCN are being provided with Cisco WebEx. Includes breakout etc. and can provide more attendees. TB to liaise with RS and BM to arrange TARGET training in conversation with other PCN CDs

8. YOUNG PERSON’S SPLW  TB to catch up with Matt Charles. In SV they have one who is doing good work with anxious children. Feedback around current SPLW in NH Locality: Icknield - Leslie has resigned. Only Jade 2 days a week. Difficult to get them embedded during COVID lockdown – no NHS mail, laptops, S1 for referrals; going through Herts Help and giving detail to SPLW. Matt Charles and team are recruiting. Tracey has been into practice at Whitwell and has been useful.  Difficult with role to deliver medications. Tracey is attending meetings and can enter details into S1. Finding out good information about patients.  SPLW is person-dependent. Who measures what they do? Matt Charles and team should pick up.

9. EGTC  Heritage Foundation not keen to keep site open but will support if hospice and local GPs are involved.  RS putting together bid for T&R funds to open EGTC with added extras. Can host AR’s.  Any ideas to use space, share with RS to have cross-party use.  Outline bid being populated over last few days.

10. FRAILTY NURSES  Covered under PCN DES

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Item Subject Action by

11. AOB  EoL Survey o Hospice trying to find out how to get to patients/next of kin. Any suggestion around tactfully asking next of kin around care of loved ones, let Tara know.  Flu o Drive thru at Priory School. Site looks good and can use with Icknield. PPE requirements still being discussed. Stevenage PM has done cost work to evidence that it is not cost effective for the PPE, letter distribution, etc given smaller numbers of immunisations. Workforce is an issue as well. One weekend morning worth of immunisations will likely take the course of a week. CQC will need updated statement of purpose. o Some patient cohorts cannot attend a drive thru service. Children with nasal spray requirements who may sneeze have been discussed. o Practices will receive a form to fill in asking what their plans are.  MJOG o Ends Friday night. Contract to be renewed before 5pm Friday. Consensus agreed to proceed.

LCCs are still useful and will carry on booking meeting. Possibly use WebEx for next meetings.

DATE OF NEXT LCC MEETING TBC

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Action Tracker

Responsible Revised Current Meeting Date Item No. and Title Action Deadline Status Manager Deadline Position 29/07/2020 3. PCN DES TB to share care coordinator job description TB Next LCC In Progress 29/07/2020 3. PCN DES AP to send TB information regarding referral rates AP Next LCC In Progress 29/07/2020 7. Finances £1PP TB to liaise with RS and BW to arrange TARGET training with other PCN TB/RS/BW 01/09/2020 In Progress CDs 29/07/2020 11. AOB - EoL Survey Suggestions around next of kin queries to TB All 01/09/2020 In Progress 29/07/2020 11. AOB - LCC Agree format for next meeting - WebEx or MS Teams All 01/09/2020 In Progress

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Stevenage Locality Committee Commissioning Meeting Tuesday 10th March 2020 Cromwell Hotel, High Street, Stevenage, SG1 3AZ 13.30-14.30pm

MINUTES Present: Name Job Title

Dr Keith Aubin (KA) GP, Stanmore Medical Group

Dr K Daodu (KD) GP, Shephall Way Health Centre

Dr Russell Hall (RH) GP, Chells Surgery (CCG Corporate GP Lead)

Dr Susan Coxall (SC) GP, Chells Way Surgery

Dr S Kota (SK) GP Bedwell Medical Centre

Dr Prag Moodley (PM) GP, Stanmore Medical Group (CCG Chair)

Dr P Raveendran (PR) GP Bedwell Medical Centre

Dr Rini Saha (RS) GP, King George Surgery (Chair)

In Attendance: Name Job Title Sunday Adeniyi (SA) ENHCCG Finance Lead

Mark Banks (MB) Federation Manager/ ICDB Chair

Sandra Copping (SC) PM, Manor House Surgery

Tony Deitsch (TD) Primary Care Support Manager ENHCCG

Amy Elliott (AE) PM, King George Surgery

Deena Keefe (DK) Primary Care Support Manager ENHCCG

Susan Lincoln (SL) PM, Stanmore Medical Group

Fiona Lucas (FL) PM, Symonds Green Surgery

Michelle Myers (MM) Chells Surgery

Lynda Rumble (LR) Team Administrator CCG

Allison Seymour (AS) PM, Bedwell Medical Centre

Karen Smith (KS) Nurse, Manor House Surgery

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Item Subject Action by

1. WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed all to the meeting. Apologies were received from:

Maxine Davis Sheilagh Reavey Ken Spooner

No clinical GP representation from Symonds Green, Manor House and King George.

The Chair declared that the meeting is quorate.

2. DECLARATIONS OF INTEREST The Chair invited the members to reconfirm their current declarations on the Register of Interests and to advise of any new declarations.

All members confirmed their declarations were accurate and up-to-date.

The Chair invited members to declare any conflicts of interest in relation to matters on the Agenda.

All members, and those in attendance, confirmed they had no conflicts of interests in relation to matters on the Agenda.

3. MINUTES OF PREVIOUS MEETING AND MATTERS ARISING

The Minutes of the meeting held on 11th February 2020 were approved virtually as an accurate record.

4. ACTION TRACKER – agree virtually

It was agreed to close actions 104 and 109.

5. FINANCE AND LOCALITY INFORMATION PACK, MONTH 9 - SA

• Current performance The Finance report has been circulated. Based on month 9 actuals, year to date, Stevenage Locality is overspent by £590K (after allocation of its share of contingency reserves) and may not be able to deliver a breakeven financial position. If this is the position at the end of the year,

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Item Subject Action by the locality will not meet the condition to receive the Financial Balance payment of £1.50 per patient paid to Practices as part of CFF 19/20.

Most of the overspend is in non-elective activity especially at ENHT which reported significant increased activity and costs compare to plan. While all providers reported increase NEL activity, PAH increase is much less which means localities using PAH have not been financially affected as much as Stevenage using ENHT.

An example of PbR issue that is currently being challenged relates to local tariff for Non Elective less than 2hrs in which the trust notified the

CCG of reverting to national tariff on 30th September. The CCG activity

analysis shows most of the NEL admission increased after 2hrs and attracts PbR tariff. The CCG is challenging the clinical and operational appropriateness of non-elective admission within 0 to 4 hrs and would like to extend the 2hr local tariff to cover 0 to 4 hrs.

While the Finance and Contract managers at CCG are reviewing both activity and costs and raising challenges, the locality is asked to come up with other strategy and plan to mitigate the significant increase in NEL activity. It was discussed if Stevenage should get a data analyst to review costs and challenge some of potential coding issues for 2020/21like LLV have done previously.

Part of new CFF payment is dependent on the delivery of the target reduction in NEL admissions.

It was felt using Stevenage or North Herts for a pilot for the frailty hub initiative would be very helpful. It was also questioned if the new CFF is activity based or Finance based?

Co-mobilities are a big issue and data needs to be clarified. UTI has been coded to cover other things, so costs have gone up. Clarity is required

around what is defined as an admission?

It was agreed that the two PCNs need to work together and look at data for four key areas (including Pneumonia & UTI) and any other key issues where the Trust is applying significantly increased charges.

SA was asked if the figures could be provided by practices to enable further analysis. SA will ask Ian Bedford to provide information requested.

ACTION RH to raise the dramatic increase in charges linked to increased RH coding with the CCG

ACTION SA to ask Ian Bedford to pull data by PCN for the four areas of SA highest overspend (including pneumonia and UTI)

• Care Homes (Action 105) - SA

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Item Subject Action by

In response to the action from previous meeting, SA confirmed KH has sent all the requested information relating to NEL and Care Homes breakdown. SA explained allocation of CHC cost to practices is based on the responsible commissioner rule. This means the practice the client is registered at the point of eligibility is responsible for the cost even if the patient has moved on to another area. Cost only transfer if a patient moves their home address permanently. In addition, all funded nursing

care are using Fair shares to all practices. For those care homes which

are specialist or receives patient before becoming eligible for CHC and registered with the GP in the area, who then become eligible for CHC, the costs associated with these homes are allocated centrally to the CCG in order not to disproportionally affect the host practice. RH said further details are required to assess if all such care homes have been allocated to the centrally allocated to the CCG. There was a discussion about areas where there is no GP involvement so they cannot control the budget e.g. CHC assessment stage and fast track

ACTION - RN to send the names of two other Care Home to SA so RN specialist costs can be moved to CCG pot.

ACTION – Raj and Ravi to contact SA about what else can be done about PR/SA upcoming budget. SA to give feedback about movement on 2020-21 locality/PCN budget at the April LCC meeting.

ACTION – CDs to contact SA for further drill down into the figures. CDs

ACTION – AD to send SA invite for April ICDB/LCC meeting AD

6. UPDATE FROM MEETINGS - RH

Constitutional Vote

Voting is now complete and the results have been communicated.

Update from PCN day 26.02.20

The third Clinical Directors PCN day has been held covering PCNs and practice member’s, VAT, Legal, PCNs & their wider partners & the system

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Item Subject Action by issue of NELs. Concerns raised from Practices will be fed back. The NHS standard contract consultation feedback is due shortly. The next session will take place around April, after the National session, to bring everyone up to speed.

HUC Cover Recent TARGET meetings and those scheduled for April have been cancelled due to lack of HUC cover. The next Stevenage TARGET is on th 19 May 2020. It was suggested that if possible, Locum cover should be used for the Locality to provide their own cover. RH ACTION RH to review

7. Virtual Reports – no updates given

• LTC • Mental Health • Prescribing (virtual report provided, Antibiotics is a key issue)

8. PATIENT PARTICIPATION GROUP – Ken Moore

Not present therefore no update given

9. ANY OTHER BUSINESS

Governing Body

The Business Plan and Coronavirus were discussed.

Next meetings Meetings have been booked for June, September and November. They will continue with same format, with more emphasis on ICDB. LCCs will follow ICDB four times a year. Attendance by each Practice is not essential for every meeting, but Practices are welcome to attend each meeting.

Care Home Ward rounds SL raised that Care Home Ward rounds are due to finish at the end of March, but there is currently no agreed plan thereafter. It was proposed to seek Locality agreement to use some of CFF funds (£1 a patient) for the

next six months.

ACTION – SL to send out email to check if Practices agree to this. SL

Business Plan

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Item Subject Action by Quick business plan to be submitted to CCG on the Visiting Service. Practices to keep records of Covid related expenses – anything that Practice income is affected by, Qof, Workforce, supplies etc. ACTION RS and RH to submit Quick Business Plan to CCG

Redacted Patient Notes AS asked if it was possible to reduce printing requirements as most requests generate lots of pages of notes.

ACTION – AS to ask the Contracts Hotline for advice AS

Phlebotomy SL updated the Locality that the Phlebotomy service that they provide for Shephall will stop soon, as it is only contracted until the end of March 2020.

DATE OF NEXT MEETING: ICDB/LCC 9th June 2020 12:30 to 14:30 Cromwell Hotel, High Street, Stevenage , SG1 3AZ TARGET 19th May 2020 12:30 to 18:30 Stevenage Football Club SG2 8RH

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Stort Valley and Villages Locality Committee Commissioning Meeting Tuesday 25th August 10:00 – 11:00 via MS Teams

MINUTES Present: Name Job Title Dr Sarah Dixon (SD) Chair, GP, Locality Lead, GB Board Member

Sharn Elton (SE) CCG Managing Director

Dr Nathalie Oates (NO) GP, Representative Much Hadham Health Centre

Dr Sian Stanley (SS) GP, Representative Church Street Partnerships

Dr Jagjit Takhar (JT) GP Representative, Parsonage Surgery

Dr E Matys GP Representative, South Street Surgery

Dr S Das (SD) GP Representative, Central Surgery

In Attendance: Name Job Title Michelle Ford (MF) Practice Manager, Parsonage Surgery

Helen Hemmingfield (HH) Administrator, CCG

Deena Keefe (DK) Primary Care Support Manager, CCG

Lucy Owen (LO) PCN Administrator

Julie Sampson (JS) Senior Pharmaceutical Advisor, CCG

Chirag Shah (CS) Senior Pharmaceutical Advisor, CCG

Karen Thomson (KT) Finance Manager, South Street Surgery

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Liz West (LW) Transformation Manager, Stort Valley & Villages

Item Subject Action by

1. WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed all to the meeting. Apologies were received from Andrew Wilkinson. The Chair declared that the meeting is quorate.

2. DECLARATIONS OF INTEREST The Chair invited the members to reconfirm their current declarations on the Register of Interests and to advise of any new declarations.

All members confirmed their declarations were accurate and up-to-date.

The Chair invited members to declare any conflicts of interest in relation to matters on the Agenda.

All members, and those in attendance, confirmed they had no conflicts of interests in relation to matters on the Agenda.

SS declared she was involved with Takeda Pharmaceuticals in a discussion group about adult ADHD Prescribing. JT has taken on the role of chair of the Federation.

3. MINUTES OF PREVIOUS MEETING AND MATTERS ARISING

The Minutes of the meeting held on 16th January 2020 were approved as an accurate record. All approved.

4. ACTION TRACKER - SD Item 26 – general discussion on the leg ulcer clinic which started in 2nd December 2019 and was going to be reviewed early February 2020, this was going really well but then had to be paused in the height of COVID. This is now operating again from Herts and Essex and Central Surgery but a little behind in reviewing things, feedback is needed from HCT on where we are now.

Item 29 - funding for Atrial Fibrillation devices, this is now completed, LW has had discussions with Emma Hollingsworth at the CCG, this is a block contract payments to provider, this cannot be progressed at this time but ready to take this forward in the future. Action to be closed.

Item 35 – Integrated Commissioning update on outcomes of

Page 2 of 6 collaborative working proposals, 3 different types of clinics through this funding, Frequent Attenders, Adolescent Health and Mental Health project, these have been moving on well given the current situation.

Frequent Attenders we had regular attenders meetings pre- COVID but have not had any recently. We have reviewed the meetings and are now working with HPFT to develop an integrated

Adolescent Health clinics have been going well these clinics have been running on Saturday mornings out of South Street Surgery. It was mentioned that the locality would like to advertise to the teenage population that these clinics can also provide sexual health services. Discussions were held about how to advertise this clinic and it was agreed to advertise as Primary Care sexual health services.

Mental Health project – physical health checks for mental health patients have re started using a virtual component clinic these have worked really well and hopefully this can be developed further and also offer clinics at Herts and Essex Hospital. There has been brief feedback from service users which has been very good.

Item 36 – Primary Care CFF Cancer Collaborative working plans SE to check with Hayley Boulden what is expected from the practices. The revised CFF has come out for this year therefore this may/may not be relevant now. Action to be closed.

The above action will be closed and the next action links in with the Primary Care Network (PCN) and the specifications related to cancer care. There will be discussions whether this will stay on this agenda going forward or under the PCN.

Item 39 - Fitness for surgery suggest we close this action as not really relevant in post COVID, there are back logs and risk stratifying is being carried out, please feedback if there are any issues.

PAH are restructuring clinics and will be delivering the majority remotely but some specialities will deliver more face to face including paediatrics and cardiology.

It was suggested that it would be useful if there were some communications sent out from PAH so the GPs know what to advise their patients.

Phase 3 recovery work is underway in getting everyone back to maximum capacity but there are constraints on certain procedures, some more difficult than others and waiting lists will be even more challenged. Concerns were raised regarding Ophthalmology, letters are being sent to GPs copying in the patients saying they have seen Page 3 of 6

in an outpatient’s appointment; the patients are angry saying they have never been contacted. We believe they are doing a virtual review of the notes. SD asked for SS to send anonymised version of that letter to DK as an example. Action: SS to send anonymised version of letter to DK as example.

The hospitals need electronic prescribing (EPS) and they are working on a solution, they should not be asking primary care to issue prescriptions. Please refer back to the contract hotline if you get any prescription requests from any of their clinics at PAH. Please also forward on any issues regarding the mental health trust and report through the contract hotline or the Director of Pharmacy at HPFT.

Item 40 – Primary Care plans on CFF this item can be closed this was in relation to the codes, there was revised guidance sent out which revised codes relating to last year.

JT also raised a concern after receiving a letter from one of the orthopaedic consultants saying they are no longer seeing patients face to face in light of national guidance, SD will clarify this if JT can send this letter onto DK and SD. Action: JT to send DK anonymised version of letter

5. UPDATE FROM GOVERNING BODY – SD

In terms of structure across the 3 CCGs.  Dr Jane Halpin is now the Joint Chief Executive and Integrated Care System (ICS), started in post on 1st June and working to put in place the new executive team structure  Alan Pond is now the Single Chief Finance Officer of Hertfordshire and West Essex CCGs  Rachel Joyce is now the Clinical and Professional Medical Director  The Chief Nursing Officer is Jane Kinneburgh  Posts still be appointed to, Joint Director of Primary Care, The Chief Digital Officer and HR and possibly Director of Performance however this post is likely to be reviewed

Managing Directors are at place in the 3 CCGs; - Peter Wightman for West Essex, David Evans for Herts Valleys and Sharn Elton for East and North Herts.

The Governing Body GPs still exist whilst going through this phase as we have to still maintain our governing bodies. The potential time frame would be September 2021 and to become a single organisation by April 2022. The infrastructure at the CCGs has changed dramatically in the last 6-8 weeks and there could be further changes going forward.

Constitution LCC and quoracy We need 4 LCC meetings a year at the moment, this is the first one, the Council of Members will count as the second and we just need to fit in

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two more after that, the quoracy is the GP lead, the PCN Clinical Director and the CCG Director and all practices that want to attend the meetings.

The constitution will have to be looked at going forward for the locality meetings. SE confirmed she will prioritise attending these meetings to the end of the calendar year.

6. PRIMARY CARE – SD Practice Managers feedback Nothing significant to report back but the meetings have been held virtually, these will be set up regularly going forward.

Mental Health Update Locality based work in secondary and primary care to work collaboratively to create better community mental health.

As a GP reaching and getting access to the Mental Health team is difficult and frustrating. We need the official route to working and need to take this back to the team. SS will speak to the mental health leads.

Prescribing Update Scott Downham has been busy supporting our flu plans and the finalising of CFF for medicines optimisation this will be sent out to practices within the next couple of weeks.

7. ANY OTHER URGENT BUSINESS

A concern was raised regarding increasing workload going forward and whether there will be additional winter resilience funding to help support extra locum sessions through the winter. An update is needed for the winter resilience plans and guidance is needed to manage expectation.

LW has put out a bid for transformation and resilience funding and asked whether this can be chased up.

Winter resilience funding has been discussed at Clinical Directors meetings.

We are doing what we can do to make sure we are prepared but we need to quantify how much flu is going to cost. James Gleed and Andrew Tarry are working on this. Action: DK to chase up transformation and resilience funding.

10. DATE OF NEXT MEETING: The Council of Members will be held on Thursday 3rd September there will be another meeting towards the end of the year and further meeting in the next quarter up to March 2021.

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No. Meeting Date Item No. & Title Action Responsible Deadline Revised Deadline Current Position Status Manager SE suggested in the short term conversations should Issue escalated in CCG. Rachael Joyce asked PJ Service started 3. General be held with HCT to find out what it would cost to Deena Keefe/ to liaise with Marina Buswell, STP Prog Mgr for 2 Dec 2019. To Discussion on Leg put on training sessions for leg ulcer dressings. Sarah Dixon Tissue Viability. SD to have discussion with Alan be reviewed 26 23/05/2019 Ulcer Clinic PJ to escalate lack of a leg ulcer dressing service for Pond early Feb 2020 6. Integrated Update on outcome of collaborative working Sarah Dixon Frequent Attenders, Adolescent Health Clinic Commissioning proposals. and Mental Heath Projects were approved. Projects have Sexual Health Clinic was not approved for started. 35 24/10/2019 funding. 4. Action Tracker SS to send DK anonymised version of letter from In progress 41 25/08/2020 Othalmology patient. Deena Keefe ongoing 4. Action Tracker JT to send SD and DK anonymised letter from Deena Keefe/ In progress 42 25/08/2020 orthopaedic consultant. Sarah Dixon ongoing 7. Any other urgent DK to chase up transformation resilience funding for In progress 43 25/08/2020 business locality. Deena Keefe ongoing

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Upper Lea Valley Locality Commissioning Committee Thursday 2nd July 2020 Virtual Meeting

MINUTES Present: Name Job Title Dr Rupal Shah [RS] GP Corporate Chair CCG Dr Rob Mayson [RM] PCN Clinical Director Hoddesdon and Broxbourne Dr Fin O’Reilly (FO’R) PCN Clinical Director Ware and Rurals Dr Giles Pratt (GP) PCN Clinical Director Hertford and Rurals Alan Pond (AP) Chief Finance Officer, CCG, ULV Executive Director

In Attendance: Name Job Title Pam Jardine [PJ] Primary Care Support Manager, CCG Dr Chris Mays (CM) GP Rep Amwell Street Lucy Eldon (LE) STP Professional Primary Care Lead Nurse Helen Hemmingfield (HH) PA Team Administrator, CCG Rachael Hunt [RH] Practice Manager, Wallace House Dr D Shah (DS) GP Rep Watton Place Michelle Morrissey-Chisholm (MMC) Project Support Officer, ULV Matt Turmaine (MT) Transformation Manager, ULV Karsan Chandegra Community Pharmacist

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Item Subject Action by

1. WELCOME AND APOLOGIES FOR ABSENCE

RS welcomed all to the meeting.

Apologies were received from:

Dr Jackie Sheridan

The Chair declared that the meeting was quorate.

Chris Mays confirmed he had replaced Jo Roberts as Amwell Street representative. Declaration forms had been sent to Governance.

2. DECLARATIONS OF INTERESTS

The Chair invited the members to reconfirm their current declarations on the Register of Interests and to state any new declarations.

All members confirmed that their declarations were accurate and up-to- date.

The Chair invited members to state any declarations of interest relating to matters on the Agenda.

All members confirmed that they have no declarations in relation to matters on the Agenda.

3. MINUTES OF PREVIOUS MEETING AND MATTERS ARISING

The Minutes of the meeting held on 15th January 2020 were approved as RS an accurate record.

MATTERS ARISING

None

ACTION TRACKER

The contents of the action tracker had all expired.

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Item Subject Action by 4. UPDATE FROM THE GOVERNING BODY – Rupal Shah

There have been a few organisational changes within the CCG.  Denise Boardman the Director of Primary Care has now retired  Beverley Flowers is no longer the Chief Executive for the CCG  Jane Halpin is now the Joint Chief Executive for the three CCGs and Integrated Care System  Alan Pond was congratulated on his appointment as the Chief Finance Officer of Hertfordshire and West Essex CCGs  Alan Pond updated the meeting on the current governance structure of the CCGs and informed all that interviews were still in progress.

5. ULV Finances – AP

 The Locality’s Finance Report showed a small overspend of 200K  The Primary Care Commissioning Committee were considering a relaxation and change in some of the achievements for target of funding framework  The ULV Locality will be awarded 19/20 financial balance  It is unknown whether patient flow will go back to where it was and input is needed from practices about what has worked well and is worth keeping The Locality should be targeting non-elective care and reducing  admissions this could be important to work through in 20/21. The MDT run via the ICDBs can support this.

6. £1 per patient funds – PJ

 PJ confirmed that the £1.00 per patient money can be used at locality or PCN level  PJ confirmed that Hot Topics training is being funded via £1 per patient and was progressing nicely with 86 people registered for training.  RM suggested taking this to a wider group to ask for project ideas from practices  The increase in the demand of Mental Health care was talked about and the idea to run a pilot project in teenage mental health employing private counsellors, something similar to the project within the Stort Valley and Villages locality

Action: PJ to liaise with Stort Valley and Villages  CM said that he had been contacted by a Company called Medicspot by Arc Health who are working with Care Homes. They provide technology for contact free video consultations in GP surgeries and COVID-19 testing hubs.

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Item Subject Action by  CM to send details to Denise Benfield to organise a demonstration from the company Action: Dr Chris Mays to send details to Denise Benfield

7. ANY OTHER URGENT BUSINESS

 The CCG is now processing interim payments to the practices and will be made by 10th July this is based on 18/19 achievement plus financial and engagement  Cancer screening payments will be sent out around October  RS talked about the Hot Sites and asked whether there should only be one site in the locality as the footfall is not high.  RM confirmed they are seeing very few patients  Ware Hot Site is running a separate model seeing 3-4 cases per day per surgery.  RM suggested that Hot sites will be used this winter, with a lot more face to face once schools are back in September with no social distancing in place, therefore it would not be not ideal to reduce down to one hub. PJ agreed to take this back to the CCG.  PJ mentioned recovery and asked what support the practices needed to get back to a new way of normal,  RM asked for safe guidance for practices to restart their procedures and what they can start doing, to also be made aware of infection rates in the ULV area. PJ agreed to take this back to the CCG  RS reminded the practices about the Hot Topics training and encouraged all to enrol. Action: PJ to inform the CCG of CDs view on retaining current hot site provision and also on need for safe guidance to restart normal service provision.

8. DATES OF NEXT MEETINGS:

Council of Members: 3rd September 2020

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WelHat Locality Commissioning Meeting Thursday 30th July 2020 Virtual meeting – MS Teams MINUTES Present: Name Job Title Dr T Gillham (TG) GP Peartree Surgery Dr Sarah Hoole (SH) GP Potterells Medical Centre Dr Eva Kreye (EK) GP Spring House Dr Saiyeesh Maheswaran (SM) GP Bridge Cottage Dr Alister Parry (AP) GP Hall Grove Surgery Dr Ashish Shah (AS) GP Wrafton House (Chair) Dr Preenal Shah (PS) GP Hall Grove Surgery Dr Rahul Shah GP Garden City Practice Dr Mark Steward (MS) GP Potterells Medical Centre Dr Vivian Tantang GP Burvill House

In Attendance: Name Job Title Alan Pond (A Pond) Chief Finance Officer ENHCCG James Brookman (JB) Practice Manager Peartree Lane Debbie Crossley (DC) Practice Manager Bridge Cottage Surgery Amy Daley (AD) Deputy Practice Manager Burvill House Surgery Tora Robinson (TR) Primary Care Support Manager ENHCCG Sarah Ellingworth (SE) Practice Manager Garden City Practice Jackie Gates (JG) Admin Manager Lister House Surgery Anne Knight (AK) Practice Manager Hall Grove Sylvia Lane (SL) Practice Manager Wrafton House Surgrey Corrine Nightingale (CN) Practice Manager Spring House Kayleigh Rose-Wood (KR-W) Practice Manager Lister House Surgery Helen Hemmingfield (HH) Team Administrator ENHCCG Lynn Saville (LS) Project Manager HCC Peter Wilson (PW) PCG Chair

Item Subject Action by

1. WELCOME AND APOLOGIES FOR ABSENCE

The Minutes of the meeting held on 23rd January 2020 were virtually approved as an accurate record.

No. 7 on the action tracker was discussed – ICDB Collaborative Working with frequent attenders, LS to share responses with the group after the meeting.

Action: AS to confirm whether the Diabetes query response email had been sent out.

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The chair welcomed all to the meeting, apologies were received from Ann Kelley. The Chair declared that the meeting is quorate.

DECLARATIONS OF INTERESTS

The Chair invited the members to reconfirm their current declarations on the Register of Interests and advice of any new declarations. All members confirmed their declarations were accurate and up-to-date. All other members confirmed their declarations were accurate and up-to- date. The Chair invited members to declare any declarations relating to matters on the Agenda. All members confirmed they have no declarations in relation to matters on the Agenda.

2. CCG update – Integrated Care System and Senior Appointments – Ashish Shah Updates over the past few months regarding the CCG mergers which were due in April 2021 have been delayed due to the Covid pandemic.

 Beverley Flowers stepped down as the Chief Executive for the CCG and is now the Interim Director of Transformation for the Integrated Care System (ICS)  Dr Jane Halpin has started as the Joint Chief Executive for the three CCGs and Integrated Care System (ICS)  Sharn Elton has taken the post of the Managing Director for ENHCCG  Alan Pond is appointed as the Chief Finance Officer of Hertfordshire and West Essex CCGs from 1st August 2020.  Denise Boardman the Director of Primary Care has left, currently Gerry Moir and James Gleed are covering the work  Sheilagh Reavey the Director for Nursing and Quality has recently resigned from her post at the CCG

3. FINANCE UPDATE – Alan Pond 19/20 – the Welhat Locality received a small underspend for the financial year, with a small overspend in month 10 to 12 The locality qualifies under the financial element of the CFF. The overspend was mainly from acute services, mostly unplanned care and non-elective admissions. Part of the recovery process going forward needs to be how we can avoid non elective admissions going back to unaffordable levels.

20/21 – there will be no financial balance in the CFF due to the financial regime being different so the funds have been deployed else in the CFF, the financial reporting will be very different.

Moving into Recovery for 21/22 the focus will be on patients with the

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highest needs and effort will be on categorisation of patients & procedures with the greatest risk. We are not sure when the standard pathways will be up and running.

PSmentioned a pilot project which is running in other areas for patients having to phone beforehand to attend A&E. This project is being carried out on a small scale as we need to understand the capacity if patients are going to be sent back into general practice. Funding may come though nationally.

KR-W said their practice was still waiting for some CFF payments for 19/20 and had not heard back the CCG claims team. The CCG have made an initial payment based on 18/19 achievements that also included the financial balance.

Assessments should be coming out soon and some practices may be entitled to a further payment, as there are two elements around cancer screening this will be known around November time and there could be further top up payments.

Statements will be sent to Practices and performance data will be sent out shortly.

4. ICPB UPDATE – Lynn Saville A virtual project update was shown to the locality. There has been a lot of work around care homes; this was a temporary funded service to support the care homes through the WHICH project and it will help to prepare for the new PCN care home specification. A pharmacy resource has also been used alongside this for the pilot project.

The MDT work was a really good learning but still some work yet to be done on how to strengthen this with the Hospice, Social Care and Mental Health support. Work is being done on how Mental Health is working in the locality. The next meeting will be held in September.

Frequent attenders final actions will be sent out after the meeting, there may be an element of expertise here to share amongst the practices.

Opoids project is something we are looking to start but would need experts from the trust to support generally there is good work around what we do next and LS will share the notes.

PS raised a query regarding the care home MDT and asked that HCT make contact with the doctors doing the ward rounds as this is part of the PCN DES, LS has asked for a full list of the doctors carrying out the ward rounds. TG said he would raise this at the Care Home meeting he was attending. Action: PS to email the list of doctors to LS to liaise with HCT.

5. Care Home temporary registrations

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CN raised a query particularly from Spring House and Peartree Surgery regarding temporary registrations at care homes, other practices might be doing something different but group agreements need to be resolved and a definite policy is needed.

TG will liaise with Dr Steve Price and CN and also involve Anna Makepeace who is talking to Contracts at the CCG. This will be left on the action tracker and re visited at the next meeting. Action: TG to liaise with Dr Steve Price and CN

CFF 19/20 As discussed in finance update.

CFF 20/21 AP and SE raised concerns that some of the targets haven’t changed in the CFF metrics and asked for these to be changed as this puts a lot of pressure on practices. It was also raised that a lot of work in the CFF seems to be face to face and questioned whether this is what the CCG want the practices to do as patients are being limited coming in the practices. Population health management is another area of concern, whereby a piece of work has been asked to be completed by the end of March 2021 with a potential need to increase capacity in resource. AP advised the targets have been changed with respect to reduced timeframe to achieve CFF and also keeping in mind the type of consultations taking place during the Covid period. If there is a second wave the CCG may have to look to see if the current CFF should be continued or send out another interim. This may be possible. It can’t be confirmed whether it will be at a local or national level.

Discussions were held about potential new locality sites for Hot clinics/ shielded patients for the winter. AS suggested looking at this now with a view to have some arrangement in place n October. The sites need to be accessible to patients geographically and managed proactively. AS suggested a small T&F group meeting to explore this further and agree to a decision. Action: TR to set up a small group within the next couple weeks to include AS, PS, MS, TG, VT, SM,AP,SE and CN

Flu Programme Waiting for NHSE to send further guidance, TR will let the localities know when something is available to be sent out; there has been a Task and Finish group set up at the CCG which includes some of the practices and PCNs.

Various options have been put forward including drive in clinics; James Gleed at the CCG is working on the financial implications and the best model to put in place for the practices. There will be a STP flu plan put in place by 10th August.

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Issues around getting the vaccines, as there are shortages across the country. Vaccines should be available by mid-September. Potentially there may be a central distribution of the vaccines. Action: TR will pass this back to James Gleed and Monica Wright at the CCG who are leading on flu.

Discussions from Public Health England advice regarding don and doffing between every vaccine, this guidance may change and if anyone has any queries please pass on to TR.

Winter Pressures Discussions have been held at board level it has been confirmed the funding will continue at the same level as last year. SE mentioned about funding going to PCNs or practices level and can the PCNs let her know and she will be happy to coordinate on behalf of the locality.

New Phlebotomy LES It was confirmed that no practices had come forward to provide this service as part of the LES. AP confirmed the LES was agreed and in place but not sure whether something has gone out.

A question was asked whether there are any plans for existing phlebotomists to go back into practices. ENHT have assured this is being looked at to expanding the phlebotomists back into the practices as capacity allows but there are staffing issues with Shielding/sickness.

Role of Locality vs PCN This year was going to be a transition year for the locality leads and the locality to work with the PCNs. Some things will be passed onto the PCN and some to continue at the locality, discussions need to take place on how to take forward and how things will carry on.

Some practices had not seen any output from the Clinical Directors weekly meetings, the understanding was the action tracker should have been shared with the PCN practices by the Clinical Directors but this doesn’t seem to have been the case. A concern was raised by PW regarding their roles going forward and asked for the action tracker to also be shared with the patient representatives. Action: TR to arrange for the action tracker to be shared with practices and patient representatives going forward.

Engagement monies for PCNs AS to take this forward with the PCN Clinical Directors regarding funding streams for the locality and PCNs. Discussion to follow outside of the meeting.

A concern was raised regarding the role of the infection control team in

Page 5 of 7

approving plans for the PCNs. If there are any issues please email VR/AS so these can be escalated to the right team at the CCG.

CCG Primary Care response during the COVID 19 Pandemic AP proposed holding a debrief meeting with the practices and the CCG about how we have coped during the pandemic. AP suggested this may be useful topic to have at the Council of Members meeting in September and could be put forward as an action.

6. AOB – The Council of Members is on the 3rd September 2020 and the next LCC is on the 1st October 2020.

Hot Site and shielded patients meetings will be organised within the next couple of weeks.

AK asked what the PCNs consultant costs were, AP asked is this was due to the service not found useful. MS and TG stated they have been in contact and have found the meetings useful. James Gleed will have these figures.

Action: TR to go back to James Gleed at the CCG.

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ACTION TRACKER

No. Meeting Item No. Action Responsible Deadline Status Date and Title Manager 1. Welcome AS to confirm whether the Diabetes Completed improvement plan 87 30.07.2020 AS – email criteria response sent to AP email from the Governing Body had been sent out. 4. ICDB PS to email the list update - of doctors to LS to 88 30.07.2020 PS Pending MDT Care liaise with HCT. Homes 5. Care TG to liaise with Dr Home Steve Price and CN. 89 30.07.2020 TG Pending temporary registrations 5. Locality TR to set up a small sites for group within the next shielded couple weeks to 90 30.07.2020 patients include PS, MS, SE, TR Completed CN and VT

5. Flu TR will pass this Programme back to James - NHSE Gleed and Monica 91 30.07.2020 TR Completed guidance Wright at the CCG who are leading on flu. TR to arrange for the Clinical Directors 5. New action tracker to be Completed 92 30.07.2020 Phlebotomy shared with TR – see LES practices and patient attached representatives going forward. 6. AOB – TR to feed back to PCN James Gleed at the 93 30.07.2020 TR Pending consultant CCG. costs

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Welwyn & Hatfield Locality Commissioning Committee 1st October 2020 MS Teams Virtual meeting MINUTES Present:

Name Job Title

Dr T Gillham GP Peartree lane Surgery Dr J Gates Gp Lister House Surgery Dr Sarah Hoole GP Potterells Medical Centre Dr Ann Kelley GP Wrafton House Dr Eva Kreye GP Spring House Dr S Jitka GP Peartree Lane Surgery Dr Richard Lavelle GP Lister Surgery Dr Saiyeesh Maheswaran GP Bridge Cottage Dr Alister Parry GP Hall Grove Surgery Dr Gwen McDowall GP Lister House Surgery Dr M Saiyeesh GP Bridge Cottage Surgery Dr Preenal Shah GP Hall Grove Surgery Dr Ashish Shah GP Wrafton House (Chair) Dr Rahul Shah GP The Garden City Practice Dr Vivian Tangang GP Burvill House

In Attendance:

Sunday Adeniyi Deputy Chief Finance Officer ENHCCG James Brookman Practice Manager Peartree Lane Debbie Crossley Practice Manager Bridge Cottage Surgery Lilian Cross Practice Manager Potterells Surgery Amy Daley Practice Manager Burvill House Surgery Helen Hemmingfield Adminstrator, CCG Sarah Ellingworth Practice Manager Garden City Practice Anne Knight Practice Manager Hall Grove Sylvia Lane Practice Manager Wrafton House Surgery John Phipps Practice Manager Burvill House Surgery Lynn Saville Project Manager HCC Peter Wilson PCG Chair

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Item Subject Action by

1. WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed all to the meeting. Apologies were received from:

 Tora Robinson

The Chair declared that the meeting is quorate.

2. DECLARATIONS OF INTERESTS

Practices will have declarations of interests around the discussion of hot clinics and CFF appeals.

The Chair invited the members to reconfirm their current declarations on the Register of Interests and advise of any new declarations. All members confirmed their declarations were accurate and up-to-date. All other members confirmed their declarations were accurate and up-to- date. The Chair invited members to declare any declarations relating to matters on the Agenda. All members confirmed they have no declarations in relation to matters on the Agenda.

3. MINUTES OF PREVIOUS MEETING AND MATTERS ARISING

The Minutes of the meeting held on 30th July 2020 were virtually approved as an accurate record.

4. ACTION TRACKER The contents of the Action Tracker were discussed. (Please see table at end of Minutes)

The following actions were agreed to be closed:

 Action 88 - PS to email the list of doctors to LS to liaise with HCT – to be closed  Action 89 - Care Home temporary registrations - TG shared document today and will comment under AOB – to be closed  Action 93 - TR to go back to James Gleed at the CCG. TR to send update to practices – ongoing

ACTION: The Action Tracker to be updated to reflect the updates.

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Item Subject Action by 5. CCG UPDATE  Discussions had around winter pressures and Care Homes DES which started from 1st October 2020  CCG and ICS transition update, letter received from the independent lead for the ICS, plan to have a partnership board from September 2020 to include representation from each organisation  First meeting was due to happen in September to discuss principles and strategies around the ICS to be formed by April 2021, update to be circulated once we have information

6. Hot clinic update  It was agreed at the last meeting to have a locality hot hub for all practices  7 practices agreed to be part of a single hub and 2 practices wished to have their own hot clinic on their own premises  A task and finish group was set up with SH, TG, MS, HP, CN and TR  This is now progressing with 7 porta cabins being sited in Spring House with logistics now in place  Groundwork is happening with cabling and plumbing and HBLICT and ITS have given the hot hubs 7 PCs and printers at no charge th  Extended access is all set up to go live from 12 October with GP appointments being booked for up to 2 weeks

 Discussions to be held around allocations and DNAs

 The draft hot hub SOP has been sent round, questions around this

will be discussed after this meeting

 The final SOP needs to be signed and sent back to AS.  Sarah Ellingworth thanked Corrine for all her hard work on behalf of everyone

A question was asked to the CCG if they would consider covering the gap and offer some reimbursement up to the £95 per hour. It is possible that the practices would be paying for this shortfall. Discussions were held and SA will take this back to Alan Pond at the CCG to find out what has been authorised. Negotiations are with the CCG at the moment.

AS will send SE the provisional submission email that was sent to the CCG.

TG has seen the first draft of the SOP, practice overhead costs need to be clarified by the CCG and a question was asked whether practices could use some of the £1 per patient money for the hot hub services.

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Item Subject Action by

7. £1pp Locality Funding The proposal is for the 7 practices to allocate £100k of remaining money along with winter pressure funding to run the locum and other services during the winter months and use this as a locality project. This was SA approved for the locality.

SA will communicate this to finance.

8. Finance Update  There will be a fixed allocation going forward  COVID funding has now been moved to ICS level – no longer giving it to CCG, the ICS will need to work out what each organisation will need to receive  Financial plan will be submitted and will explain what areas have increased costs, most of the increased costs are around Continuing Healthcare and prescribing  The hospital discharge programme will be funded nationally, this might impact the locality regarding what PPE would be funded, particularly regarding the Spirometry service

 A letter was sent out which gives some detail of what localities

need to do with COVID claims, COVID claims will cease in Primary Care from 1st October 2020 to end of this year, practices were encouraged to send their outstanding claims without delay

PS mentioned a letter regarding spirometry with the potential to have a spirometry hub, this is quite a lot work for the practices now around PPE and cleaning the room before and after, is this something that could be commissioned differently and set up a spirometry service – SA will take this back to the CCG.

ACTION: Query regarding spirometry service and whether something SA different could be commissioned – SA to feed back to the CCG.

9. Provider Board Update Mental Health Service HPFT Lyn Saville shared the highlight report – some of them are listed below.  Very good mental health discussions at a recent meeting with CAMHS colleagues  Trying to understand route referrals and how services are commissioned and linked together  Upskilling and trying to develop better understanding of pathways  CAMHS commissioner Deborah has developed a pathway tool which she has agreed to share  CAMHS service currently recruiting for a GP lead as a sessional

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Item Subject Action by placement  Set up of a task and finish group about opioids, pilot project to find alternatives for patients  Good work going on regarding delirium pathways  Integrated Care Home and the DES has been supported  Link nurses from HCT to the care homes Pauline will send out an email

PW mentioned a report circulated on hoarding and on the approaches to identify and manage patients this is well worth a read.

10. CFF 2019/20 Appeals SE wanted to raise that there are quite a lot of appeals going on at the moment and this is very time consuming for practices involved. There are specific areas that are not explained and AS offered to take this back to the CCG. Hopefully going forward in the coming year the CFF will be a little more streamlined.

The claims process is being handled by the Finance team at the CCG. .

Flu reclaim and cost calculations A question was asked about claiming extra costs and should this be on monthly basis? There needs to be some clarity and AS asked that Kayleigh share the email and he will be happy to take this forward.

COVID expenses claim

No further questions.

Phlebotomy LES

Phlebotomy LES has been sent round to the practices and no practices

have taken this up, there is a funding gap for phlebotomists this is only

short term to March 2021.

HPFT GP + service

This has been covered at the provider board and has been actioned. Currently we don’t have an idea if HPFT are going to continue with this service over the next financial year.

ACTION: AS to take forward query around claiming for extra flu AS costs.

11. AOBs

Care Home registration proposal Care Home temporary registrations involving a patient from Peartree Surgery who was transferred to Oak View Care Home. This lead forward to discussions and proposed actions about where the care of the patient should fall.

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Item Subject Action by

Proposed actions were shared on the screen this is a broad agreement and is for discussion and agreement on a protocol.

This will be taken outside the meeting and TG will email round to get some feedback to try and finalise a policy.

The next meeting will be held on 7th January 2021.

Action Tracker – LCC October 2020 No. Meeting Item No. Action Responsible Deadline Status Date and Title Manager Query raised regarding spirometry service and 7. Finance whether something 94 02.10.2020 SA Completed Update different could be commissioned – SA to take back to the CCG. 10. Flu AS to take forward query reclaim and around claiming for extra 95 01.10.2020 AS Completed cost flu costs. calculations

Page 6 of 6 Appendix 5

05/03/2021 Gifts, Hospitality and Sponsorship Register 2020-21

Name Current position(s) Date of Offer Declined or Date of Receipt Details of Gift / Hospitality / Estimated Value Supplier / Offeror Name and Reason for Declining or Details of Officer Reviewing Date form signed off held in the CCG (To the day) Accepted? (if applicable) Sponsorship Nature of Business Accepting / Approving the Declaration (if applicable)

Sue Fogden Assistant Director – 17/12/2020 Declined N/A Limited Edition Print as a gift from N/A AHR Norwich Union House, AHR are the architects N/A N/A Premises them at this festive time. High Street, Huddersfield, appointed by Imagile on the West Yorkshire HD1 2LR Herts and Essex project, they are contractors

Page 1 of 1 Agenda Item No: 8

Date of Meeting: 25 March 2021

Governing Body Meeting in Public

Paper Title: Integrated Performance and Quality Report

Decision or Approval Discussion Information

Report author: Jo O’Connor – Acting Associate Director Performance Rosie Connolly – Acting Associate Director, Quality Improvement Report signed off by: Jo Burlingham – Interim Director of Operations and Resilience Jane Kinniburgh – Director of Nursing and Quality, HWE ICS

Executive Summary: This Integrated Performance and Quality report provides an update on the performance and quality of local NHS Trusts in relation to key national performance standards. It includes quality and performance information at CCG level and also at provider level (ENHCCG, ENHT, PAH, HUC, EEAST, HPFT, HCT and Primary Care).

The performance and quality metrics included within the report are published information predominantly for the January position. All metrics have been included with commentary for exceptions where performance standards have not been met.

Recommendations . To note to the members:

Conflicts of Interest None to declare. involved:

Page | 1 Conflict of Interest Definitions

The following table describes the sub-classifications of interests:

Type Description Financial Interests This is where an individual may get direct financial benefits from the consequences of a commissioning decision. Non-Financial This is where an individual may obtain a non-financial professional benefit Professional Interests from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. Non-Financial This is where an individual may benefit personally in ways which are not Personal Interests directly linked to their professional career and do not give rise to a direct financial benefit. Indirect Interests This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non- financial personal interest in a commissioning decision.

Page | 2 1. Background

N/A

2. Issues

N/A

3. Options

N/A

4. Resources implications

N/A

5. Risks/Mitigation Measures

N/A

6. Recommendations

. To note

7. Next Steps

N/A

Page | 3 REPORT MONTH: January 2021 ENHCCG INTEGRATED PERFORMANCE AND QUALITY REPORT

Contents Report Authors Introduction

Quality Commentary ...... Page 2/3 Jo O'Connor Acting Assistant Director of This Integrated Performance Report provides an update on the ENHCCG ...... Page 4 performance and quality of local NHS Trusts in relation to key national Performance performance standards. In this report the published metrics being ENHT ...... Page 5 reported are for January 2021 unless stated otherwise. Rosie Connolly Acting Associate Director, Quality ENHT Referrals ...... Page 6 Improvement

PAH ...... Page 7

HUC ...... Page 8 Director Sign off Data Sources

EEAST ...... Page 9 Interim Director of Operations . Cancer: NHS Digital Jo Burlingham HPFT & HCT...... Page 10 . RTT, A&E and Diagnostics: NHSE Statistics

. Referrals and Ambulance Handover: Individual Trust Reporting Primary Care...... Page 11 Jane Kinniburgh Director of Nursing and Quality,

HWE ICS

Performance Headlines

. Covid-19 Impact on Reporting: Nationally, mandatory reporting was stepped down from the 1st April 2020 with the exception of statutory requirements; A&E 4 hour waits, cancer waiting times and RTT ambitions. Throughout the pandemic however, we have worked with providers to understand the most up to date position; this report is based on the published data of constitutional standards to January (February for Provider A&E) and local data to March; . A&E: Performance improved in February at both ENHT and PAH, however still remains below 80% at both providers with continued pressure to staffing and increased IPC measures due to Covid-19; . RTT: 18 week performance declined at both ENHT and PAH in January, with further cancellations of electives in response to the most recent wave of the pandemic; all Priority 3 and Priority 4 elective procedures were stood down regionally at the end of December. The number of patients waiting over 52 weeks continues to increase in line with the clinical prioritisation and treatment of patients; . Cancer: ENHT met 6 of the 8 national cancer standards in January including 62 day first, with PAH remaining below the majority of standards.

Quality Headlines . Impact of Covid-19: The CCG continues to liaise regularly with all key providers to understand any urgent or significant quality and safety issue s and risks resulting from the Covid-19 pandemic, and the mitigating action taken by the providers. A key issue for all providers is the current pressure on workforce as a result of Covid-19 related sickness and staff required to isolate. . ENHT Never Event: A third Never Event was reported in December relating to wrong site biopsy; the investigation is ongoing. The Trust has repor ted a total of three Never Events YTD. . PAH Never Event: A Never Event was reported in October relating to a patient who was connected to air flow rather than oxygen; the investigati on is currently ongoing. . PAH Maternity services: PAH are currently being supported via the Maternity Services Support Programme. A thematic review of Serious Incidents has ta ken place, and an external review has been undertaken in relation to the incidents identified in order to identify any further improvements required. Whilst learning h as been identified from the external review, no overarching themes were found. ENHCCG and WECCG are working with PAH to seek assurance regarding the timely progression of their improvement plan, a nd a further stakeholder event is to take place in April. . HCT CQC: CQC have undertaken a Transitional Regulatory Approach (TRA) in mid-January 2021. This focuses on safety, how effectively a service is led, and how easily people can access the service. Verbal feedback has been received; the Trust has advised that there is only one area of action required relating to the recor ding of clinical supervision of staff. . EEAST CQC: NHSE&I placed EEAST into Special Measures in October 2020 following significant concerns identified by the CQC during an ins pection undertaken in June and July 2020. 4 key areas of concern have been identified: leadership capability and capacity; culture; governance assurance and oversight; and safeguardi ng. Additional support has been provided to the Trust which includes the appointment of an Improvement Director, increased ‘Freedom to Speak Up’ capacity, ‘buddying’ arrangements with fellow ambulan ce services, and Board development sessions. Oversite and Assurance Group meetings have been established monthly to monitor EEAST. ENHCCG will be sighted on progress through the mon thly Oversite and Assurance Group with the host commissioner and NHSE&I, and through Locality meetings.

P.1 Quality Overview January 2021 The CCG continues to liaise regularly with all key providers to understand any urgent or significant quality and safety issues and risks result ing from the Covid-19 pandemic, and the mitigating action taken by the providers. A key issue for all providers is the current

pressure on workforce as a result of Covid-19 related sickness and staff required to isolate.

East and North Herts NHS Trust Never Events: Three Never Events have been reported by the Trust YTD. One relates to a patient who was connected to air flow rather than oxygen, the investigation is now closed. The second relates to a wrong site procedure; a third Never Event was reported in December relating to a wrong site biopsy. The investigations for both Never Events are currently ongoing. Sepsis: Sepsis performance in relation to treatment with intravenous antibiotics within 1 hour remains below the target of 90% both in ED and inpatient settings. In ED the performance in January was 64% compared to 62% in December and in the inpatient setting performance was 25% in January compared with 0% in December, the sample size for data collection remains low. The Trust continues to work on improvements through a joint approach across the Sepsis, Acute Kidney Injury, Resus and Critical Care Outreach Teams. The overall Trust aim was to have full compliance with all six elements of the care bundle for 95% of patients by March 2021, however progress has been impacted due to the current Covid-19 pressures. The Trust is providing the CCG with an updated timeline at the March Quality Meeting. Discharges: A theme regarding the quality of discharges from the Lister site was identified during the initial wave of the pandemic; concerns were reported through patient and family feedback as well as through the CQC. A SI investigation was undertaken and work is ongoing to make improvements both within the Trust and across the local system. This includes an end to end review of the discharge process, clarification of roles and responsibilities, and a focus on discharge medication.

Princess Alexandra Hospital NHS Trust Never Event: The investigation is ongoing regarding the Never Event reported in October relating to a patient who was connected to air flow rather than oxygen. No further Never Events have been declared YTD Maternity services: PAH are currently being supported via the Maternity Services Support Programme. A thematic review of Serious Incidents has taken place, and an external review has been undertaken in relation to the incidents identified in order to identify any further improvements required. Whilst learning has been identified from the external review, no overarching themes were found. ENHCCG and WECCG are working with PAH to seek assurance regarding the timely progression of their improvement plan, and a further stakeholder event is to take place in April.

Hertfordshire Community NHS Trust CQC: CQC have undertaken a Transitional Regulatory Approach (TRA) in mid-January 2021. This focuses on safety, how effectively a service is led, and how easily people can access the service. Verbal feedback has been received; the Trust has advised that there is only one area of action required relating to the recording of clinical supervision of staff to enable the Board to have full oversight and assurance. Covid-19 Vaccination: HCT is co-ordinating the mass vaccination sites in Hertfordshire with 11 sites now open. Pressure Ulcers: Pressure Ulcers remain the most commonly reported incidents within the Trust. The number of pressure ulcers reported has increased since December 2020, with 113 pressure ulcers reported in January. This is the highest figure reported since May 2020. The Trust has advised the impact of Covid-19 and the pressure teams have experienced is likely to have impacted on the number of pressure ulcers reported. Where specific localities have seen an increase in pressure ulcers senior support has been increased.

East of England Ambulance Service NHS Trust CQC: NHSE&I placed EEAST into Special Measures in October 2020 following significant concerns identified by the CQC during an inspection undertaken in June and July 2020. 4 key areas of concern have been identified: leadership capability and capacity; culture; governance assurance and oversight; and safeguarding.

Additional support has been provided to the Trust which includes the appointment of an Improvement Director, increased ‘Freedom to Speak Up’ capacity, ‘buddying’ arrangements with fellow ambulance services, and Board development sessions. Oversight and Assurance Group meetings have been established monthly to monitor EEAST. ENHCCG will be sighted on progress through the monthly Oversight and Assurance Group with the host commissioner and NHSE&I ,and through Locality meetings.

Hertfordshire Eye Hospital (HEH) ENHCCG’s contract with HEH ceased in December 2017; however the CCG has been made aware through the GP hotline of a small number of patients who had been booked to attend clinics at HEH during this year. On attending the appointment they have found that the service is no longer there. ENHCCG has liaised with HEH to seek assurance in relation to this, and letters have been sent to a cohort of relevant patients asking them to contact the CCG if they believe they are waiting to be seen at HEH in order that we can work with practices to review and onward refer where appropriate.

Care homes There remains a significant focus on care homes during the pandemic. The ENH Outbreak Cell remains in place to support care homes, residential and nursing homes, learning disabilities, supported living and assisted living during a Covid -19 outbreak. The Strategic Outbreak Cell reviews lessons learnt from ENH and HV outbreak cells and reviews new guidance, amending processes as required. The cell ensures that there is a consistent message to the care homes regarding the continued use of PPE, and that IP C guidance is maintained. There has been a significant increase in the size of outbreaks since December 2020, there are current ly 7 care homes with pauses to admission, this is reviewed every 48 hours.

Due to restricted visiting in care homes due to Covid-19, the CCG are unable to visit the homes for routine assurance and support, therefore ENHCCG and HCC implemented a remote interim monitoring process in July and are utilising professionals visiting the homes in a clinical capacity for example, District Nurses, Frailty Nurses, GPs and ambulance staff. Remote monitoring will be reviewed frequently; where there are serious concerns raised, ENHCCG and HCC would undertake a visit to the home based on a ris k assessment.

The Safety Improvement Process is commenced when there are concerns about a particular service provided to vulnerable adults. This process usually follows a safeguarding investigation regarding one vulnerable adult where concerns are raised about the ca re of others in the same service. There are currently twelve care homes within the Safety Improvement Process within ENHCCG which a re monitored jointly by the CCG and HCC.

A multi-agency Vaccination Cell has been established to support the vaccination process and provide support and communication to the care homes. All care homes for all older people and learning disabilities received their first vaccination for those resi dents that were well enough, consented and not Covid positive by the 24th January 2021. Mop up sessions and 2nd doses are to be schedule d. Staff have all been offered routes to receive vaccination either by PCN or mass vaccination centres.

P.2

Quality Overview January 2021

Maternity Following the publication of the emerging themes from the Ockenden review, each acute trust was required to submit an initial outline of their assessment against 12 urgent clinical priorities by 21st December 2020. A more detailed assurance assessment tool was then completed and submitted by mid-February. Key areas related to enhanced safety, listening to women and their families, staff training, risk assessment and management of complex pregnancies, fetal monitoring, and informed consent.

ENHT completed their submission with oversight from the Trust Board, the Local Maternity and Neonatal System and the CCG. The Trust is compliant in the majority of areas, and has a plan in place to reach full compliance.

Learning Disabilities and LeDeR ENHCCG has been working with colleagues across primary and secondary care to ensure that required actions are taken to support patients with a learning disability, particularly in light of the inequalities highlighted by Covid-19. This includes the sharing of all national guidance and supporting care homes and supported living for those with a learning disability.

ENHCCG has been working with commissioning colleagues to review the recommendations from the LeDeR national publications, and undertaking work to understand the current position across Hertfordshire including the identification of any gaps, and associated actions required. Work is planned to ensure a consistent approach across the ICS, working with primary care, care homes, and secondary care providers to take action and make improvements where required. Updates will be included in future reports.

Harm reviews There are currently a significant number of patients waiting longer than usual for treatment as a result of the pandemic, and where patients breach either the 62 day cancer standard or wait longer than 52 weeks on the RTT pathway, a harm review is undertaken.

As an ICS we have agreed to adopt a standardised approach to harm ratings. These have been developed following clinical consultation and are based on work by Norfolk and Norwich NHS Foundation Trust. The harm review process has been discussed at the ENHT quality meeting, and the CCG is currently liaising with ENHT in order to obtain regular reports summarising the outcomes of the harm reviews undertaken and identifying learning.

Nosocomial infections

During December ENHT recorded a total of 298 Covid-19 cases of which a total of 67 were either probable or definite nosocomial infections. A further 647 Covid-19 cases were reported in January, of which 101 were either probable or definite nosocomial infections.

The Trust discusses and reviews all new nosocomial infections at the daily Gold meeting, and where learning is identified from review of nosocomial cases and Covid-19 outbreaks, this is shared Trust-wide.

P.3 ENHCCG January 2021

Standard/ Area Metric Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Trend Threshold A&E 1 % Seen within 4 hours 95% 75.93% 81.60% 84.86% 85.54% 82.38% 79.48% 79.14% 75.70% 70.28% 65.72% 78.47% C1 (Median) 07:00 8:01 5:56 6:05 6:05 6:14 6:02 6:30 5:52 6:32 7:19 6:28 Ambulance C2 (Median) 18:00 27:52 17:30 17:29 20:53 23:27 24:03 23:59 21:30 28:00 33:00 23:46 Response C3 (90th Percentile) 02:00:00 01:57:32 01:04:44 01:17:44 01:30:11 01:54:19 01:53:27 01:57:08 02:03:24 02:50:41 04:10:42 02:03:59 Times 2 C4 (90th Percentile) 03:00:00 02:39:02 01:53:15 02:05:19 01:55:20 01:51:58 02:14:59 02:48:47 01:40:09 04:23:40 03:31:38 02:30:27 2ww All Cancer 93% 95.82% 97.72% 94.26% 91.43% 89.54% 89.82% 91.83% 92.22% 95.10% 95.02% 92.85% 2ww Breast Symptoms 93% 83.78% 98.85% 88.99% 90.30% 94.74% 98.44% 94.24% 89.17% 87.60% 91.84% 92.08% 31 day First 96% 98.42% 98.71% 94.51% 94.95% 97.19% 96.00% 95.26% 97.32% 98.02% 94.89% 96.50% 31 day Sub Surgery 94% 92.50% 97.06% 92.50% 94.74% 87.50% 91.91% 89.47% 95.00% 97.14% 77.78% 91.00% Cancer 31 day Sub Drug 98% 100% 100% 100% 100% 100% 100% 98.18% 100% 100% 95.59% 99% 31 day Sub Radiotherapy 94% 97.73% 98.73% 100.00% 98.59% 98.53% 98.63% 100% 96.25% 98.44% 96.23% 98.38% 62 day First 85% 83.33% 81.25% 78.13% 84.91% 82.35% 79.31% 78.95% 82.31% 83.82% 81.10% 81.58% 62 day Screening 90% 37.50% 0.00% 0.00% 20.00% 0.00% 83.33% 75.00% 88.89% 80.00% 76.47% 63.86% 62 day Upgrade 85% 88.00% 95.24% 85.71% 85.71% 91.30% 70.21% 84.21% 93.10% 82.50% 84.85% 85.45% Incomplete Pathways 92% 70.61% 62.19% 53.75% 51.98% 59.12% 64.04% 69.43% 73.53% 72.21% 69.70% 69.70% RTT 3 52 weeks 0 100 216 275 549 705 886 1,095 1,181 1,394 1,979 8,380 Diagnostics 6 week wait 1% 61.42% 61.12% 49.24% 42.76% 41.95% 33.76% 23.76% 22.21% 24.60% 33.98% 33.98%

1 Seen within 4 hours 2 Ambulance Response Times 3 Incomplete Pathways 100% 00:40:00 100% 00:33:20 90% 90% 00:26:40 80% 80% 00:20:00 00:13:20 70% 70% 00:06:40 00:00:00 60% 60% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 50%

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Nov Mar May C1 (Median) C2 (Median) C1 Target C2 Target % Seen within 4 hours Target % Incomplete Pathways Target %

Commentary Further detail is provided on the Provider pages A&E: Performance declined in January to 65.72% at CCG level in line with the latest wave of the pandemic; there were increased numbers of Covid-19 patients throughout January and significant pressures to staffing levels; RTT: 18 week performance declined at CCG level in January to just below 70% with elective treatments being stood in response to the latest wave of the pandemic; Priority 3 and Priority 4 electives were stood down regionally at the end of December. The number of 52 week waits continues to increase in line with the clinical prioritisation and treatment of patients on the waiting list; Cancer: 2 cancer standards were met at CCG level in January. 62 day first performance declined to 81.10%; ENHT continued to achieve standard in January however, with PAH remaining significantly below.

P.4 East and North Herts NHS Trust January 2021 Standard/ Area Metric Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Trend Threshold A&E 1 % Seen within 4 hours 95% 78.00% 83.38% 88.13% 90.11% 87.09% 84.84% 84.54% 82.38% 78.18% 75.18% 78.78% 83.30% Handover To A&E <15 mins 100% 21.00% 33.00% 32.00% 33.00% 31.00% 27.00% 32.00% 24.00% 20.00% 22.00% 27.50% 2ww All Cancer 93% 97.72% 99.35% 99.32% 92.80% 95.84% 97.25% 96.74% 97.36% 98.12% 96.17% 92.85% 2ww Breast Symptoms 93% 79.31% 100% 98.59% 97.98% 98.67% 99.00% 96.36% 97.64% 93.33% 93.40% 92.08% 31 day First 96% 98.60% 98.50% 98.63% 94.67% 98.22% 98.48% 98.28% 98.68% 99.57% 99.05% 96.50% 31 day Sub Surgery 94% 94.44% 96.15% 100% 94.67% 96.15% 90.00% 95.12% 95.45% 100% 75.00% 91.00% Cancer 31 day Sub Drug 98% 100% 99.39% 100% 100% 99.39% 100% 100% 100% 100% 100% 99.36% 31 day Sub Radiotherapy 94% 98.56% 98.59% 99.04% 99.30% 97.70% 98.10% 100% 98.90% 99.63% 98.76% 98.38% 2 62 day First 85% 87.08% 85.31% 87.78% 90.16% 85.15% 80.11% 86.92% 86.55% 86.96% 86.87% 81.58% 62 day Screening 90% 38.46% 0.00% N/A 20.00% 0.00% 80.00% 100% 100% 84.62% 80.00% 63.86% 62 day Upgrade 85% 70.37% 81.82% 100% 93.55% 100% 74.42% 82.81% 89.71% 71.43% 73.68% 85.45% Incomplete Pathways 92% 67.38% 57.95% 49.50% 46.76% 54.83% 59.79% 65.94% 71.26% 69.73% 67.20% 67.20% RTT 3 52 weeks 0 90 209 190 483 604 735 931 987 1,158 1,724 7,111 Diagnostics 6 week wait 1% 61.77% 61.16% 48.99% 40.18% 38.16% 29.38% 19.73% 17.36% 21.01% 29.60% 29.60%

1 Seen within 4 hours 2 ENHT Cancer 62 Days Target 3 Incomplete Pathways 100% 100% 95% 85% 90% 90% 85% 65% 80% 80% 75% 45% 70% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar % Seen within 4 hours Target % 62 day First Target % Incomplete Pathways Target %

Commentary

RTT and Diagnostics: RTT performance declined in January to 67.20%. Pressures on waiting lists have increased as a direct result of Covid-19 and the stepping down of elective treatments at peak times of the pandemic; all Priority 3 and Priority 4 elective treatments were stood down regionally at the end of December. The number of incomplete pathways over 18 weeks have increased together with the number waiting over 52 weeks, as patients are treated in order of clinical priority. Clinicians are continuing to review their admitted PTLs and risk stratify patients according to clinical need in line with the national Risk Stratification programme (Priorities 1-6); the Trust is currently prioritising P1 and P2 patients only as per regional instruction. Work is also underway across the ICS to jointly review demand and capacity across the system and offer mutual aid where possible. Use of the Independent sector capacity continues, with increased capacity again becoming availably for NHS surge from the middle of January. The number of referrals to ENHT declined significantly from the second half of March 2020 due to the impact of wave 1 of Covid-19. They subsequently recovered back to pre Covid levels however have since declined with the latest wave of the pandemic; please see ENHT referrals information on page 6. Diagnostic performance declined in January to just under 30% with an increasing number of patients waiting over 6 and 13 weeks due to pressures on capacity and staffing. An endoscopy task and finish group has been set up to work through backlogs and capacity constraints. Endoscopy direct access has been stopped to allow for consistent prioritisation of patients and pathway changes such as FIT testing are in place. Alternative diagnostics are also being reviewed and the Trust has signed up to a capsule endoscopy national programme. Recovery triggers for RTT and Diagnostics are in place and a recovery plan is in development.

A&E: Performance improved in February to 78.78% despite the challenges provided by the pandemic to maintain appropriate IPC (Infection Prevention Control) and responding to the staffing challenges experienced. To maintain the required IPC, the A&E is divided into Covid and Non-Covid pathways to create better flow and leadership in both areas. Additionally ward re-configurations were required to allow for the co-horting of Covid patients. Critical care capacity has been expanded to meet the current demand and mutual aid requests from across the country; capacity will continue to be reviewed in line with demand. The impact on staffing remains a challenge in light of the requirements of the pandemic. To mitigate the staffing challenges, on the 11th January the UTC at the New QEII Hospital was closed overnight on a temporary basis to redeploy clinical staff to where they are best utilised. Work continues within the system to utilise appropriate alternatives to admission. This includes community-based streaming of all patients, both Covid and Non-Covid, expansion of community support including virtual ward and remote monitoring with rapid access to acute support. Work also continues to minimise ambulance handover delays and inappropriate conveyance.

Cancer: The Trust met 6 of the national cancer standards in January, including 62 day first which continued to achieve standard at 86.87%. 31 day subsequent surgery dropped below standard in January due to a lack of theatre capacity; this standard is expected to recover in February with the reopening of additional theatres. 62 day screening also continued below standard with very low numbers coming through the screening service. Progress continues on speciality cancer action plans with all plans being reviewed and updated weekly. Shadow monitoring of the new 28 day faster diagnosis standard reported achievement in January for 2 week wait and breast symptom performance, with screening continuing below standard. Cancer PTLs are being reviewed across the ICS and mutual aid and capacity assessed. 2 week wait referrals declined significantly over wave 1 of Covid- 19 however subsequently recovered back above pre Covid-19 levels; referrals also saw a decline with the latest wave of the pandemic however have again recovered; please see ENHT referrals information on page 6.

P.5 COVID-19 Impact on East and North Hertfordshire Trust Referrals; weekly trend from December 19

All Referrals . Average of 3,208 referrals per week into ENHT from 1st December 2019 to week ending 15th March 2020, with a decline the following week to 2,053 referrals; . In the following period to week ending 7th March 2021, there have been an average of 2,352 referrals per week; . Referrals went down to their lowest of 979 the week ending 12th April, however increased back to 3,459 by mid November; they have declined again since with wave 2 of the pandemic, currently standing at 2,483 week ending 7th March; . Current overall decline of 23% on pre-Covid 19 average referral levels, with Other referrals predominantly driving the decrease. GP Referrals . Average of 1,583 GP referrals per week to ENHT from 1st December 2019 to week ending 15th March 2020, followed by a decline to 944 referrals the following week; . In the following period to week ending 7th March 2021, there have been an average of 1,236 referrals per week; . Referrals went down to their lowest of 310 week ending 12th April, however increased to 2,015 by mid November; they have since declined with the 2nd wave of the pandemic and numbers have varied week on week, currently standing at 1,488 week ending 7th March. This now represents an overall 6% decrease upon pre-Covid levels; urgent referrals have increased by 8% and two week referrals by 14%, however routine referrals have decreased by 15% upon pre-Covid 19 levels. . There was an average of 281 two week wait referrals per week up to week ending 15th March and an average of 260 in the following weeks of the reporting period. 2 week wait referrals hit their lowest point week ending 12th April at 88, however increased to 344 by the beginning of November; they had declined again with Wave 2 of the pandemic with numbers varying week on week, however stood at 320 week ending 7th March; this is an increase of 14% compared to pre-C19 averages; . GP referrals made up 53% of total ENHT referrals at the start of the reporting period with this steadily dropping to 32% by week ending 12th April; at week ending 7th March they are at 60%. Other Referrals . Average of 1,625 Other referrals per week from 1st December 2019 to week ending 22nd March 2020, followed by a decline to 1,109 referrals the following week; . In the following period to week ending 7th March 2021 there have been an average of 1,116 referrals per week; . Referrals had declined to much lower levels by the beginning of April, increasing again through to the middle of November; they have subsequently declined again with wave 2 of the pandemic, currently standing at 995 week ending 7th March. Urgent referrals have increased by 12% on pre-Covid 19 levels and routine referrals had decreased by 53%; . Other referrals made up 47% of total ENHT referrals at the start of the reporting period which steadily increased to 68% by week ending 12th April; at week ending 7th March they stood at 40%.

P.6 Princess Alexandra Hospital NHS Trust January 2021

Standard/ Area Metric Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Trend Threshold A&E 1 % Seen within 4 hours 95% 88.92% 91.22% 90.70% 88.32% 85.81% 83.85% 83.42% 80.68% 73.19% 69.80% 70.82% 82.70% Handover To A&E <15 mins 100% 38.00% 46.00% 42.00% 41.00% 33.00% 31.00% 27.00% 29.00% 22.00% 9.00% 34.33% 2ww All Cancer 93% 87.52% 92.59% 77.53% 85.91% 74.43% 68.67% 81.72% 72.06% 89.16% 90.56% 80.73% 2ww Breast Symptoms 93% 91.94% 97.48% 89.78% 82.50% 92.27% 92.89% 91.12% 61.49% 79.90% 86.84% 86.03% 31 day First 96% 94.92% 90.91% 86.89% 91.11% 87.10% 90.24% 87.38% 92.63% 93.68% 89.29% 98.31% 31 day Sub Surgery 94% 95.08% 100% 66.67% 85.71% 66.67% 100% 100% 80.00% 83.33% 100% 88.71% Cancer 31 day Sub Drug 98% 100% 100% 100% 100% 100% 100% 100% 100% 100% 88.00% 98.80% 31 day Sub Radiotherapy 94% 0.00% 0.00% 2 62 day First 85% 61.29% 61.90% 75.64% 74.47% 57.83% 66.27% 54.92% 67.33% 68.38% 65.42% 65.35% 62 day Screening 90% 66.67% 0.00% 0.00% 14.29% 0.00% 60.00% 0.00% 83.33% 70.59% 75.00% 53.42% 62 day Upgrade 85% 89.66% 85.11% 79.63% 80.23% 88.00% 70.65% 80.56% 87.50% 89.53% 84.91% 82.92% Incomplete Pathways 92% 80.26% 75.07% 71.20% 70.95% 75.28% 77.35% 78.24% 77.54% 73.76% 69.82% 69.82% RTT 3 52 weeks 0 27 58 140 213 272 363 420 467 657 914 3,531 Diagnostics 6 week wait 1% 59.12% 51.51% 35.64% 31.51% 34.40% 35.65% 31.32% 35.40% 37.82% 48.88% 48.88%

1 Seen within 4 hours 2 PAH Cancer 62 day First 3 Incomplete Pathways 100% 95% 95% 90% 85% 80% 50% 80% 65% 75% 70% 0% 50% 65% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar % Seen within 4 hours Target % 62 day First Target % Incomplete Pathways Target %

Commentary

A&E: A&E performance improved marginally in February to just over 70%; the Trust continued to be under pressure from acuity of patients attending, the admission rate and flow through wards to disc harge, with staffing also remaining a key challenge. Daily Patient Panels ensure that there is senior challenge to discharge planning and execution in addition to focussing on re d to green days during a patient's stay. Further work on professional standards is keeping a focus on ensuring patients receive timely investigation and decision making and is tracke d through the weekly Urgent Care Board. ICS wide surge and escalation discussions continue.

Cancer: 1 cancer standard was met in January; 31 day subsequent surgery. 2 week wait performance continued below national standard with continued pressure on Dermatology, Lower GI and Upper GI. Performance against 62 day first declined from December to 65.42% in January, remaining significantly below standard; performance reflects the increased treatments of patients that have breached the 62 day target as the Trust ensures that the longest waiting patients are diagnosed and treated as quickly as possible. Cancer performance recovery is closely monitored through weekly PTL meetings and Access Board with a detailed action plan in place. Cancer PTLs are being reviewed across the ICS and mutual aid and capacity assessed. Use of Independent Sector capacity continues and has being expanded to support.

RTT & Diagnostics: 18 week performance declined in January to just under 70% with cancellations of elective procedures in response to the latest wave of the pandemic; Priority 3 and Priority 4 procedures were stepped down regionally at the end of December with the Trust prioritising P1 and P2 patients. The Trust continues to clinically re view all patients on the waiting list and to book patients in priority order increasing the number of long waiting patients over 52 weeks. Diagnostic performance declined in January at 48.88% and remains significantly below st andard. The Trust is continuing to work closely with Independent Sector providers to utilise as much operating and diagnostic capacity as possible, with the plan to restart elective work at PAH by April.

P.7

Herts Urgent Care January 2021

Standard/ Area Metric Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Trend Threshold Calls answered ≤60 secs 95% 64.23% 89.57% 95.16% 94.26% 93.86% 64.97% 88.80% 84.76% 87.73% 74.25% 83.66% 1 Calls abandoned >30 secs ≤5% 10.60% 2.10% 0.90% 0.70% 0.60% 8.40% 1.40% 3.30% 4.10% 7.70% 4.16% Direct booking into IUC or Extended Access ≥95% 100% 100% 100% 99.79% 99.53% 99.48% 99.96% 100% 99.96% 100.00% 99.86% Direct Booking into UTC ≥50% 73.17% 78.29% 72.06% 65.85% 60.27% 72.76% 74.52% 69.32% 74.58% 66.83% 70.77% Revalidation of Cat. 3 & 4 ambulance dispositions ≥95% 97.98% 98.42% 97.80% 98.54% 97.87% 98.56% 98.75% 95.23% 98.09% 98.01% 98.30% National Standards Revalidation of ED dispositions ≥95% 97.25% 96.02% 94.60% 96.66% 95.63% 97.50% 97.32% 96.92% 98.76% 98.32% 96.92% Triaged calls to receive clinical input ≥50% 64.39% 67.94% 65.93% 65.48% 64.30% 63.30% 65.02% 64.56% 67.94% 69.12% 65.82% 2 Urgent visits <2hrs ≥95% 84.96% 93.18% 93.65% 97.24% 93.80% 96.00% 92.38% 94.49% 96.62% 90.48% 93.46% Routine visits <6hrs ≥95% 98.43% 99.28% 99.25% 97.45% 96.97% 97.15% 97.72% 97.29% 95.80% 94.98% 97.31% Urgent consults <2hrs ≥95% 91.76% 93.42% 97.03% 94.96% 91.02% 89.57% 92.43% 91.51% 85.59% 88.44% 93.46% Routine consults <6hrs ≥95% 98.45% 98.68% 99.21% 99.32% 99.71% 99.23% 99.20% 99.49% 97.10% 99.22% 97.31% AiHVS % Routine visits <6hrs ≥95% 100% 99.80% 99.40% 99.40% 99.80% 99.70% 99.07% 100% 99.51% 99.33% 99.60% 3 111 Online Activity - 30,456 15,864 10,758 9,661 9,476 17,570 9,526 8364 10994 13731 7050 136,400 Cat. 3&4 Ambulance Disposition - 1,343 1,054 821 631 726 690 580 540 557 900 573 7,842 Cat. 3&4 CAS validated - 543 441 321 231 307 263 202 186 195 377 209 3,066 111 Online ED Disposition - 561 470 319 286 286 293 181 159 170 348 242 3,073 ED CAS validated - 1,380 1,120 837 732 756 759 562 520 559 917 643 8,142 Total number of ITK call backs - 3,129 2,864 1,657 1273 1,324 2,003 1,307 1270 1636 2751 1238 19,214 COVID-19 Calls to 111 with Coronavirus Concerns - 8,038 2,498 1,624 1,498 1643 4,604 2,612 1,001 1,908 2,384 27,810

1 2 111 Online Cat. 3&4 Ambulance and ED Dispositions (Hertfordshire) NHS 111 Calls Home Visiting and Come to Centre 3 100% 12% 100% 1500 80% 10% 80% 8% 1000 60% 60% 6% 40% 40% 4% 20% 500 20% 2% 0% 0% 0% 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Calls answered ≤60 secs Target 95% Urgent visits <2hrs Routine visits <6hrs Urgent consults <2hrs Cat. 3&4 Ambulance Disposition Cat. 3&4 CAS validated Calls abandoned >30 secs Target ≤5% Routine consults <6hrs Target 95% ED Disposition ED CAS validated Commentary

111: During January, the HWE call centre saw staffing significantly impacted by Covid-19 which affected performance; of the 35,150 calls, HUC answered 74.3% within 60 seconds and saw an abandonment rate of 7.7% (2.7% above the standard) . In response, HUC offered incentives to staff to cover additional shifts, implemented cross site working and on occasion activated National Contingency. To support further during this period, HUC implemented Health Advisors working from home to increase resilience and continued with recruitment virtually with a move towards virtual assessment centres.

OOH: There was a decrease of 3% in routine appointment volumes in January, however urgent appointments increased by 4% from 673 in December to 702 in January. Although continuing below standard, urgent appointment performance increased from 85.6% in December to 88.4% in January and routine appointments achieved 99.2%. Of these appointments at a centre, 28% were seen earlier than appointment time, 27% within 15 minutes of appointment time and 13% waited 15 minutes or longer. None of the cases waiting 15 minutes or longer resulted in serious or emergency outcomes or harm. Routine and Urgent home visits achieved above 90% in January, but fell below the 95% standard.

P.8 East of England Ambulance Service NHS Trust January 2021

Standard/ Area Metric Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Trend Threshold C1 (Median) 1 7:00 8:01 5:56 6:05 6:05 6:14 6:02 6:30 5:52 6:32 7:19 6:28 Ambulance Response C2 (Median) 18:00 27:25 17:30 17:29 20:53 23:27 24:03 23:59 21:30 28:00 33:00 23:46 Times C3 (90th Percentile) 02:00:00 01:57:32 01:04:44 01:17:44 01:30:11 01:54:19 01:53:27 01:57:08 02:03:24 02:50:41 04:10:42 02:03:59 C4 (90th Percentile) 03:00:00 02:39:02 01:53:15 02:05:19 01:55:20 01:51:58 02:14:59 02:48:47 01:40:09 04:23:40 03:31:58 02:30:27 ENHT <15 mins % 100% 58.00% 64.00% 65.00% 66.00% 64.00% 64.00% 66.00% 63.00% 65.00% 59.00% 63.40% Handover to clear PAH <15 mins % 100% 44.00% 56.00% 57.00% 41.00% 57.00% 31.00% 60.00% 58.00% 60.00% 62.00% 53.80% 2 ENHT > 30 mins (No. breaches) 316 235 232 242 285 393 286 365 634 467 3455 PAH > 30 mins (No. breaches) 142 110 167 204 295 337 345 445 667 991 3703 ENHT > 60+ mins (No. breaches) 38 10 6 5 19 1 64 2 265 144 499 Arrival to handover PAH > 60+ mins (No. breaches) 3 4 1 5 11 3 7 4 303 423 767 ENHT Average Handover Time (mins) 25 21 21 21 21 22 23 28 34 28 24 3 PAH Average Handover Time (mins) 21 19 20 21 22 25 26 26 42 57 28

Arrival to Handover - Average 1 Ambulance Response Times 2 Arrival to Handover > 30 Mins No. Breaches 3 60 00:36:00 1,100 50 00:28:48 900 700 40 00:21:36 500 30 00:14:24 300 20 00:07:12 100 10 00:00:00 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar ENHT > 30 mins (No. breaches) ENHT Average Handover Time (mins) PAH > 30 mins (No. breaches) C1 (Median) C2 (Median) C1 Target C2 Target PAH Average Handover Time (mins)

Commentary

In January , EEAST saw a higher than average number of conveyances at 6,005, compared to the year to date average of 5,427. This increased activity and staff pressures as a result of Covid-19, had a significant impact on performance across all four Ambulance Response Time categories. Improvements in performance have been seen in February and March to date.

To ensure patient safety and support the system, EEAST allocated two pre planned Ambulance Crews to cohort at WGH. Operational leads led the response with daily intelligence on staffing levels and absence, implementing actions accordingly. General Mangers were moved to each Acute Trust for the first 2 weeks of January and were subsequently allocated as and when required. There were daily operational calls and load levelling in place when required. Regular calls have been held with NHSE/I.

Hospital handovers continue to remain a challenge due to Covid-19 pressures impacting ED departments and increased IPC processes.

P.9 Herts Partnership Foundation Trust January 2021

Standard/ Area Metric Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Trend Threshold 18 week RTT 95% 99.85% 100% 99.90% 100% 100% 100% 100% 100% 100% 100% 100% IAPT Recovery 50% 30.27% 43.72% 43.10% 52.45% 52.03% 53.20% 52.10% 50.70% 53.30% 56.20% 48.70% 6 Week Wait 75% 73.77% 85.71% 98.50% 98.43% 97.26% 95.90% 96.40% 97.70% 99.00% 98.30% 98.32% National Dementia Diagnosis 66.7% 64.10% 62.50% 61.70% 61.80% 62.00% 61.50% 61.30% 61.60% 61.10% 59.50% 61.71% Standard DToC DToC Rate % 3.5% 3.46% 4.42% 4.90% 5.30% 7.90% 6.70% 5.70% 5.60% 4.50% 4.00% 5.25% Access EIP 14 day wait 56% 100% 91.70% 100% 91.70% 100% 80.00% 80.00% 100% 100% 91.70% 93.50% CAMHS 28 Day Routine Waiting Time 95% 8.20% 100% 100% 100% 100% 100% 100% 100% 100% 100% 90.82% (ENHCCG) 1st Face to Face to 2nd Face to Face Average CAMHS - 30.00 50.00 35.00 24.00 37.00 38.00 40.00 32.00 26.00 50.00 36.20 Wait (Days) (Herts) Longest wait (Days) - 179 167 256 175 393 341 299 194 121 237 393 SPA Clinical Call Wait Time - TBC TBC TBC TBC TBC TBC TBC TBC TBC

Commentary HPFT restarted their Business Continuity Plan at the beginning of January 2021 with the latest wave of Covid-19. No services were suspended, although some services such as EMDASS had staff redeployed to inpatient areas and crisis teams. Staffing levels on inpatient wards and across HPFT improved throughout February 2021 into March, and most redeployed staff have now moved back. DToC: Although there has been continued high demand on inpatient beds, HPFT managed to reduce the numbers of DToC days in December to 449 and to 395 in January; this is in comparison to previous averages of 730 in August and September. Winter funding for MH discharge support schemes is helping support mental health discharge; recruitment is underway for additional staff in liaison teams and crisis/community teams to speed up discharges and help avoid admissions. Work is also ongoing with the voluntary sector and housing authorities to improve discharge pathways for people with complex needs. SPA: Demand continues to increase, with 8,298 calls in January compared to 6,775 calls in December; adult CMHT capacity remains under pressure and performance against the 28 day referral to initial assessment metric fell to 85%. Average length of calls to SPA is up from December at 8.6 minutes to 9.6 minutes in January. Direct access from NHS 111 option 2 has seen an increase in overall call volumes, particularly out of hours. Webchats into SPA are providing further support and have received positive feed back. Schools and social workers have been able to receive quicker advice and support and 4% of demand has been diverted from telephones; HPFT forecast this will increase. The current call wait time to speak with a clinician is being reviewed following feedback from GPs of long waits. CAMHS: Standards have been achieved and bed pressure is reducing. Eating disorder referrals remain very high, which is also reflected nationally. Pressure has reduced on CAMHS S136 capacity. IAPT: All IAPT standards continued to be met in January. Referrals are beginning to return to pre-Covid 19 levels however not to the levels required to meet the increased 20/21 access targets; HPFT are working on outreach webinars to help with service awareness promotion and have successfully trialled online groups which are now being rolled out county-wide. Dementia Diagnosis: There was a further reduction in diagnosis against prevalence in ENHCCG to 59.5% (4,090) in January compared to December 61.1% (4,225); this is 7.2% below the national target of 66.7%. 387 additional patients are required to reach target, however NHSE have indicated that the algorithm for the national standard does not account for the mortality impacts of Covid-19. The Early Memory Diagnosis and Support Service (EMDASS) diagnosed 94.29% of patients within 12 weeks in December; 467 service users are waiting at the end of February. Referral numbers into EMDASS have recovered to around 80% of pre- Covid referral levels.

Herts Community NHS Trust Standard/ Area Metric Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Trend Threshold RTT Incomplete Pathways within 18 weeks 92% 76.57% 62.43% 46.19% 41.58% 56.95% 66.78% 73.47% 76.61% 74.13% 73.36% 73.36% (Consultant Led) 52 weeks 0 1 2 1 3 1 1 1 1 1 1 13 All Waiters - 8,106 7,715 7,632 7,525 7,523 6,696 6,871 6,292 6,312 64,672 All Waiters 18+ Wk Waiters - 1,160 2,021 3,281 3,817 2,888 1,668 1,039 634 389 16,897

Commentary HCT has reduce d the number of overall waiters from April and maintained a waiting list of circa 6,000 since September. The total number waiting over 18 weeks has also reduced to 6% in December. HCT continue to co -ordinate the mass vaccination site in Hertfordshire, as well as a number of additional sites. Daily exception reports continue to be provided t o the CCG. A meeting has been held with HCT to discuss each of the services, and the impact of the pandemic upon delivery. HCT is now also regularly providing the CCG with detailed reporting about each service line, detailing whether the service is fully operational, partially operational (including what elements are effected), or fully closed. HCT has taken the following actions to support the system and help address issues faced by other organisations, including social care and care homes: - Flexing of criteria within our Discharge Home to Assess Service (capacity 120): taking patients needing additional clinical support using our Prevention of Admission (POA) service and/or requiring some hom e care support. - Extension of HCT’s Prevention of Admission service through use of remote monitoring. - Delivering additional wrap around therapy and POA support to non-COVID IMC beds commissioned via ENHCCG and COVID nursing beds commissioned via County Council/CCG. - Ensuring that the appropriate support is provided to care homes in conjunction with PCNs: rather than necessarily meeting the specific requirements in the Enhanced Health in care .

P.10 Primary Care

Table of CQC ratings 1 2

Quality Commentary 3 Overall experience of GP Practice 2019 to 2020 (percentage point change)

Current CQC Ratings: The majority of the practices have been inspected. Of the reports that have been published, the following outcomes have 14 THE NEVELLS ROAD SURGERY 1 8 CENTRAL SURGERY been achieved: 50 practices are CQC rated as ‘Good’, 1 practice is rated ‘Requires Improvement’, and 1 practice has an archived inspection 8 THE BALDOCK SURGERY (Sawbridgeworth MC/Jacobs HC). 8 CUFFLEY AND GOFFS OAK MEDICAL PRACTICE 7 STOCKWELL LODGE MED.CTR. The CQC have suspended routine inspections but will continue to monitor services. They will only undertake inspection activity that either helps 7 BEDWELL MEDICAL CENTRE create capacity to respond to Covid-19 or in response to significant risk of harm to the public. 7 DOLPHIN HOUSE SURGERY 7 THE MAPLES 7 WALLACE HOUSE Serious Incidents 2020/21: There have been no Serious Incidents reports YTD. 6 WATTON PLACE CLINIC 6 THE LIMES SURGERY

6 ASHWELL SURGERY 2 NHSE/I Complaints 2020/21: Between Q1 to Q3 2020/21 there were a total of 26 complaints received. In Q3 out of the 6 complaints received, 1 5 THE GARDEN CITY SURGERY was upheld and 5 remain ongoing/unknown. The majority of complaint themes are GPD06 Clinical Treatment (inc errors). This is a similar pattern 5 CASTLEGATE SURGERY to previous years. 5 THE SOLLERSHOTT SURGERY 5 WRAFTON HOUSE SURGERY 4 KING GEORGE SURGERY Extended Access: One extended access service, Lower Lea Valley, has a current CQC rating of 'Requires Improvement' overall. The Quality 3 THE MEDICAL CENTRE BUNTINGFORD 3 THE PORTMILL SURGERY team have offered support to the service . The Quality Team have also produced resources based on best practice to help support all EA services 3 ABBEY ROAD SURGERY in ENHCCG. The Quality Team will continue to offer support where required going forward. 2 REGAL CHAMBERS SURGERY 2 BRIDGE COTTAGE SURGERY 1 MANOR HOUSE SURGERY Friends and Family Test (FFT): Practices have not been required to submit monthly FFT data due to the Covid-19 pandemic. The last data 1 SHEPHALL HEALTH CENTRE HANSCOMBE HOUSE SURGERY submission was February 2020. Data submission for primary care is still suspended. However, practices can still use the Friends and Family Test 1 0 SPRING HOUSE HEALTH to gather feedback from their patients. Practices will be updated once further advice from NHS/I is available. 0 THE SYMONDS GREEN HEALTH CENTRE 0 PARK LANE SURGERY 0 CHELLS SURGERY 3 General Practice Patient Survey (GPPS) 2020: The CCG continues to support practices where required following the publication of the GPPS 0 KNEBWORTH & MARYMEAD MEDICAL PRACTICE results. The GPPS for 2021 is currently being collected and will be published in the Summer 2021. 0 LISTER HOUSE SURGERY -1 CHURCH STREET PARTNERSHIP -1 PEARTREE LANE SURGERY -1 BURVILL HOUSE SURGERY -2 PARSONAGE SURGERY -2 WHITWELL SURGERY -2 CHURCH STREET SURGERY -2 AMWELL SURGERY -2 POTTERELLS MEDICAL CENTRE -2 STANMORE MEDICAL GROUP -3 STANHOPE SURGERY Contracts Commentary -3 ORCHARD SURGERY List Closures -3 BIRCHWOOD SURGERY -3 HALL GROVE GROUP PRACTICE As at 9th March 2021, there are no closed lists in East and North Hertfordshire. -3 PUCKERIDGE & STANDON SURGERY -4 WARE ROAD SURGERY APMS Contracts -5 MUCH HADHAM HEALTH CENTRE Sawbridgeworth Medical Services provides primary medical services for the neuro centre at Ramsay Healthcare. The contract will be extended for a -6 HAILEY VIEW SURGERY further year, as mutually agreed by East and North Hertfordshire CCG and Sawbridgeworth Medical Services. -6 THE GARDEN CITY PRACTICE -7 BANCROFT MEDICAL CENTRE -10 SOUTH STREET SURGERY -15 WARDEN LODGE MEDICAL PRACTICE -16 CROMWELL MEDICAL CENTRE -21 HIGH STREET SURGERY -25 -20 -15 -10 -5 0 5 10 15 20 P.11 Agenda Item No: 9

Date of Meeting: 25 March 2021

Governing Body Meeting in Public

Paper Title: East and North Hertfordshire Integrated Care Partnership Update

Decision or Approval Discussion Information

Report author: Sam Tappenden, Development Director for ENH ICP

Report signed off by: Sharn Elton, Managing Director

Executive Summary: The attached papers summarise the discussion of the ENH ICP Partnership Board which was held on 5th March 2021. The discussion focussed on three key areas: (1) an opportunity for partners to provide a ‘stocktake’; (2) a discussion on relationship development and (3) an update on the models of collaboration work.

The Partnership Board took away a number of actions, based on the survey feedback taken live in the session, to improve relationships and trust across the partnership. Given the partnership is beginning to restart development work with groups restarting, next month’s Partnership Board will continue with the usual Development Director and associated key group reports.

Attachments: Appendix 1 – ENH ICP Partnership Board Slides March 2021 Appendix 2 – ENH ICP Partnership Board Poll Results

Recommendations The Governing Body is asked to discuss the contents of the to the members: papers, specifically the live survey feedback regarding relationship development.

Conflicts of Interest The author has no conflicts of interest. involved:

Page | 1 Conflict of Interest Definitions

The following table describes the sub-classifications of interests:

Type Description Financial Interests This is where an individual may get direct financial benefits from the consequences of a commissioning decision. Non-Financial This is where an individual may obtain a non-financial professional benefit Professional Interests from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. Non-Financial This is where an individual may benefit personally in ways which are not Personal Interests directly linked to their professional career and do not give rise to a direct financial benefit. Indirect Interests This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non- financial personal interest in a commissioning decision.

Page | 2 1. Executive summary The attached papers summarise the discussion of the ENH ICP Partnership Board which was held on 5th March 2021. The discussion focussed on three key areas: (1) an opportunity for partners to provide a ‘stocktake’; (2) a discussion on relationship development and (3) an update on the models of collaboration work.

The Partnership Board took away a number of actions, based on the survey feedback taken live in the session, to improve relationships and trust across the partnership. Given the partnership is beginning to restart development work with groups restarting, next month’s Partnership Board will continue with the usual Development Director and associated key group reports.

2. Background

3. Issues N/A

4. Options N/A

5. Resources implications N/A

6. Risks/Mitigation Measures N/A

7. Recommendations The Governing Body is asked to discuss the contents of the papers, specifically the live survey feedback regarding relationship development.

8. Next Steps N/A

Page | 3 Appendix 2

ENH ICP Partnership Board 05 - 06 Mar 2021

Poll results Table of contents

To what extent do you think our partnership is focussed on a shared goal? To what extent do you think our partnership is built on trusting relationships? To what extent do you think our partnership is clearly owned by committed partners? To what extent do you think our partnership has clear, measurable expectations? To what extent do you think our partnership enables risks to be effectively managed? To what extent do you think our partnership enables 'rewards' to be shared amongst partners? To what extent do you think our partnership is robust enough on accountability? Rating poll

To what extent do you think our partnership is 0 1 5 focussed on a shared goal?

Score: 2.7

53%

40%

7% 0% 1 2 3 4 Rating poll

To what extent do you think our partnership is 0 1 5 built on trusting relationships?

Score: 2.2

67%

27%

7% 0% 1 2 3 4 Rating poll

To what extent do you think our partnership is 0 1 5 clearly owned by committed partners?

Score: 2.1

67%

20% 13%

0% 1 2 3 4 Rating poll

To what extent do you think our partnership 0 1 5 has clear, measurable expectations?

Score: 1.8

40% 40%

20%

0% 1 2 3 4 Rating poll

To what extent do you think our partnership 0 1 5 enables risks to be effectively managed?

Score: 2.1

60%

27%

13%

0% 1 2 3 4 Rating poll

To what extent do you think our partnership 0 1 5 enables 'rewards' to be shared amongst partners?

Score: 1.5

53% 47%

0% 0% 1 2 3 4 Rating poll

To what extent do you think our partnership is 0 1 4 robust enough on accountability?

Score: 1.8

79%

21%

0% 0% 1 2 3 4