Agenda Part 1

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

Blackburn with Darwen Clinical Commissioning Group Governing Body and East Lancashire Clinical Commissioning Group Governing Body Meeting in Common

The meeting Wednesday, 15 January 2020, 13:00-14:30 will be digitally Meeting Rooms 1 and 2, Blackburn Central Library recorded Town Hall Street, Blackburn BB2 1AG

AGENDA

PART 1 Item Lead Strategic Report/ Time Objective Category 1 Welcome, Introductions and Chair’s Mr G Burgess Verbal 13:00 Update (Meeting Chair) 2 Patient and Public Involvement

2.1 Public Questions Mr G Burgess Verbal

3 Governance Arrangements

3.1 Apologies for Absence and Confirmation Mr G Burgess Verbal of Quoracy 3.2 Declarations of Interest Mr G Burgess Verbal Members and Attendees are requested to identify any interests relating specifically to the agenda items (see guide below) and inform the Chair and Governing Body Secretary in advance of the meeting. 3.3 Declarations of Other Business Mr G Burgess Verbal

3.4 Minutes of the previous Governing Body Meetings and Matters Arising: a. Blackburn with Darwen Clinical Mr G Burgess Attached Commissioning Group held on 13th November 2019 b. East Lancashire Clinical Dr R Robinson Attached Commissioning Group held on 13th November 2019 3.5 Combined Action Matrix : Blackburn with Darwen Clinical Commissioning Group & East Lancashire Mr G Burgess Attached Clinical Commissioning Group 4 Business

4.1 Joint Chief Officer Report Dr J Higgins To Follow 13:10

4.2 a. Performance Report Mr R Parr To Follow 13:20 b. Quality Assurance Report Mrs K Lord All Attached 4.3 Governing Body Assurance Framework Mrs K Hollis All Attached 13:40

4.4 Finance Report a. Blackburn with Darwen Clinical Mr R Parr 2 Attached 13:50 Commissioning Group b. East Lancashire Clinical Mrs K Hollis To Follow Commissioning Group 4.5 Blackburn with Darwen Clinical Commissioning Group Specific Business Governing Body Terms of Reference Mrs D Atkinson Attached 14:10

5 Reports Received for Information

5.1 Governing Bodies’ Sub Committees, Mrs D Atkinson Attached 14:15 Groups and Stakeholder Minutes 5.2 Accident and Emergency Delivery Board Mr A Walker Attached Chair’s Report 5.3 Communications and Engagement Update Mrs K Hollis All Attached

6 Any Other Business

6.1 Items for inclusion on the Corporate Risk Register

7 Date and Time of Next Meeting 14:25

Wednesday, 11 March 2020, 13:00 hrs Burnley Football Club

RESOLUTION “That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.” (Section 1[2] Public Bodies (Admission to Meetings) Act 1960.

Types of Interest Type of Description Interest Financial This is where an individual may get direct financial benefits from the consequences of a Interests commissioning decision. This could, for example, include being:  A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations;  A shareholder (or similar owner interests), a partner or owner of a private or not-for- profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.  A management consultant for a provider;  In secondary employment (see paragraph 56 to 57);  In receipt of secondary income from a provider;  In receipt of a grant from a provider;  In receipt of any payments (for example honoraria, one off payments, day allowances or travel or subsistence) from a provider  In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and  Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider). Non- This is where an individual may obtain a non-financial professional benefit from the Financial consequences of a commissioning decision, such as increasing their professional Professional reputation or status or promoting their professional career. This may, for example, include Interests situations where the individual is:  An advocate for a particular group of patients;  A GP with special interests e.g., in dermatology, acupuncture etc.  A member of a particular specialist professional body (although routine GP membership of the RCGP, BMA or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);  An advisor for Care Quality Commission (CQC) or National Institute for Health and Care Excellence (NICE);  A medical researcher. Non- This is where an individual may benefit personally in ways which are not directly linked to Financial their professional career and do not give rise to a direct financial benefit. This could Personal include, for example, where the individual is: Interests  A voluntary sector champion for a provider;  A volunteer for a provider;  A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation;  Suffering from a particular condition requiring individually funded treatment;  A member of a lobby or pressure groups with an interest in health. Indirect This is where an individual has a close association with an individual who has a financial Interests interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). For example, this should include:  Spouse / partner;  Close relative e.g., parent, grandparent, child, grandchild or sibling;  Close friend;  Business partner.

NHS East Lancashire Clinical Commissioning Group NHS Blackburn with Darwen Clinical Commissioning Group

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common

Minutes of Part 1 of the Meeting held on Wednesday, 13 November 2019 at The ACE Centre, Cross Street, Nelson BB9 7NN

PRESENT: Blackburn with Darwen CCG

Mr Graham Burgess CCG Chair Mr Roger Parr Chief Finance Officer/Deputy Chief Officer Mrs Claire Richardson Director of Population Strategy and Transformation Dr Zaki Patel (Part) General Practitioner (GP) Executive Member Dr Adam Black (Part) GP Executive Member, Dr Geraint Jones Secondary Care Doctor (Retired) Dr Nigel Horsfield Lay Member Mr Paul Hinnigan Lay Member – Governance Professor Dominic Harrison Director of Public Health and Well-being, BwD Borough Council (BC)

In East Lancashire CCG Attendance Dr Richard Robinson CCG Chair (Chair of the Meeting) Dr Julie Higgins Joint Accountable Officer, BwD and EL CCGs Dr Santhosh Davis Clinical Advisor & Governing Body Member Dr Mark Dziobon Medical Director, EL CCG Mrs Kirsty Hollis Deputy Chief Officer / Chief Finance Officer Dr Tom Mackenzie Clinical Advisor & Governing Body Member Mrs Michelle Pilling Deputy Chair & Lay Member – Quality & Patient Engagement Mr David Swift Lay Member – Governance Dr Paul Taylor Secondary Care Doctor

Mr David Rogers Head of Communication and Engagement, BwD & EL CCGs Carol Hedley (Item MiC/19.002) Cancer Transformation Lead Mrs Debbie Ross (Item Head of Safeguarding, BwD & EL CCGs MiC/19.015) Ms Caroline Waldron (Item Deputy Designated Nurse for Safeguarding Children MiC/19.015) and Looked After Children Mrs Collette Walsh – Item Deputy Director of Commissioning MiC/19.009 Mrs Caroline Marshall Head of Quality Mrs Anne Holden Corporate Administration Manager, EL CCG Mrs Pauline Milligan Business Administration Manager, BwD CCG

Public Mr Ian Makin Wockhardt UK Pharmaceutical Company Attendees:

Page 1 of 18 Minutes Approved by the Chair : Jan 2020

Min Ref ACTION MiC/19.001 Welcome & Introductions

Dr Richard Robinson, Chair of East Lancashire CCG was chairing the meeting and welcomed all members to the first Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common. He also welcomed members of the public who were in attendance as observers.

He thanked Members for tolerating the large number of papers sent via emails, which would hopefully be fewer in number as we move forward. He pointed out there was a full agenda and asked Members to be mindful when presenting and to use time effectively. Members were also reminded Purdah and to take this into consideration during discussions.

Dr Robinson confirmed that he and Mr Graham Burgess would rotate chairing the meetings over the coming 12 months.

MiC/19.002 Patient Story

Dr Robinson advised that East Lancashire CCG usually start their Governing Body meetings with a patient story covering a topic that is pertinent to the health economy. As this month is International Mens Health month it was felt appropriate to focus on one element of that. With the help of Dr Neil Smith and the Cancer Team it was agreed the focus this month would be Prostate Cancer. Dr Robinson advised we often have patients in the room, but this month the story would take the form of a video and a written briefing had been included with the meeting papers. He welcomed Carol Hedley from the Cancer Team and David Rogers, Head of Communications & Engagement.

Members viewed the video which outlined an emotional story and physical journey through the illness. Dr Robinson felt there was a need to think about what this means locally for our population and how we go about managing the context of cancer, and invited discussion.

Dr Black and Dr Patel joined the meeting.

Mrs Pilling felt the story was very emotional and asked if there was a standard message that we should be communicating out to the public. She referred to the mass screening event organised by Burnley Football Club and asked if the CCG are encouraging people to attend for screening. In response Mrs Hedley pointed out there are many pre referral criteria to be met before screening and outlined the work ongoing through the Cancer Alliance, details of which were included in the briefing note. She advised that Urology are working on a single site service, with specific referral criteria.

Reference was made to the Prostate-Specific Antigen (PSA) test. Dr Taylor pointed out there was confusion in the media regarding the value of the test and it is important to identify what message we want to communicate.

Dr Dziobon pointed out that men often don’t seek health care and there is a need to use these stories to inform some commissioning decisions, in terms of raising awareness as part of prevention agenda and seeking care. He felt the Burnley FC event generated some unnecessary anxiety, but at the same time raised awareness about symptoms.

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Clinicians shared their views regarding the PSA testing procedure and highlighted the importance of listening to patients early in the diagnostic pathway and act appropriately. It was noted that there currently isn’t a national screening programme for prostate cancer, as the Wilson criteria were not met.

Dr Patel pointed out that opinion varies between individuals and felt that discussions should take place in a different forum. There is a need to ensure the message is aligned with national expert guidance and also national messages via NHS Patient Choice information leaflets, in addition to any additional emphasis we might provide locally, but room for manoeuvre with clinicians in discussions with patients.

Dr Higgins referred to discussions at a recent Joint Commissioning Committee where there was a presentation from the Cancer Alliance. She pointed out that cancer commission is still undertaken as individual CCGs and there is work ongoing to strengthen our collaborative commissioning as this is the best way forward. She felt that when this has progressed, that is where the social marketing local to Lancashire will be done, to ensure the insight is right.

ACTION: An update to the next GB meeting outlining the position regarding AW/CH the Cancer Alliance work and where they are in relation to Prostate Cancer.

The Chair concluded the discussions, pointing out this is a complicated issue but all agreed the importance of having an informed consent from the patient before a PSA test is carried out in isolation.

MiC/19.003 Public Questions

No questions had been received from members of the public.

MiC/19.004 Apologies for Absence & Confirmation of Quoracy

BwD CCG Apologies had been received from:

Dr John Randall, GP Executive Member (Vice Chair) Dr Ridwaan Ahmed, Clinical Director for Quality and Primary Care Dr Penny Morris, Medical Director Mrs Kathryn Lord, Director of Quality and Chief Nurse, EL CCG

The Chair noted that apologies had also been received from Mr Iain Fletcher, Head of Corporate Business. The meeting was confirmed as inquorate for BwD CCG Members.

EL CCG Apologies had been received from:

Mrs Kathryn Lord, Director of Quality and Chief Nurse Mrs Naz Zaman, Lay Member – Equality and Inclusion The meeting was confirmed as quorate for EL CCG Members.

It was noted that Mr Alex Walker would need to leave at 3.15pm.

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MiC/19.005 Declarations of Interest

The Chair invited members to declare any interest they may have in relation to items on the agenda.

Dr Santhosh Davis declared an interest in Agenda Item 4.2 – Integration Accelerator as he had been part of the team involved in developing the proposal. It was agreed Dr Davis would remain in the room during the discussion.

MiC/19.006 Minutes of the Previous Governing Body Meetings and Matters Arising

MiC/19.006.1 a. Blackburn with Darwen CCG – 11 September 2019

The Chair moved that the draft minutes of the meeting on 11th September 2019 be approved as an accurate record.

This was agreed by the members present.

MiC/19.006.2 b. Blackburn with Darwen CCG, Extract from Part 2 – 11 September 2019

The Chair moved that the draft minutes of the Extract from Part 2 of the meeting on 11th September 2019 be approved as an accurate record.

This was agreed by the members present.

MiC/19.006.3 c. Blackburn with Darwen CCG Annual General Meeting, 11 September 2019

The Chair moved that the draft minutes of the Annual General Meeting on 11th September 2019 be approved as an accurate record.

This was agreed by the members present.

The following items were ratified via Chair’s Action with email agreement from members of the GB who were absent from the meeting on 11th November 2019.

RESOLVED:

i. That the minutes of the meeting held on 11th September 2019 were approved as an accurate record. ii. That the Extract of Part 2 of the Minutes of the Meeting held on 11th September 2019 was approved as an accurate record. iii. That the minutes of the AGM held on 11th September 2018 were approved as an accurate record

MiC/19.006.4 d. East Lancashire CCG – 4 September 2019 . Min Ref: 19:120 – The first bullet point should read NHS Chorley & South Ribble CCG . Min Ref: 19:108 - Dr Taylor wished to amend the wording regarding Sepsis and would share details with Mrs Holden.

RESOLVED: that subject to the above amendments, the minutes were approved as an accurate record.

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MiC/19.006.5 e. East Lancashire CCG Annual General Meeting – 4 September 2019

RESOLVED: that the minutes of the AGM held on 4 September 2019 were approved as an accurate record.

MiC/19.007 Action Matrix/Matters Arising

MiC/19.007.1 Matters Arising

There were no Matters Arising which were not listed on the Action Matrix.

MiC/19.007.2 a. Blackburn with Darwen CCG

The Action Matrix was reviewed and the following were noted:

Minute 19.050 – Any Other Business – Measles Vaccination Professor Dominic Harrison referred to the action in relation to the production of a report on the uptake of vaccinations and screening and explained that, as Public Health (PH) now rested with the Local Authority, it could not have access to some NHS vaccination data due to Information Governance (IG) issues. He added that PH were exploring this with NHS England and would bring a report when a solution was found.

ACTION: Professor Harrison to bring a report to a future meeting. DH

Minute 19.064.1 – Neighbourhood Level Data/Mapping Tool Professor Harrison referred to the action in relation to the organisation of a live interactive joint Pennine Lancashire (PL) GB session to demonstrate the above tool, which covered all of the 13 neighbourhoods in PL. He explained that an initial demonstration had been provided in the Blackburn West neighbourhood and following this it had been agreed it would be better to run a separate workshop involving the 13 neighbourhoods, rather than provide a demonstration to the GBs and this would be followed up

Similarly, in relation to a previous discussion at BwD’s GB on child mortality, a further separate workshop would be held to explore issues relating to consanguinity and genetic risks and representatives from the 13 neighbourhoods in PL would be invited to participate.

ACTION: Following a request from Dr Julie Higgins, Professor Harrison agreed to explore how the IG issues could be resolved in order for the DH PH Team developing the neighbourhood mapping tool to be able to access Primary Care data relevant to the Quality Outcomes Framework.

All remaining actions were listed as completed.

MiC/19.007.3 b. East Lancashire CCG

18:15 – MH Act 1983 Code of Practice Mr Alex Walker confirmed there were no further updates in relation to the signing of the protocol. This would continue to be monitored through the Northumberland, Tyne & Wear (NTW) Review and Action Plan, recognising there was a need to take some step changes at ELHT as to how they deal with Mental Health. It was agreed the action would remain on the matrix.

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19.88 – Primary Care Networks and Accountability to the CCG Mrs Claire Richardson confirmed that work is ongoing in terms of governance arrangements. Three PCN Clinical Directors had been invited to sit on the Partnership Leaders Forum and all Clinical Directors are working together through the Federations. It was agreed to close the action.

19.120 – Use of the Seal It was agreed to close the action as this will not be a common issue.

19.122 – Performance Report A new report had been developed which will provide more detail going forward. It was agreed the action would be closed.

MiC/19.008 Integrated Care System Strategic Plan Development

Mrs Claire Richardson, Director of Population Strategy and Transformation presented the report which outlined the process and current position in terms of Integrated Care System (ICS) Strategy development.

The report reflected discussions through the Governing Body, particularly issues regarding finance and activity projections at the last GB Development Session. The Plan had also been considered at the ICS Board, at which Dr Higgins represents the PL CCGs and the final strategy was to be submitted by the following Friday,

Mrs Richardson advised this is not the end of the process, as the Strategic Plan will continue with an annual planning round in terms of activity and finance. Feedback for the Pennine Lancashire system has been positive and planning is closely aligned with ELHT.

Dr Jones advised that Healthwatch in Blackburn with Darwen had led some of the work which has been fed into the process and Dr Higgins will lead on engagement work with the public.

Mr Burgess considered there should be emphasis in the Strategy relating to narrowing the gap between health outcomes from the most deprived communities with others, and this should be included within the priorities.

Dr Higgins advised that Public Health England and NHS England, in the feedback to an earlier draft, had highlighted that the narrative between health inequalities, health outcomes and health needs links to the action they are going to take and how this will shift the dials. The ICS need to demonstrate they have a strategy that will make a difference to health outcomes and reduce health inequalities and to ensure a Public Health officer is involved in this work. In terms of governance, there was also a need to consider if Directors of Public Health are represented enough in some of these discussions.

Professor Harrison echoed Dr Higgins comments, pointing out that some of the areas where there is worse performance in the ICS are the areas that NHS E took control of post 2013, particularly relating to screening and immunisation. Public Health services locally and national have been asset stripped of resources to deliver increasingly important priorities for prevention and public health.

He also supported the recommendation made by Dr Higgins to ensure there

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is public health representation, pointing out there is no Director of Public Health (DPH) on the ICS Board and few CCGs in Lancashire have a DPH on their Boards. He felt that the whole system needs to reprioritise if they want to make a difference.

Professor Harrison also referred to the debate around general practice, pointing out the number of wte GPs in L&SC ICS has reduced since 2015. If our key strategy for improving health outcomes is to move patients out of hospital, the capacity to deliver this is not there, which he considered to be a failure at a strategic level and wished this to be fed back to NHS E.

Recognising the intention to shift resources left and invest in prevention, Dr Higgins advised that Professor Harrison was working on a business case which would require £15m investment with a sustained investment year on year. She highlighted the need to look at our growth money to invest in this, with our partners investing too. It was also agreed to look at the possibility of a bursary scheme to encourage people to come into General Practice and this would be included in the list for investment for next year.

ACTION : Mr Burgess referred to the submission date of 15 November and requested that a formal comment be made to ensure that issues relating to CR health inequality and outcomes are included as a priority.

RESOLVED: that Members endorse the approach taken but not the next steps without the points raised being included.

MiC/19.009 Integration Accelerator Proposals

Dr Davis had declared an interest in this item as he was part of the team who had developed the Integration Accelerator proposals. It was agreed he would remain in the discussion.

Mr Alex Walker, Director of Performance & Delivery introduced the report which outlined proposals to implement the Neighbourhood Integration Accelerator Pathfinder across Pennine Lancashire. He confirmed the CCG had made significant progress in terms of Primary Care Network (PCN) development and partnership working and these proposals knit together both primary care development and neighbourhood delivery teams into a more closely aligned model.

The accelerated approach would be piloted within some PCN areas and identify complex case management that will work together as a much more integrated team and integrated delivery model. He confirmed that across PL approximately 6,500 people will be supported through this mechanism up to March 2021 as a test to see what impact can be made.

Mrs Collette Walsh, Deputy Director of Commissioning, was in attendance for this item and provided a detailed overview of the proposals and the impact these would have on general practice. This would provide an opportunity to support all 74 Pennine Lancashire GP practices to explore new ways of working within their core practice teams, to manage rising demand and explore models for integrated neighbourhood team working. Most importantly it will ensure individuals are linked into social prescribing and ensure leadership teams are linked into a place based approach.

In terms of next steps, the service specification would be issued by the end of

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the week and Expressions of Interest would be requested. More work was required in relating to governance arrangements to ensure there are links to the new Integrated Community Care Board and particularly how the Local Community Partnership and Local Integrated Community Partnership can support these developments. Following receipt of EoI it was anticipated the pilots would be launched at the beginning of January 2020. An outcomes framework was being developed, in co-production with the teams and Mrs Walsh welcomed Public Health involvement to ensure we are measuring the right things. She also highlighted the importance of ensuring there is CCG and CSU support available to support the leadership teams to get the right results.

It was recognised this was a big ask of people who are already under pressure but this is an opportunity to look at how to work differently. Investment is to pump prime a change in the way we work, a change for people who have a way in their care and ultimately a change for the system.

Dr Davis had been involved in developing the proposals and felt this is the most progressive way of moving forward and PCNs are keen to take this forward.

It was confirmed that the CCGs have committed to increase funding in primary care and funding for these proposals will be provided by both CCGs to support the nine East Lancashire PCNs and four Blackburn with Darwen PCNs. Going forward it was anticipated this would be included in the commissioning process in the future.

The Chair asked if Members considered this to be the right approach for our population. Discussion followed and Clinicians expressed concern that the system is already under pressure and requested assurance that some service capacity modelling has been undertaken across Pennine Lancashire.

Dr Higgins highlighted the need to make fundamental changes and help general practice to take a different approach and mobile their staff in a different way.

Dr Dziobon considered this will test general practice and the community provider to mobilise in a different way and there is a need to look at the mechanism to get there, as this is the way forward.

Dr Higgins pointed out this is the starting point of what will be a long journey and it is important to look at workforce transformation to ensure staff are in the right place. Different conversations are also starting to take place with the hospitals in terms of planning and growth monies and how we work together. It is important to ensure the CCGs are driving this and ensure the appropriate governance arrangements are in place. An Integrated Community Care Board (ICCB) has now been established, co-chaired by Dr Higgins and Dr Dziobon, which will take this work forward.

Mr Burgess made reference to the community care provider and the associated gaps, pointing out there may be gaps with other Local Authority services, in particular housing and leisure, that are equally important and there is a need to ensure there is Local Authority representation on the ICCB.

Mrs Pilling fully supported this new way of working, however with reference to the cohort selection outlined in the report, she considered this felt

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constrained rather than being generally matched population health management. In response, Mr Walker confirmed that the ICCB will identify cohorts that are unexpected but that will benefit from the case management approach.

RESOLVED: that Members receive the report and endorse the proposal to develop Neighbourhood Integration Accelerator Pathfinders across Pennine Lancashire and support the project going forward, subject to formal agreement by each of the participating organisations.

MiC/19.010 Joint Chief Officer Report

Dr Higgins presented the report which provided an update on national and local issues. Members attention was drawn to Para 3.3 which provided a summary of decisions taken at the October meeting of the BwD CCG and the EL CCG Commissioning Committees in Common.

Dr Higgins handed over to Dr Dziobon to provide an update in relation to winter planning.

He pointed out there has been a lot of scrutiny regarding the 4 hour standard in A&E, however in the last few months Pennine Lancashire has been the best performing area in the North West with regard to the 4 hour target.

He confirmed that the Winter Plan has been developed and approved through the Pennine Lancashire A&E Delivery Board and includes a number of mitigations to support in and out of hospital services. Primary care extended access capacity has been increased across Pennine Lancashire, including 144 additional slots in Hyndburn per week with an additional 100 slots per week across Pennine Lancashire. It was also confirmed that the flu vaccination programmes are continuing without issue.

Members discussed the impact on primary care and the need to arrange manpower appropriately, particularly over the Christmas and New Year holiday period.

Dr White referred to discussions ongoing regarding local offers in local areas, pointing out that the PCN Clinical Directors will be involved in informing this. Community hubs and wellbeing areas are also being developed and there is a need to consider where we site our Urgent Treatment Centres.

Reference was also made to the Long Term Plan and the need to look at managing demand now, strengthening the triage, using out of hours to deflect patients away from the A&E Department and providing alternative provision in the community.

Mrs Pilling felt there was a need to be cautious about over simplifying the narrative. She requested assurance that the full winter plan had been seen by the Sustainability Committee as there was no detail in the A&E Delivery Board report. It was confirmed that both Governing Bodies had delegated authority to the A&E Delivery Board as to how winter pressures money would be utilised, noting that plans for additional beds in winter were in place.

In conclusion, Dr Higgins pointed out that CCGs have been asked to respond to winter pressures and a range of measures have been put in place, with more support in primary care. Dr White and colleagues are also leading the

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transformation programmes in urgent primary care, looking at patient cohorts within the ICP to fast track them.

The Chair thanked Members for their views regarding winter plans.

RESOLVED: that Members receive the report.

MiC/19.011 Corporate Business Plan

In presenting the report Dr Higgins made reference to discussions at the previous meeting of the Governing Body in respect of the Corporate Business Plan, which reflects the CCGs move towards alignment of commissioning organisations across Pennine Lancashire through the appointment of a Joint Accountable Officer and single Executive Team. The Plan outlined the organisations objectives and will ensure delivery of the priorities.

Members attention was drawn to Page 5 of the report which outlined the CCGs system leadership and priorities in terms of system response, improvement, transformation and development.

Large scale change is required over the next five years, across the health and care system to fundamentally change what we do outside hospital and move towards an Integrated Care Provide. It was noted that a number of schemes are being managed through the newly established Integrated Community Care Board, co-chaired by Dr Higgins and Dr Dziobon, which will develop large scale change capability and the delegation of budgets to PCNs, enabling staff to have skills and expertise to develop and manage plans for fully integrated commissioning in Pennine Lancashire. We willl start to use this to report our priorities through the performance report,

Mrs Pilling referred to the objectives outlined in the report which did not encompass the entirety of the inequalities faced across Pennine Lancashire and felt these should be incorporated into the Plan.

Mr Hinnigan referred to Appendix A which provided a summary of proposed outcomes, but there was no metric to show what those targets are. Dr Higgins advised these relate to a number of areas, particularly the out of hospital agenda and the work that will be taken through the Community Care Board. Some will be constitutional targets and other areas will be outputs and outcomes that need to be developed through the ICP.

Dr Higgins advised we are looking at constitutional targets and the purpose of the Corporate Business Plan is to widen what we look at over time. She described this work as being on a journey which provides a strong position to move into an Integrated Care organisation. Mr Parr confirmed that a detailed business plan is in place and is aligned to the priorities with milestones.

Mr Hinnigan also made reference to the last sentence in paragraph 1.5 which referred to ICS changes and risks going forward in terms of allocations. He asked if there are there any specific issues that are being looking at. Dr Higgins confirmed this related to the broader issues that are being looked at regarding a move to one CCG.

RESOLVED: that Members receive the report.

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MiC/19.012 Performance Report

Mr Roger Parr, Chief Finance Officer presented the Performance Report was had been produced in a revised format. It was recognised that a lot of data relating to performance indicators is received on a monthly basis and as the report is being developed, any feedback via email from members would be welcome. The report provided performance against constitutional targets and indicators relevant to the objectives of the organisation. Appendix B outlined the latest performance metrics for mortality and recognising the health risk factors in the system, targeting the priorities of the CCG for Cardiovascular Disease (CVD) and Chronic Obstructive Pulmonary Disease (COPD). Appendix C provided a high level indicator of groups of general practices for COPD reported prevalence and emergency admission rates.

It was noted that information is produced on a monthly, quarterly and annual basis and this will be reviewed as part of the development going forward.

It was noted the report provided examples of areas being reviewed and how the information will be used to support the Primary Care Networks (PCNs) going forward.

Mr Parr welcomed any feedback as to how to develop this report and make it more meaningful in terms of the outcomes.

It was noted that the PCNs will have dashboards which should align with the performance dashboards and include specific issues. It was also noted there was no Mental Health or contract information included.

ACTION: Members to provide any feedback to Mr Parr.

RESOLVED: that Members receive the report. ALL

MiC/19.013 Finance Report

MiC/19.013.1 a. Blackburn with Darwen CCG

Mr Roger Parr presented the Month 6 report. He confirmed that the CCG was reporting a break even position in line with the financial plan.

There were risks within the system; in relation to prescribing and complex cases. He added that complex cases were of low volume but high cost and prescribing was an ongoing pressure but the figures were being closely monitored.

He reported a slight underspend in running costs.

In relation to the delivery of the CCG’s Quality, Innovation, Productivity and Prevention (QIPP) target, savings had been identified during the course of the year and the CCG expected to deliver its target at the end of the financial year.

Questions and answers followed.

The members present noted the content of the financial summary and the financial position of the CCG at the end of September 2019.

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MiC/19.013.2 b. East Lancashire CCG

Mrs Kirsty Hollis, Chief Finance Officer presented the Month 6 report and confirmed that the CCG was forecasting to deliver a break even position with a surplus of £14m. The CCG was on target to deliver all statutory duties and was delivering in excess of the 95% target in respect of the Better Payment Practice Code. The CCG was carrying a number of risks and there were common themes across PL.

Prescribing is the biggest area of risk across Pennine Lancashire, however this is a national issue in view of the upturn in prescribing costs nationally. There are also a number of pressures relating to specific mental health cases.

The report included additional information this month which outlined the position regarding the Mental Health Investment Standard. The CCG had received an External Audit against this and whilst the results had not yet been formally published, the Audit Committee had received a favourable report. Details of potential risks and horizon scanning were also included in the report.

Mr Swift referred to the Mental Health Investment Standard, pointing out this had not been achieved in a number of CCGs. He felt that to achieve this was good and paid tribute to Mrs Hollis and the Finance Team for their work.

In terms of Learning Disability transformation and the possible reduction of funding, Mrs Hollis outlined the position confirming that an allocation of £3.4m had been received to invest in LD and Autism on behalf of Lancashire & South Cumbria. As a Transforming Care Partnership this was a challenge as Lancashire & South Cumbria are behind trajectory in discharging patients from low and medium secure facilities.

The Chair thanked Mr Parr and Mrs Hollis for their reports.

RESOLVED: that Members receive the report.

MiC/19.014 Quality Assurance Report

Mrs Hollis presented the report on behalf of Mrs Lord and Dr Ahmed and was supported by Mrs Marshall, Head of Quality, should members have any queries. The report provided an update on national policy documents, publications and quality improvement work ongoing. The report was taken as read and key points were highlighted.

Following a CQC inspection at BMI The Lancaster Hospital in May 2019, an overall rating of ‘Requires Improvement’ was received. BMI received two requirement notices relating to outpatient and diagnostic services and the Quality Team are working with the provider to ensure improvements are put in place.

East Lancashire Hospitals Trust (ELHT) have been nominated for the Chartered Institute of Public Relations Pride Awards in the Best Publication category for their ‘Share 2 Care publication. The ceremony was scheduled to take place on 29 November 2019. It was also reported that ELHT had been rated A in the national stroke audit for the fourth successive quarter.

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Following the Listening into Action (LiA) programme at Lancashire & South Cumbria Foundation Trust (L&SC FT) a number of positive actions have been taken as a result of the staff survey earlier in the year. The Trust have also been shortlisted in the North Excellence in Supply Awards in recognition of their work to support delivery of a new Health & Social Care Network across the Lancashire Integrated Care System.

Roll out of the myGP healthcare app, which supports patients to book and cancel appointments, order repeat prescription etc has been enabled in BwD with 100% coverage across all practices. Rollout for EL CCG practices is currently underway, with 10 of the 49 practices enabled.

Work is ongoing within primary care to improve awareness of Sepsis and to identify a Sepsis Lead within each GP Practice. This was supported by a GP education event in September together with online training and resources being made available for all practice staff.

From 18 to 24 November 2019 is Self Care Week across the country and the CCG will be promoting this via social media. Details were also provided of six recently published national clinical audit and patient outcomes programme reports, outlining a number of recommendations on access to services and treatments.

The Chair thanked Mrs Hollis for presenting the report and invited any questions. With reference to the BMI CQC inspection, it was noted that the regulatory areas for improvement relating in the main to diagnostic equipment and there were no issues relating to patient care.

RESOLVED: that Members receive the report.

MiC/19.015 Safeguarding Annual Update

Debbie Ross, Head of Safeguarding and Caroline Waldron, Deputy Designated Nurse for Safeguarding Children and Looked After Children across Pennine Lancashire CCGs were in attendance and thanked Members for allowing them time to provide the annual update. In view of the number of changes over the last twelve months, it was agreed to provide an interim update to the Governing Body and provide an Annual Report in April 2020.

A number of legislative changes have resulted in new responsibilities for different organisations. CCGs have become one of the statutory partners in the multi-agency safeguarding partnerships, alongside Lancashire Constabulary and the Local Authorities across the footprint. It was confirmed that Adult Boards remain but Safeguarding Children’s Boards are no longer in place and decision making sits with statutory partners, which is an increase of accountability for CCGs.

The presentation provided an update on safeguarding progress and developments from a national and local context. A Pennine Lancashire CCGs Safeguarding Strategy for 2019-2021 had been developed, details of which were shared with Members. Members received a detailed outline of the three key objectives of the Strategy which included: . Delivery of the CCG s statutory safeguarding arrangements; . Development and maintenance of high quality standards of safeguarding practice across the health system including system challenges;

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. Community Safe Services.

Reference was made to the NHS Accountability and Assurance Framework which sets out all the responsibilities in terms of the requirements for all organisations and members had received details of this previously.

From a safeguarding perspective, a full compliance report was presented to the PL Quality Committee in June 2019 in relation to safeguarding compliance for all our commissioned services, and is presented on a quarterly basis. One of the areas identified related to training. Since the last compliance submission, Level 1 Adult and Level 2 Children training compliance for CCGs had reduced and there was a request to ensure that staff complete the training to increase compliance.

Reference was also made to the CQC Safeguarding inspection which had taken place in Blackburn with Darwen earlier in the year. A response to the CQC is being coordinated on behalf of the health economy and some of the key areas highlighted are part of the actions highlighted on the safeguarding compliance action plan.

In terms of Looked After Children, there are concerns regarding CCGs accountability in respect of initial health assessments. Mrs Waldron outlined the national position in terms of the difficulty in achieving compliance in respect of the initial health assessment which should be completed within 20 working days of the child becoming looked after. There are a number of challenges and she described the work ongoing with providers and the Local Authority in Blackburn with Darwen to achieve our goal. Mrs Waldron currently represents the health economy on a Lancashire wide Health Assessment Redesign Project to strengthen the workforce understanding and ensure there is a good quality timely assessment by a trained workforce.

There is a trajectory and improvements are being made, however there has recently been a decline in terms of performance. She described the work ongoing to train foster carers and social workers to understand their roles and responsibilities and to improve the position. Mrs Ross pointed out this has been on the Risk Register for some time and there has been challenge in a number of Committees, however a lot of multi-agency work is ongoing locally and nationally to address this.

Members received an overview of national and local issues, some of the key areas are focusing on modern slavery, human trafficking, sexual exploitation and knife crime is up and coming on the national agenda. Pennine Lancashire has also been key in developing some health scenarios in terms of PREVENT which will be launched across social media.

Mrs Ross described the local picture, confirming that since April 2019 there have been nine unexpected child deaths where there have been some safeguarding concerns. Common themes related to sleeping environment and she outlined the work ongoing to address this. There were currently five of Serious Case Reviews for Children in East Lancashire and one in Blackburn with Darwen and key themes include safer sleeping, neglect and multi agency information sharing and work is ongoing to develop the pathways across all agencies. Five Safeguarding Adult Reviews are ongoing across East Lancashire and major themes emerging include self neglect and mental health issues. There is currently one domestic homicide in Blackburn with Darwen.

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The CCG safeguarding resource in Pennine Lancashire was outlined together with key achievements over the last 12 months. The CCG has been heavily involved in being a blueprint for the country in terms of the future for safeguarding in the ICS and how we develop in ICPs. Locally, the Safeguarding and Quality Teams were one of the first teams to work as a Pennine Lancashire resource. It was also highlighted that Mrs Waldron had article published in community practitioner journal this year.

Key priorities for the next 12 months were outlined, all of which are aligned to the Corporate Objectives. Main issues related to the preparation for Liberty Protection Safeguards, and strengthening the community and enhanced safeguarding service redesign to better align with PCN development and locality working.

The Chair recognised that the pace of change is high regarding the national requirements and asked if available resource locally is keeping pace with the national ask. Mrs Ross confirmed that the Team are working closely with NHS E regarding national directives, recognising there are a lot more priorities for safeguarding but not the resource to support that. The CQC highlighted GP capacity in primary care. The Team now have an identified safeguarding practitioner working with named GPs in primary care and the Team are looking at how to work differently to support the key priority areas.

Mrs Pilling congratulated the team on their fantastic work and congratulated Mrs Ross on receiving the Chief Nursing Officer Gold Award. She felt the presentation did not set in context the amount of work the Safeguarding Team are working with. She pointed out that one area of Burnley alone has the highest number of children taken into care across the County and the highest number of children with parents who are in prison, together with a significant amount of domestic violence. The scale of work is increasing and she felt it would be helpful to have this in context to understand the demand across Pennine Lancashire. She asked if the number of cases being supported are measured and reported. She also welcomed the support for PCN development. Mrs Ross outlined the work ongoing to look at safeguarding metrics in terms of consistency, as these are different in each organisation. It was also recognised that for anyone dealing with safeguarding issues it is emotionally draining and it is important to ensure staff are supported in their work.

Mr Walker wished to take the opportunity to mention the PL Community Safety Partnership (CSP) which works closely with safeguarding. The CCG is co-chair of the CSP with Probation and they are encouraging the districts to become more involved to bring extra resources into PL to support violence reduction.

Dr Dziobon referred to the significant numbers of cases of looked after children in the system and asked that details are provided to understand the DR scale of the work ongoing.

He also asked that the information in the booklet provided at the safeguarding training is made readily accessible to GPs outlining pragmatic and local information. Reference was made to Team.net which is regularly updated with all the resources in terms of contact numbers and referral forms etc. It was also noted that NHSE have devised an App to talk through the processes and is worthwhile to have which is updated regularly.

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In conclusion, Dr Higgins congratulated the Team on their work and felt that it would be helpful to have a Development Session to look at Children’s Services as a whole and what we can do to support. She referred to work ongoing in Blackburn with Darwen and Burnley looking at trauma informed schools and trauma informed communities, recognising that the issues we are discussing start in those environments. There is a need to consider how we can mobilise ourselves differently, particularly if we start to pool resources and bring together children’s budgets and start to work differently to reduce the number of adverse childhood events

The Chair thanked Mrs Ross and Mrs Waldron for their presentation.

ACTION: Children’s Services to be considered at the February Governing Body Development Session. CR

MiC/19.016 Accident & Emergency Delivery Board Chair’s Report

Mr Walker presented the A&E Delivery Board Chairs Report, pointing out that the October meeting took the form of a short business meeting which was followed by a workshop focusing on safe avoidance of ambulance hospital conveyances, noting that some of the work was supported by the Home Support Service.

In relation to four hour performance, the system had achieved 85% against a trajectory of 89% which was a significant improvement compared to the previous year.

Members were also advised of the closure of the Mental Health Decision Unit (MHDU) based at the Royal Blackburn Hospital site. This followed a CQC visit to Lancashire & South Cumbria Foundation Trust (LSCCFT) resulting in the staged closure of those units. He advised the impact of the closure had not been significant, and there was no marked impact on 12 hour breaches. However this was still an area of performance that requires improvement, particularly regarding crisis and community service delivery, rather than relying on this particular unit.

Mr Walker advised there were a number of issues under scrutiny for winter particularly A&E performance and the overall emergency system. Two weekly monitoring calls with NHS E have now been stepped down which shows positivity as to how we are currently performing. NHS E have also confirmed our winter plans are robust.

Discussion followed and reference was made to the £1m funding gap identified in the winter planning paper. It was confirmed that this has been resolved, in that funding is for the system and a spending plan has been agreed at the Committees in Common but schemes have yet to be identified.

Mr Swift asked if LSCFT have a winter plan to provide additional beds in the Trust. Mr Walker provided clarity, confirming that the focus was to look at flow through the system rather than providing additional beds. Although the MHDU has closed, which was not bed based, those resources are being recycled and investment is being made in community services. Dr White referred to the previous reconfiguration of acute mental health beds, which reduced the bed base for mental health patients, but did not provide the redesign and capacity in primary care. He pointed out there are not enough acute mental health beds for our population but there are a significant number

Page 16 of 18 Minutes Approved by the Chair : Jan 2020

of out of area mental health acute beds. He requested assurance that there is very close monitoring in terms of mental beds to ensure there is no slippage in the redesign of the capacity of the community mental health services.

Mr Walker confirmed that 24/7 crisis care in our community is now in place. The onus is now to look at community delivery and Pennine Lancashire are the first to take this work forward in Lancashire, due to the pressures on the system. PCNs will be involved in this work and supported by Northumberland, Tyne and Wear NHS Trust over the next six months to look at the changes required in the community.

In conclusion Mr Walker confirmed there has been some improvement regarding 12 hour breaches and improvement with liaison services with a number of positive outcomes over the last 6 months, but there was still a long way to go.

RESOLVED: that Members receive the report.

Mr Walker left the meeting at 15.30.

MiC/19.017 Sub Committee Summary & Stakeholder Minutes

Mrs Debra Atkinson presented the reports on behalf of both CCGs.

She explained that there was duplication of some of the minutes in the reports for those meetings already held on a Pennine Lancashire footprint.

The reports presented the minutes of the CCGs’ Governing Body Sub- Committees and Groups and highlighted the work and key decisions taken through the meetings.

Mrs Atkinson reiterated that, as highlighted by Dr Higgins during the presentation of her report, key commissioning decisions would be incorporated into the Joint Chief Officer Report going forwards.

a. Blackburn with Darwen CCG

There were no questions.

The members present received and noted the content of the report.

b. East Lancashire CCG

There were no questions.

RESOLVED: That the GB received the report.

MiC/19.018 Pennine Lancashire Emergency Preparedness Submission

Mrs Hollis presented the report which outlined compliance against the NHS England Core Standards in relation to Emergency Preparedness, Resilience and Response. The final submission outlines full compliance against all standards and was presented for information.

RESOLVED: that Members receive the report.

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MiC/19.019 Blackburn with Darwen Health & Well-Being Annual Report 2018/19

Professor Dominic Harrison presented the report.

For the information of the members present, he provided background to the establishment and development of the Leisure, Health and Well-Being Services in Blackburn with Darwen, which spanned a period of ten years; following a commitment between the NHS and Local Authority.

The services had largely increased the amount of physical activity undertaken by BwD residents; especially those from low income families.

Professor Harrison reminded members that it had been agreed that Annual Reports would be provided and the report detailed a range of services from universal provision population health prevention to targeted interventions and long term condition specific services.

He explained that, as part of the development of the Sports England work across Pennine Lancashire, discussions had been held with District Councils in terms of aligning their services with BwD’s. BwD’s Leisure, Health and Well-Being Services were viewed nationally as a success; partly arising from NHS investment.

Questions and answers followed.

ACTION: Following an enquiry from Mr Graham Burgess, Professor Harrison agreed to produce a Pennine Lancashire Health and Well- PM Being Annual Report next year. Mrs Pauline Milligan to add to the Forward Plan.

Members discussed the costs of running the services and if there would be pressure on them in the future.

The members present noted the content of the report.

MiC/19.020 Any Other Business

. Items for inclusion on the Corporate Risk Register There were no new items for inclusion on the Corporate Risk Register. . November Governing Body meeting The Chair advised that representatives from the ICS Team would be attending the Joint Development Session on 11 December and asked Members to ensure their attendance.

MiC/19.021 Date & Time of Next Meeting

The next meeting was confirmed as Wednesday, 15 January 2020, 1pm at Blackburn Central Library, Town Hall Street, Blackburn BB2 1AG

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NHS East Lancashire Clinical Commissioning Group NHS Blackburn with Darwen Clinical Commissioning Group

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common

Minutes of Part 1 of the Meeting held on Wednesday, 13 November 2019 at The ACE Centre, Cross Street, Nelson BB9 7NN

PRESENT: East Lancashire CCG Dr Richard Robinson CCG Chair (Chair of the Meeting) Dr Julie Higgins Joint Accountable Officer, BwD and EL CCGs Dr Santhosh Davis Clinical Advisor & Governing Body Member Dr Mark Dziobon Medical Director, EL CCG Mrs Kirsty Hollis Deputy Chief Officer / Chief Finance Officer Dr Tom Mackenzie Clinical Advisor & Governing Body Member Mrs Michelle Pilling Deputy Chair & Lay Member – Quality & Patient Engagement Mr David Swift Lay Member – Governance Dr Paul Taylor Secondary Care Doctor

In Blackburn with Darwen CCG Attendance Mr Graham Burgess CCG Chair Mr Roger Parr Chief Finance Officer/Deputy Chief Officer Mrs Claire Richardson Director of Population Strategy and Transformation Dr Zaki Patel (Part) General Practitioner (GP) Executive Member Dr Adam Black (Part) GP Executive Member, Dr Geraint Jones Secondary Care Doctor (Retired) Dr Nigel Horsfield Lay Member Mr Paul Hinnigan Lay Member – Governance Professor Dominic Harrison Director of Public Health and Well-being, BwD Borough Council (BC)

Public Mr Ian Makin Wockhardt UK Pharmaceutical Company Attendees:

Page 1 of 18 Minutes Approved by the Chair : Jan 2020

Min Ref ACTION MiC/19.001 Welcome & Introductions

Dr Robinson confirmed that he and Mr Graham Burgess would rotate chairing the meetings over the coming 12 months.

MiC/19.002 Patient Story

Dr Black and Dr Patel joined the meeting.

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ACTION: An update to the next GB meeting outlining the position regarding AW/CH the Cancer Alliance work and where they are in relation to Prostate Cancer.

MiC/19.003 Public Questions

No questions had been received from members of the public.

MiC/19.004 Apologies for Absence & Confirmation of Quoracy

BwD CCG Apologies had been received from:

The Chair noted that apologies had also been received from Mr Iain Fletcher, Head of Corporate Business. The meeting was confirmed as inquorate for BwD CCG Members.

EL CCG Apologies had been received from:

Mrs Kathryn Lord, Director of Quality and Chief Nurse Mrs Naz Zaman, Lay Member – Equality and Inclusion The meeting was confirmed as quorate for EL CCG Members.

It was noted that Mr Alex Walker would need to leave at 3.15pm.

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MiC/19.005 Declarations of Interest

The Chair invited members to declare any interest they may have in relation to items on the agenda.

MiC/19.006 Minutes of the Previous Governing Body Meetings and Matters Arising

MiC/19.006.1 a. Blackburn with Darwen CCG – 11 September 2019

The Chair moved that the draft minutes of the meeting on 11th September 2019 be approved as an accurate record.

This was agreed by the members present.

MiC/19.006.2 b. Blackburn with Darwen CCG, Extract from Part 2 – 11 September 2019

The Chair moved that the draft minutes of the Extract from Part 2 of the meeting on 11th September 2019 be approved as an accurate record.

This was agreed by the members present.

MiC/19.006.3 c. Blackburn with Darwen CCG Annual General Meeting, 11 September 2019

The Chair moved that the draft minutes of the Annual General Meeting on 11th September 2019 be approved as an accurate record.

This was agreed by the members present.

The following items were ratified via Chair’s Action with email agreement from members of the GB who were absent from the meeting on 11th November 2019.

RESOLVED:

RESOLVED: that subject to the above amendments, the minutes were approved as an accurate record.

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MiC/19.006.5 e. East Lancashire CCG Annual General Meeting – 4 September 2019

RESOLVED: that the minutes of the AGM held on 4 September 2019 were approved as an accurate record.

MiC/19.007 Action Matrix/Matters Arising

MiC/19.007.1 Matters Arising

There were no Matters Arising which were not listed on the Action Matrix.

MiC/19.007.2 a. Blackburn with Darwen CCG

The Action Matrix was reviewed and the following were noted:

ACTION: Professor Harrison to bring a report to a future meeting. DH

All remaining actions were listed as completed.

MiC/19.007.3 b. East Lancashire CCG

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19.120 – Use of the Seal It was agreed to close the action as this will not be a common issue.

19.122 – Performance Report A new report had been developed which will provide more detail going forward. It was agreed the action would be closed.

MiC/19.008 Integrated Care System Strategic Plan Development

Dr Jones advised that Healthwatch in Blackburn with Darwen had led some of the work which has been fed into the process and Dr Higgins will lead on engagement work with the public.

He also supported the recommendation made by Dr Higgins to ensure there

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RESOLVED: that Members endorse the approach taken but not the next steps without the points raised being included.

MiC/19.009 Integration Accelerator Proposals

Dr Davis had declared an interest in this item as he was part of the team who had developed the Integration Accelerator proposals. It was agreed he would remain in the discussion.

In terms of next steps, the service specification would be issued by the end of

Page 7 of 18 Minutes Approved by the Chair : Jan 2020

Dr Davis had been involved in developing the proposals and felt this is the most progressive way of moving forward and PCNs are keen to take this forward.

Dr Higgins highlighted the need to make fundamental changes and help general practice to take a different approach and mobile their staff in a different way.

Dr Dziobon considered this will test general practice and the community provider to mobilise in a different way and there is a need to look at the mechanism to get there, as this is the way forward.

Mrs Pilling fully supported this new way of working, however with reference to the cohort selection outlined in the report, she considered this felt

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MiC/19.010 Joint Chief Officer Report

Dr Higgins handed over to Dr Dziobon to provide an update in relation to winter planning.

Members discussed the impact on primary care and the need to arrange manpower appropriately, particularly over the Christmas and New Year holiday period.

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transformation programmes in urgent primary care, looking at patient cohorts within the ICP to fast track them.

The Chair thanked Members for their views regarding winter plans.

RESOLVED: that Members receive the report.

MiC/19.011 Corporate Business Plan

Members attention was drawn to Page 5 of the report which outlined the CCGs system leadership and priorities in terms of system response, improvement, transformation and development.

RESOLVED: that Members receive the report.

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MiC/19.012 Performance Report

It was noted that information is produced on a monthly, quarterly and annual basis and this will be reviewed as part of the development going forward.

It was noted the report provided examples of areas being reviewed and how the information will be used to support the Primary Care Networks (PCNs) going forward.

Mr Parr welcomed any feedback as to how to develop this report and make it more meaningful in terms of the outcomes.

ACTION: Members to provide any feedback to Mr Parr.

RESOLVED: that Members receive the report. ALL

MiC/19.013 Finance Report

MiC/19.013.1 a. Blackburn with Darwen CCG

Mr Roger Parr presented the Month 6 report. He confirmed that the CCG was reporting a break even position in line with the financial plan.

He reported a slight underspend in running costs.

Questions and answers followed.

The members present noted the content of the financial summary and the financial position of the CCG at the end of September 2019.

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MiC/19.013.2 b. East Lancashire CCG

The Chair thanked Mr Parr and Mrs Hollis for their reports.

RESOLVED: that Members receive the report.

MiC/19.014 Quality Assurance Report

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RESOLVED: that Members receive the report.

MiC/19.015 Safeguarding Annual Update

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. Community Safe Services.

Page 14 of 18 Minutes Approved by the Chair : Jan 2020

Dr Dziobon referred to the significant numbers of cases of looked after children in the system and asked that details are provided to understand the DR scale of the work ongoing.

Page 15 of 18 Minutes Approved by the Chair : Jan 2020

The Chair thanked Mrs Ross and Mrs Waldron for their presentation.

ACTION: Children’s Services to be considered at the February Governing Body Development Session. CR

MiC/19.016 Accident & Emergency Delivery Board Chair’s Report

In relation to four hour performance, the system had achieved 85% against a trajectory of 89% which was a significant improvement compared to the previous year.

Page 16 of 18 Minutes Approved by the Chair : Jan 2020

RESOLVED: that Members receive the report.

Mr Walker left the meeting at 15.30.

MiC/19.017 Sub Committee Summary & Stakeholder Minutes

Mrs Debra Atkinson presented the reports on behalf of both CCGs.

She explained that there was duplication of some of the minutes in the reports for those meetings already held on a Pennine Lancashire footprint.

The reports presented the minutes of the CCGs’ Governing Body Sub- Committees and Groups and highlighted the work and key decisions taken through the meetings.

Mrs Atkinson reiterated that, as highlighted by Dr Higgins during the presentation of her report, key commissioning decisions would be incorporated into the Joint Chief Officer Report going forwards.

a. Blackburn with Darwen CCG

There were no questions.

The members present received and noted the content of the report.

b. East Lancashire CCG

There were no questions.

RESOLVED: That the GB received the report.

MiC/19.018 Pennine Lancashire Emergency Preparedness Submission

RESOLVED: that Members receive the report.

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MiC/19.019 Blackburn with Darwen Health & Well-Being Annual Report 2018/19

Professor Dominic Harrison presented the report.

The services had largely increased the amount of physical activity undertaken by BwD residents; especially those from low income families.

Questions and answers followed.

Members discussed the costs of running the services and if there would be pressure on them in the future.

The members present noted the content of the report.

MiC/19.020 Any Other Business

MiC/19.021 Date & Time of Next Meeting

The next meeting was confirmed as Wednesday, 15 January 2020, 1pm at Blackburn Central Library, Town Hall Street, Blackburn BB2 1AG

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BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

PART 1 - ACTION MATRIX January 2020 MIN REF: ACTION OWNER COMMENT RAG 22 January 2018 – ELCCG Historic Actions Ongoing 18:15 A&E Delivery Board Chair’s Report – A revised draft protocol has been signed off by the Mental MH Act 1983 Code of Practice Health Oversight Group at STP level. This now needs to go . David Swift felt the Code of Practice recommendations through the governance processes of all organisations for sign did not provide assurance that the protocol is in place. AW off and Alex Walker is leading on this for EL CCG. He requested this should be presented to the statutory 4.6.18: Alex Walker to provide an update via email SM body. 23.7.18: This was to remain amber until ELHT have signed off the Protocol. AW 26.9.18 : Protocol not yet signed off, further enquiries to be made with ELHT. AW 26.11.18 : Protocol to be signed off at the next meeting of the Patient Safety & Risk Assurance Cttee. 28.1.19 : Still in progress – remain on the matrix until complete. 25.3.19 : Ensure this is finalised through ELHT governance processes. AW 21.5.19 : Ensure the protocol has been signed by ELHT – KL 3.7.19 : Concerns expressed that the protocol had not been signed. Action to remain on the Matrix and ensure it aligns with the NTW Action Plan . 4.9.19 : There was currently no update and the position would be monitored through the NTW Review Report & Action Plan. 13.11.19 : No further updates available, continue to monitor through the NTW Review. 4 September 2019 19:88 Joint Chief Officer Report – 4.7.19 David Swift highlighted the need to consider how PCNs will CR Discussions are ongoing with ELHT regarding tripartite be accountable to the CCG as the statutory body, pointing development and reviewing governance arrangements, out this had not transferred to the Action Matrix from the recognising the need to have a mechanism in place for PCNs to July meeting. report into ICPs . 13.11.19 : Governance arrangements outlined that 3 PCN Clinical Directors had been invited to sit on the Partnership Leaders Forum and all CDs are working together through the Federations. Action Closed. 19:120 Use of the Seal . Attach relevant documents to future reports regarding AH Include as and when required. – Action Closed the use of the Seal.

19:122 Performance Report . The PL QC are reviewing a number of hot spots and a The Performance Report has been reviewed and will look at key resume would be shared with the GB to understand the AW areas and provide more detail regarding performance, through amount of work ongoing in specific areas with key both the PL Quality Committee & Governing Body. Action actions. Closed 13 November 2019 – Merged Action Matrix MiC/ Patient Story 19.002 . Members to receive an update outlining the position CHedley Briefing circulated to Members – Complete. regarding the Cancer Alliance work and where they are in relation to Prostate Cancer. MiC/ Measles Vaccination 19.007.2a . The update of vaccinations and screening sits within Public Health (PH) and as PH now rests with the Local DH Report to a future meeting. Authority, there was no access to NHS data due to IG issues. PH and NHSE are exploring this and a report will be provided when a solution is found. MiC/ Neighbourhood Level Data/Mapping Tool 19.007.2b . Professor Harrison to explore how the IG issues could be resolved in order for the PH Team developing the DH In Progress neighbourhood mapping tool to be able to access Primary Care data relevant to the Quality Outcomes Framework. MiC/ ICS Strategic Plan Development - Submission 19.008 . Formal comment to ensure that issues relating to CR Complete health inequalities and outcomes are included in the Strategy as a priority. MiC/ Performance Report 19.012 . Members to provide any feedback to Mr Parr. ALL Complete MiC/ Safeguarding Annual Update 19.015 . Details of the numbers of cases of looked after children DR . 2109 children and young people (CYP) are looked after in the system to be provided to understand the scale of children (LAC) by Lancashire Local Authority the work ongoing. . 985 CYP are placed in Lancashire by other LAs . 403 CYP are looked after by BwD LA . 61 CYP are placed in BwD by other LAs . 823 CYP are LAC by Lancashire originating from East Lancashire . 381 CYP are placed in East Lancashire by other LAs Total of 1668 children and young people are LAC who come within the remit of the Pennine ICP

. Children’s Services to be considered at the February CR Include on the Agenda for the February Development Session. GB Development Session. MiC/ Blackburn with Darwen Health & Well-Being Annual 19.019 Report 2018/19 . It was requested that a PL Health & Wellbeing Annual DH Included on the GB Forward Plan. Report will be produced next year.

NHS BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP NHS EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common

Agenda Report Title: Joint Chief Officer’s Report 4.1 No: Meeting Date: 15 January 2020 Summary of Report: This is a report to the Pennine Lancashire (PL) Governing Bodies (GBs), which provides an update on national and local issues of interest to members Report Recommendations: The GB is requested to receive this report and note the items as detailed Financial Implications: None Procurement Implications: None Report Category: Tick Support and recommend/forward the report. Approve the recommendations outlined in the report. Debate the content of the report. Receive the report for information. Author: Dr Julie Higgins

Presented By: Dr Julie Higgins Other Committees N/A Consulted: Has a PIA been completed in respect of this report? Privacy Impact Assessment N (PIA) If Yes, please attach If No, provide reason below. Has an EIA been completed in respect of this report? Equality Impact Analysis N (EIA) If Yes, please attach If No, provide reason below. Data Protection Impact Is a Data Protection Impact Assessment Required? N Assessment Have any risks been identified / assessed? N/A Risks: Conflict of Interest: Is there a conflict of interest associated with this report? N Has any clinical engagement/involvement taken place as part Y Clinical Engagement: of the proposal being presented? Patient Engagement: Have patients been involved in the drafting of this report? N Privacy Status: Can the document be shared Y CCG Corporate Objectives : CO1 To commission the best quality and effective services to deliver optimal healthcare outcomes for our local population. CO2 Ensure the balance of our health investment reflects our population’s needs and keeps the population well CO3 Deliver the 10 year strategy by engagement with the population we serve and ensure we commission services that meet local needs with a clear focus on population health management strategies CO4 We will focus on population health outcomes through helping to deliver successful Integrated Care Partnerships and ensure decisions, provision and access to local services is based on the needs of our population. CO5 As local health leaders, we will focus on increasing life expectancy across Pennine Lancashire to be at, or above the national average in the next 10 years. Report of the Joint Chief Officer Page 1 of 6

NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP and EAST LANCASHIRE CLINICAL COMMISIONING GROUP

GOVERNING BODIES MEETING IN COMMON

15 JANUARY 2020

JOINT CHIEF OFFICER’S REPORT

1. Introduction

I am pleased to present my joint report to the Pennine Lancashire (PL) Governing Bodies (GB) meeting in common (Blackburn with Darwen CCG and East Lancashire CCG), to provide an update on national and local issues of interest to members.

2. System Updates

2.2 Lancashire Better Care Fund (BCF) 2.2.1 Better Care Fund Plan 2019/20 Assurance On the 8th January 2020 confirmation that the Lancashire BCF plan had been approved at national level was received in a letter from Neil Permain, Director of NHS Operations and Delivery and SRO for the Better Care Fund. His letter recognises the challenges in preparing plans at a late stage and at pace. The approval allows for the formal release of CCG BCF funding with an expectation that the pooling of these funds will be confirmed within a section 75 agreement to be in place by the end of January 2020. Further feedback on BCF plans is to be provided to identify areas for improvement and share where systems may benefit from conversations with other areas 2.2.2 Winter Pressures On 27th December 2019 the Secretary of State for Health and Social Care and the Secretary of State for Housing Communities and Local Government wrote to all leaders of Social Care Local Authorities. The letter gave a commitment to the publication of 2020/21 BCF Policy Framework as early as possible in the New Year. It also recognised the success in reducing delayed transfers of care (DTOC) seen in early 2019 but highlights the increasing system pressures and more recent increases in DTOC. The letter asked that leaders confirm jointly with local acute trust Chief Executive(s) that service capacity, across the number of home care packages, hours of home care and care home placements that are available locally during this winter period to support prompt patient discharge, will be at least the level provided during winter 2018/19. The letter is an indicator of the high level of national attention that is being given to delivering the BCF and its impact upon the priority areas as well as progress in integration.

Report of the Joint Chief Officer Page 2 of 6

2.2.3 Lancashire Better Care Fund Plan 2020/21 The Lancashire Advancing Integration Board has instigated a proactive approach with Integrated Care Partnership (ICP) level BCF planning sessions to take place during January and February 2020. These will analyse current health and social care expenditure within the BCF, identify what has worked and what hasn’t and priorities for investment so supporting decision making for the shape of BCF plans. This process will provide a basis for wider analysis and forecasting required for delivering the Intermediate Care Programme. Once ICP level plans are drafted all will be brought together for a process of deciding the best level for action and the mechanisms for driving any required change along with defining best commissioning/ procurement activity. This will be the basis for the Lancashire BCF plan. 2.2.4 High Impact Change Model There is a requirement that each Better Care Fund partnership produces a “High Impact Change Model (HICM) “plan. This planning is underway. The HICM is a tool that identifies a set of changes that support the reduction of delayed transfers of care. The areas of change are:

1. Early discharge planning 5. Flexible working patterns 2. Monitoring and responding to system demand 6. Trusted assessment and capacity 7. Engagement and choice 3. Multi-disciplinary working 8. Improved discharge to care homes 4. Home first 9. Housing and related services.

The last of these changes “housing and related services” is new in the latest draft of the model and will provide a strong incentive and leverage to better engage district councils in the planning and delivery of integration. 2.4 Intermediate Care Programme The intermediate care programme held an introductory workshop on the 29th November with Carnell Farrar to review the ICP plans for the implementation and have discussions with the ICS around the potential assistance for enabling functions across the ICS footprint. We are currently working with Carnell Farrar to refresh the activity and finance information and support the implantation plan development. The outputs from this workshop and the ICP plans are currently being worked into a Programme Initiation Document for submission in January to system leaders. Additionally, we have recently recruited to the project manager role to support this work going forward. 2.5 Pennine Lancashire Integrated Care Partnership (ICP)

2.5.1 ICS/ICP Strategy Development

The Integrated Community Care Programme is a key area of work in the Integrated Care Partnership transformation programme, with a focus on out of hospital health and care. The purpose of the Integrated Community Care Programme is to drive tangible improvements in the provision of health and care services in the community and primary care that will:

 improve health outcomes;  deliver responsive care based on need;  enable a shift of resources and activity closer to home; Report of the Joint Chief Officer Page 3 of 6

 reduce demand for hospital services; and  deliver an affordable and sustainable level of activity in the Pennine Lancashire system.

The Programme seeks to:

 Enable the development of Primary Care Networks (PCNs) and neighbourhood teams so that they can support local people to live in their communities in a way that promotes health, independence and happiness; this will include managing and delivering same day urgent primary care and drawing on step up intermediate tier interventions as required. Over time, we expect health and care staff to work in self-directed teams, taking a population health management approach, managing the health of their local populations in a much more proactive way, predicting care needs and preventing crises.

 Transform intermediate tier services to help people to stay out of hospital and support people to get back home after spending time in hospital, taking the learning from developments such as Albion Mill extra care in Blackburn with Darwen.

This will include:  integrating the intermediate tier services that make up the current out of hospital service offer;  increasing the range and capacity of non-bed based interventions;  redesigning the current community bed base to create the right mix of extra care beds, nursing home beds and community hospital beds; and  creating a care navigation system that will deploy rapid and appropriate care to meet identified needs.

The default offer will become ‘step up’ reducing the demand on hospital services and increasing independence and recovery. This range of services will particularly support people with complex co-morbidities, those nearing end of life and the growing older population as they become frailer.

 Commission community services at scale, integrating and tailoring them to local PCNs and neighbourhoods, and ensuring the commissioned intermediate tier offer is effective, responsive and fit for purpose.

 Take a place-based approach to planning and care delivery that takes account of local peoples’ needs and community assets and is tailored to the individual districts in Pennine Lancashire. There is recognition that whilst there may be a need for a ‘Pennine Lancashire view’ about a particular service or piece of work, the execution and delivery of any change needs to be managed in a ‘place’ context, taking into account the specific needs, views and assets in local communities. Our place based planning will be managed and delivered based on appropriate council geography and involve all the relevant stakeholders in each place.

 Develop programme budgeting and integrated commissioning approaches so that the health and care resources in scope are utilised to maximum effect.

The programme will operate three workstreams, each of which has identified priorities for fast track delivery: Primary and Community Care, Intermediate Tier and Place Planning with each workstream identifying a priority project:

 Primary and Community Care, prioritising Integration Accelerator  Intermediate Tier, prioritising Integration of Non-Bed Based Care  Place Planning, with an initial focus on Hyndburn

Report of the Joint Chief Officer Page 4 of 6

3. Clinical Commissioning Group Updates

3.1 GP Governing Body Elected Members

The Terms of Office for both Dr Preeti Shukla and Dr John Randall as Executive GP members on the CCG Governing Body ended on 31st October 2019. Following an election process, the CCG’s members voted to re-elect Dr John Randall for a further 3 years and I am pleased to announce that Dr Qashuf Hussain, a GP partner in Darwen was newly elected to the Governing Body by the membership. We look forward to welcoming Dr Hussain to the CCG and working with him over the next 3 years.

3.2 Blackburn with Darwen Medical Director

Following the announcement from Dr Penny Morris of her intention to retire from general practice from the end of January 2020, and also therefore in her appointed role as the CCG’s Medical Director, a recruitment process was undertaken. We are delighted that Dr John Randall applied for, and was offered the position of Medical Director for BwD CCG. We look forward to working with John in his new position and wish Penny all the very best wishes for a long and happy retirement.

3.3 Darwen Healthcare winners of the “General Practice Awards 2019”

Darwen Healthcare has won 2 prestigious awards for GP surgeries that go above and beyond to meet their patients’ needs. This year the practice won both “GP Team of the Year” and the “Practice Nursing Award 2019” at an awards ceremony held in London on 29 November 2019. The General Practice awards are designed to recognise, highlight and reward the hard work and innovation that gets carried out every day in surgeries throughout the UK. Our congratulations go to all of those involved in this fantastic achievement.

3.4 National CCG Prescriber Awards 2019

East Lancashire and Blackburn with Darwen CCGs were both winners at a recent conference for their work on heart disease. East Lancashire CCG had 8 nominations, whilst Blackburn with Darwen had 7 at the CCG Prescriber Conference 2019 on November 14 and 15. In the National CCG Prescriber Awards East Lancashire CCG won the “Best Monitoring” category for heart disease and Blackburn with Darwen CCG came top in the “Effective Implementation” category for Protection of Heart Disease – huge congratulations to everyone involved.

3.5 Key Commissioning Decisions Taken

3.5.1 Learning Disability and Autism Assessment and Treatment Beds and Admission Avoidance Services – the CCG reviewed and agreed a business case for a more cost efficient method of service provision. This is an 18 month arrangement whilst a longer term plan is developed.

3.5.2 Social Prescribing/Small Grants – East Lancashire CCG approved the extension of a grant for 12 months to the Council for Voluntary Services to provide a social prescribing service for East Lancashire. Both CCGs agreed a further extension to the current service delivery model for Personalised Integrated Care Programme provided by Age UK Lancashire until March 2022.

Report of the Joint Chief Officer Page 5 of 6

4. East Lancashire Hospital Trust – Medical Director Appointment

In November 2019 the Chief Executive at East Lancashire Hospitals Trust (ELHT) announced that Mr Jawad Hussain will take up the position of Executive Medical Director at the Trust. Dr Husain, a Consultant Urological Surgeon, is currently medical director at Royal Oldham Hospital within the Northern Care Alliance.

5. NHS England Updates

5.1 Action on 2019/20 Pension Tax Impact

NHS leaders Simon Stevens and Amanda Pritchard, have written to all NHS organisations to set out the position that will apply in 2019/20, to all clinician members of the NHS Pension Scheme who are in active clinical roles. The letter outlines that clinicians who exceed their NHS pension annual allowance in the 2019/20 financial year will not be financially out of pocket due to additional tax liabilities.

Those members will be able to choose “Scheme Pays” on their pension form meaning they don’t have to pay the charge now, of their own pocket. Additionally the NHS will make a contractually binding commitment to pay them a corresponding amount on retirement, ensuring they are fully compensated for the effect of the “Scheme Pays” deduction.

A detailed set of “Frequently Asked Questions” is available online at www.england.nhs.uk/pensions but this announcement means clinicians should immediately be able to take on additional shifts or sessions without worrying about an annual allowance charge on their pension.

5.2 Advice on Antiviral Medicines for Influenza

Data has indicated that influenza levels in the community now warrant the use of antiviral medicines. The Chief Medical Officer and Chief Pharmaceutical Officer have therefore issued advice on prescribing and supplying antiviral medicines for preventing and treating influenza. They recommend prescribing antiviral medicines for people with flu-like illness, in line with regulations and current NICE guidance. https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=102939

6. Recommendation

The GBs are requested to receive this report and note the items as detailed.

Dr Julie Higgins Joint Chief Officer 10 January 2020

Report of the Joint Chief Officer Page 6 of 6

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

Blackburn with Darwen CCG Governing Body and East Lancashire CCG Governing Body Meeting in Common

Agenda Report Title: Performance and Contract Summary Report 4.2a No: Meeting Date: 15th January 2020 Summary of Report: This report provides Governing Body members with performance contract exceptions for 2019/20 M07 – October 2019. Report Recommendations: Receive the report for information Financial Implications: None Procurement Implications: None Report Category: Tick Support and recommend/forward the report. Approve the recommendations outlined in the report. Debate the content of the report. Receive the report for information. √ Author: Mr Neil Holt, Head of Commissioning Performance Mr Jason Newman, Head of Performance and Delivery Mrs Carolyn Craven, Acting Senior Contract Manager, Midlands and Lancashire Commissioning Support Unit (M&LCSU) Mr Andrew Taylor, Business Intelligence Manage, M&LCSU Report supported & approved by your Senior Lead? Y

Presented By: Mr. Roger Parr – Deputy Chief Officer / Chief Finance Officer (BwD) Other Committees Consulted: Not Applicable Has a PIA been completed in respect of this report? Privacy Impact Assessment N (PIA) If Yes, please attach If No, provide reason below. Has an EIA been completed in respect of this report? Equality Impact Analysis (EIA) N If Yes, please attach If No, provide reason below.

Data Protection Impact Is a Data Protection Impact Assessment Required? N Assessment Have any risks been identified / assessed? Risks: N

Conflict of Interest: Is there a conflict of interest associated with this report? N Has any clinical engagement/involvement taken place as part of the N Clinical Engagement: proposal being presented? Patient Engagement: Have patients been involved in the drafting of this report? N Privacy Status: Can the document be shared Y

CCG Corporate Objectives :

To commission the best quality and effective services to deliver optimal healthcare outcomes for CO1 √ our local population. Ensure the balance of our health investment reflects our population’s needs and keeps the CO2 √ population well CO3 Deliver the 10 year strategy by engagement with the population we serve and ensure we commission services that meet local needs with a clear focus on population health management strategies CO4 We will focus on population health outcomes through helping to deliver successful Integrated Care Partnerships and ensure decisions, provision and access to local services is based on the √ needs of our population. CO5 As local health leaders, we will focus on increasing life expectancy across Pennine Lancashire to be at, or above the national average in the next 10 years. √

Page 1 of 38 Performance Framework Matrix

[A] NHS Oversight Metrics

[B] Headline Measures

[C] Focus Area Quadrants

[D] Contract Performance

Page 2 of 38 NHS Oversight Metrics [New Service Models]

00Q : Metric 01A : East Metric Description Blackburn Ref Lancashire with Darwen

105b Personal health budgets 19‐20 Q1 207.87 205.98 127b Emergency admissions for urgent care sensitive conditions 19‐20 Q2 3016.66 2501.25 127c Percentage of patients admitted, transferred or discharged from A&E within 4 hours [System]  Dec‐19 77.35% 77.35% 127f Population use of hospital beds following emergency admission 18‐19 Q2 532.06 536.84 128b Patient experience of GP services 2018 84.09% 84.98% 128c Patient experience of getting an appropriate GP Appointment Mar‐19 100.00% 100.00% 130a Achievement of clinical standards in the delivery of 7 day services 2017‐18 100.00% 100.00% 131a Percentage of NHS Continuing Healthcare full assessments taking place in an acute hospital setting 19‐20 Q1 31.25% 19.15% 144a Utilisation of the NHS e‐referral service to enable choice at first routine elective referral Aug‐19 100.49% 93.90%

Reporting in development / Not currently in Aristotle summary report

00Q : Metric 01A : East Metric Description Blackburn Ref Lancashire with Darwen

127e Delayed Transfers of Care per 100,000 population  Oct‐19 464

KEY Performance worse than national average / not at target levels Performance better than national average / above target levels

Data not available / metric construction detail required / PageNot 3currently of 38 in Aristotle reporting system NHS Oversight Metrics [Preventing ill health and reducing inequalities]

00Q : Metric 01A : East Metric Description Blackburn Ref Lancashire with Darwen

102a Percentage of children aged 10‐11 classified as overweight or obese  15‐16 to 17‐18 35.20% 35.10% 104a Injuries from falls in people aged 65 and over 19‐20 Q2 1886.39 1837.28 106a Inequality in unplanned hospitalisation for chronic ambulatory care sensitive conditions 18‐19 Q2 3019.67 2321.87 107a Anti‐microbial resistance: appropriate prescribing of antibiotics in primary care  Jul‐19 1.08 0.99 107b Anti‐microbial resistance: appropriate prescribing of broad spectrum antibiotics in primary care Jul‐19 7 6.7 123g Proportion of people on GP severe mental illness register receiving physical health checks 19‐20 Q2 38.96% 37.54% 125d Maternal smoking at delivery  19‐20 Q2 13.00% 15.50%

Page 4 of 38 NHS Oversight Metrics [Quality of care and outcomes ‐ 1]

00Q : Metric 01A : East Metric Description Blackburn Ref Lancashire with Darwen

Diabetes patients that have achieved all the NICE recommended treatment targets: three (HbA1c, chol 103a 2017‐18 40.10% 38.39% and bp) for adults and one (HbA1c) for children 103b People with diabetes diagnosed less than a year who attend structured education course 2017‐18 10.64% 9.41% 105c Percentage of deaths with three or more emergency admissions in last three months of life 2017 7.91% 6.35% 108a The proportion of carers with a long term condition who feel supported to manage their condition 2019 0.63 0.61 121a Provision of high quality care ‐ Hospitals 19‐20 Q1 60 59 121b Provision of high quality care ‐ Primary Medical Services 19‐20 Q1 64 68 122a Cancers diagnosed at early stage  18‐19 Q1 45.00% 51.70% 122b People with urgent GP referral having first definitive treatment for cancer within 62 days of referral 19‐20 Q2 76.99% 77.48% 122c One‐year survival from all cancers (%) 2017 70.4 71.4 122d Cancer patient experience 2018 8.87 8.85 123a Improving Access to Psychological Therapies recovery rate Jul‐19 52.38% 53.30% 123b Improving Access to Psychological Therapies – access Jul‐19 4.75% 5.34% People with first episode of psychosis starting treatment with a NICE recommended package of care 123c Sep‐19 100.00% 66.67% treated within 2 weeks of referral 124a Reliance on specialist inpatient care for people with a learning disability and/or autism 18‐19 Q4 72 72 124b Proportion of people with a learning disability on the GP register receiving an annual health check 2017‐18 55.74% 45.03% 124c Completeness of the GP learning disability register 2017‐18 0.48% 0.48% 125a Neonatal mortality and stillbirths  2016 7.82 6.64 125b Women's experience of maternity services 2018 87.09 87.68 125c Choices in maternity services 2018 71.16 68.88

Page 5 of 38 NHS Oversight Metrics [Quality of care and outcomes ‐ 2]

00Q : Metric 01A : East Metric Description Blackburn Ref Lancashire with Darwen

126a Estimated diagnosis rate for people with dementia Sep‐19 73.37% 69.96% 126b Dementia care planning and post‐diagnostic support 2017‐18 79.86% 83.23% 129a Patients waiting 18 weeks or less from referral to hospital treatment Oct‐19 84.70% 84.60% 129b Overall size of the waiting list  Oct‐19 11885 29079 129c Patients waiting over 52 weeks for treatment  Oct‐19 2 0 132a Evidence That SEPSIS awareness raising amongst healthcare professionals has been prioritised by the CCG 2018 Green Star Amber 133a Patients waiting six weeks or more for a diagnostic test Oct‐19 0.97% 1.00%

Reporting in development / Not currently in Aristotle summary report

00Q : Metric 01A : East Metric Description Blackburn Ref Lancashire with Darwen

123f Mental Health Out of Area Placements 134a Evidence Based Interventions 123j Quality of Mental Health Data submitted to NHS Digital (DQMI) Learning disabilities mortality review : the percentage of reviews completed within 6 months of 124d notificaiton

Page 6 of 38 NHS Oversight Metrics [Leadership and workforce / Finance and use of resources ]

00Q : Metric 01A : East Metric Description Blackburn Ref Lancashire with Darwen

128d Primary care workforce Sep‐19 0.9 1.12 162a Probity and corporate governance 18‐19 Q4 Fully ComplianFully Complian 163a Staff engagement index 2018 3.84 3.86 163b Progress against workforce race equality standard 2018 0.17 0.18 164a Effectiveness of working relationships in the local system 2018‐19 76.19 69.44 165a Quality of CCG leadership 19‐20 Q1 Green Green

166a Compliance with statutory guidance on patient and public participation in commissioning health and care 2018‐19 Green Green Star

123i Delivery of the mental health investment standard 19‐20 Q1 Green Green 141b In‐year financial performance 19‐20 Q1 Green Green 145a Expenditure in areas with identified scope for improvement 19‐20 Q1 Green Amber

Reporting in development / Not currently in Aristotle summary report

00Q : Metric 01A : East Metric Description Blackburn Ref Lancashire with Darwen

123k Children and young people and eating disorders investment as a percentage of total mental health spend

123d Children and young people's mental health service transformation Reducing the rate of low priority prescribing

Page 7 of 38 HEADLINE MEASURES

Theme Metric Period BwD EL A&E 4 Hr Performance [95% target] [Pennine System ‐ ELHT] Dec 2019 77.4% 77.4%

18 week Incomplete pathways for all patients [92% target] Oct 2019 84.7% 84.6%

18 week Incomplete pathways for all patients [Waiters – March 2020 target] Oct 2019 587 2,386

CANCER Patients seen within 2 weeks for an urgent GP referral for suspected Oct 2019 92.24% 91.74% cancer [93% target] [YTD Apr‐Oct 2019] CANCER Patients receiving first definitive treatment within 1 month of a Oct 2019 95.85% 96.65% cancer diagnosis [96% target] [YTD Apr‐Oct 2019] CANCER Patients receiving first definitive treatment for cancer within two Oct 2019 77.91% 78.65% months [85% target] [YTD Apr‐Oct 2019] IAPT IAPT Access [4.75% Q1 Q2 Q3 / 5.5% Q4] Q2 19/20 4.83% 4.76%

IAPT IAPT Recovery [50% target] Q2 19/20 54.4% 56.0%

MATERNITY Smoking at time of delivery (SATOD) Q2 19/20 13.0% 15.5%

Page 8 of 38 MEASURE A&E ATTENDANCE NUMBERS AND 4 HOUR PERFORMANCE 127c RISKS GBAF‐259

OWNER Elizabeth Fleming DIRECTOR Alex Walker ICP PB ICCB MHW SCB AEDB Commentary Pennine Lancashire System: • Performance for December 2019 was 77.35% and the system did not meet the trajectory which was 84%. • For overall 4 hour performance, the most recent published national performance is for November 2019 which was 81.4% and Pennine Lancashire performance was 80.45%. On most weeks Pennine Lancashire performance is in the middle of national ranking.

Mitigation Conclusion/Risks • System‐wide work plan (Plan on a Page) agreed by system & • Lack of full system view due to no formal ‘real time’ capacity being delivered through Accident Emergency Delivery Board management system. (AEDB) • Surge demand for services can be out of the CCG's control ‐ for • POAP includes the transformation work‐streams, including: e.g., RBH is the busiest ED in the North West in terms of Access; ED front door & streaming; Flow; Discharge and ambulance conveyance (c. 130 a day), mental health bed recovery; Extended Primary Care; Resilience and escalation availability • System Winter Plan implemented and fully operational, with the • Vulnerable to short notice staffing changes and sustainability of exception of Acute Visiting Service in East Lancashire current staffing model • National request for additional mitigation regarding reducing • Ability of out of hospital system to transform at pace and scale, A&E corridor care and Urgent Care Pod being developed at RBH and absorb demand which would otherwise be in the hospital site (go‐live expected February 2020) setting. • Demand management –actions reflected in corporate business plan to stem ambulance and walk in demand.

Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 9 of 38 NHS East Lancashire Clinical Commissioning Group MEASURE Delayed Transfers of Care per 100,000 Population 127e RISKS

OWNER Elizabeth Fleming DIRECTOR Alex Walker ICP PB ICCB MHW SCB AEDB Commentary • Delayed Transfers of Care per 100,000 Population not currently routinely measured • Other accepted measures for Delayed Transfers of Care show the following for the Pennine Lancashire System: • Delayed Transfers of Care (% of acute beds) –performance for November 2019 was 2.68% against a system target of 3.5%, meaning the target was met. Performance for November 2018 against this target was 3.40% showing a year on year improvement of ‐0.72%. Note that throughout the year there have been fluctuations in the DTOC metric. To encourage minimising delayed transfers of care, enable timely discharge or transfer to the most appropriate care setting and promote smooth flow through the system for medically optimised patients. This is one of the desired outcomes of social care. Mitigation Conclusion/Risks • Delayed Transfers of Care position reviewed regularly via • Delayed Transfers of Care per 100,000 Population not currently Accident and Emergency Delivery Board (part of system wide routinely measured at CCG level. Technical guidance outlines work plan; Plan on a Page>Discharge and Recovery) how to apportion the Local Authority level figures to estimate • Delayed Transfers of Care Recovery Manager appointed to assist the CCG position and this is being explored locally. with micro management of cases (October 2019) • Need to commence data collection from an agreed point in time • Specific focus on ward areas showing highest levels of formal • Need to establish baseline and agree target / trajectory delays with Integrated Discharge Service response reorganised • Admission avoidance including the proactive care management to serve these areas in the community of complex frail elderly patients, has the • Increased level of scrutiny informing plans to unblock delays potential to provide a longer term sustainable solution. relating to funding decisions • Pathways already established for Home First, Discharge to Assess (non‐complex) which are critical for this patient group. Work progressing to develop pathways to support effective processes for earlier discharge (following on from system wide Continuing Health Care 3 day improvement event –November 2019) • ‘Perfect Week’ held at the hospital in November, with further Page 10 of 38 ‘Perfect Week’ planned for 13/01/2020 MEASURE Percentage of children aged 10‐11 classified as overweight or obese 102a RISKS

OWNER Kirsty Hamer DIRECTOR Claire Richardson ICP PB ICCB MHW SCB AEDB

15/16‐17/18 Commentary

• Weight status at the end of primary school, like earlier in childhood, is an important predictor of health outcomes later in EL BwD life. Monitoring of trends in weight status across childhood helps identify pivotal points during childhood to intervene and prevent England average = 34.18% children becoming overweight and obese. In England, the proportion of children at healthy weight at Year 6 has stayed Number of children in Year 6 (aged 10‐11 years) classified as fairly constant since 2007, although there was an increase in the overweight or obese in the National Child Measurement proportion of obese children in 2015/2016. Children living in the Programme (NCMP) attending participating state maintained most deprived areas are more likely to be overweight or obese schools in England as a proportion of all children measured. compared with children in the least deprived areas. Rationale : To encourage action on overweight and obese children, yas the are more likely to become overweight or obese adults, with consequent health problems. Mitigation Conclusion/Risks • A Childhood Obesity trailblazer has been approved for Pennine • Lack of a system approach to addressing obesity across Lancashire and this is being led by ‘Food Active’. This is a three Pennine Lancashire. year programme aimed at making more takeaways supply • To be discussed at Children and Young People’s ICP Strategy healthier food by changing planning permission criteria’s Group. • Implementation of a guide to implementing a Healthy weight declaration across local authorities in Pennine Lancashire.

Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 11 of 38 NHS East Lancashire Clinical Commissioning Group MEASURE Anti‐microbial resistance: appropriate prescribing of antibiotics in primary care 107a RISKS

OWNER Lisa Rogan / Julie Kenyon DIRECTOR Kathryn Lord ICP PB ICCB MHW SCB AEDB Commentary July 2019 To help prevent development of resistance it is important to prescribe antibiotics EL BwD only when necessary, not for self‐limiting infection and restrict prescribing of long England average = 0.95 term antibiotics for limited, specific circumstances. The MMT has undertaken a range of interventions to support prescribers to target antibiotics appropriately. Evidence suggests that antimicrobial resistance (AMR) is driven by These are highlighted in the following section. over‐using antibiotics and prescribing them inappropriately. Reducing 2019‐20 National target is 0.965 or below. the inappropriate use of antibiotics will delay the development of antimicrobial resistance that leads to patient harm from infections that are harder and more costly to treat. Reducing inappropriate antibiotic use will also protect patients from healthcare acquired infections such as Clostridium difficile infections and reduce the risk of Gram‐negative blood stream infections.

Mitigation Conclusion/Risks • Reviewing + and updating the Health Economy Antibiotic Guidelines 2018‐19 for Primary Care through the website and Digital Smartphone MicroGuide application, thus increasing • Although volume of prescribing remains above England average, accessibility across a broad range of clinicians including community nurses and care homes. the position has improved significantly between Jan 18‐Dec 19 • The 2019‐20 and 2020‐21 Prescribing Scheme includes Antibiotic Reviews as a compulsory compared with Oct 18‐Sept 19. element for ALL practices. • Delivery of clinical workshops delivered by Consultant Microbiologist from Acute Trust • The MMTs continue to work with practices to improve targeted at all practices, mandatory for poorer performing practices. antimicrobial stewardship. • Resources & strategies to support practices have been shared & promoted among primary • A Health Economy wide group that includes the two CCGs and care clinicians and community pharmacists eg. strategies adopted for delayed prescribing. • Guidance has been developed and training delivered to care homes on urine dipsticks and Acute Hospital has been set up to help tackle some of the those with catheters. challenges highlighted. • All patients on long term antibiotics for various conditions have been reviewed including: acne; UTIs; prostatitis. • Working with OOHs to reduce levels of prescribing in line with local guidance and formulary. Monthly reporting is shared with all practices with comparisons with peers alongside LSC and national levels. • Some practices participating in research to support prescribing for respiratory infections – CHICO. • Templates have been developed by the MMT alongside the Data Quality Team (DQT) to support implementation of the prescribing scheme for Tonsilitis; Otitis Media and UTIs. • Self‐care is being heavily promoted. Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 12 of 38 NHS East Lancashire Clinical Commissioning Group MEASURE MATERNITY: Maternal smoking at delivery 125d RISKS

OWNER Kirsty Hamer DIRECTOR Claire Richardson ICP PB ICCB MHW SCB AEDB

Maternal smoking at delivery Commentary 19‐20 Q2 BwD CCG EL CCG National • Smoking during pregnancy causes up to 2,200 premature births, 20.00% 5,000 miscarriages and 300 perinatal deaths every year in the 18.00% UK. Pennine Lancs (PL) is one of the more deprived areas of the 16.00% UK and levels of child poverty vary across the patch – Evidence 14.00% shows that quit rates drop in deprived areas. 12.00% • 10.00% Recent LA budget cuts will have impacted smoking cessation 8.00% services. 6.00% • Although rates of smokers setting a quit date compare 4.00% England average = 10.4% favourably to the national position, the actual number of 2.00% successful quitters is reducing against previous years. 0.00% • Across BwD and Lancashire, approximately 1/3 of those who set 15 16 17 18 19 15 16 17 18 15 19 16 17 18 16 19 17 18 19 20 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ a quit date successfully quit (and this is confirmed) Jun Jun Jun Jun Jun Sep Sep Sep Sep Sep Dec Dec Dec Dec Dec Mar Mar Mar Mar Mar • Rationale : To encourage the continued prioritisation of action to reduce smoking at delivery. Mitigation Conclusion/Risks • A Pennine Lancashire Smoking in Pregnancy Action Plan is in • Smoking Cessation services, commissioned by the Local place and being implemented which includes the following: Authority (LA) differ across PL. • The East Lancs smoking cessation team (Quit Squad) are working closely with Maternity Services and provide services aligned within Maternity at the Trust. • Blackburn with Darwen’s model signposts patients to Pharmacy services for support. • tMuch join working is taking place including an approach raising the profile with midwives. • From April 2020 a CCG commissioned service will expand its specification to incorporate Smoking in Pregnancy. This service will cover PL to address the inconsistent approach. • A recovery trajectory is being established to close the gap to the national position. Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 13 of 38 NHS East Lancashire Clinical Commissioning Group MEASURE CANCER: Cancers diagnosed at early stage 122a RISKS

OWNER Cathy Gardener DIRECTOR Roger Parr ICP PB ICCB MHW SCB AEDB Commentary • Diagnosis at an early stage of the cancer’s development leads to BWD EL CCG dramatically improved survival chances. Specific interventions, such as screening programmes, information/education campaigns and greater GP access to diagnostic services all aim to improve rates of early diagnosis. • Both CCGs are demonstrating improved earlier stage cancer diagnosis as a trend but BwD performance has declined over the 4 quarters to March 2018 • LHC will asses patients and identify those at high risk of lung cancer and refer for low dose CT Scan. • Implementation of Rapid Diagnostic Centres (pathways) (RDC) ; BwD EL England National cancer team initiative to develop and support the Q1 2018‐19 45.0% 51.7% 51.8% transformation of cancer diagnosis . Working in partnership with ELHT and Cancer Alliance to implement the RDC model to deliver faster and earlier diagnosis . Mitigation Conclusion/Risks • PCN service spec has focus on supporting Early Cancer Diagnosis • Increased demand against limited resources makes achievement • Local campaigns to increase uptake of all screening programmes progressively more challenging and raise awareness of signs and symptoms • NHS Long Term plan aims for 75% of all cancers diagnosed at • 28 Day Faster Diagnosis Standard, patients should receive a stage 1 or 2 by 2028. Local projections indicate achievement by definitive diagnosis or ruling out of cancer within 28 days of a 2035 referral • Dependant on National Government investment in Diagnostics • CCGs with the highest incidence of, and mortality from, lung to support early diagnosis and cancer care cancer have been selected as one of the 14 phase one sites in a • Investment in NHS/health service in recruiting the staff it needs national roll out, Lung Health Checks (LHC) ‐ Blackburn with for the future workforce, many specialisms unable to recruit Darwen (BwD) selected as a CCG with high lung cancer skilled staff e.g. Oncology/ Histopathology in addition to an incidence and morbidity taking part in the first stage roll out of Ageing workforce. the national targeted LHC for individuals age between 55 ‐74 and current/ever smoked. (Long Term Plan 2019)

Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 14 of 38 NHS East Lancashire Clinical Commissioning Group MEASURE CANCER: 2 Week Rule / 31 Day Diagnosis to treatment / 62 Day referral to treatment RISKS GBAF 239‐1819

OWNER Cathy Gardener DIRECTOR Roger Parr ICP PB ICCB MHW SCB AEDB Commentary CANCER TARGETS [YTD Apr‐Oct 2019] BwD EL • BwD CCG & Blackpool CCG are participating in a national Targeted Lung Health Check programme pilot (patient review ex‐ 2 Week [93% Target] 92.24% 91.74% smokers who are between 55‐74yrs); • Focused work between Cancer Research UK & Primary Care; 31 Day [96% Target] 95.85% 96.65% • Local “Let`s Talk Cancer” campaign; aim to inspire everyone to talk about cancer. A focus on the importance of engaging with 62 Day [85% Target] 77.91% 78.65% screening programmes is a key theme. • Change from 14 day to 28 day measure (standard not confirmed), improving on the Two Week Wait (2WW) Standard with a more patient and outcomes‐focussed Faster Diagnosis Standard (FDS);

Mitigation Conclusion/Risks • Cancer Champions in each practice: Improving / coordinating • Scheduled Care Board has only recently been formed and there care with patients; has been no escalation process in place. A Primary Care clinical • Supporting Primary Care Networks (PCN) to engage specifically lead has now been identified as part of the membership of this with early cancer diagnosis. PCN service spec has a focus on Board. supporting Early Cancer Diagnosis • Locally and nationally performance is declining –increased • Faecal Immunochemical Tests (FIT) for symptomatic patients demand, impact of pension change, diagnostic capacity across L&SC Alliance (from Nov 2018) FIT for Screening July • Across both CCGs there are large variations in performance 2018. Above expected increase in uptake and positivity rates, between specialities with a couple 'shoring up' some of the significant impact on waiting times for colonoscopies; poorer performing ones. Patient choice has a more significant • Redesigned hospital cancer pathways to reflect national optimal affect in e.g. urology (prostate). pathways and improve patients experience (including Supported • Many head and neck need tooth extractions, detox before they Self‐Management Follow‐up); can commence on the pathway proper. • Rapid Diagnostic Centre (RDC) development (NHS Long Term Plan): Vague symptoms and pancreatic • 28 Day Faster Diagnosis Standard (FDS) Task & Finish Group.

Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 15 of 38 NHS East Lancashire Clinical Commissioning Group MEASURE MATERNITY: Neonatal Mortality and Stillbirths 125a RISKS

OWNER Kirsty Hamer DIRECTOR Claire Richardson ICP PB ICCB MHW SCB AEDB Commentary 2016 • A national ambition to halve the rates of stillbirths, neonatal and BwD maternal deaths and intrapartum brain injuries by 2030, with a 20% reduction by 2020 England average = 4.61 • Neonatal mortality accounts for between 70% and 80% of infant deaths. EL • The great majority of neonatal deaths and stillbirth are due to perinatal causes, particularly preterm birth, and are strongly related to maternal health, as well as congenital malformations. The number of stillbirths and neonatal deaths per 1,000 births. This Social inequalities play a role in almost all the leading causes of indicator measures the rate of stillbirths and deaths within 28 days of infant death, with increasing risk associated with higher levels of birth per 1,000 live births and stillbirths, reported at CCG of residence maternal deprivation. The mechanisms underlying this social level by calendar year. gradient are related to increased risk of preterm delivery in more deprived groups, as well as to maternal health during pregnancy (for example, smoking, poor nutrition, substance abuse). • Maternal age is also associated with infant mortality. Children of very young mothers have a substantially higher IMR; in England and Wales the IMR for mothers aged less than 20 years is 6.1 deaths per 1,000 live births compared with 3.4 deaths per 1,000 live births in mothers aged 25 to 29 years (Office of National Statistics, 2014).

Mitigation Conclusion/Risks • Monthly reporting through the maternity dashboard • Resource to implement Better Births and Saving Babies Lives 2. • Self‐assessment against national guidance implementation of • Overview of performance at an ICP level. Saving Babies Lives 2. Out of the five elements, 3 are RAG rated as green and 2 are amber and will be completed by March 2021.

Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 16 of 38 NHS East Lancashire Clinical Commissioning Group MEASURE 18 Week RTT Performance 129a RISKS GBAF‐262

OWNER Cathy Gardener DIRECTOR Roger Parr ICP PB ICCB MHW SCB AEDB

Mar‐19 BWD CCG [October 2019] 2018‐19 2019‐20 Variance Target Commentary • Both CCGs have patients waiting over 18 weeks at ELHT, 18 Week Waiting List 9,923 11,885 1,962 11,299 Lancashire Teaching Hospitals Trust and Manchester 18 Week Performance % 90.0% 84.7% University Foundation Trust (with smaller numbers across Mar‐19 multiple providers). EL CCG [October 2019] 2018‐19 2019‐20 Variance Target • ELHT is one of the national pilot sites for new RTT standard; • Waiting lists reported under Trauma and Orthopaedics increased 18 Week Waiting List 24,378 29,079 4,701 26,694 at ELHT in February 2019 with the inclusion of MSK activity. 18 Week Performance % 91.0% 84.6%

• 129a: % of patients waiting to start non‐emergency consultant‐led treatment who were waiting 18w or less at the end of the reporting period . Mitigation Conclusion/Risks • A Pennine Lancashire Scheduled Care Board has been established • The Scheduled Care Board has only recently been formed and within the ICP Governance; membership includes both clinical and there has been no escalation process in place. A Primary Care managerial membership from all partners. There is shared SRO clinical lead has now been identified as part of the membership responsibility at Director level for both ELHT and CCGs and ELHT of this Board. Chief Executive is the sponsor of the Board. • Sufficient medical staffing to staff current and future models ‐ • The Board’s remit includes performance management oversight and e.g. use of locum staffing active management and transformational /pathway redesign for • Change of pensions has impacted on consultant availability to longer term sustainability. undertake capacity / waiting list initiatives • Outpatient Transformation Group reports to Scheduled Care Board. • Every Clinical Division has plans in place to reduce pressures within the RTT pathways including the development and testing of patient triggered reviews, waiting list cleanse exercise, group consultation & telephone clinics. Each project has a range of outcome measures • ELHT are working with an insourcing agency early in 2020 to provide solutions for waiting list reduction in Gastro, Max Fax and Ophthalmology.

Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 17 of 38 NHS East Lancashire Clinical Commissioning Group MEASURE Demand Management –GP Referrals RISKS

OWNER Cathy Gardener DIRECTOR Roger Parr ICP PB ICCB MHW SCB AEDB

% Commentary GP Referrals [Apr‐Oct19] 2018‐19 2019‐20 Variance Variance • There are fewer GP referrals being made for a consultant‐led first OP appointment in 2019‐20 than in the previous year. BwD CCG 18,933 18,861 ‐72 ‐0.4% • 2 Week Rule referrals are showing increases while routine referrals are reducing. EL CCG 47,176 45,670 ‐1,506 ‐3.2%

% Other Refs [Apr‐Oct19] 2018‐19 2019‐20 Variance Variance

BwD CCG 7,944 8,384 +440 5.5%

EL CCG 19,148 19,630 +482 2.5%

Mitigation Conclusion/Risks • A Pennine Lancashire Scheduled Care Board has been • Scheduled Care Board has only recently been formed and there established within the ICP Governance Structure; membership has been no escalation process in place. A Primary Care clinical includes both clinical and managerial membership from all lead has now been identified as part of the membership of this partners. There is shared SRO responsibility at Director level for Board. both ELHT and CCGs and ELHT Chief Executive is the sponsor of the Board. • The Boards remit includes immediate performance management oversight and active management and transformational /pathway redesign for longer term sustainability. • Outpatient Transformation Group is in place reporting to the Scheduled Care Board. • Referral rates by practice and PCN being investigated. • Demand Management plan to be implemented to include the roll out of Advice and Guidance across agreed specialties, use of shared decision making tools and peer review of referral activity.

Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 18 of 38 NHS East Lancashire Clinical Commissioning Group MEASURE Patients waiting over 52 weeks for treatment 129c RISKS

OWNER Cathy Gardener DIRECTOR Roger Parr ICP PB ICCB MHW SCB AEDB Commentary Referral to Treatment (RTT) waits over 52 weeks (Target 0) For October 2019 Oct ‘19 Q1 Jul Aug Sep Oct Nov YTD • Ophthalmology services (at Lancashire Teaching Hospitals): One BwD CCG patient has now received treatment for bilateral ptosis BwD CCG 1000203 repair. • General Surgery (at East Lancashire Hospitals Trust): One BwD j EL CCG 4100005 patient. The breach was due to an incorrect clock stop on 10/01/2019 and once this was re‐opened, it didn’t accountr fo • The number of incomplete Referral to Treatment (RTT) pathways the time lost in the pathway until it was revalidated on of 52 weeks or more at the end of the reporting period. 23/10/2019. The service believed that the patient would be treated within their 52w target date and made the appropriate plans to ensure this was the case; however the pathway that was tracked was incorrect in terms of the weeks on the pathway.

Mitigation Conclusion/Risks • General Surgery (at East Lancashire Hospitals Trust) are currently developing a plan to ensure consistent tracking and validation across the division.

Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 19 of 38 NHS East Lancashire Clinical Commissioning Group MEASURE IAPT: Recovery Rate & Access 123a & 123b RISKS

OWNER Cathy Gardener DIRECTOR Alex Walker ICP PB ICCB MHW SCB AEDB

IAPT [Q2 2019/20] BwD EL TARGET Commentary • National expectation that each CCG will achieve a rate of at least IAPT Recovery (123a) 54.41% 56.04% 50% 5.5% of local prevalence entering services by quarter 4 of 2019/20 and a minimum of 4.75% in all other quarters. IAPT Access (123b) 4.83% 4.76% 4.75% • To maintain recovery rates at/or above 50% standard during 19/20 • Waiting times from referral to treatment in improving access to 6 Weeks First Treatment 97.30% 96.86% 75% psychological therapies (IAPT) services for people with depression and/or anxiety disorders continue to surpass national minimum 18 Weeks First Treatment 100% 100% 100% standards. • 123a: % of people who finished treatment within the reporting • BwD CCG – Commissions LSCFT to deliver IAPT . East Lancs period, initially assessed as “at caseness”, have attended at least 2 Commissions LSCFT = 16.8% and Lancashire Womens = 5.3% treatment contacts and discharged (assessed as moving to recovery) • Across L&SC footprint representatives from EL & BwD CCG’s and • 123b: % of people that enter treatment against the level of need in C&SR CCG (MH Commissioners) are leading a review of IAPT the general population i.e. % of people who have depression and/or Services. Several meetings had taken place with MH anxiety disorders who receive psychological therapies. Commissioners from other CCG’s to start to map out all IAPT Services, including financing. Mitigation Conclusion/Risks • The LCFT ‘Mindsmatter’ Clinical Lead is currently reviewing the • Mental Health & Wellbeing Board has only recently been formed. complexity of referrals accepted by the service and the interface • Recovery Target is on track across East Lancs and BwD CCG between primary and secondary care mental health teams. The • Access (prevalence) is not being achieved consistently in each review is focused on: month. Q4 requires an even greater number of patients to access • Appropriateness of referrals seen by the service; IPAT services as per the national mandate. • Treatment effectiveness , risk and recovery rates for the ‘non • Access Target should be met for both CCG’s. NHSE agreement to IAPT’ cohort. only achieving the 19% Target in 19/20 (22% in 2020/21). In 20/21 • Learning from ‘non‐recovered’ patient review ‐ Reasons for non‐ the system will recover the IAPT target delivery and in 21/22 will recovery: deliver the required IAPT target.. This was approved by the ICS and • Patient complexity ‐ patients are not reaching the full threshold supported by the mental health board within L&SC. for recovery; • Some interventions have higher rates of non‐recovery; action to address. • BwD CV has not been signed off by LSCFT . Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 20 of 38 NHS East Lancashire Clinical Commissioning Group MEASURE ED16 – Online Consultations RISKS

OWNER Collette Walsh DIRECTOR Alex Walker ICP PB ICCB MHW SCB AEDB Commentary ONLINE CONSULTATIONS BwD EL TARGET • BwD CCG has the pre‐GP functionality of iPlato established in Q1 2019‐20 100% 51% 75% each practice and as such has achieved the national target. • EL CCG has 46 out of 49 GP practices registered with iPlato and are at various stages of training/installation. Out of those, 25 GP practices have completed the pre‐GP Set up which provides the E.D.16: Proportion of the population with access to online ability to provide online consultations. consultations • The aim is by 31 March 2020 for 98% of practices in East Lancs CCGs are expected to work with their practices to ensure that by to be offering online consultations. March 2020, 75% of practices are offering online consultations to their patients.

Mitigation Conclusion/Risks • Digital Working Group is overseeing the roll out of iPLATO in East • Progress is being monitored by the Digital Working Group. Lancashire. • Details of how to register with iPLATO have been circulated to East Lancs practices w/c 30th September 2019 • Knowledge sharing events across EL CCG in latter half of September 2019

Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 21 of 38 NHS East Lancashire Clinical Commissioning Group MEASURE Looked after Children (LAC) –Initial Health Assessments RISKS GBAF‐220

OWNER Kirsty Hamer DIRECTOR Claire Richardson ICP PB ICCB MHW SCB AEDB

Initial Health Assessments – Commentary BwD EL TARGET Looked After Children • BwD CCG : Initial health assessments undertaken within the 20 day statutory timescale of a child becoming looked after has Q1 2019‐20 48.5% 51.4% 100% increased from 3% in quarter 4 1819 to 48.5% in Q1 1920. • ELCCG : Initial health assessments undertaken within the 20 day statutory timescale of a child becoming looked after has There is a statutory requirement for initial health assessments to be increased from 3% in quarter 4 1819 to 51.4% in Q1 1920. completed in 20 working days.

Mitigation Conclusion/Risks • Recovery / Action plan developed • Lack of consistent robust performance data. • Escalation process developed between ELHT, LCC and BWD Local Authority regarding timescales. Regular meetings in place to monitor progress. • Initial health assessments built into ELHT quality schedule. • In‐house paediatrician provides lead role and oversight for completion of IHA's, thereby improving quality and timeliness • Joint/Partnership Controls • Reporting framework in place. Safeguarding working with Providers to continue to improve reporting processes • Service redesign of IHA process taking place in Lancashire and expected to have an impact on the timeliness of IHA's. The Deputy Designated Nurse for Safeguarding and LAC provides the health economy representation as a member of the health assessment project group alongside CSU representation. • Community Paediatrics review underway including performance of service against national standards.

Working in partnership: NHS Blackburn with Darwen Clinical Commissioning Group Page 22 of 38 NHS East Lancashire Clinical Commissioning Group Section 1: Contract Performance Summary – Month 07 October 2019

Contract Performance – Lancashire and South Cumbria NHS Foundation Trust (LSCFT)

Psychological Therapies – Blackburn with Darwen and East Lancashire Clinical Commissioning Groups (Pennine Lancs CCGs) need to achieve a monthly access target of 1048 (22.0% p.a. of estimated prevalence by Q4 2019/20). The CCGs year to date (YTD) performance, including the Long‐Term Conditions (LTC) IAPT Service, is below the level required to achieve this target. It is also below the planned year to date level (the year to date plan being an annualised rate of 21.2% of estimated prevalence, with 22% to be achieved in Q4): o LCFT IAPT ‐ Core Service: 5708 Patients into treatment o LCFT IAPT – LTC Service: 2301 Patients into treatment o YTD Total 8009 Patients (20.2% p.a. estimated prevalence) o YTD Target: 8421 Patients (21.2% of estimated prevalence)

The underperformance is being monitored through the Performance and Effectiveness Group (PEG) which meets on a monthly basis.

Referrals – at Month 7, Pennine Lancashire CCG referrals to LCFT Mental Health Services have decreased on 2018‐19 levels ‐92 (‐1.8%). When compared to 2018‐19 plans, referrals are below the expected level ‐214 (‐ 4.1%).

Admissions ‐ including Out of Area admissions, and against plans based on LCFT total capacity split by each CCG's current Mental Health weighted population, Pennine Lancashire CCGs are below plan at month 7, ‐18 (‐ 3.7%).

Bed Days ‐ including Out of Area bed days and based on plans which are calculated by taking LCFT’s total available bed days, at month 7, Pennine Lancashire CCGs patients have accounted for more than the CCGs Mental Health weighted population share of bed days i.e. +4326 bed days(+18.9%).

Out of Area Placements (OAPs)

Tables Showing OAPs as a Percentage of Total Admissions / Bed Days

Out of Area Placements Yr on Yr Change 2018/19 2019/20 (as at Month 7) in OAP % Admissions 15 out of 153 (9.8%) 35 out of 163 (21.5%) 11.7% BwD CCG Bed Days 974 out of 8586 (11.3%) 1860 out of 7912 (23.5%) 5.8% Admissions 33 out of 309 (10.7%) 52 out of 290 (17.9%) 7.3% EL CCG Bed Days 1324 out of 14561 (9.1%) 3785 out of 19331 (19.6%) 3.8% Pennine Admissions 48 out of 462 (10.4%) 87 out of 453 (19.2%) 8.8% CCGs Bed Days 2298 out of 23147 (9.9%) 5645 out of 27243 (20.7%) 12.2% Lancs CCGs Admissions 131 out of 1256 (10.4%) 189 out of 1300 (14.5%) +4.1% Combined Bed Days 7664 out of 67377 (11.4%) 13008 out of 78053 (16.7%) +5.3%

OAPs account for 19.2% of Pennine CCG admissions and 20.7% of all Pennine CCG bed days. This is high compared to all Lancashire CCGs combined, and is also a substantial increase on the same period last year.

Page 23 of 38 At Trust level there have been 427 Out of Area Placements (OAPs) in 2019‐20, against the decreasing trajectory (now 11 per month – see below). This October figure (79) is +68 above the October trajectory, and is +11 higher than the year’s previous high of 68 in June.

There is a plan to reduce OAPs across Lancashire CCGs, with the new trajectory set as follows:

Apr‐19 May‐19 Jun‐19 Jul‐19 Aug‐19 Sep‐19 Oct‐19 and onwards 57 52 46 23 18 12 11

The OAPs position and the impact of admission avoidance schemes are reported monthly via the LCFT Operational Resilience Group. Trajectories set relate specifically to OAPs funding and monitored via the formal Risk Share Agreement

Page 24 of 38 Contract Performance – Lancashire and South Cumbria NHS Foundation Trust Contract Performance – East Lancashire Hospitals NHS Trust (ELHT)

Point of Delivery BwD CCG EL CCG (POD) Activity Variance Cost £ Variance Activity Variance Cost £ Variance A&E (including MIU) +850 (+2.6%) Cost as per plan +1598 (+2.3%) Cost as per plan Elective (Ordinary + ‐219 (‐2.5%) ‐£513K (‐5.9%) ‐88 (‐0.4%) ‐£144K (‐0.7%) Day Cases) Elective Excess Bed ‐277 (‐53%) ‐£72K (‐55%) +492 (+202%) +£132K (+203%) Days Elective Costs Inc. Excess Bed Days ‐£586K (‐6.6%) ‐£12K (‐0.1%) Non‐Elective (NEL) + +666 (+6.1%) Cost as per plan +204 (+1.0%) Cost as per plan Non‐Emergency (NE) NEL + NEL NE Excess +481 (+20%) Cost as per plan ‐268 (‐4.9%) Cost as per plan Bed Days Outpatients First ‐45 (‐0.3%) Cost as per plan ‐1001 (‐2.7%) Cost as per plan Attends Outpatient Follow‐up ‐1630 (‐4.8%) Cost as per plan ‐3777 (‐4.8%) Cost as per plan Attends Outpatient Procedure ‐61 (‐0.2%) Cost as per plan ‐27 (0.0%) Cost as per plan Other (e.g. Tel) Outpatient Procedure +199 (+4.0%) £31K (+4.2%) +963 (+8.5%) £154K (+9.1%) – New Outpatient Procedure ‐764 (‐6.6%) ‐£101K (‐7.0%) +193 (+0.8%) £87K (+2.9%) – Review

Pennine Lancashire CCGs (Combined) Point of Delivery (POD) Activity Variance £ Variance A&E (including MIU) +2448 (+2.4%) Cost as per plan Elective (Ordinary + Day Cases) ‐307 (‐1.0%) ‐£657K (‐2.2%) Elective Excess Bed Days +215 (+29.0%) +£59K (+30.2%) Elective Costs Inc. Excess Bed Days ‐£598K (‐2.0%) Non‐Elective (NEL) + Non‐Emergency (NE) +870 (+2.8%) Cost as per plan NEL + NEL NE Excess Bed Days +213 (+2.7%) Cost as per plan Outpatients First Attends ‐1047 (‐2.0%) Cost as per plan Outpatient Follow‐up Attends ‐5407 (‐4.8%) Cost as per plan Outpatient Procedure Other (e.g. Tel) ‐88 (‐0.1%) Cost as per plan Outpatient Procedure – New +1162 (+7.1%) £185K (+7.6%) Outpatient Procedure – Review ‐571 (‐1.6%) ‐£14K (‐0.3%)

Inpatient Care is below plan on cost ‐£657K (‐2.2%) from below plan activity (‐307 spells, ‐1.0%). Day Case activity is below plan (‐111 spells, ‐0.4%) and below plan on cost [‐£329K, ‐1.7%]; Ordinary Elective activity (EL) is below plan on both activity (‐196 spells, ‐5.0%) [‐£328K, ‐3.0%]. Above plan Excess Bed Days (+215 bed days, +29%) has increased Elective Admission costs by +£59K, resulting in a total Elective under performance of ‐£598K (‐2.0%).

Outpatient Care is below plan for both Outpatient First Attendances (‐1,047, ‐2.0%) and Outpatient Follow‐ ups (‐5,407, ‐4.8%). While this would normally see a cost underperformance of ‐198K (‐2.1%) and ‐£216K (‐ 2.5%) respectively, Outpatient Attendance costs for 2019/20 with ELHT, have been set to be equal to plan, so no cost benefit is realised.

Page 25 of 38 Non‐Elective (NEL) Admissions including Non‐Emergency is above plan for Non‐Elective (Emergency) Admissions (+870, ‐2.8%); is close to plan for Non‐Elective (Non‐Emergency) Admissions (+4, 3.5%); and is above plan for excess bed days (+213, +2.7%). While this would normally see a cost overperformance of +921K (+1.5%), Non‐Elective costs for 2019/20 with ELHT, have been set to be equal to plan, so no unplanned costs are incurred. This also applies to A&E activity, which would have seen unplanned costs of £+249K.

Maternity and Paediatrics have also seen costs set as per plan. These two specialties are both below plan in terms of costs which would otherwise have been incurred: Maternity ‐£287K (‐1.6%); Paediatrics ‐£722K (‐ 8.4%).

Overall, the contractual cost safeguards mentioned, and others have seen little net result, with what would have been a +£19K overspend (+0.01%) becoming +£60K (+0.03%).

Referral to Treatment – the number of Pennine Lancashire CCG patients awaiting treatment at ELHT is 29,346 at M7. This is an increase from the previous month (+446, +1.5%), and is a significant increase on the same period last year (+5599, +24%).

Part of the growth in activity versus the same period last year, is accounted for by Trauma and Orthopaedics pathways now including MSK pathways. It is estimated that this change added an extra 3,000 pathways (in Feb‐19) in respect of Pennine Lancashire CCGs patients. As such, real growth in pathways over the last 12 months is estimated to be +2,599 (+11%).

There are 4,391 waiting >18 weeks = 15.0% i.e. above the target threshold of <=8%.

Referrals – Referrals to the CCG’s main hospital provider (ELHT) have increased this year (+2.3%) compared to the same period last year. Referrals to Non‐ELHT providers have fallen ‐1.0% compared to the same period last year. Overall, referrals are increased +1.8%, (+3.8% at BwD CCG and +0.9% at EL CCG). The overall Increase in referrals is driven by referrals from Non GP professionals (+12.0%), with GP referrals being reduced (‐3.2%).

BwD CCG EL CCG Pennine CCGs GP Referrals ‐232 ‐1.5% ‐1502 ‐3.9% ‐1734 ‐3.2% ELHT Non‐GP Professional Referrals 1316 12.4% 2458 10.8% 3774 11.3% Total 1084 4.1% 956 1.6% 2040 2.3% GP Referrals ‐9 ‐0.2% ‐860 ‐9.2% ‐869 ‐6.5% Non- ELHT Non‐GP Professional Referrals 119 10.8% 583 19.4% 702 17.1% Total 110 2.2% ‐277 ‐2.2% ‐167 ‐1.0% GP Referrals ‐241 ‐1.2% ‐2362 ‐4.9% ‐2603 ‐3.9% TOTAL Non‐GP Professional Referrals 1435 12.2% 3041 11.8% 4476 12.0% Total 1194 3.8% 679 0.9% 1873 1.8%

NB. Referrals via A&E, following Emergency Admission and self‐referrals, are no longer included in data flows. The increase in Non‐GP referrals at ELHT is mostly due to the following Medical Specialties:

 Respiratory Medicine (+1861, +76%)  Gastroenterology (+288, +31%)

While the Non‐GP Gastroenterology increase at ELHT is almost entirely offset by a fall in GP Gastroenterology referrals (‐285, ‐9%), GP referrals to Respiratory Medicine at ELHT have also increased (+83, +7%), meaning Respiratory Medicine referrals have increased at ELHT by +1944 (+54%).

Page 26 of 38 Contract Performance – Lancashire and South Cumbria NHS Foundation Trust ‐ Community

The process for reporting against variances (+/‐10%) as agreed by Chorley and South Ribble CCG (CSR CCG) as lead contractor for LCFT Community Services is for the Trust to provide an exception report in the month following the previous quarter.

BwD CCG has 17 service lines – 4 services are over performing and 4 are underperforming +/‐10% with the remaining 9 service lines operating within tolerance.

EL CCG has 4 service lines – 2 are overperforming. 2 children’s therapy services currently have no agreed plan due to the ongoing performance issues with RTT. The host Commissioner has advised that there are on‐going discussions with the Trust in relation to their trajectories before baselines can be agreed.

BwD Services:

Adult Learning Disabilities (+723, +48.0%) – The CCG recalculated the baselines for LD (lowered) with the introduction of RIO. The baselines were negotiated on the basis that any overperformance would be on the assumption that the baseline had probably been underestimated as it was based on a relatively short period of time that the Trust had been recording on RIO when they were calculated. The CCGs sought assurance that LSCFT would not request extra investment due to this perceived over performance.

Children’s Learning Disability (+121, +12.0%) ‐ The Trust reports increased use of psychology consultation. Groups are offered after first intervention and are well attended.

Community Stroke Service (+380, +21.3%) ‐ The vacancies in the team have reduced and staff have worked additional hours to reduce the patient waiting times which has resulted in activity over baseline. On‐going monthly meetings are taking place to monitor waiting lists, staffing and patient outcomes.

Intensive Home Support (+5461, +30.6%) – The IHSS team are working to full capacity in all services. The Rapid Assessment team have seen an increase in Early Supported Discharges from acute and community hospitals and the Trust continue to prioritise these.

Dermatology Service (‐1427, ‐46.5%) – Very recent discussions have taken place with the CCG and there has been an agreement that moving forwards data from About Health (GPwSI Dermatology service) will not be required to inform the contract and a new baseline will be agreed. The Trust has proposed a new baseline which the CCG are considering.

DESMOND (‐78, ‐41.3%) – During M7 3 DESMOND courses were held, there were 34 places booked yet only 13 people attended and completed the course. 2 courses had to be cancelled due to sickness of the Educator. All patients were contacted and either re‐booked or new dates shared with them to re‐book. The service will continue to seek DESMOND educators to provide backfill support for the programmes.

Oxygen Service (‐259, ‐11.5%) – Oxygen team are 11.5% under target due to a temporary reduction in capacity which has been supporting urgent work in the respiratory service. The service is now back to full staffing which will enable the oxygen service to recover to within its trajectory.

Pulmonary Rehabilitation (‐608, ‐17.3%) – Referrals to Pulmonary Rehab are down by approx. 5% this year but the bigger impact has been sickness across the respiratory service and a vacancy that has now been filled. Two staff have reduced their time in Pulmonary Rehab to give support to higher intensity COPD work which has resulted in the current underperformance. Activity is forecast to return to trajectory levels over the next 2 months due to the new member of staff, with deficit being recovered to within 10% parameters within year.

Page 27 of 38 EL services:

Adult Learning Disabilities (+1729, +68.0%) – The CCG recalculated the baselines for LD (lowered) with the introduction of RIO. The baselines were negotiated on the basis that any overperformance would be on the assumption that the baseline had probably been underestimated as it was based on a relatively short period of time that the Trust had been recording on RIO when they were calculated. The CCGs sought assurance that LSCFT would not request extra investment due to this perceived over performance.

Children’s Learning Disability (+121, +12.0%) ‐ The Trust reports increased use of psychology consultation. Groups are offered after first intervention and are well attended.

The overall contract activity total is over plan by +6725, +4.1%.

Contract Performance – East Lancashire Hospitals NHS Foundation Trust (ELHT) ‐ Community

East Lancashire CCG commissioners are currently working on the ELHT community performance metrics as part of the Data Quality Improvement Plan (DQIP). The expectation is that this will be completed by the end of the year for inclusion in the 2020/21 contract, subject to ongoing review of service specifications.

Page 28 of 38 Contract Performance – Out of Hours (ELMS)

BwD CCG Year to date ‐ Activity Full Year Forecast ‐ Activity 2019/20 2018/19 Variance Status 2019/20 2018/19 Variance Status

To Be Seen 4,569 4,371 198 4.5% A 8,609 8,236 373 4.5% A

Advice 8,666 6,523 2,143 32.9% R 16,609 12,502 4,107 32.9% R

Total 13,235 10,894 2,341 21.5% R 25,218 20,738 4,480 21.6% R

Data Source: Monitoring report provided by East Lancashire Medical Services (ELMS)

Compared to last year’s Month 7 data total activity for the Out of Hours service provided by ELMS is over plan overall YTD by +2,341 (+21.5%). This is now a like‐for‐like comparison, since the service & reporting changes made at April 2018. The overall activity comprises two elements: Advice (+2,143, +32.9%), and To Be Seen (+198, +4.5%).

EL CCG Year to date ‐ Activity Full Year Forecast ‐ Activity 2019/20 2018/19 Variance Status 2019/20 2018/19 Variance Status

To Be Seen 9,585 9,267 318 3.4% A 17,827 17,236 591 3.4% A

Advice 17,040 13,235 3,805 28.7% R 32,006 24,859 7,147 28.7% R

Total 26,625 22,502 4,123 18.3% R 49,833 42,094 7,738 18.4% R

Data Source: Monitoring report provided by East Lancashire Medical Services (ELMS)

Compared to last year’s Month 7 data total activity for the Out of Hours service provided by ELMS is over plan overall YTD by +4,123 (+18.3%). The overall activity comprises two elements: Advice (+3,805, +28.7%), and To Be Seen (+318, +3.4%).

This is now a like‐for‐like comparison for both CCGs, since the service & reporting changes made at April 2018

Page 29 of 38 Contract Performance – Other

BMI Beardwood + BMI Gisburne Park ‐ Total costs are below plan ‐£263K (‐2.9%).

 BMI Beardwood: +£256K (+4.1%)  BMI Gisburne Park: ‐£519K (‐17.8%)

Elective Inpatient Care (EL + DC) position at month 7 shows activity ‐61 spells below plan (‐1.1%), with cost below plan ‐£214K (‐3.2%).

The under trade is mostly due to:

 Trauma and Orthopaedics (inc. Spinal Surgery) ‐£249K (‐6.7%) [‐21 spells, ‐1.6%]  Gastroenterology ‐82 spells (‐30%) [‐£50K, ‐35%]

Specialties above plan are:

 General Surgery +£52K (+11%) [+9 spells, +1.6%]  ENT +£26K (+10%) [+23 spells, +12%]

Across all Points of Delivery (PODs) combined, the following specialties are well below:

 Trauma and Orthopaedics (inc. Spinal Surgery) ‐£314K (‐7.1%)  Gastroenterology ‐£95K (‐37%)

Across all Points of Delivery (PODs) combined, the only specialties above plan to a notable degree are:

 General Surgery +£56K (+8.2%)  ENT +£102K (+19%)

Page 30 of 38 Appendix 1a

East Lancashire Hospitals NHS Trust: Pennine Lancashire CCGs’ Contract: 1st April 2019 – 31st October

Pennine Lancashire Year to Date CCGs’ position at EAST LANCASHIRE Activity Activity Activity % Cost Cost Cost % HOSPITALS NHS TRUST Plan Actual Variance Variance Plan Actual Variance Var

Cost = As A&E (including MIU) 102,590 105,038 2,448 2.4% £14.224M £14.224M 0.0% per plan

Elective 30,444 30,137 ‐307 28.9% £30.020M £29.363M ‐£657K ‐2.2% (Ordinary + Daycases)

Excess Bed Days (Elective) 273 960 ‐97 ‐35.6% £197K £256K £59K 30.2%

Non‐Elective 31,196 32,062 866 2.8% £57.564M £57.564M 0.0%

Excess Bed Days 7,621 7,931 310 4.1% £1.975M £1.975M 0.0% (Non‐Elective) Cost = Non‐Elective Non‐ As 114 118 4 3.5% £610K £610K 0.0% Emergency Per plan Excess Bed Days (Non‐ 273 176 ‐97 ‐35.6% £72K £72K 0.0% Elective Non‐Emergency)

Outpatient First Attends 52,577 51,530 ‐1,047 ‐2.0% £9.655M £9.655M 0.0%

Outpatient Follow‐up 112,512 107,105 ‐5,407 ‐4.8% £8.585M £8.585M 0.0% Attends

Outpatient Other 107,844 107,756 ‐88 ‐0.1% £4.025M £4.025M 0.0%

Outpatient Procedure – 16,410 17,572 1,162 7.1% £2.431M £2.616M £185K 7.6% New

Outpatient Procedure – 35,087 34,516 ‐571 ‐1.6% £4.502M £4.488M ‐£14K ‐0.3% Review

Total £133.859M £133.432M ‐£427K ‐0.3%

Other £49.581M £50.068M £487K 1.0%

Grand Total £183.440M £183.499M £60K 0.0%

Based upon Version 2 of the Contract Monitoring Pivot, updated at 05/12/2019

Page 31 of 38 Appendix 1b

East Lancashire Hospitals NHS Trust: Pennine Lancashire CCGs’ Contract: 1st April 2019 – 31st October

Costs which would have occurred without Control Totals

Pennine Lancashire Year to Date CCGs’ position at EAST LANCASHIRE Activity Activity Activity % Cost Cost Cost % HOSPITALS NHS TRUST Plan Actual Variance Variance Plan Actual Variance Var

A&E (including MIU) 102,590 105,038 2,448 2.4% £14.224M £14.441M £217K 1.5%

Elective 30,444 30,137 ‐307 28.9% £30.020M £29.363M ‐£657K ‐2.2% (Ordinary + Daycases)

Excess Bed Days (Elective) 273 960 ‐97 ‐35.6% £197K £256K £59K 30.2%

Non‐Elective 31,196 32,062 866 2.8% £57.564M £58.482M £918K 1.6%

Excess Bed Days 7,621 7,931 310 4.1% £1.975M £2.055M £80K 4.1% (Non‐Elective)

Non‐Elective Non‐ 114 118 4 3.5% £610K £560K ‐£49K ‐8.1% Emergency

Excess Bed Days (Non‐ 273 176 ‐97 ‐35.6% £72K £44K ‐£28K ‐38.7% Elective Non‐Emergency)

Outpatient First Attends 52,577 51,530 ‐1,047 ‐2.0% £9.655M £9.457M ‐£198K ‐2.1%

Outpatient Follow‐up 112,512 107,105 ‐5,407 ‐4.8% £8.585M £8.369M ‐£216K ‐2.5% Attends

Outpatient Other 107,844 107,756 ‐88 ‐0.1% £4.025M £4.020M ‐£4K ‐0.1%

Outpatient Procedure – 16,410 17,572 1,162 7.1% £2.431M £2.616M £185K 7.6% New

Outpatient Procedure – 35,087 34,516 ‐571 ‐1.6% £4.502M £4.488M ‐£14K ‐0.3% Review

Total £133.859M £134.152M £293K 0.2%

Other £49.581M £49.307M ‐£275K ‐0.6%

Grand Total £183.440M £183.458M £19K 0.0%

Based upon Version 2 of the Contract Monitoring Pivot, updated at 05/12/2019

Page 32 of 38 Appendix 2

All Providers: Pennine Lancashire CCGs’ Contracts: – 1st April 2019 – 31st October

Pennine Lancashire Year to Date CCGs’ position at ALL HOSPITAL Activity Activity Activity % Cost Cost Cost % PROVIDERS Plan Actual Variance Variance Plan Actual Variance Var

A&E (including MIU) 115,839 119,356 3,517 3.0% £15.823M £16.208M £385K 2.4%

Elective 44,157 44,226 69 29.8% £47.374M £45.990M ‐£1.385M ‐2.9% (Ordinary + Daycases)

Excess Bed Days (Elective) 378 1,539 ‐82 ‐21.8% £318K £413K £94K 29.7%

Non‐Elective 34,878 35,982 1,104 3.2% £64.258M £66.150M £1.893M 2.9%

Excess Bed Days 8,874 9,672 798 9.0% £2.298M £2.515M £217K 9.4% (Non‐Elective)

Non‐Elective Non‐ 255 257 2 0.7% £1.065M £1.021M ‐£44K ‐4.2% Emergency

Excess Bed Days (Non‐ 378 296 ‐82 ‐21.8% £105K £77K ‐£28K ‐26.8% Elective Non‐Emergency)

Outpatient First Attends 71,417 69,924 ‐1,493 ‐2.1% £12.962M £12.675M ‐£287K ‐2.2%

Outpatient Follow‐up 162,942 157,719 ‐5,223 ‐3.2% £12.733M £12.477M ‐£256K ‐2.0% Attends

Outpatient ‐ Other 107,939 107,803 ‐136 ‐0.1% £4.133M £4.053M ‐£80K ‐1.9%

Outpatient Procedure – 17,113 19,228 2,115 12.4% £2.535M £2.868M £333K 13.2% New

Outpatient Procedure – 36,898 38,127 1,229 3.3% £4.750M £4.984M £235K 4.9% Review

Outpatient Procedure – 7,302 4,352 ‐2,950 ‐40.4% £950K £638K ‐£311K ‐32.8% Unspecified

Total £169.304M £170.069M £765K 0.5%

Other £57.596M £57.334M ‐£261K ‐0.5%

Grand Total £226.900M £227.404M £504K 0.2%

Based upon Version 2 of the Contract Monitoring Pivot, updated at 05/12/2019

Page 33 of 38 Appendix 3 ELHT Referral Data for 2019/20 – GP Referrals

1 Community Paediatrics and Community Paediatric Neurodevelopmental Service 2 A&E, Cardiothoracic Surgery, Child & Adolescent Psychiatry, Clinical Genetics, Critical Care Medicine, Clinical Haematology, Endocrinology, Medical Oncology, Neonatology, Palliative Medicine, Radiotherapy, Rehabilitation 3 Paediatrics, Paediatric Surgery, Paediatric Cardiology, Paediatric Nephrology and Paediatric Respiratory 4 Pain Management, Anaesthetics

Referrals via A&E, following Emergency Admission and Self Referrals, are no longer included in data flows.

Page 34 of 38 Appendix 3 - Cont ELHT Referral Data for 2019/20 – Other Referrals

Pennine Lancashire CCGs' Referrals to ELHT as at Month 7 Referral Type Trend 2018‐19 2019‐20 Variance Variance % (last 19 months) GPs Referrals to ELHT 53962 52228 -1734 -3.2% Other Referrals to ELHT 33322 37096 3774 11.3% Total 87284 89324 2040 2.3%

Other Referrals are from non‐GP professionals e.g. Consultant, Nurse Specialist, Other Practitioner

Page 35 of 38 Appendix 4

LCFT Community Contract ‐ LCFT: Service Line Activity Against Plan – October 2019

Year to date ‐ Activity (2018/19) Full Year ‐ Activity Year‐on‐Year Comparison (Planned Activity) Service Line Plan Actual Variance Var % Status Plan Forecast 17/18 18/19 Variance Var % Adult Learning Disability Service 3688 6,505 2,817 76.4%  5509 11151 5,411 6,505 1,094 20.2% (combined) Children's Learning Disability 1216 1,460 244 20.1%  1039 2503 1,404 1,460 56 4.0% Service (combined) Children's Speech & Language No Plan 10,845 N/A  6703 18591 10,672 10,845 173 1.6% Therapy (combined) Children's Occupational Therapy No Plan 2,928 N/A  1553 5019 2,943 2,928 ‐15 ‐0.5% (combined)

Community Stroke Service 1785 2,165 380 21.3%  6083 3711 1,922 2,165 243 12.6%

Dermatology Service 3066 1,639 ‐1,427 ‐46.5%  5251 2810 2,839 1,639 ‐1,200 ‐42.3%

DESMOND (Completed Courses) 189 111 ‐78 ‐41.3%  243 190 185 111 ‐74 ‐40.0%

Diabetes Specialist Nursing 3360 3,100 ‐260 ‐7.7%  5752 5314 3,324 3,100 ‐224 ‐6.7% BwD Diabetes Education (1:1 693 708 15 2.2%  53 1214 419 708 289 69.0% session)

District Nursing 51891 53,277 1,386 2.7%  88966 91332 55,134 53,277 ‐1,857 ‐3.4%

Out of Hours (District Nursing) 3815 3,900 85 2.2%  6543 6686 3,243 3,900 657 20.3%

District Nursing (inc. Out of Hours) 55706 57177 1,471 2.6%  95509 98018 58377 57,177 ‐1,200 ‐2.1%

Intermediate Care ACS 7455 8,006 551 7.4%  12787 13725 6,787 8,006 1,219 18.0%

Under Plan Close to Plan Above Plan ^ Status = change in variance to plan (year to date M7 to M6) Reporting Tolerances <‐10% >‐10% to <+10% >+10%   % Variance Widened % Variance Narrowed Revisions to the 2018/19 plan have been made. However, those Service Lines marked ‘No Plan’ are still under negotiation. Data mostly relates to BwD CCG, although EL CCG has activity within the highlighted rows.

Page 36 of 38 Appendix 4 – Continued

Year to date ‐ Activity Full Year ‐ Activity Year‐on‐Year Comparison (Planned Activity) Service Line Plan Actual Variance Var % Status Plan Forecast 17/18 18/19 Variance Var % Intensive Home Support 17836 23297 5,461 30.6%  32234 39938 19484 23,297 3,813 19.6% Community IV Service BwD 700 822 122 17.4%  2862 1409 8 80 822 14 1.7% Complex Case Management 2807 5,644 2,837 101.1%  4809 9675 2,867 5,644 2,777 96.9% Community Respiratory Service 3864 4,594 730 18.9%  6626 7875 4,651 4,594 ‐57 ‐1.2% Rapid Assessment Team 10465 12,237 1,772 16.9%  17937 20978 11,158 12,237 1,079 9.7% Oxygen Service 2261 2,002 ‐259 ‐11.5%  3868 3432 2,392 2,002 ‐390 ‐16.3% Podiatry 11858 10,719 ‐1,139 ‐9.6%  20334 18375 10,920 10,719 ‐201 ‐1.8% Pulmonary Rehabilitation 3507 2,899 ‐608 ‐17.3%  6012 4970 4,868 2,899 ‐1,969 ‐40.4% Treatment Room 50148 49615 ‐533 ‐1.1%  85089 85054 51797 49,615 ‐2,182 ‐4.2% Treatment Room 47628 45,333 ‐2,295 ‐4.8%  81645 77714 48,445 45,333 ‐3,112 ‐6.4% Specialist Ear Care 504 438 ‐66 ‐13.1%  0 751 4 46 438 ‐26 ‐5.6% Non‐Serious Injury 875 1,402 527 60.2%  1496 2403 1,372 1,402 30 2.2% Ulcer & Vascular 1141 2,442 1,301 114.0%  1948 4186 1,516 2,442 926 61.1% Tissue Viability ‐ Healthy Legs 511 555 44 8.6%  1110 951 3 33 555 222 66.7% Tissue Viability Service 525 571 46 8.8%  1132 979 8 82 571 ‐257 ‐31.0% Grand Total ‐ Activity with Plans 163804 170529 6725 4.1%  282005 292335 171290 170529 ‐761 ‐0.4%

Under Plan Close to Plan Above Plan ^ Status = change in variance to plan (year to date M7 to M6 Reporting Tolerances <‐10% >‐10% to <+10% >+10%   % Variance Widened % Variance Narrowed

Page 37 of 38 Appendix 5

Inpatient Waiting List

Source : ELHT East Lancashire Hospitals Current Month Previous Month Performance Report 0‐<6 6‐<13 13‐<20 20 + Grand 0‐<6 6‐<13 13‐<20 20 + Grand Specialty Variance %age +/‐ Weeks Weeks Weeks Weeks Total Weeks Weeks Weeks Weeks Total General Surgery 781 226 99 57 1163 788 221 79 64 1152 11 1.0% Urology 410 172 61 46 689 369 162 81 49 661 28 4.2% Breast Care 57 20 2 6 85 63 11 6 8 88 ‐3 ‐3.4% Vascular 118 72 4 8 202 120 68 12 18 218 ‐16 ‐7.3% Orthopaedics 644 346 227 158 1375 554 474 223 151 1402 ‐27 ‐1.9% ENT 233 123 90 131 577 208 160 100 114 582 ‐5 ‐0.9% Ophthalmology 458 347 284 216 1305 500 355 275 155 1285 20 1.6% Oral Surgery / Maxillo Facial 495 261 233 220 1209 437 338 206 240 1221 ‐12 ‐1.0% Dermatology 0 0 0 0 0 0 0 0 0 0 0 N/A Medical Oncology 16 2 2 6 26 7 4 2 4 17 9 52.9% Clinical Oncology 8 2 0 2 12 4 0 0 2 6 6 100.0% Surgical Division 3220 1571 1002 850 6643 3050 1793 984 805 6632 11 0.2% General Medicine 1012 66 21 17 1116 1001 117 8 14 1140 ‐24 ‐2.1% Rehabilitation 0 0 0 0 0 0 0 0 0 0 0 N/A Cardiology 197 63 32 17 309 155 66 37 9 267 42 15.7% Thoracic Medicine 48 11 15 15 89 40 14 11 13 78 11 14.1% Nephrology 3 2 0 3 8 1 1 1 2 5 3 60.0% Medical Division 1260 142 68 52 1522 1197 198 57 38 1490 32 2.1% Gynaecology 352 171 33 6 562 384 148 20 4 556 6 1.1% Family Care Division 352 171 33 6 562 384 148 20 4 556 6 1.1% Pain Management 61 77 41 64 243 60 67 37 46 210 33 15.7% Rheumatology 68 49 13 7 137 88 58 25 10 181 ‐44 ‐24.3% Haematology 42 15 3 10 70 33 8 4 9 54 16 29.6% Diagnostic & Clinical Support 171 141 57 81 450 181 133 66 65 445 5 1.1%

Grand Total 5003 2025 1160 989 9177 4812 2272 1127 912 9123 54 0.6%

Page 38 of 38

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common

Agenda Report Title: Quality Assurance Report 4.2b No: Meeting Date: 15th January 2020 Summary of Report: This paper outlines for Governing Body members recent national policy documents, publications and conferences along with quality improvement work to improve the health and care of our population. Report Recommendations: Note the content of the report Financial Implications: None Procurement Implications: None Report Category: Tick Support and recommend/forward the report. Approve the recommendations outlined in the report. Debate the content of the report. Receive the report for information.  Author: Quality and Performance Team Officers

Report supported & approved by your Senior Lead? Y Presented By: Mrs Kathryn Lord – Interim Director of Quality and Chief Nurse Other Committees None Consulted: Has a PIA been completed in respect of this report? Privacy Impact Assessment N (PIA) If Yes, please attach If No, provide reason below. Has an EIA been completed in respect of this report? Equality Impact Analysis N (EIA) If Yes, please attach If No, provide reason below. Data Protection Impact Is a Data Protection Impact Assessment Required? N Assessment Risks: Have any risks been identified / assessed? N Conflict of Interest: Is there a conflict of interest associated with this report? N Has any clinical engagement/involvement taken place as part N Clinical Engagement: of the proposal being presented. Patient Engagement: Have patients been involved in the drafting of this report? N Privacy Status: Can the document be shared Y

CCG Corporate Objectives :

To commission the best quality and effective services to deliver optimal healthcare CO1  outcomes for our local population. Ensure the balance of our health investment reflects our population’s needs and keeps CO2  the population well CO3 Deliver the 10 year strategy by engagement with the population we serve and ensure we commission services that meet local needs with a clear focus on population health  management strategies CO4 We will focus on population health outcomes through helping to deliver successful Integrated Care Partnerships and ensure decisions, provision and access to local  services is based on the needs of our population. CO5 As local health leaders, we will focus on increasing life expectancy across Pennine Lancashire to be at, or above the national average in the next 10 years. 

1 Agenda Item No: 4.2

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common

15th January 2019

Quality Assurance Report

1. Introduction

1.1 This paper outlines for Governing Body members recent national policy documents, publications and conferences along with quality improvement work underway across the local health care economy to improve the health and care of our population.

2. Provider Updates

2.1 East Lancashire Hospital Trust

2.1.1 East Lancashire Child and Adolescence Services (ELCAS)

The ELCAS service, based at Burnley General Teaching Hospital, has been accredited by the Royal College of Psychiatry’s Quality Network for Community CAMHS (QNCC). This is only the second service in the UK to receive a national accreditation for quality.

QNCC is a network hosted by the Royal College of Psychiatrists which works with professionals from health, social services, education and the voluntary sector to improve the quality of young people’s mental health services.

ELCAS is also the only young people’s mental health service in England to have achieve both QNCC accreditation and an ‘Outstanding’ rating from the CQC.

2.1.2 Chartered Institute of Public Relations (CIPR) Pride Awards

The CIPR Pride Awards are a regional public relations awards which recognise outstanding work being delivered by organisations. ELHT won a Best Publication Award for their Share 2 Care publication ‘A focus on Human Factors’. The awards ceremony took place on 29th November 2019.

2.1.3 Centralised Outpatients and Admin Services (COAS)

All GP referrals are now received electronically as per the National Directive in 2018. GP’s are able to view where the patient’s referral is within secondary care. The patient is also able to view and book their own first appointment for the majority of specialties.

Several services where the pathway is complex have been set up to allow the referral to be triaged before an appointment is booked so that the ELHT clinician can guide the patient to the correct pathway first time, allowing tests to be done first or directing the patient straight to a procedure.

2.1.4 Fairhurst Unit Burnley General Hospital

The Main Outpatients Department (OPD) at BGH has moved into the new Fairhurst building at Burnley General Hospital. The department consists of 21 consulting rooms, two treatment rooms and a dedicated venepuncture room. The move into the new OPD has enabled the majority of cardiology clinics to be sited next to the cardiology department in Area 7 BGH, improving patient flow for this service.

2 2.2 Lancashire and South Cumbria Foundation Trust (LSCFT)

2.2.1 Medical Education Team As part of their studies, fourth year students at Manchester University’s Medical School each year undertake four week placements at various NHS providers in the North West.

Psychiatry placements are provided by LSCFT to provide students with experience in mental health. Having attended 13 different placements at various NHS providers this year, students from Manchester University voted the Trust second place for ‘Best Teaching Placement in Year 4.’

2.2.2 Excellence in Supply Awards 2019 The Trust, along with the Lancashire and South Cumbria Integrated Care System and the North West Shared Infrastructure Services, won the NHS Procurement Innovation Award at the recently held NHS in the North Excellence in Supply Awards 2019.

The award recognises work that the Trust has undertaken in engaging partners to help deliver a new Health and Social Care Network (HSCN) across the Lancashire Integrated Care System. The HSCN is a data network that allows health and care organisations to access and exchange electronic information, helping clinicians to deliver more timely care and a better patient experience.

2.2.3 NHS Elect Awards Several of the Trust’s teams have been shortlisted for awards in the national NHS Elect Patient Experience and Quality Improvement Awards 2019/2020. The Trust’s Central Lancashire Moving Well Service is a finalist in the Excellent Teamwork category, the Blackburn with Darwen Pulmonary Rehab team in the Patient Experience and Communication category and work undertaken by the Seclusion Continuous Improvement group is a finalist in the Co-Created service award.

2.2.4 Clinical Strategy Colleagues from across the Trust’s clinical services have attended a workshop to support the development of the Clinical Strategy to ensure a bottom up and staff led approach to its design. This has resulted in the development of a set of principles upon which all services should be delivered. The wider LSCFT workforce is now being given the opportunity to comment on these principles and to vote on which they believe to be the most important. Engagement with service users and carers as well as external partners is also planned.

3. Primary Care

3.1 GP Patient Survey

The 2020 GP Patient Survey launched on Monday 6th January 2019. Last year more than 770,000 people gave feedback on around 7,000 GP practices across England. The results provide a key source of information about the performance of practices, CCGs and STPs.

4. GIRFT Ophthalmology National Report

A Getting It Right First Time review of ophthalmology has been undertaken over the last two years with visits to 120 Trusts across England. The report published in December 2019, brings together the findings and recommendations in areas that can make the most difference. There has been focus on the three most common sight threatening conditions, where small changes to practice have the potential to make a big difference to overall capacity and to large numbers of patients. The timescales for recommendations covers a 2 year period of implementation and will now be discussed with Providers to ensure that there are clear plans in place.

5. International Year of the Nurse and Midwife

2020 is Florence Nightingale’s bicentennial year, designated by World Health Organisation as the first ever global Year of the Nurse and Midwife. Nurses and midwives make up the largest numbers of the NHS workforce. They are highly skilled, multi-faceted professionals from a host of backgrounds that represent our diverse communities. 2020 is our time to reflect on these skills, the commitment and expert clinical care they bring, and the impact they make on the lives of so many. The CCG will be taking the opportunity to say thank you to the professions; to showcase their diverse talents and expertise; and to promote nursing and midwifery as careers with a great deal to offer.

6. Acute Kidney Injury (AKI) and Fluid Management National Survey

The newly formed national AKI nurses’ network is conducting a survey to gain an insight into the provision of in-patient AKI services and the management of fluid/hydration and fluid balance across the country. The results of the survey will provide valuable information for the network to identify potential opportunities for improvements in the care of patients at risk or with AKI, which will be used to inform improvements in local services.

7. Conclusion

This paper outlines information in relation to recent national policy documents, publications and conferences and quality improvements being undertaken by commissioned Providers.

8. Recommendations

8.1 Members are asked to:  Note the content of the report

Mrs Kathryn Lord Interim Director of Quality and Chief Nurse

GOVERG BODGOVERNING BODY MEETING Y

BLACKBURN WITH DARWEN CCG GOVERNING BODY AND EAST LANCASHIRE CCG GOVERNING BODY MEETING IN COMMON

Agenda Report Title: GOVERNING BODIES ASSURANCE FRAMEWORK 4.3 No: Meeting Date: 15 JANUARY 2020 Summary of Report: The Governing Bodies will review their Governing Body Assurance Framework on a quarterly basis in order to provide assurance to both organisations that systems and processes for risk management are embedded and operating effectively. Report Recommendations: Review the risks on the GBAF listed in sections 3 and 4 and direct any further action required to ensure effective management of those risks. Identify any further risks which may prevent the achievement of the organisation’s corporate objectives. Financial Implications: Nil Procurement Implications: Nil Report Category: Tick Support and recommend/forward the report. Approve the recommendations outlined in the report. Y Debate the content of the report. Y Receive the report for information. Author: Claire Moir Governance, Assurance and Delivery Manager Report supported & approved by your Senior Lead? Y Debra Atkinson Head of Corporate Business Presented By: Kirsty Hollis Chief Finance Officer Other Committees Consulted: Pennine Lancashire Quality Committee Has a PIA been completed in respect of this report? Privacy Impact Assessment N (PIA) If Yes, please attach If No, provide reason below. Has an EIA been completed in respect of this report? Equality Impact Analysis (EIA) N If Yes, please attach If No, provide reason below.

Data Protection Impact Is a Data Protection Impact Assessment Required? N Assessment Have any risks been identified / assessed? Y Risks: Conflict of Interest: Is there a conflict of interest associated with this report? N Has any clinical engagement/involvement taken place as part of the N Clinical Engagement: proposal being presented? Patient Engagement: Have patients been involved in the drafting of this report? N Privacy Status: Can the document be shared Y

CCG Corporate Objectives :

To commission the best quality and effective services to deliver optimal healthcare outcomes for CO1 Y our local population. Ensure the balance of our health investment reflects our population’s needs and keeps the CO2 Y population well CO3 Deliver the 10 year strategy by engagement with the population we serve and ensure we commission services that meet local needs with a clear focus on population health management Y strategies CO4 We will focus on population health outcomes through helping to deliver successful Integrated Care Partnerships and ensure decisions, provision and access to local services is based on the Y needs of our population. CO5 As local health leaders, we will focus on increasing life expectancy across Pennine Lancashire to be at, or about the national average in the next 10 years. Y

Governing Body Meeting Page 1 of 4

BLACKBURN WITH DARWEN CCG GOVERNING BODY AND EAST LANCASHIRE CCG GOVERNING BODY MEETING IN COMMON WEDNESDAY 15th JANUARY 2020

GOVERNING BODIES ASSURANCE FRAMEWORK

1. Introduction

1.1 The purpose of this report is to present the CCGs’ Governing Body Assurance Framework (GBAF) for review.

2. Background

2.1 The Governing Body Assurance Framework (GBAF) is the principal way by which both NHS Blackburn with Darwen (BwD) and NHS East Lancashire (EL) Clinical Commissioning Group (CCG) holds themselves to account. The GBAF is a key document which links the Corporate Objectives to risks, controls and assurances and is the main tool that the Governing Bodies use to discharge their overall responsibility for internal control.

2.2 In accordance with the CCGs’ shared Risk Management Strategy, the GBAF has been updated to reflect the changes in the risks the CCGs hold with a rating of “15” and above. The GBAF provides details of assurances and controls to those risks to the CCGs.

2.3 The GBAF will be presented to the Governing Bodies on a quarterly basis, but is also presented on a bi-monthly basis to the Pennine Lancashire Quality Committee (PLQC), and monthly to the Pennine Risk Management Group (RMG). A detailed report is provided to both CCGs’ Audit Committees whose remit is to ensure the systems and processes for risk management are robust. The most recent report to the PLQC was on 27th November 2019.

3. Review of current GBAF Risks

3.1 Each risk has been assessed and rated based on the CCGs’ Risk Rating Matrix. A senior manager has been identified and the lead for each risk, with responsibility for monitoring and updating the status of each risk, and where gaps in controls exist, ensuring action plans are in place to mitigate these.

3.2 The GBAF currently holds 9 risks rated =>15; the full GBAF is attached at Appendix A:

 PL 19/20_9 (Risk 259): Failure to achieve the planned trajectory for 4 hour standard of patients admitted, transferred or discharged within Accident and Emergency Services within Pennine Lancashire.

 PL 19/20_10 (Risk 157): Failure of the North West Ambulance Service to adhere to standards outlined in the Ambulance Response Programme (ARP).

 PL 19/20_11 (Risk 239 18/19): Failure of the CCG to achieve Waiting Times for Suspected Cancer | 62-day wait for first treatment following an urgent GP referral | (Operational Standard = 85%).

 PL 19/20_12 (Risk 262): Failing to deliver the 18-week incomplete pathway referral to treatment (RTT) NHS Constitution Standard.

Governing Body Meeting Page 2 of 4

 PL19/20_16 (Risk 2019-03 BwD): Failure to achieve stroke requirements for people who have had a stroke being admitted to an acute stroke ward within 4 hours. This was previously held on the BwD CRR but it was agreed that this should be a jointly held risk for both CCGs and is rated “15” therefore held on the GBAF.

 PL 19/20_15 (Risk EL 133): Failure of the MLCSU to deliver CHC/FNC/ Joint Packages of Care service in line with the national framework (this is an EL CCG GBAF risk only).

3.3 Risk Movement

 PL 19/20_13 (Risk 264): Mental Health system pressures impacting on quality and performance of services (for closure). This risk was held on both CCGs GBAFs at “16”. A complete review of the risk was undertaken and new risk assessment was received by the RMG. The PLQC in November approved the findings of the risk review, and agreed that this risk would be re-opened at a rating of “12” (PL19/20_23) and monitored via the Corporate Risk Register (CRR).

 PL19/20_14 (Risk 2019-06): Gaps in support for children and young people who have a learning disability and mental health condition who require a T4 specialist bed. This risk was re-assessed highlighting the lack of availability of specialist learning disability beds; further to the review the risk rating was increased from “12” to “16”.

4. New Risks

4.1 The following new risk has been added to both CCGs GBAF:

 PL 19/20_22 Resilience and Sustainability of General Practice in Pennine Lancashire. There are significant finance, workload and clinical workforce capacity issues within general practice which have the potential to impact on the delivery of the CCGs operating plans. This risk has been reviewed to incorporate the risk previously held risk on BwD CCG’s GBAF regarding clinical workforce capacity CO6.1.

4.2 A new risk assessment is currently being drafted to incorporate 2 previously held risks on the BwD CCG GBAF:

 System wide capacity issues may emerge that prevent the delivery of the health economy’s plans and priorities.

 The local health economy may not be sustainable unless there is a programme of change.

This will be considered at the RMG in January 2020 and included on the register once approved via the PLQC.

5. Update on Corporate Risk Register

5.1 The Governing Body has delegated authority to the Pennine Lancashire Quality Committee (PLQC) for the management of risks on the CCG’s Corporate Risk Register (CRR). A joint risk management report between Blackburn with Darwen and East Lancashire CCG continues to be presented for review by the PLQC on a bi-monthly basis.

5.2 As previously reported the following risks are held by both CCGs and were reviewed at the RMG and the PLQC at their respective meetings in November 2019 with no movement in risk rating:

Governing Body Meeting Page 3 of 4

 PL 19/20_21 (Risk 2019/04): Non-achievement of statutory financial duties of the CCGs in 2019/20 and future years

 PL 19/20_8 (Risk 2019/05): Non-achievement of QIPP (savings) delivery within Pennine Lancashire CCGs in 2019/20

 PL 19/20_17 (Risk 227): The CCGs may be non-compliant with statutory initial health assessments for Looked After Children

 PL 19/20_7 (Risk 265): UK’s exit from EU (with a deal or no deal) presents unknown risks that may adversely affect the healthcare delivery across Pennine Lancashire

 PL 19/20_18/PL 19/20_20 (Risk 263 and 2018/03): Failure to meet the reforms for children with Special Educational Needs and Disabilities (SEND) as set out in the Children and Families Act (2014)

 PL19/20_19: Fragility of the Regulated Care Sector across Pennine Lancashire and the impact on the wider system.

6. Recommendations

6.1 The Governing Bodies are asked to:

 Note the contents of the report

 Note the risks listed in sections 3-5 and direct any further action required to ensure the effective management of those risks.

 Identify any further risks which may prevent the achievement of the CCGs Corporate Objectives

Kirsty Hollis

Chief Finance Offer

15th January 2020

Governing Body Meeting Page 4 of 4

Governing Body Assurance Framework

Blackburn with Darwen CCG and East Lancashire CCG Governing Body Assurance Framework 15 January 2020

Corporate Gaps in Assurance Current Risk Target Risk Objectives Risk Identifier Risk Title Description of Risk Date Added Sources Actions Required Gaps in Control Measures Score Score CO1 - Quality and PL19/20_9 Failure to achieve the planned Failure to achieve the 4 hour standard has a significant 07/01/16 Lack of notification through 19.06.18 - Agreed A&E Trajectory is consistently monitored Lack of full system review due to no 20 8 Effective Services trajectory for 4 hour standard of impact on the CCG. This is a key constitutional standard situation reports or against performance and will continue to do so. formal "real time" capacity patients admitted, transferred or which is underpinned by evidence which concludes that teleconferences. management system discharged within Accident and protracted waits in overcrowded A&Es (particularly EDs) Incident reports may not always Urgent Care Team to support implementation of the EMS + Surge demand for services can be out Emergency Services within can lead to poorer clinical outcomes for patients. In be accurate / timely. system (Escalation management system) across the Lancashire of the CCG's control e.g. RBH is the Pennine Lancashire addition this standard is often referenced as a baromter of Full system view - the and South Cumbria System (this is on-going/monitored monthly) busiest ED in the North West in terms system performance and resilience. The Pennine development of the ICS plan of ambulance conveyance (c.130 per 1 Lancashire system (ELHT and CCGs) have submitted and other Lancashire wide Urgent Care Team to finalise the 2019/20 System Winter Plan day), mental health bed availability trajectories to regulatory bodies (NHS England) which plans could impact on PL (complete - submitted to NHSE) Insufficient medical staffing to staff aspire to achieve a maximum in month performance of developments current and future models e.g. reliance 89%, hence the system is not planning to deliver 95% in on use of locum staffing. year. These trajectories have been accepted by the regulators and other ICPs across Lancashire have submitted and have accepted trajectories which will not reach 95%. CO1 - Quality and PL19/20_10 Failure of the North West Impact for CCGs local populations due to North West 06/01/14 Slight time lag on reporting due Hold AEDB workshop to support planning to safely reduce The CCGs are not lead commissioners 16 8 Effective Services Ambulance Service to adhere to Ambulance Failure to meet ARP response standards to verification of data, usually 1- avoidable conveyances in Pennine Lancashire for this service, therefore controls are safety standards outlined in the 2 calendar months in arrears managed through a wider Pennine Ambulance Response Lancashire partnership Programme (ARP) Participation in the Ambulance Handover Collaborative focusing 2 on handover at hospital (NW wide initiative) and supporting the delivery of Phase 2 90 day programme - monthly meetings

Steering Group now established to deliver improvements on conveyance avoidance CO1 - Quality and PL19/20_12 Failing to deliver the 18-week There is risk that more patients may have to wait longer 12/02/18 ELHT – Performance below ELHT have been identified as one of 12 field test sites nationally Scheduled Care Board has only 16 8 Effective Services incomplete pathway referral to than 18 weeks from referral to first definitive treatment than 92% threshold at the end of to participate in the field testing of the elective care standards. recently been formed and there has treatment (RTT) (92%) the 92% threshold mandated within the NHS Constitution. June at 89.92% with 10 This will have a significant impact on how RTT performance is been no escalation process in place. A Performance in 2018-19 was below the 92% target at underperforming specialties managed over the coming years. Any new standard will have Primary Care clinical lead has now 90.7%. The 2018/19 revised planning guidance also (General Surgery 89.1%, implications for how Trusts manage and report their incomplete been identified as part of the emphasized the need to deliver a waiting list size, by March Urology 91.3%, ENT 88.5%, waiting lists, and the field testing will prove or disprove whether membership of this Board 2019, that is less than or equal to the waiting list size at Ophthalmology 84.3%, Chronic new standards will have a positive impact. Analytical and March 2018. In February 2019, East Lancashire Hospitals Pain 91.2%, Gastroenterology Behavioural Workshops are taking place throughout July with NHS Trust started to include their MSK interface service 84.7%, Dermatology 81.3%, representation from both ELHT and Commissioners with the live within 18 week reporting following guidance from NHS Thoracic Medicine 85.4%, testing commencing on 1st August. At the end of November a Improvement. This increased the numbers of patients on Cardiothoracic Surgery 90%, decision will be made how the field test will progress in 2020. an incomplete pathway significantly (around 2000 patients Max Fax 77.3%). The for ELCCG and 1150 patients for BwDCCG) and therefore Directorates all have action ELHT have been successful in securing NHSE funding from the both CCGs are well adrift of the March 2018 position. NHS plans in place that they are Elective Transformation Programme to deliver the following four England are aware of this increase and have confirmed that working towards to improve initiatives (expected completion date 31.03.19) our planning trajectory for 2019-20 can be adjusted to performance and reduce the •Additional administration clerk to support RTT validation and the reflect this new baseline (though we now need to deliver a number of patients over 18 Trust in maintaining RTT position between Jan and March ‘19 March 2020 waiting list that is no bigger than the March weeks •Additional ENT Out Patient Clinics to improve RTT performance 2019 list). However, even if NHSE did factor in this LTH – Neurology continues to and provide an additional 35 out patient slots per week for new adjustment when they assess this metric we would still be the biggest issue, referrals have more patients waiting at March 2019 than March performance way below 92% •Additional Orthopaedic Elective Activity to reduce the backlog 2018. Following a detailed specialty by specialty modelling (73.9%) and improve the RTT position – up to an additional 70 cases and review process, additional activity has been BMI – Performance above 92% over a three month period commissioned within the ELHT contract for 2019-29 within UHM – Performance well below •Additional weekend sessions in Ophthalmology to improve the key specialties to try and support 18 week delivery. 92% (84.5%) RTT position – up to an additional 36 cases over a three month period

Following a neurology/neurosciences optimum design workshop on 4th February, a business case was presented to the ICS 3 Executive Team on 11th June to request that neurosciences are prioritised by the ICS and adopted as one of the transformational programmes of work for 2019/20. Feedback awaited

An Out Patient Improvement Group (OPIG) and Scheduled Care Board have been established to drive forward the priorities in line with the NHS Long Term Plan, to reduce face to face outpatient visits by a third. The OPIG are implementing a number of projects within specialties to reduce activity i.e. patient initiated follow ups, virtual clinics, nurse led clinics. The impact of these projects will be monitored through the OPIG on a monthly basis.

The PL Scheduled Care Board (SCB) is now well established and has responsibility for monitoring 18 week RTT performance at the main provider, ELHT, with the monthly Outpatient Improvement (OPIG) sub group reporting in. The OPIG are responsible for monitoring a number of projects (x27) across all Directorates within ELHT to reduce face to face outpatient activity and reduce the current holding lists, by implementing patient triggered reviews, virtual clinics, nurse led follow up or group consultations, with key performance indicators attached. The Trust continue to be a field test site in the new NHSE elective care standard. In addition, the CCGs are working closely with the Trust to work collaboratively to manage the current waiting list position and reduce back down to the March 2019 level, as part of the system assurance. Monthly updates via the OPIG and SCB. The next Scheduled Care Board is 4th December at which a performance update will be discussed.

Exported on January 8, 2020 2:28:54 PM WET Highlighting changes made in the last Hour Page 1 of 3 Corporate Gaps in Assurance Current Risk Target Risk Objectives Risk Identifier Risk Title Description of Risk Date Added Sources Actions Required Gaps in Control Measures Score Score CO1 - Quality and PL19/20_14 Gaps in support for children and A lack of available specialist learning disability beds for 09/19/19 Lack of progress from specialist CAMHS redesign to consider crisis support as part of THRIVE Lack of pro-active CETRs for children 16 8 Effective Services young people who have a children and young people results in the following: commissioning in relation to offer (risk support and admissions avoidance) by April 2021 and young people with a learning learning disability and mental • Children and young people being placed on the paediatric learning disability beds disability to plan for a potential crisis health condition who require a ward until a learning disability specialist bed has been Timely flow of paediatric Transforming Care Partnership considering all age service and reduce the risk T4 specialist bed. There is a identified. admissions data for those provision for learning disabilities. Timescale to be confirmed Lack of capacity in commissioning to lack of learning disability beds • Additional packages of care in the community to keep the children and young people on undertake pro-active CETRs for children and young people young person and others safe whilst a bed is identified. the ward Continue to coordinate CETR’s to avoid admissions to hospital This leads to the following outcomes: where possible. As required. 4 •A delay in children and young people accessing the support they need leading to further deterioration in their Regular monitoring of risk register for children and young people mental health and wellbeing with a learning disability. •Additional workforce capacity on the ward to manage the risk i.e., 1:1 support. •Disruption to other children on the ward •Additional cost to the CCG to fund additional support onto the ward or package of care in the community until a bed is identified. CO1 - Quality and PL19/20_15 Failure of the MLCSU to deliver There are financial and patient safety risks due to the 11/01/13 Internal: CCG's agreement to fund for additional posts on permanent "Internal: 15 6 Effective Services CHC/FNC/Joint packages of delays in assessments for eligibility and reviews and a Gaps in all assurances: basis. CSU are recruiting to vacancies Lack of assurance around record care service in line with the reputational risk to the CCG as a result of this. keeping. national framework Lack of management Brief provided to CCG Director of Finance to be raised at Reliance on CSU for data information available to the meeting with CSU customer liaison manager Limited KPIs in Detailed Service Offer. locality team to prioritise and Capacity within team impacting on 5 programme work Action plan developed following "deep dive" exercise for managing the backlog External: Pennine Lancashire External: MLCSU do not have an action plan to mitigate this risk on behalf of the CCG

" CO3 - 10 Year PL19/20_22 Sustainability and Resilience of There is a risk to the resilience and sustainability of 11/11/19 The GMS Contract is a national 5 Year GP Contract Framework – additional investment into Out of date GMS/PMS Contracts. (New 16 12 Strategy General Practice in Pennine General Practice in Pennine Lancashire due to significant contract. Negotiations led by primary care. contracts have now been issued by Lancashire finance, workload and clinical workforce capacity issues NHS England with BMA. CCG Working with national Time for Care team to support PCN NHSE on behalf of CCG) within general practice which may have the potential to limited control over national development in East Lancashire Workload and workforce pressures in impact on the CCGs Operating Plans investments. Leadership development - Commissioned Confident Leaders Primary Care Programme and Confident Practice Manger Programme in East GP Practice struggling to recruit and Continued financial pressure on Lancashire retain GP workforce resulting in over NHS resources Working with NHSE to ensure appropriate investment of GPFV reliance on expensive locum/session resilience resource GPs Nationally reported shortages in Pennine Lancs Primary Care Quality Assurance and 6 primary care clinical workforce Sustainability Group established Quality Framework/QUEST development ongoing GPFV Transformational Resource into Primary Care PCNs in early stages of GPFV Care Navigation and Clinical Correspondence development Working in close collaboration with HEE to ensure Pennine Lancs maximises potential resource, training and staff development opportunities including introduction of new role into primary care Pennine Lancs Enhanced Training Hub Support and advice provided to practice wishing to merge/collaborate. CO5 - Life PL19/20_11 Failure of the CCG to achieve Waiting Times for Suspected Cancer - 62-day wait for first 06/01/18 This risk will remain constant Continue to work with through the Cancer Alliance to influence Internal: 16 4 Exepectancy waiting times for suspected treatment following an urgent GP referral: due to the number of variables and contribute to 5 priority cancer work streams - Limited ability to influence national cancer - 62 day wait for first Patients starting a first definitive treatment for a new and interdependencies involved shortage in workforce required to treatment following an urgent primary cancer following an urgent GP referral for i.e. Demand which outstrips 29.01.19 Lets Talk Cancer campaign created to raise patient deliver cancer care and treatment, e.g. GP referral (85%) suspected cancer. The operational standard states that capacity, inability to predict that and public awareness re early diagnosis and importance of Consultant Radiologists, Specialist 85% of patients should receive a first definitive anti-cancer demand, patient choice and the attending screening and hospital appointments Nursing, etc. - Recruitment and treatment within 62 days of the urgent referral date. aforementioned national 23.10.19 Drafts produced of campaign materials for Phase 2, retention remains a pressure and we CCGs are required to achieve the national standard workforce shortages/other feedback being sought are awaiting the national work force identified above on an annual basis. Risk of failure to staffing issues. plan from NHSE achieve 2019/20 62 day standard. Across the Pennine Lancs foot print there is a constant 04.04.19 GP education event to launch the campaign and External: pressure due to capacity and demand with fluctuating campaign materials. - changes to pension rules resulting in monthly performance putting the annual reduction in additional sessions being Non clinical cancer champions workshop taking place 15.10.19 worked. to further develop their non clinical role. 1stevent held 30.04.19 - Access and reporting of diagnostics: this year High demand is outstripping capacity to examine and report on patients, which 7 impacts on waiting times; - Challenging theatre capacity within acute trusts; - Challenge in managing clinically complex patients on difficult pathways, often requiring a higher number of diagnostic testing pre-treatment which then breach the 62-Day standard; - Number of patients with co- morbidities requiring non-cancer treatment whilst on a cancer pathway, e.g. cardiac surgery, interventions, etc.; - Patients who choose to delay or decline appointments, and DNAs - Many head and neck patients require tooth extractions, some require detox before they can commence on the pathway proper.

Exported on January 8, 2020 2:28:54 PM WET Highlighting changes made in the last Hour Page 2 of 3 Corporate Gaps in Assurance Current Risk Target Risk Objectives Risk Identifier Risk Title Description of Risk Date Added Sources Actions Required Gaps in Control Measures Score Score CO5 - Life PL19/20_16 Failure to achieve stroke Patients not receiving the appropriate care within the 02/28/18 "Issue identified that the breach Attendance at Stroke Board meetings by at least one Quality team not requesting supportive 15 9 Exepectancy requirements for people who timescales recommended by national guidance proved to forms are not being completed. commissioner to challenge performance against 4 hour target. narrative to address non achievement have had a stroke being give patients the best chance of recovery. This may result Stroke Nurse Consultant (SNC) Lead commissioner then to assess if sufficient progress being of 4 hour target due to SSNAP admitted to an acute stroke in less than optimal treatment and outcomes and recovery to work on improving made. If below par, lead commissioner to escalate with provider achievement of a grade A assessment. ward within 4 hours rates. compliance. Stroke Nurse and invoke contract levers where appropriate. Assurance given however that if the Consultant to attend the position remains below target, quality operational monthly meeting Completion of Out of Hospital business case to allow for team will be seeking further assurance 8 with Emergency Department implementation of increased early intensive community care at around the measures being taken to and North West Ambulance point of discharge to allow for improved acute patient flow. improve Service and to share breach Reasons for delays of transfer from information when relevant. A&E to the stroke ward are varied but " often include patient flow issues (which may be improved by improvements in community services

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Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common

Agenda Report Title: Chief Finance Officer Report 4.4a No: Meeting Date: 15th January 2020 Summary of Report: The report outlines the summary financial position for NHS Blackburn with Darwen CCG at November 2019. Report Recommendations: The CCG Governing Body is asked to note the contents of this financial summary and the financial position of the CCG at the end of November 2019. Financial Implications: None Procurement Implications: None Report Category: Tick Support and recommend/forward the report. Approve the recommendations outlined in the report. Debate the content of the report. Receive the report for information. Y Author: Mrs Linda Ring, Finance Manager

Report supported & approved by your Senior Lead? Y Presented By: Mr Roger Parr, Chief Finance Officer and Deputy Chief Officer Other Committees None Consulted: Has a PIA been completed in respect of this report? Privacy Impact Assessment If No, provide reason below: N (PIA) If Yes, please attach not required Has an EIA been completed in respect of this report? Equality Impact Analysis If No, provide reason below: N (EIA) If Yes, please attach not required Data Protection Impact Is a Data Protection Impact Assessment Required? N Assessment Have any risks been identified / assessed? Y Risks: Ref No: 2019/04 & 2019/05 Conflict of Interest: Is there a conflict of interest associated with this report? N Has any clinical engagement/involvement taken place as part N Clinical Engagement: of the proposal being presented. Patient Engagement: Have patients been involved in the drafting of this report? N Privacy Status: Can the document be shared Y CCG Corporate Objectives : To commission the best quality and effective services to deliver optimal healthcare CO1 outcomes for our local population. Ensure the balance of our health investment reflects our population’s needs and keeps CO2 Y the population well CO3 Deliver the 10 year strategy by engagement with the population we serve and ensure we commission services that meet local needs with a clear focus on population health management strategies CO4 We will focus on population health outcomes through helping to deliver successful Integrated Care Partnerships and ensure decisions, provision and access to local services is based on the needs of our population. CO5 As local health leaders, we will focus on increasing life expectancy across Pennine Lancashire to be at, or above the national average in the next 10 years.

1 Executive Financial Summary Month 8 – Period Ending 30th November 2019

Year to Date (YTD) Full Year Forecast Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000 Funds Available 181,276 181,276 0 274,870 274,870 0

Commissioning 139,904 140,420 (516) 207,715 208,556 (841) Primary Care 36,554 36,577 (23) 55,969 56,018 (49) Corporate 4,373 4,279 94 6,695 6,619 76 Reserves 445 0 445 4,491 3,677 814 Balance 0 0 0 0 0 0

Summary Financial Position – The CCG is reporting a breakeven position in line with the financial plan. The CCG is on plan to deliver its year end forecast breakeven position.

Commissioned Services Risks

 Healthcare Commissioning is reporting a YTD overspend of £516k with  The CCG has a QIPP target of £6.0m and has achieved savings of a year-end forecast overspend of £841k. 61.0% of the target. There is a risk that some schemes will not fully  Primary Care Services are reporting a YTD overspend of £23k with release the planned savings in year and the CCG continues to look for forecast year end overspend of £49k. Prescribing expenditure figures opportunities to mitigate any shortfalls. have been received for April to September with October and November  Acute activity levels continue to be a key factor in 2019/20. Schemes expenditure estimated. A YTD overspend of £76k is reported at this are in place to manage demand time. An overspend of £112k is forecast on prescribing.  Continuing health care and complex packages continues to be a key  Corporate Services are reporting an underspend of £94k and a year risk as these are generally high cost and low volume. The CCG end forecast overspend of £76k. continues to closely monitor this area of expenditure.  Prescribing expenditure is volatile and is monitored closely by the Capital Medicines Management Team. The prescribing waste scheme and the prescribing hub continue into 2019/20.  A combined budget for hardware replacement of the GPIT estates, provision of infrastructure, mobility working and operating software has QIPP been approved by NHS England on behalf of the CCG. Expenditure of  The CCG has actioned 61.0% of its QIPP savings to date and is on plan £244k is expected in 2019/20. to meet the full year savings of £6.0m.

Recommendation: The CCG Governing Body is asked to note the contents of this financial summary and the financial position of the CCG at the end of November 2019.

2 NHS Blackburn with Darwen CCG APPENDIX A

Summary Governing Body Report ‐ November 2019

Annual Forecast Budget to Date Expenditure to Date Variance to Date Annual Budget Annual Forecast Variance £000 £000 £000 £000 £000 £000

Revenue Resource Limit

Confirmed (181,276) (181,276) 0 (274,870) (274,870) 0 Anticipated 000000 Total Revenue Resource Limit (181,276) (181,276) 0 (274,870) (274,870) 0

Expenditure

Commissioning (Page 2) 176,458 176,997 (539) 263,684 264,574 (890) Corporate (Page 4) 2,131 2,065 66 3,190 3,164 26 Reserves (Page 4) 445 0 445 4,491 3,677 814 Healthcare Sub Total 179,034 179,062 (28) 271,365 271,415 (50)

Running Costs (Page 4) 2,242 2,214 28 3,505 3,455 50 Total Expenditure 181,276 181,276 0 274,870 274,870 0

Surplus/(Deficit) 000000

Better Payment Practice Code YTD Value (%) YTD Volume (%) FOT Value (%) FOT Volume (%) Target (%)

NHS 99.9 99.6 99.0 99.0 95.0

Non NHS 99.7 99.7 99.0 99.0 95.0

Page 1 NHS Blackburn with Darwen CCG APPENDIX B

Healthcare Commissioning Report ‐ November 2019

Expenditure to Annual Forecast Budget to Date Variance to Date Annual Budget Annual Forecast Date Variance £000 £000 £000 £000 £000 £000

Acute Services

NHS contracts (includes Ambulance Services) 86,722 86,804 (82) 130,070 130,193 (123) Non NHS Providers 4,168 4,554 (386) 6,219 6,798 (579) NHS Contract Exclusions / Cost per Case 352 361 (9) 488 494 (6) Non Contract Activity 1,385 1,342 43 2,078 2,013 65 Other 1,924 1,985 (61) 2,013 2,076 (63) Sub Total Acute Contracts 94,551 95,046 (495) 140,868 141,574 (706)

Mental Health Services

NHS contracts 13,584 13,581 3 19,639 19,660 (21) Non NHS Providers 561 539 22 801 801 0 IPA ‐ Complex Packages 1,771 1,752 19 2,657 2,625 32 Non Contract Activity 418 418 0 450 450 0 Other 638 627 11 788 782 6 Sub Total Mental Health Services 16,972 16,917 55 24,335 24,318 17

Community Health Services

NHS contracts 9,885 9,885 0 14,827 14,827 0 Non NHS Providers 1,132 1,208 (76) 1,734 1,876 (142) IPA ‐ Complex Packages 161 161 0 241 242 (1) NHS Contract Exclusions / Cost per Case 239 237 2 365 365 0 Non Contract Activity 000000

Hospices 738 738 0 1,096 1,096 0 Other 000000 Sub Total Community Services 12,155 12,229 (74) 18,263 18,406 (143)

Total Healthcare Contracts 123,678 124,192 (514) 183,466 184,298 (832)

Continuing Care Services

Continuing Care 5,757 5,815 (58) 8,636 8,722 (86) Free Nursing Care 821 717 104 1,231 1,075 156 Sub Total Continuing Care Services 6,578 6,532 46 9,867 9,797 70

Primary Care Services

Prescribing 16,688 16,764 (76) 25,123 25,235 (112) Enhanced Services 1,607 1,578 29 2,411 2,361 50 Primary Care Co‐Commissioning 14,879 14,871 8 23,299 23,299 0

Out of Hours 910 909 1 1,365 1,365 0 Commissioning 1,712 1,704 8 2,592 2,579 13 Other 758 751 7 1,179 1,179 0 Sub‐total Primary Care services 36,554 36,577 (23) 55,969 56,018 (49)

Other Programme Services

Other Non Acute 6,146 6,198 (52) 9,129 9,214 (85) Complex Cases & Individual Funding Requests 3,502 3,498 4 5,253 5,247 6 Sub Total Other Programme Services 9,648 9,696 (48) 14,382 14,461 (79)

Surplus/(Deficit) 176,458 176,997 (539) 263,684 264,574 (890)

Page 2 NHS Blackburn with Darwen CCG APPENDIX C

Main Healthcare Contracts ‐ November 2019

Expenditure to Annual Forecast Budget to Date Variance to Date Annual Budget Annual Forecast Date Variance £000 £000 £000 £000 £000 £000

Acute Contracts Main Provider

East Lancashire Hospitals NHS Trust 74,432 74,433 (1) 111,649 111,650 (1)

Other Lancashire Providers

Lancashire Teaching Hospitals NHS FT 3,796 3,805 (9) 5,694 5,708 (14) Blackpool Fylde & Wyre Hospitals NHS FT 302 417 (115) 448 618 (170) University Hospitals Morecambe Bay NHS FT 92 84 8 138 127 11 North West Ambulance Service NHS Trust (Block) 5,191 5,218 (27) 7,787 7,827 (40) Sub Total Other Lancashire Providers 9,381 9,524 (143) 14,067 14,280 (213)

Greater Manchester Providers

University Hospital South Manchester NHS FT 000000

Salford Royal NHS FT 274 277 (3) 402 406 (4) Royal Bolton Hospitals NHS FT 185 197 (12) 278 296 (18) Wrightington, Wigan & Leigh NHS FT 700 611 89 1,052 917 135 Central Manchester University Hospital NHS FT 1,385 1,289 96 2,078 1,933 145 Pennine Acute NHS Trust 148 130 18 224 197 27 The Christie NHS FT 141 209 (68) 211 313 (102) Sub Total Greater Manchester Providers 2,833 2,713 120 4,245 4,062 183

Merseyside Providers

Royal Liverpool & Broadgreen NHS Trust (April ‐ Sep) 55 74 (19) 55 74 (19) Liverpool University Hospital NHS FT (Oct ‐ March) 18 59 (41) 55 126 (71) Sub Total Merseyside Providers 73 133 (60) 110 200 (90)

Independent Sector Contracts

BMI Healthcare (Beardwood, Beaumont, Gisburne) 3,848 4,065 (217) 5,732 6,058 (326) Ramsay 320 489 (169) 487 740 (253) Sub Total 4,168 4,554 (386) 6,219 6,798 (579)

Total Acute Contracts 90,887 91,357 (470) 136,290 136,990 (700)

Mental Health Contracts

Lancashire Care NHS FT (Block) 13,551 13,548 3 19,589 19,610 (21) Calderstones Partnership NHS FT (Block) 000000 Greater Manchester West NHS FT 22 22 0 33 33 0 Total Mental Health Contracts 13,573 13,570 3 19,622 19,643 (21)

Community Health Contracts

Lancashire Care NHS FT (Block) 9,885 9,885 0 14,827 14,827 0 Total Community Health Contracts 9,885 9,885 0 14,827 14,827 0

Surplus/(Deficit) 114,345 114,812 (467) 170,739 171,460 (721)

Page 4 NHS Blackburn with Darwen CCG APPENDIX D

Non Healthcare Commissioning Report ‐ November 2019

Annual Forecast Budget to Date Expenditure to Date Variance to Date Annual Budget Annual Forecast Variance £000 £000 £000 £000 £000 £000

Other Corporate Costs (Non‐Running Costs)

CSU re‐charge 000000 NHS Property Services re‐charge 1,769 1,769 0 2,653 2,682 (29) Other 362 296 66 537 482 55 Sub Total Corporate Costs 2,131 2,065 66 3,190 3,164 26

Plan requirements & reserves

Reserves 445 0 445 4,491 3,677 814 Sub Total Reserves 445 0 445 4,491 3,677 814

Running Costs

CCG Pay 1,149 1,119 30 1,744 1,722 22 CSU re‐charge 759 765 (6) 1,139 1,139 0 NHS Property Services re‐charge 89 89 0 133 133 0 Other 245 241 4 489 461 28 Running Costs Reserve 000000 Sub Total Running Costs 2,242 2,214 28 3,505 3,455 50

Surplus/(Deficit) 4,818 4,279 539 11,186 10,296 890

Page 5 NHS Blackburn with Darwen CCG APPENDIX E

Statement of Financial Position ‐ November 2019

November Statement of Financial Position £000

Non Current Assets Intangible Assets 9

Total Non Current Assets 9

Current Assets Trade and Other Receivables 2,146 Financial Assets 0 Inventory 803 Cash and Bank 219

Total Current Assets 3,168

Total Assets 3,177

Current Liabilities Trade and Other Payables (6,462) Other Liabilities 0 Provisions (113) Borrowings 0

Total Current Liabilities (6,575)

Total Assets less Current Liabilities (3,398)

Non Current Liabilities Trade and Other Payables 0 Provisions 0 Borrowings 0 Other Liabilities 0

Total Non Current Liabilities 0

Total Assets Employed (3,398)

Financed By General Fund (3,398) Revaluation Reserve 0 Donated Asset Reserve 0 Government Grant Reserve 0 Other Reserves 0

Total Equity (3,398)

Page 6 Item 4.4 b

FOR THE EIGHT MONTH PERIOD TO 30th of NOVEMBER 2019 Statutory Duties KEY M8 Better/ 1% Better than Plan Worse

On Plan Revenue Resource Limit 1% Worse than Plan Cash Limit

Not Applicable NHS Better Payment Non Neutral awaiting Practice Code NHS information Financial Performance M8 Better /Worse

In year Breakeven

0.5 % NR Contingency

QIPP Performance – delivery of target - YTD QIPP Performance – delivery against identified schemes

Main Provider Performance Monthly Summary Infographic – November 2019  Revenue Resource Limit (RRL) ◦ Expenditure MUST stay within the limits set for the financial year

Limit £’000 On Target Notes The figures reported are the total of both the Commissioning 654,680  notified and confirmed allocations and also Budgets includes the Primary Care Co Commissioning allocation transferred from NHS England. Running Costs 7,772 

 Cash Limit (CL) ◦ Cash spending must stay within the maximum cash drawdown allocated to the CCG for the year

Limit £’000 On Target Notes

The CCG is currently on target as regards spending being within the maximum CCG Total 648,368  allocated cash drawdown. This figure changes subject to any allocation adjustments.  Better Payment Practice Code (BPPC)

◦ The target is to pay ALL invoices within 30 days of receipt of a valid invoice

Cumulative On Target Performance for Year Target to Date End Notes Value 95% 99.8%  NHS Volume 95% 98.5%  With regard to the Better Payment Practice Code, the CCG is currently Value 95% 99.3%  exceeding target levels for both Non- NHS and non-NHS invoices. NHS Volume 95% 99.4%   1% Surplus ◦ The CCG has to plan to deliver a 1% surplus

Month 8 Month 8 Annual Planned Actual reported Surplus Surplus Surplus £’000 £’000 £’000 Confidence Dial Notes The CCG has planned for a surplus of £14,215 million . The CCG is currently on target to achieve the required level of surplus by year end. 14,215 9,477 9,477

Target Surplus 2019-20 15,000 Cumulative Plan £'000 Actual Achieved £'000

10,000

5,000

0 April May June July August Sept Oct Nov Dec Jan Feb March Statutory Duty Summary Financial Position Allocation Annual Plan Actual Performance Annual Plan M8 Plan M8 Actual

800 350 300 600 250 £m 400 200 £m 150 200 100 50 0 0 April May June July Aug Sept Oct Nov Dec Jan Feb March Acute Comm CHC MH Other Prog Primary Corporate Prescribing Care

The CCGs statutory duty is for expenditure not to exceed the Revenue In 2019-20 the CCG has planned for a surplus of £14.215m, currently the CCG Resource Limit for 2019-20 which is £662.5m, of which £7.8m relates to remains on target to deliver this surplus. running costs. As at month 8 the CCG is on target to meet this duty.

QIPP Cash Drawdown Annual Plan Cumulative Plan Cumulative Actual Cash Spending Limit 14.0 700

12.0 600 10.0 500 8.0 400 £'m 6.0 300 200 4.0 100 2.0 0 0.0 April May June July Aug Sept Oct Nov Dec Jan Feb March Identified Unidentified Total

For 2019-20 the QIPP target is £12.7m, of which £8.9m has been identified The CCG is permitted a cash drawdown limit £648.368m. in total of which £5.1m is non-recurrent. The balance of QIPP is being delivered via other mitigations i.e. holding back of investments. Significant Currently the CCG is on target to not exceed this limit. new QIPP schemes will need to be identified in order to recurrently achieve the required target. Annual Budget Year to Date (YTD) Position Annual Budget Actuals Variance Forecast Variance Trend £'000 £'000 £'000 £'000 £'000 Acute Commissioning East Lancashire 247,593 165,099 165,485 (386) (386)  Airedale 14,126 9,417 10,242 (824) (1,200)  Pennine Acute 6,950 4,633 4,609 24 39  Other Acute Providers 32,112 18,356 18,556 (200) (442)  Independent Sector 12,828 8,563 8,568 (5) (38)  North West Ambulance Services 15,317 10,212 10,213 (1) (2)  NCAS/OATS 2,316 1,544 2,094 (550) (716)  Urgent Care 216 144 143 1 0  Sub Total Acute Commissioning 331,458 217,969 219,909 (1,941) (2,745) 

Community Health 7,889 5,226 5,590 (364) (669)  ELHT Community Contract 35,758 23,839 23,839 0 0  Better Care Fund ‐ Community 13,038 8,692 8,692 0 0  Better Care Fund ‐ Mental Health 142 95 95 0 0  Better Care Fund ‐ Acute 0000 0 Better Care Fund ‐ LCC Contribution 8,764 5,843 5,843 0 0 

Sub Total Community Services 65,592 43,695 44,058 (364) (669)  Mental Health 66,133 43,897 44,417 (520) (894)  Continuing Care 26,216 17,451 17,453 (2) 123  Other Commissioning 6,831 4,554 4,778 (224) (359)  Sub Total Other Commissioning 99,181 65,901 66,648 (746) (1,129)  Primary Care Local Enhanced Services 5,410 3,591 3,591 0 0  Co‐Commissioning 52,922 33,955 33,961 (6) (333)  Out of Hours 3,327 2,218 2,216 2 9  Oxygen 472 315 310 5 0  Central Drugs 1,800 1,200 1,177 23 25  Palliative Care 322 215 214 1 (4)  Prescribing 56,527 37,685 40,086 (2,401) (4,000)  Primary Care IT 1,438 959 959 0 0  Commissioning Schemes 966 639 577 62 91  GP Forward View 2,309 1,163 1,163 0 0  Sub‐total Primary Care Services 125,494 81,940 84,253 (2,314) (4,212) 

Corporate Costs (Non‐Running costs) 5,130 3,420 3,359 61 71  Corporate (Running Costs) 7,772 4,878 4,572 306 357 

Commissioning Reserves 13,610 4,999 0 4,999 8,328 

Reporting Surplus 14,215 9,477 0 9,477 14,215 

GRAND TOTAL 662,452 432,277 422,801 9,477 14,215 

Favourable variances are depicted in black. Adverse variances are depicted in red and in brackets. Best Likely Worst Case Case Case Area Comment £’000 £’000 £’000

Acute SLA’s As at month 8 the CCG continue to report an overspend within the Acute sector . The CCG continues to have significant over-trade at Airedale, the small project team continues to meet and review the position at Airedale with the aim of reducing demand and the £2,745k £3,000k subsequent over-performance. As at month 8 ELHT are reporting over trade on the non- £0k aligned elements of the contract, the CCG is working with the Trust to validate those Adv Adv forecast outturn assumptions.

Prescribing PPA prescribing data is received two months after the months concerned. Hence only prescribing data for April to September 2019 has been received at the date of this report. £3,600k £4,000k £4,000k The level of charged costs in April to September coupled with the notification of a £1m Adv Adv Adv central charge re category M drugs has led to the forecasting of an adverse financial position re prescribing.

Primary Care For Primary Care currently a breakeven position is forecast for year-end. £0k £0k £0k

Based upon the latest information from NHS England, the Co-commissioning budget is £330k £330k Co-Commissioning forecast to breakeven. However significantly increased costs from NHSPS and CHP are £0k Adv Adv the main reason for the overspend. Discussions are ongoing with NHSPS and CHP.

Continuing Care is shown with an overspend at month 8. Due to difficulties with the transition of packages from 18/19 to 19/20 on the ‘ADAM’ system a review is being Continuing Health undertaken with a year end underspend currently forecast. However in September, the (£150k) £0k £500k Care CCG saw a significant increase in the number of new packages and increased cost per packages approved, which has impacted on a deterioration on the forecast outturn.

As at month 8, the CCG is reporting an overspend on Mental Health budgets. The position continues to be reviewed. However any improvement in the position does not contribute to £894k £894k Mental Health the overall CCG position because we have to maintain delivery of the Mental Health £0k Adv Adv investment standard any reduced spend compared to plan has to be re-invested to maintain the level of investment. ELHT Activity Trend Analysis 7000 1400 Planned Care Activity Trend Analysis Trend Analyis - Excess Bed Days ELXBD 6000 DC 1200 NELNEXBD EL 5000 1000 NELXBD OPPROC 4000 800

Linear Linear (ELXBD) 3000 (DC) 600

Linear (EL) Linear (NELNEXBD) 2000 400

Linear Linear (NELXBD) 1000 (OPPROC) 200

0 0 Jul-19 Jul-18 Jan-19 Jan-18 Jun-19 Jun-18 Oct-19 Oct-18 Feb-19 Apr-19 Sep-19 Feb-18 Apr-18 Sep-18 Dec-18 Dec-17 Jul-19 Mar-19 Jul-18 Mar-18 Nov-18 Nov-17 May-19 Aug-19 May-18 Aug-18 Jan-19 Jan-18 Jun-19 Jun-18 Oct-19 Oct-18 Feb-19 Sep-19 Feb-18 Sep-18 Apr-19 Apr-18 Dec-18 Mar-19 Dec-17 Mar-18 Nov-18 Nov-17 Aug-19 Aug-18 May-19 May-18

Activity for planned care has shown an increase in September and October especially in day cases Excess bed-days have shown an increase in October after a reduction in September. and outpatient procedures. The position is being reviewed. The position is being monitored.

Trend Analysis - Unplanned Care NEL A & E Activity Trend AandE 3000 10000 NELNE 9000 2500 AANDE_MIU NELSD 8000 2000 NELST 7000 Ambulatory Care 6000 Emergency Unit 1500 Linear (NEL) 5000 1000 Linear (AandE) Linear (NELNE) 4000 3000 500 Linear (NELSD) 2000 Linear 0 Linear (NELST) (AANDE_MIU) 1000

-500 Jul-18 Jul-19 0 Jan-18 Jan-19 Jun-18 Jun-19 Oct-18 Oct-19 Feb-18 Apr-18 Sep-18 Feb-19 Apr-19 Sep-19 Dec-17 Dec-18 Mar-18 Mar-19 Nov-17 Nov-18 May-18 Aug-18 May-19 Aug-19 Jul-18 Jul-19 Jan-18 Jan-19 Jun-18 Jun-19 Oct-18 Oct-19 Feb-18 Apr-18 Sep-18 Feb-19 Apr-19 Sep-19 Dec-17 Dec-18 Mar-18 Mar-19 Nov-17 Nov-18 May-18 Aug-18 May-19 Aug-19

Non Elective activity has fallen back in October compared to September with Activity within A & E and the MIU overall has increased in October. the activity levels still below that of the same period last year. The position Ambulatory Care Emergency Unit Activity has been incorporated into this is being monitored. report to give a more complete picture. Airedale Activity Trend Analysis

400 DC Planned Care Activity Trend Analysis 300 Trend Analyis - Excess Bed Days 350 250 300 EL ELXBD NELNEXBD

250 200 NELXBD Linear (ELXBD) OPPROC 200 Linear (NELXBD) 150 150 Linear 100 100 (DC)

50 Linear 50 (EL) 0 0 Jul-19 Jul-18 Jan-19 Jan-18 Jun-19 Jun-18 Oct-19 Oct-18 Feb-19 Sep-19 Feb-18 Sep-18 Apr-19 Apr-18 Dec-18 Mar-19 Dec-17 Mar-18 Nov-18 Nov-17 May-19 Aug-19 May-18 Aug-18 Jul-19 Jul-18 Jan-19 Jan-18 Jun-19 Jun-18 Oct-19 Oct-18 Feb-19 Sep-19 Feb-18 Sep-18 Apr-19 Apr-18 Dec-18 Mar-19 Dec-17 Mar-18 Nov-18 Nov-17 Aug-19 Aug-18 May-19 May-18

Despite a drop in May Outpatient Procedures have nearly tripled since the same period last Overall despite peaks and troughs over previous months, there is an upward trend in excess year. Airedale has given the reason for the spike in activity as being due to a change in the bed days. This position is being reviewed. way they are counting/coding OPPROC, which had been communicated to the host CCG and remains a code of conduct query.

NEL Trend Analysis - Unplanned Care A & E Activity Trend

250 NELNE 1400

NELST 1200 200

Linear (NEL) 1000 150 800 Linear (NELNE)

600 100 Linear (NELST) 400 50 AandE Linear (AandE) 200

0 0 Jul-19 Jul-18 Jan-19 Jan-18 Jun-19 Jun-18 Oct-19 Oct-18 Sep-19 Sep-18 Feb-19 Apr-19 Feb-18 Apr-18 Jul-18 Jul-19 Dec-18 Dec-17 Mar-19 Mar-18 Nov-18 Nov-17 Aug-19 Aug-18 May-19 May-18 Jan-18 Jan-19 Jun-18 Jun-19 Oct-18 Oct-19 Feb-18 Apr-18 Sep-18 Feb-19 Apr-19 Sep-19 Dec-17 Dec-18 Mar-18 Mar-19 Nov-17 Nov-18 May-18 Aug-18 May-19 Aug-19

Unplanned Care activity has shown an across the board increase in October. Activity will The trend for A & E attendances remains on an upward trajectory despite the drop in be monitored going forward. September.  QIPP 2019/20 – based upon the latest financial plan, the CCG will be required to deliver QIPP savings in 2019/20 circa £12.72m. £11.4m of schemes have been identified however £5.1m non recurrently and £3.8m recurrently of the £11.4m. The CCG has mitigations in place for 2019-20. Any shortfall in 2019-20 will be first call on growth monies in 2020-21.

 ELHT – The CCGs have invested significantly into the ELHT contract in 2019-20 to enable the provider to agree their control total, as part of that agreement and also to support managing the ICP system risk an aligned contract has been developed and agreed The aligned contract has been based upon system costs as opposed to income and should support progress towards system balance. Unfortunately there still remains a system shortfall of £2.5m which has been distributed across the 3 ICP partners equitably and still requires closing.

 LD Transformation – in line with the national directive, Learning Disability (LD) services are undergoing a transformation. Our main local provider Mersey Care NHS FT (formerly Calderstones NHS Trust) LD clients will be re-settled within the community and there is a potential risk that the associated costs of re-settlement will be higher than the current service provision. As at October 2019 the majority of East Lancashire CCG clients have been re-settled, however whilst the site remains open the CCG are still required to support the transitional costs. In addition as part of the LD transformation agenda CCGs were set a planned level of discharges for 2018-19, unfortunately this was not achieved and as a result it is likely that funding in 2019-20 will be reduced giving a potential financial pressure.

 Following an announcement by NHS England that CCGs have a responsibility to accept and review cases for periods of care since 1st April 2012 (Retrospective Review Post Cases), initial numbers indicate the CCG currently have 44 cases of which, 8 have been deemed not eligible; 36 are still pending review/outcome, future cases are estimated at approximately 4 per annum. Latest information from MLCSU is that potentially the CCG may have to fund circa £1.8m for these packages, the calculation has been based on an average weekly nursing care rate of £535, should all cases meet the eligibility criteria. The CCG has prudently planned for the majority this risk in 2018-19, early indications are that approximately 25% claims may be successful. The MLCSU are currently reviewing those o/s packages and will provide regular updates on the potential success of those claims. Potential Risks Continued

 Mental Health Out of Area placements, as part of the planning round CCGs, were requested to set funding aside for OAPs. The latest intelligence indicates that, despite additional investment which was supposed to reduce the number of OAPs, the latest forecast outturn will significantly exceed the funding set aside. The forecast continues to be reviewed for robustness.

 CHC/MH IPA projections from the CSU re future commitments vary significantly month on month making forecast outturn difficult to project. In addition the transition of packages from 2018/19 to 2019/20 was problematic leading to significant cleansing of the ‘Adam’ data by the MLCSU IPA Team. The forecast will continue to be scrutinised and challenged where appropriate.

 Prescribing – due to the challenging QIPP target levied on the prescribing budget plus notification of a significant central charge to prescribing budgets re Category M drugs, the prescribing budget will overspend. The outturn level of overspending suggests an overspend circa £4.0m however this may increase depending on the extent of the anticipated charge re Category M drugs from October.

 Mental Health Investment Standard – Guidance MH Prescribing In both 2017-18 & 2018-19 the mechanism the CCG used to count Mental Health prescribing spend, was to apportion prescribing costs based upon the programme budgeting % allocated to Mental Health. As part of the Mental Health Audit for the financial year 2018-19 guidance was introduced that stated spend should be identified using specific mental health drugs. This has resulted in an impact circa £1m for the CCG of reduced spend in 2019-20 compared to plan. Should NHS England not re-state the plan for 2018-19, based upon this reduction there is a risk that the CCG may fail its Mental Health Investment Standard unless we are able to identify additional spend to compensate.  Stroke – East Lancashire Hospitals Trust are working towards an improvement in the Stroke pathway. The CCG have agreed to work with the Trust to ensure any changes are in line with CCG strategy and agreed Lancashire wide stroke pathways.

 Pennine Lancashire Transformation Programme Team are working on delivering the ‘Case for Change’ model, focussing on six key areas of enquiry to ensure affordability; health outcomes and inequality gap; current care delivery system; technology and innovation; workforce and citizen participation and empowerment. The CCGs Corporate Business Plan will ultimately feed into the Integrated Partnership Work programme to support delivery of the NHS Long Term Plan and deliver local efficiencies.

 Although the CCG met the required target for Personal Health Budgets in 2018-19 there is an increased trajectory for 2020/21 that the CCG will need to deliver. In addition CCGs from 2nd December, 2019 are also required to offer PHBs to individuals eligible under Section 117 of the MHA.

 The ICS may require further funding to support transformational schemes including CAMHS, Learning Disability; Mental Health and Stroke which may have an impact upon the CCGs financial position.

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common

Blackburn with Darwen CCG Agenda Report Title: 4.5 Governing Body Terms of Reference No: Meeting Date: 15 January 2020 Summary of Report: In September 2019 the Governing Body approved a revision of its Terms of Reference (ToRs) to reflect the new arrangements following the appointment of a Joint Chief Officer, the move to a single Executive Team across the Pennie Lancashire CCGs on 1st June 2019 and a revision to the voting membership of the Governing Body to maintain a clinical majority.

In particular, the voting membership was amended to reflect the Executive Nurse, Director of Population Strategy and the third lay member as non-voting.

The move to a single Executive Team across the PL CCGs in June 20129 included the establishment of a joint position of Director of Quality & Chief Nurse. This role also undertakes one of the six statutory GB member roles, as its Registered Nurse.

Report Recommendations: Members are asked to receive and approve the Governing Body Terms of Reference. Financial Implications: Procurement Implications: Report Category: Tick Support and recommend/forward the report. x Approve the recommendations outlined in the report. Debate the content of the report. Receive the report for information. Author: Mrs Debra Atkinson

Report supported & approved by your Senior Lead? Y Presented By: Mrs Debra Atkinson Other Committees Consulted: Has a PIA been completed in respect of this report? Privacy Impact Assessment N (PIA) If Yes, please attach If No, provide reason below. Has an EIA been completed in respect of this report? Equality Impact Analysis N (EIA) If Yes, please attach If No, provide reason below. Data Protection Impact Is a Data Protection Impact Assessment Required? N Assessment Have any risks been identified / assessed? N Risks: Conflict of Interest: Is there a conflict of interest associated with this report? N Has any clinical engagement/involvement taken place as part N Clinical Engagement: of the proposal being presented. Patient Engagement: Have patients been involved in the drafting of this report? N Privacy Status: Can the document be shared Y

CCG Corporate Objectives : 1

To commission the best quality and effective services to deliver optimal healthcare CO1 outcomes for our local population. Ensure the balance of our health investment reflects our population’s needs and keeps CO2 the population well. CO3 Deliver the 10 year strategy by engagement with the population we serve and ensure we commission services that meet local needs with a clear focus on population health management strategies. CO4 We will focus on population health outcomes through helping to deliver successful Integrated Care Partnerships and ensure decisions, provision and access to local services is based on the needs of our population. CO5 As local health leaders, we will focus on increasing life expectancy across Pennine Lancashire to be at, or above, the national average in the next 10 years.

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common

15 January 2020

BLACKBURN WITH DARWEN CCG GOVERNING BODY TERMS OF REFERENCE

1. Introduction

In September 2019 the Governing Body approved a revision of its Terms of Reference (ToRs) to reflect the new arrangements following the appointment of a Joint Chief Officer, the move to a single Executive Team across the Pennie Lancashire CCGs on 1st June 2019 and a revision to the voting membership of the Governing Body to maintain a clinical majority.

In particular, the voting membership was amended to reflect the Executive Nurse, Director of Population Strategy and the third lay member as non-voting.

2. Amendments to the ToRs

2.1 Voting

The move to a single Executive Team across the Pennine Lancashire CCGs in June 2019 included the establishment of a joint position of Director of Quality and Chief Nurse. This role also undertakes one of the six statutory governing body member roles, as its Registered Nurse1

It is therefore proposed that the role of Director of Quality and Chief Nurse be a voting member of the Governing Body. This will also strengthen clinical representation and maintain the clinical majority.

Blackburn with Darwen CCG Governing Body now meets in common with East Lancashire CCG Governing Body, and this has also been reflected in the attendance section.

The membership would be:  Chair and Lay Member for Patient and Public Involvement (v)  Lay Member Governance (v)  Joint Chief Officer (v)  Deputy Chief Officer/Chief Finance Officer (v)  Secondary Care Doctor (v)  Director of Quality and Chief Nurse (v)  Four elected GP Governing Body members (includes the Vice Chair) (v)  Medical Director (v)  Clinical Director of Quality and Primary Care (v)  Director of Population Strategy and Transformation  Lay Member

Co-opted Member:  Director of Public Health (Blackburn with Darwen Local Authority)

1 http://www.legislation.gov.uk/uksi/2012/1631/made 3

In Attendance:  East Lancashire CCG Governing Body (Meeting in Common)  Head of Corporate Business  Administration Support

2.2 Quorum

Section 6.4 (exceptional circumstances 1 and 3) has been updated to reflect changes to Governing Body membership since January 2019 so that:

Where significant conflicts of interest exist with GP members the quorum will be achieved by five of the remaining six Governing Body members:

 Joint Chief Officer, Deputy Chief Officer/Chief Finance Officer, Director of Quality and Chief Nurse, Secondary Care Doctor, two Lay Members/Chair (and any non- conflicted GP members)

Where a decision is to be made on Remuneration for the two Lay Members, Chair and Secondary Care Doctor, the quorum will be achieved by a minimum of five of the following members:

 Joint Chief Officer, Deputy Chief Officer/Chief Finance Officer, Director of Quality and Chief Nurse, Medical Director, Clinical Director of Quality and Primary Care and four GP members.

2.3 Other minor amendments

Section 2.19 has been updated to reflect that the Governing Body will approve all VSM/Governing Body remuneration levels.

Section 6.3 has been updated to reflect recent changes to Integrated Governance arrangements across BwD and East Lancashire CCGs.

3. Recommendation

Blackburn with Darwen Governing Body is requested to receive and approve the Governing Body ToRs.

The revised ToRs are attached as Appendix 1.

Debra Atkinson Head of Corporate Business

CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY TERMS OF REFERENCE

1.0 Purpose of the Committee The purpose of the NHS Blackburn with Darwen Clinical Commissioning Group (CCG) Governing Body is, on behalf of their population, to:

a. commission safe and effective community and secondary health care services b. continually work towards the quality improvement of health care c. work in partnership with other Clinical Commissioning Groups and agencies to secure the overall health and well-being of the population d. conduct the business in accordance with the constitution of the CCG and the NHS constitution and other NHS statutory guidance.

In discharging its obligations the CCG Governing Body will be responsible and accountable for delivering financial balance, managing risks and for achieving national and local quality, productivity and service delivery targets.

The CCG Governing Body will delegate responsibility for a range of functions to its committees and working groups, e.g. the Pennine Lancashire Quality Committee, the Primary Care Commissioning Committee, the Audit Committee, the Remuneration and Terms of Service Committee, the Commissioning Business Group, and the Executive Joint Commissioning Group. These functions are set out in the approved Terms of Reference of each committee/group and the CCG’s Standing Orders and Schemes of Delegation.

2.0 Roles and Responsibilities 2.1 The CCG Governing Body will operate within the legal framework.

2.2 The CCG Governing Body will comply with its standing orders and standing financial instructions and the terms of reference will be reviewed at least annually.

2.3 The CCG Governing Body is subject to governance, ethical and legal guidelines. This includes requirements around ethical behaviour, conflicts of interest declarations and maintaining a register of interests.

2.4 The CCG Governing Body will establish committees and working groups as required to effectively transact the business of the Clinical Commissioning Group, approving all Terms of Reference and clearly setting out all delegated functions. 2.5 The CCG Governing Body will agree to delegate powers of budgetary responsibility to its committees and groups. A formal Scheme of Delegation will be agreed between the CCG Governing Body and its committees and groups. 2.6 NHS England will hold the CCG Governing Body to account for delivery of its delegated responsibilities / accountability. NHS England has the power to intervene in the work of the CCG should it be considered necessary. 2.7 The elected General Practitioner (GP) representatives on the Governing Body of the CCG Governing Body will, as part of a team, ensure that the CCG exercises its functions efficiently, effectively and economically with good governance and in accordance with the terms of the CCG as agreed with its members. The development of the governance arrangements is in accordance with the legal requirements in the Health and Social Care Act 2012 for the establishment of CCGs. 2.8 The CCG Governing Body will receive regular reports from its committees and groups from which to gain assurance on the delivery of the annual and strategic Operational and Financial Plans. 5

2.9 The CCG Governing Body will be responsible for ensuring that services for the population of Blackburn with Darwen are informed and commissioned in a way which delivers improved health and social care, improved outcomes, improved patient experience, good productivity and minimises health inequalities and that its work is in accordance with the requirements of the NHS Constitution. 2.10 The CCG Governing Body will develop the commissioning intentions and oversee the conduct of contracting negotiations for the major CCG led contracts. 2.11 The CCG Governing Body will continually review quality and performance, outcomes and efficiency and effectiveness of spend in all commissioned services that fall within the scope of the CCG. 2.12 The CCG Governing Body will be responsible for the assurance that services are safe, of a consistently high quality, value for money and sustainable. 2.13 The CCG Governing Body will ensure continuous and meaningful engagement with the public and patients in the planning, delivery and prioritisation of services. 2.14 The CCG Governing Body will work collaboratively with a range of partners to commission services which will improve health and minimise health inequalities. 2.15 The CCG Governing Body will ensure that planning, prioritisation and decision making are transparent, equitable and auditable. 2.16 The CCG Governing Body will ensure that the CCG achieves a balanced budget, whilst delivering the agreed Single Integrated Plan. 2.17 The CCG Governing Body will lead the development of the strategic planning process for the CCG. 2.18 The CCG Governing Body will be responsible for and take ownership of Quality, Innovation, productivity and Prevention (QIPP) and performance management. 2.19 The CCG Governing Body will be responsible for approving all VSM and Governing Body remuneration levels.

2.20 The Governing Body will receive confirmation reports on the determined remuneration levels and conditions of service of the Executive Officers and GP Executive members from the Remuneration and Terms of Service Committee. 3.0 Deliverables 3.1 To commission a comprehensive range of appropriate, cost effective and high quality health services for the population of Blackburn with Darwen. 3.2 Create and lead the development of the system locally to ensure that the CCG remains fit for purpose. 3.3 Lead and drive the change of behaviour and culture in the NHS that is required for optimal productivity and sustainability by creating meaningful relationships across the whole system. 3.4 Ensure inclusion of all GP practices and that practices’/clinical engagement is harnessed and targeted to deliver priorities. 3.5 Ensure that the CCG Governing Body has a mandate from its constituent practices/GPs.

3.6 Be responsible for the organisational development of the CCG.

3.7 Ensure effective and appropriate practice education development and communication in relation to CCG led commissioning. 3.8 Develop meaningful engagement/links with Local Authority/Public Health Service/ NHS England / Health and Well-Being Board / Healthwatch and other organisations as appropriate to ensure system development in line with the implementation of the Health and Social Care Act 2012. 3.9 Communication and sharing of learning locally, regionally and nationally.

3.10 Minutes recording the decisions reached and the reasons for such decisions shall be maintained. 3.11 The Publication of the Governing Body’s Annual Report.

4.0 Constraints/Risks 4.1 The CCG Governing Body will work within the constitution and legal framework of the NHS. 5.0 Membership 5.1 The membership of the CCG Governing Body is:

 Chair and Lay Member for Patient and Public Involvement (v)  Lay Member Governance (v)  Joint Chief Officer (v)  Deputy Chief Officer/Chief Finance Officer (v)  Secondary Care Doctor (v)  Director of Quality and Chief Nurse (v)  Four elected GP Governing Body members (includes the Vice Chair) (v)  Medical Director (v)  Clinical Director of Quality and Primary Care (v)  Director of Population Strategy and Transformation  Lay Member

Co-opted Member:  Director of Public Health (Blackburn with Darwen Local Authority)

In Attendance:  East Lancashire CCG Governing Body (Meeting in Common)  Head of Corporate Business  Administration Support

Voting members of the Governing Body are those indicated by (v).

In the absence of the Chair the Vice Chair will conduct proceedings.

In the absence of the Joint Chief Officer the Deputy Chief Officer will act as their deputy.

Members must comply with the requirements of the CCG’s conflict of interest policy.

5.2 The CCG Governing Body will also invite other individuals to attend meetings as required from time to time. These individuals will not have voting rights.

5.3 The CCG Governing Body reserves the right to co-opt additional members where appropriate.

6.0 Governance and Reporting 6.1 Reporting arrangements - into The CCG Governing Body will report to NHS England. 6.2 The CCG Governing Body will make the minutes of meetings available to member practices, after each Governing Body Meeting and will keep them informed by messages from the Joint Chief Officer as key strategic decisions are taken. 6.3 Reporting arrangements – from

The CCGs sub-committees and groups listed below will report into the CCG Governing Body:-

- Pennine Lancashire Quality Committee

- Commissioning Business Group

- Primary Care Commissioning Committee

- Remuneration and Terms of Service Committee

- Audit Committee

- Executive Joint Commissioning Group

- Lancashire and South Cumbria Joint Committee of Clinical Commissioning Groups (JCCCG)

The CCG will also on occasions be required to establish other Sub-Committees in line with the CCG’s constitution.

6.4 Quorum A meeting of the Clinical Commissioning Group Governing Body shall be quorate when there are a minimum of five members, to include three GPs, one Executive Officer and one Lay Member present, unless the exceptional circumstances apply as described below:-

1. Where a decision is to be made where significant conflicts of interest exist with GP members the quorum will be achieved by five of the remaining six Governing Body members: Deputy Chief Officer/Chief Finance Officer, Director of Quality and Chief Nurse, Secondary Care Doctor, two Lay Members/Chair (and any non-conflicted GP members) re paragraph 2.20. 2. Where a decision is to be made where a conflict of interest exists with a sitting Vice Chair, the role of the Chair will be deferred to a Governing Body Member. 3. Where a decision is to be made on Remuneration etc. as paragraph 2.19. for the two Lay Members, Chair and Secondary Care Doctor, the quorum will be achieved by a minimum of five of the following members: Joint Chief Officer, Deputy Chief Officer/Chief Finance Officer, Director of Quality and Chief Nurse, Medical Director, Clinical Director of Quality and Primary Care and four GP members.

The conflicts of interest policy will be applied to both these scenarios.

6.5 Attendance Each member is expected to attend a minimum of 75% of scheduled formal and Development meetings per annum.

6.6 Review The Terms of Reference will be reviewed annually by the CCG Governing Body.

6.7 Recording of Proceedings

CCG The CCG will make an audio recording of proceedings. Members of the Governing Body have agreed to the recording of the meetings, as an aide-memoire for the minute taker; to ensure an accurate transcript of the meeting. The copy of the audio recording will be kept by the Governing Body Secretary. The recording will be destroyed following the ratification of the minutes of the last meeting at the next available meeting.

Members of the Public in Attendance The CCG will accommodate members of the public who wish to film, photograph or record CCG meetings in so far as it does not disrupt business and respects the rights of individuals who may not wish to be filmed. Any member of the public wishing to film the meeting is required to make the request in writing at least 24 hours in advance.

The filming, photographing or audio recordings will only be made from the designated public seating area and may be taken from one fixed position, to prevent obstructing others from observing proceedings.

Attendees will be advised at the start that the meeting is being filmed, photographed or audio recorded, and given the name and contact details of the individual undertaking the recording.

The Chair shall instruct that filming, photographing or audio recordings is stopped:

 During those parts of the meeting when the press and public have been excluded due to the nature of the business being discussed i.e. either exempt or confidential matters;  If there is a public disturbance or suspension/adjournment of the meeting;  If to his judgement the recording has become disruptive or distracting to the good order and conduct of the meeting;  If the Chair determines that it has not been possible to obtain informed consent from a person with known learning disabilities or mental health issues or parental consent for a young person speaking.

In allowing this, the CCG requests that those recording proceedings must not edit the film/recording/photographs in a way that could lead to misinterpretation of the proceedings, or infringe the core values of the CCG.

The use of flash photography or additional lighting will not be allowed unless this has been discussed in advance of the meeting and agreement reached on how it can be done without disrupting proceedings.

Public Order The Chair may, at any time, require the public or individual members of the public or media to leave the meeting or may adjourn the meeting to a private location if he considers that those present are disrupting the proper conduct of the meeting or the business of the Governing Body.

7.0 Relationships/Interdependencies with other Bodies 7.1 The Governing Body will cooperate and collaborate with other organisations in order to achieve its objectives.

8.0 Location of shared information such as plans, or contact information 8.1 These will be stored electronically on the Clinical Commissioning Group drive.

9.0 Related Policies 9.1  Standing Financial Instructions  Standing Orders  Scheme of Delegation  Governance Framework  Risk Management Policy  Conflict of Interest Policy  Constitution

10.0 Schedule of Meetings 10.1 The Governing Body will meet a minimum of 6 times per year in public with additional meetings being scheduled as required to ensure Governing Body development and discussion.

9 BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY AND EAST LANCASHIRE CCG GOVERNING BODY MEETING IN COMMON

Governing Bodies’ Sub-Committees and Agenda Report Title: 5.1 Groups’ Minutes No: Meeting Date: 15th January 2020 Summary of Report: This report presents the minutes of the Governing Body Sub- Committees and Groups for receipt and note by members. Report Recommendations: The Governing Body is requested to receive and note the content of the report. Financial Implications: None Procurement Implications: None Report Category: Tick Support and recommend/forward the report. Approve the recommendations outlined in the report. Debate the content of the report. Receive the report for information. √ Author: Mrs Debra Atkinson, Head of Corporate Business, East Lancashire CCG Report supported & approved by your Senior Lead? Y Mrs Debra Atkinson, Head of Corporate Business, East Lancashire Presented By: CCG Other Committees No Consulted: Has a PIA been completed in respect of this report? Privacy Impact Assessment N (PIA) If Yes, please attach If No, provide reason below. Has an EIA been completed in respect of this report? Equality Impact Analysis N (EIA) If Yes, please attach If No, provide reason below. Data Protection Impact Is a Data Protection Impact Assessment Required? N Assessment Have any risks been identified / assessed? N Risks: Conflict of Interest: Is there a conflict of interest associated with this report? N Has any clinical engagement/involvement taken place as part N Clinical Engagement: of the proposal being presented. Patient Engagement: Have patients been involved in the drafting of this report? N Privacy Status: Can the document be shared Y

CCG Corporate Objectives :

To commission the best quality and effective services to deliver optimal healthcare CO1 outcomes for our local population. Ensure the balance of our health investment reflects our population’s needs and keeps CO2 the population well CO3 Deliver the 10 year strategy by engagement with the population we serve and ensure we commission services that meet local needs with a clear focus on population health management strategies CO4 We will focus on population health outcomes through helping to deliver successful Integrated Care Partnerships and ensure decisions, provision and access to local services is based on the needs of our population. CO5 As local health leaders, we will focus on increasing life expectancy across Pennine Lancashire to be at, or about the national average in the next 10 years.

Page 1 of 2

BLACKBURN WITH DARWEN CCG GOVERNING BODY AND EAST LANCASHIRE CCG GOVERNING BODY MEETING IN COMMON

15TH JANUARY 2020

GOVERNING BODIES’ SUB-COMMITTEES AND GROUPS’ MINUTES

1. Introduction

This report presents the minutes of the Governing Bodies’ Sub-Committees and Groups for receipt and note by members.

The minutes inform members of delegated and key decisions taken and provide information regarding items of particular interest or potential risk.

2. Pennine Lancashire CCGs

2.1 Pennine Lancashire Quality Committee

The ratified minutes of the meeting held on 30th October 2019 are attached as Appendix 1.

2.2 Information Governance Group

The ratified minutes of the meeting held on 10th September 2019 are attached as Appendix 2.

2.3 Blackburn with Darwen CCG Commissioning Business Group and East Lancashire CCG Sustainability Committee meeting as Pennine Lancashire Committees in Common

The ratified minutes of the meetings held on 16th October and 20th November 2019 are attached as Appendices 3 and 4.

3. Blackburn with Darwen CCG

3.1 Primary Care Co-Commissioning Committee

The ratified minutes of the meeting held on 17th September 2019 are attached as Appendix 5.

3.2 Audit Committee

The ratified minutes of the meeting held on 20th August 2019 are attached as Appendix 6.

4. East Lancashire CCG

4.1 Primary Care Committee

The ratified minutes of the meetings held on 15th October and 19th November 2091 are attached as Appendices 7 and 8.

5. Recommendation

The Governing Body is requested to receive and note the content of the report.

Debra Atkinson Head of Corporate Business Page 2 of 2

NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group

30th October 2019 East Lancashire CCG PENNINE LANCASHIRE QUALITY COMMITTEE PRESENT: 2019 2020

Name and Title Org * 22/05 26/06 25/07 28/08 25/09 30/10 27/11 22/01 26/02 25/03 00/04 00/05 00/06 00/07 00/08 00/09 00/10 *25/12 Clinical Representatives (3 ): Michelle Pilling - Lay Advisor: Quality and Patient ELCCG A Engagement - Chair Geraint Jones -Secondary CareDoctor (Retired) - Chair BwDCCG L 

Caroline Marshall - Interim Head of Quality ELCCG  Kirsty Hollis - Chief Finance Officer ELCCG A A A  Alex Walker - Director of Commissioning ELCCG AR AR A AR A Kathryn Lord - Interim Director of Quality and Chief ELCCG A A A Nurse (Clinical Post) Dr Ridwaan Ahmed - Director of Quality and BwDCCG A A A Performance (Clinical Post) Clair Moir - Governance, Assurance and Delivery BwDCCG A A  Manager Dr Umesh Chauhan - GP Quality Lead (Clinical Post) ELCCG A  Dr Stephen Gunn - GP Representative (Clinical Post) BwDCCG A A Dr Zeenat Sykes - GP Representative (Clinical Post) ELCCG A A L A Dr Nigel Horsfield - Lay Member BwDCCG  Dr Paul Taylor - Secondary Care Consultant ELCCG A A A A  Medicines Management Representatives (one needed): Julie Kenyon - Senior Operating Officer, Primary, BwDCCG - - A A A A Community and Medicines Commissioning Lisa Rogan - Associate Director of Research, Medicines ELCCG A A and Clinical Effectiveness Safeguarding Representative (one needed): Peter Chapman - Head of Safeguarding (Adults)RATIFIED and PLCCG A -  MCA Leads Susan Clarke - Head of Safeguarding (Children) PLCGG - - A - Debbie Ross - Head of Safeguarding (Children) PLCGG - - - - In Attendance:

In Attendance:

Jacquie Allan - Corporate Support Judith Johnston - Head of Clinical Commissioning Simon Bradley - Quality and Performance Manager Vanessa Morris - IPC Lead Nurse Catherine Wright - Primary Care Commissioning

Pennine Lancashire Quality Committee Page 1 of 8 Minutes Approved by the Chair:

NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group

REF: ACTION 19.217 Welcome & Chair’s Update

Dr Geraint deputised for the Chair and opened the Pennine Lancashire Quality Committee welcoming all attendees.

19.218 Apologies

Apologies were received and noted as above.

19.219 Declarations of Interest

No declarations of interest were noted. Any conflicts that transpire during the meeting are to be declared and managed appropriately.

The meeting was not quorate. 19.220 Minutes of the Meeting held on 25th September 2019

The minutes were recommended for approval as an accurate record of the meeting, these will need to be ratified at the November meeting due to quoracy.

19.221 Action Matrix

19.182 Infection Prevention Team Report Healthcare Associated Infections Update Q1 2019/20 Action: Vanessa Morris to forward the report to Dr Geraint Jones. This has been completed and the action now closed

19.186 LD Transforming Care, STOMP and LeDer Update This was presented and the action is closed.

19.199.1 Pennine Lancashire Quality and Performance Report – Month 04 Data around 111 to be addressed to ascertain if there is a link to demand. 111 is not included in the report, activity is static and demand will reduce, this action is now closed

19.199.2 Pennine Lancashire Quality and Performance Report – Month 04 A Trend graph is to be inserted on pages 3, 7, and 8 replacing trend ‘up and down’ arrows. More charts have been addedRATIFIED to the report and this action is now closed.

19.199.3 Pennine Lancashire Quality and Performance Report – Month 04 There is a query on the workforce BMI on pages 12 and 40. Staffing rates to be confirmed. This was an error which has been corrected, this action is now closed.

19.206 Risk Management Group Terms of Reference Primary Care should be represented at this group, update to be given at the October meeting. Once the consultation has finished Primary Care will be represented at this meeting, this is now closed. 19.222 Mixed Sex Accommodation

Mrs Caroline Marshall presented a slide deck detailing the mixed sex accommodation breaches.

The 2018/19 position was currently in line with the National guidance and no financial sanctions will be applied.

Pennine Lancashire Quality Committee Page 2 of 8 Minutes Approved by the Chair: NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group

The current position YTD 2019/20 is that no financial sanctions will be applied and that out of the 44 breaches report, 43 were reported by LCFT. ELHT only experienced one which was in June 2019. This was due to all patients requiring critical care being split between a critical care unit and ward B20 due to bed pressures. The first opportunity to transfer the patient from B20 was at 2 am when the patient had already breached at midnight in line with the national standard.

As this is not a regular event at ELHT actions have been taken to reduce any further reoccurrence. This has included discussions at the bed meetings regarding heightened awareness around the importance of timely transfers and ward staff being advised to contact critical care when a step down patient was expected and not arrived. These were also shared at a Band 7 Professional Practice meeting in August 2019. No patient harm was noted for the breach.

LTHT do not have one particular area where breaches occur. These areas can include Critical Care Unit, Respiratory High Care (NIV bay), Coronary Care and Endoscopy. Flow and capacity remains a challenge and actions have been implemented by the Trust.

Caroline was asked how we compared to other CCGs in Pennine Lancashire, and she replied that LTHT numbers are really high if you add all of the incidents up. We are not in an acceptable position but we are better than the other CCGs and compared with national benchmarking were lower is better, ELCCG is 123rd highest against 226 CCGs, and BwD CCG are 85th.

New guidance will be coming out in January 2020, and with the new guidelines breaches which are currently happening will not occur.

The CCGs had not received any complaints regarding mixed sex accommodation.

Estates could be the issue with LTHT, and the CCG has asked for reassurance that all policies and procedures are being implemented within an aging building. 19.223 Pennine Lancashire Quality and Performance Report – Month 05

A Power Point presentation of the performance report was given by Mr Simon Bradley. The key highlights presented were: There was underperformanceRATIFIED against the 4 hour A & E target with performance in August 2019 at 82.71% (ELHT), although there has been some good performance mental health attendances have continued to be a pressure throughout August where there were ten validated 12 hour mental health breaches. Monitoring for Delayed Transfers of Care (DTOC) has shown a decline on the previous month and the position for August 2019 is 4.70% against a target of 3.5%. The DTOC performance is being micro-managed on a daily basis and there is a downward trend with the number of lost bed days each week. A detailed recovery plan has been established which involves all relevant partner agencies.

A perfect week is taking place at the Trust week commencing the 4th November 2019. There is also a continuing healthcare event.

Ambulance performance is seeing an increase in the number of calls being received. NWAS has developed a system to auto divert resource from lower graded calls to Category 1, which went live on 14th August 2019. It is anticipated that this development once embedded will improve the overall NWAS Category 1 mean by approximately 10 seconds.

Referral to treatment remains incomplete. A Pennine Lancashire Scheduled Care Board has

Pennine Lancashire Quality Committee Page 3 of 8 Minutes Approved by the Chair: NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group

been established within the ICP Governance Structure; membership includes both clinical and managerial membership from all partners. There is shared SRO responsibility at Director level for both ELHT and CCGs and the ELHT Chief Executive, is the sponsor of the Board. The Board’s remit includes immediate performance management oversight and active management and transformational/pathway redesign for longer term sustainability. There are a number of vacant posts out to recruit and a GP MSK event is taking place on the 6th November.

With diagnostics ELHT have now subcontracted to Morecambe Bay to provide additional capacity and this figure should start to improve, although the issue is national.

There continues to be a high number of breaches relating to patient-initiated delays. As previously reported, the ‘Let’s Talk Cancer’ phase 2 concept has been agreed which will focus on cancer screening. The Trust has introduced patient information cards. There is a focus on offering patients an appointment within 7 days and the position will continue to be closely monitored over the coming months. Surgical capacity continues to be a pressure in a number of tumour sites, relevant Directorates are working day to day to ensure sufficient capacity is available and where not, exploring all options to increase the number of surgical lists provided. There is a Cancer Alliance Workshop on 6th November to share 28 day faster diagnosis standard progress and updates.

There are a low number of patients going through early intervention in psychosis, with the focus around referral to treatment. There is continued improvement in performance at both Trust level and BwD CCG in August 2019, but a deterioration in performance at EL CCG. We will continue to work with the Trust.

MAS have seen an improvement in performance for BwD CCG and ELCCG, and the recovery trajectory is on target.

IAPT has seen an improvement in prevalence performance for BwD CCG but a decrease in prevalence for EL CCG due to low referral rate in August 2019. The communication strategy continues, to achieve more appropriate referrals and reduce DNAs. We are also targeting work in the CCGs to improve referral quality with the aim to reduce rejected referrals.

BMI Healthcare: Lancaster Hospital CQC

The CQC published an inspection report on the 15th October 2019, for the inspection carried out at BMI The Lancaster HospitalRATIFIED on the 14th and 15th May 2019. The rating of the hospital stayed the same with an overall rating of ‘Requires Improvement’.

Following the inspection, the CQC have told the provider that it must take some actions to comply with the regulations and that is should make other improvements, even though a regulation had not been breached, to help the hospital improve. BMI were issued with two requirement notices that affected outpatient and diagnostic services.

Flu Update

Vanessa Morris provided an update on the infection control workstream. There was nothing further to add to the flu update presented in August 2019 around seasonal flu in Australia. The flu campaign is now underway and there are concerns with cancelled clinics and availability, because of this our numbers may be lower this year. Internally we have found that some people have been given two codes to attend Boots for their vaccination. The Flu Ends are going to be later than planned with GPs only receiving half of the numbers requested.

Pennine Lancashire Quality Committee Page 4 of 8 Minutes Approved by the Chair: NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group

The Chair thanked Simon for the report. There were three request from the members:

a. There were reports that the number of beds being blocked had escalated to 150 – SB 30.10.19 was this correct? b. There were a number of vehicles being diverted from ELHT to Airedale – at the SB

request of ELHT – was this correct? SB c. RTT Neurology could this be reported in more detail in the report?

19.224 CONFIDENTIAL: Provider Update Paper

This paper was tabled for reference. The content of this item is for Committee members and attendees only and is not for wider distribution. The confidential minutes of this part of the meeting will be circulated under separate cover.

Members received and acknowledged this report.

19.225 CONFIDENTIAL: ICS Mental Health Systems Improvement Board

This paper was tabled for reference. These were distributed prior to the meeting for information. No comments were raised. The confidential minutes of this part of the meeting will be circulated under separate cover.

Members received these minutes.

19.226 Pennine Lancashire Primary Care Update

Mrs Catherine Wright presented a bi-monthly report providing an update on the quality of the 49 GP Practices in East Lancashire Clinical Commissioning Group (EL CCG) and 23 practices in Blackburn with Darwen Clinical Commissioning Group (BwD CCG).

We continue to get low reporting for serious incidents in primary care and practices are aware that NRLS is changing and we are awaiting further details of this from NHS England/Improvement. Further work will then be undertaken to encourage reporting across the Pennine footprint:

Following the survey and reviewRATIFIED of FFT with Practice Managers in July 2019, the Quality Team has developed guidance for Managers to encourage and improve the use of FFT within practices. This has been included on the GP Bulletin and GP TeamNet. The questions will change in April 2020 and practices were being encouraged to use the new questions now.

BwD CCG results for the GP patient survey where better than East Lancs but there seems to be a down trend nationally. Hopefully with the introduction of IPLATO/my GP this could increase next year.

Blakewater operate a DVT Service are they covered separately by CQC with this? Catherine confirmed she would look into this.

There is a new CAS (Central Alerting System) from 1st October 2019 and all GP Practices in Pennine Lancashire have now registered with the new system providing both an email address and mobile number to be used as back up when email systems are down.

Pennine Lancashire Quality Committee Page 5 of 8 Minutes Approved by the Chair:

NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group

The Primary Care Committee agreed a proposal from the Burnley practices to disperse the Daneshouse Medical Practice list from 1st October 2019.

19.227 Pennine Lancashire IPA and CHC Update

Mrs Judith Johnson presented a paper on Individual Patient Activity (IPA) and Continuing Health Care (CHC). This report was to update the Quality Committee on progress and current risks in relation to Individual Patient Activity and share information on activity.

The IPA Board is now a delivery board. With the ICS improvement plans now in place it has allowed the team to concentrate on local actions. There has been joint MLCSU and CCG meetings to understand the back log of referrals which for Blackburn with Darwen has led to a refreshed total of 21 outstanding reviews (from original figure of 28 provided by CSU). The same exercise has not led to a noticeable reduction for East Lancashire but has provided further intelligence with regard to more targeted remedial actions, for example approximately 30% of individuals have diagnosis of Learning Disabilities and therefore identified type of nurse needed to undertake eligibility assessments.

We currently have no issues with care provisions but do have some problems with CHC delays and funding care packages for some patients, but are expecting to see improvements with assessments, social services and community packages.

Pennie ICP is furthest from the improvement trajectory, this is due to a lack of staff and training of staff in hospital setting to speak with families. This has been identified and action plans put in place. There is a tight timescale to address this but the team is confident that they will be on track and reduced backlog and complaints will continue to improve.

The Chair thanked Judith for her report and the effort from the team. He stressed the importance of this work.

19.228 Safeguarding Dashboards

Mr Peter Chapman presented the latest Safeguarding Dashboard covering the reporting period from July 2019 – September 2019, ensuring that the Pennine Lancashire Quality Committee is sighted on ELCCG and BWDCCG’s key safeguarding priorities and is aware of the safeguarding activity which have taken place within the last 3 months.

Through the ICS developmentRATIFIED the team is now working closer with other CCGs and picking up individual work streams including Prevent and Safeguarding.

Looked After Children has now moved into the redesign phase and a joint action plan developed to address the project findings.

NHS England have written out to all CCG’s requesting assurance that provider trusts will have achieved 85% compliance for Prevent training by March 2018. The CCG includes Prevent training as part of the requirements for our providers and monitors this via the safeguarding assurance returns received back into the CCG via the formal contractual process.

Yvonne Jackson has now taken on the safeguarding function focusing on Primary Care. Dr Umesh Chauhan mentioned that GPs are now being requested to produce witness statements for patients suffering domestic abuse and this is becoming a lengthy process. Peter asked if GPs could share details of these request with him and he would follow these up.

Pennine Lancashire Quality Committee Page 6 of 8 Minutes Approved by the Chair:

NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group

19.229 STOMP Update

Mrs Judith Johnstone requested that this item be deferred to allow for additional information JJ to be circulated to the members in a non PDF format. November 2019 The Chair requested that at the December meeting Judith also submitted a paper on the LeDer Update. 19.230 Serious Incident Report Quarter 2 Recommendations

Mrs Deryn Ashby presented a paper to provide an analysis of Serious Incidents reported by provider organisations and the CCG in Quarter 2 of 2019/20.

In Q2 2019/20 there were 48 RCA reports submitted by providers hosted by EL CCG and BwD CCGs with treatment delay being the highest incident type.

The CCG and ELHT have agreed to undertake a thematic review of this area to identify the actions needed to mitigate this; this will be presented in the Q3 report. ELHT are currently auditing the notes across their organisation to mitigate human error. They are performing well compared to other Trusts. The mature relationship that exists between the CCG and ELHT Quality teams attributes to this.

No Never events were reported during this period.

In Lancashire and South Cumbria Foundation Trust (LSCFT) there were 38 incidents reported which could be due to a change in reporting procedure with the Police, which includes receving real time information on suicides. This has resulted in an increase of incidents reported due to a backlog of cases being received, impacting on capacity. Relationships with LSCFT need to replication those with ELHT.

19.231 Special Education Needs Disabilities

Due to unforeseen circumstances there was no representation at the meeting. This paper KH will be deferred to December 2019, when further updates may be available. December 2019 19.232 Apex/Plato/Digital Position and Virtual GP Appointments Update

Mrs Catherine Wright presented an update paper on the digital developments within Primary Care. RATIFIED Eight specific areas were highlighted in the 5 year plan. Five of which will be resolved with the introduction of Iplato and My GP.

Mrs Kirsty Hollis sits on the Digital Health Board and a Pennine Lancs Digital Working Group has been put into place ensuring that all eight requirements are implemented. Kho A further update will be provided to the Quality Committee early 2020 with progress against February the requirements 2020 19.233 Pennine Lancashire Policy Updates

Mrs Liz Otley presented Policy updates to be ratified. A few amendments still had to be made.

With the changes, the committee approved the policies to be uploaded onto the respective CCG websites.

Pennine Lancashire Quality Committee Page 7 of 8 Minutes Approved by the Chair:

NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group

19.234 Quality Meetings Draft Minutes

LCFTJoint MH & Community Performance and Quality Meeting LCFT Quality and Performance Group

These minutes were tabled for reference. They were distributed prior to the meeting for information. No comments were raised.

Members received these minutes

19.235 Risk Management and Compliance Group Minutes

The minutes were tabled for reference. These were distributed prior to the meeting for information. No comments were raised.

Members received these minutes.

19.236 Pennine Lancashire Cancer Tactical Group Minutes – September 2019

The minutes were tabled for reference. These were distributed prior to the meeting for information. No comments were raised.

Members received these minutes.

19.237 Items for Inclusion on the Corporate Risk Register

It was agreed that a confidential item discussed in part 2 of the meeting would be included on the risk register.

19.238 AOB

Building Cladding

The Chair asked if the CCG was aware of any of the buildings having effected cladding in view of the recent media. It was confirmed that at the time of the Glenfell Tower incident that both CCGs had no issues with its estate.

19.239 Date & Time of Next MeetingRATIFIED

The next meeting has been scheduled on Wednesday 28th November 2019 at 1.00 pm Meeting Room 1, Walshaw House, Nelson

Deadline for papers is 5.00 pm on 15th November 2019.

Pennine Lancashire Quality Committee Page 8 of 8 Minutes Approved by the Chair:

BLACKBURN WITH DARWEN AND EAST LANCASHIRE CLINICAL COMMISSIONING GROUPS (CCGs) Minutes of the Information Governance Group Meeting held on 10th September 2019 at 10:30 – 11.30 – Walshaw House

PRESENT: Neil Holt – Head of Commissioning Performance (Chair) Paul Hinnigan – Governance Lay Member Claire Moir - Governance, Assurance and Delivery Manager Bronwyn Casey – Information Governance Business Partner – Lancashire Olivia Binsley – Information Governance Compliance Officer

IN ATTENDANCE: Kirsty Hollis – Chief Finance Officer Debra Atkinson – Head of Corporate Business Jason Newman - Head of Performance and Delivery

Agenda Actions Item: 1 Apologies None noted.

2 Minutes and Actions of the previous meeting – 11th June 2019 Minutes of the meeting held on 11th of June 2019 were agreed as accurate with Olivia a few spelling amendments. Olivia Binsley to amend minutes of meeting to Binsley reflect comments made. 3 Declarations of Interest None noted.

4 Any Matters Arising

Shred It Assurances from St Modwen’s were previously agreed as sufficient to meet the requirements for the Data Security and Protection Toolkit (DSPT) therefore the action was closed. The action was then reopened during the meeting dated 11th June 2019 after the group agreed the action should stay open for assurance purposes and protection of the CCG’s. The group was updated that an addendum was received however deemed as unacceptable. The group discussed that appropriate assurance from Shred It still hadn’t been met therefore action will remain open. Action was agreed for Jason Newman to Jason contact Lauren Ridgard at Property Services Ltd for a response regarding Newman/ the contract. Claire Moir to obtain assurance from Hansteens that they Claire have a contract in place with Shred-it. Bronwyn Casey also confirmed that Moir there is a new DSPT assertion for an audit to be conducted of confidential waste processes.

Information Asset Assistants and Information Asset Owners (IAAs & IAOs) Bronwyn Casey confirmed she has reviewed all the IAO actions on the Commissioning Asset Register for Blackburn with Darwen CCG. Bronwyn will review these assets within this role until the CCG determine who the nominated individual is named. The group agreed the action can be closed and revisited on

Page 1 of 4

a future date.

GDPR Accountability principle - CCG Contracts Claire Moir is in the process of reviewing contracts and contacting providers to check if personal data is processed for Blackburn with Darwen CCG. Claire Bronwyn Casey confirmed she will contact Elizabeth Ottley regarding contracts Moir for East Lancashire CCG. Claire Moir to continue reviewing had advised she is Bronwyn still in the process of doing this. On going action for Claire Moir to continue Casey reviewing contracts. Bronwyn Casey to contact Elizabeth Ottley for an update in regard to the position of East Lancashire CCG contracts.

Data Protection Officer (DPO) service The group discussed the DPO service provided by Hayley Gidman. In particular, the quarterly reports in which the CCG should receive as part of the service level agreement detailing that the CCG would receive a quarterly report. To date, one Bronwyn report has been received running from June - December 2018. The action is Casey ongoing for Bronwyn Casey to pick this up again with Hayley Gidman for an update.

5 Terms of Reference (TOR) - Review

The group discussed the Terms of Reference arrangements moving forward. It was agreed that Blackburn with Darwen and East Lancashire Clinical Commissioning Groups will combine the group and Information Governance report. The group would also like to bring in other elements into the group such as Health and Safety, Mandatory training and Freedom of Information. Therefore, rename the group to Information Governance and Compliance Steering Group which will report to the Quality Committee group.

The group also discussed the Quorum of the group. It was established Kirsty Hollis as Senior Information Risk Owner (SIRO) across both organisations would Chair the Steering Group moving forward. It was also agreed that the minimum Kirsty attendance would be Chair plus two members, including a lay member. Kirsty Hollis Hollis will liaise with Lay Members, to confirm who will attend future IG Steering group meetings. Claire Claire Moir has drafted a new Terms of Reference to be circulated to the group Moir for comments. Claire Moir to circulate the TOR to the group for review.

6 Data Protection Impact Assessment (DPIA) – Discussion Claire Moir The group discussed the high level Data Protection Impact Assessment that has been completed, entitled ‘Review of Corporate Functions’. As Both CCGs are now under one executive team and the CCGs are beginning to work a lot closer together it is important that the Corporate function can identify where they can align their services. The DPIA was the most appropriate tool to provide this. The DPIA was completed to outline what information will be shared between each organisation and for what purpose. The assessment has allowed the sharing of personal information to be fully risk assessed ahead of the Corporate teams and the CCGs begin to work more closely together. The completion of this assessment will feed into the Data Sharing Agreement (DSA) to be agreed and signed by both organisations.

Claire Moir met with Bronwyn Casey to complete the DPIA, which was sent to the DPO for approval on the 9th of September 2019. Once the DPIA has been approved by the Data Protection Officer and then Senior Information Risk Owner (SIRO), Bronwyn Casey will draft the agreement. The group agreed that the Accountable Officer, Julie Higgins would be more appropriate to sign the DPIA

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and DSA for extra assurance and to avoid any conflict of interest. Bronwyn Casey to forward the completed DPIA to Kirsty Hollis and Kathryn Lord for their comments and approvals once DPO comments have been received.

7 September Information Governance Bi-monthly Report

Bronwyn Casey discussed the report highlighting the key points, firstly advising that one staff member across the two CCG’s had booked on to the Information Governance Annual Refresher Training so far. Bronwyn highlighted that the training date are included on ‘IG dates to remember’ at the bottom of the newsletter sent to staff and is not clearly communicated to staff. The group also Bronwyn discussed the new method for staff to complete the Code of Conduct by signing Casey and sending to the Information Team to manage. An action was agreed for Bronwyn Casey to send information to the Communications and Engagement team regarding training dates and the new way of completing the Code of Conduct by Thursday 12th September 2019

Bronwyn Casey highlighted to the group that one assertion on the Delivery plan has not been completed within the timescale allocated. The assertion The Information Governance Management Framework (IGMF) which highlights the clear lines of responsibility and accountability to named individuals for data Bronwyn security Bronwyn Casey also mentioned that she will arrange a time to meet with Casey the IG leads in regards to the non-mandatory DSPT requirements to establish the CCGs stance on whether or not they wish to complete these. Bronwyn Casey to draft the IGMF to be ratified and the assertion to be completed for the next Bi-monthly report and discuss non-mandatory assertions with IG leads. Bronwyn Casey The group queried the DPIAs that have been outstanding for some time, particularly those were the IG team have not received a response from the project lead. Bronwyn Casey advised the period of the log is a 12-month rolling period which also includes any further DPIA’s ongoing passed the 12 months. Bronwyn confirmed that the team chase for an update from the Project lead. The Bronwyn group confirmed that should there be no response from the project lead after a Casey period of time these can be removed from the Bi-Monthly report. The group also established The Data Migration and Population Health Management DPIA’s was not present on the DPIA log. IG Team to remove all entries where no response has been received from the project lead and to include the missing DPIA for data migration for the next Bi-Monthly report.

It was noted that for Data Sharing Agreements (DSA) that are received from NHS Digital and signed on the DARs portal are not present on the DSA log. Jason Bronwyn Casey informed the group that the IG team are not always made aware Newman of these agreements and ask that the CCGs provide this information to be added to the appropriate log. Jason Newman to send the DARS agreement to Bronwyn for the bi-monthly report, it was established that the IG team did not receive this and do not always receive notifications from NHS Digital.

Bronwyn Casey informed the group that due to the increased requirements for CCGs to meet for the 2019-2020 submission of the Data Security and Protection Bronwyn Toolkit (DSPT), NHS Digital have informed the IG team that they will be required Casey to submit a baseline submission of the DSPT at the end of October. Bronwyn confirmed that the IG team are working towards this submission, which also aligns with the Mersey Internal Audit Agency (MIAA) DSPT audit. Phase one of the audit has been arranged for the beginning of October to which Bronwyn has confirmed she will be meeting with MIAA at this time. Bronwyn Casey to feedback to the group following the submission and audit. Page 3 of 4

8 Freedom of Information (FOI) The FOI Freedom of Information Quarterly Report 01/04/2019 – 30/06/2019 was discussed. Blackburn with Darwen and East Lancashire CCG have asked for a standardised report moving forward.

Comments were made that the report layout has improved, the narrative was consistent and no emerging breaches. However, the group were concerned round the report figures not adding up. The group agreed to wait to see the outcome of the Q2 FDOI report before discussing further.

It was also discussed that due to limited knowledge around the FOI report from representatives of the IG team a suggestion was made for a member of the FOI team to attend the steering group to discuss the report in detail.

9 PHM – Data Warehouse Development Claire Moir Claire Moir informed the Group in regard to a Data Protection Impact Assessment DPIA that will be sent to the CCGs in regard to the Population Health management project originating from the ICS. When the DPIA has been completed this will be circulated around all CCGs to comment on and approve. Bronwyn Casey confirmed that Hayley Gidman has been heavily involved in the completion of this assessment.

10 Any other business Bronwyn Casey advised the group that there will be a new Information Governance Business Partner joining her to cover the Lancashire and South Cumbria CCGs.

The group also discussed the new role of the IG HUB, Bronwyn Casey informed the group of for all general queries to be sent through to provide first line advice. It was also mentioned for the HUB to be promoted through training sessions, staff briefings and information circulated via the communications and engagement team to staff along with the Face-to-Face training dates and Code of Conduct process.

11 Next Meeting End of November – date TBC

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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group

Pennine Lancashire Committees in Common Minutes of the Blackburn with Darwen CCG Commissioning Business Group and East Lancashire CCG Sustainability Committee held on 16th October, 2019 at Walshaw House, Nelson

PRESENT: Blackburn with Darwen CCG Dr John Randall General Practitioner (GP) Executive Member - Chair Dr Adam Black GP Executive Member Paul Hinnigan Lay Member (Governance) Dr Geraint Jones Lay Member (Secondary Care Doctor – Retired) Dr Penny Morris Clinical Director Roger Parr Deputy Chief Executive/Chief Finance Officer Kathryn Lord Interim Director of Quality and Chief Nurse East Lancashire CCG: David Swift Lay Member (Governance) Dr Mark Dziobon Medical Director Dr Julie Higgins Joint Chief Officer Dr Santhosh Davis Clinical Advisor & Governing Body Member Dr Rakesh Sharma Clinical Advisor & Governing Body Member Dr David White Clinical Advisor & Governing Body Member Alex Walker Director of Performance & Delivery

In Attendance: Gifford Kerr Consultant in Public Health Medicine David Rogers Head of Communication & Engagement Dr Lisa Rogan Associate Director of Medicines, Research and Clinical Effectiveness Deidre Lewis Head of Finance Angela Thornton Head of Mental Health and Cancer Commissioning Teams Collette Walsh Interim Deputy Director of Commissioning Cath Coughlan Locality Manager - Pendle Elizabeth Fleming Head of Urgent & Emergency Care Kirsty Hamer Commissioning Lead Children, Families and Maternity Services Elaine Craven Executive Assistant - Minutes

Min Ref: ACTION 19:121 Welcome & Chairs Update The Chair welcomed members to the meeting. The Chair then advised members that he was pleased to have been re-elected as a GP Executive member for Blackburn with Darwen CCG. Members welcomed this news and congratulated Dr Randall. The Chair went on to advise that Dr Preeti Shukla had made the decision to step down as a Blackburn with Darwen CCG GP Executive Member, effective 31st October, 2019 and would no longer be a member of the Commissioning Business Group. He asked that, on behalf of members from both committees, thanks be placed on record to Dr Shukla for her service. The Chair then welcomed Dr David White and Dr Rakesh Sharma as members of the East Lancashire CCG Sustainability Committee. Dr White, Dr Sharma and Dr Santhosh Davis have all been elected as East Lancashire CCG Clinical Advisors

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& Governing Body Members.

19:122 Apologies Apologies were received from Dr Ridwaan Ahmed, Dr Julie Higgins, Dr Zaki Patel, Dr Preeti Shukla, Kirsty Hollis, Dr Tom MacKenzie, Naz Zaman, Kenneth Barnsley, Debra Atkinson, Jason Newman and Aidan Kirkpatrick. It was noted that Alex Walker, Elizabeth Fleming and Lisa Rogan would be late arrivals for the meeting. 19:123 Governance The Chair reminded members of their obligation to declare any interest they may have on any issues arising during the meeting, which might conflict with the business of the Clinical Commissioning Groups. The Chair referred members to the outline definitions in relation to types of interest, attached to the meeting agenda. Declarations of Interest: There were no declarations of interest made at this point in the meeting. Quoracy: Both Committees were quorate at this point in the meeting. Deidre Lewis was in attendance as the East Lancashire Clinical Commissioning Group Chief Finance Officer’s nominated deputy. 19:124 Minutes of the meeting held on 21st August, 2019 The minutes of the meeting held on 21st August, 2019 were approved as an accurate record by members of both Committees. 19:125 Action Matrix: 18:31 Pennine STEP (Succeed Thrive Empower Pennine) Service Included on the agenda. 19:57 Pan Lancashire Audiology Services The Chair updated the Committees. As the September Committees in Common meeting was stood down, a paper was circulated for virtual decision. The purpose of the paper was to provide the Committees with the outcome of the Lancashire and South Cumbria wide procurement of the Any Qualified Provider (AQP) Plus Audiology service with a request to approve the award of contract across Blackburn with Darwen and East Lancashire Clinical Commissioning Groups. The Committees were requested to:  Note the procurement process and risk, financial information highlighted;  Note the timescales and governance process across Lancashire and South Cumbria CCGs;  Agree to award the contracts. Quorate responses in support of the recommendations were received from both Committees and a record filed for audit purposes. The report author was advised of the decision. Action closed. 19:83 Governance Kirsty Hollis to bring an update to the November meeting. 19:72 Tuberculosis Service Review It was advised that having considered the request, the CCGs were struggling to find capacity, so were not willing to take on the lead role for the Integrated Care System in providing a Tuberculosis Service. Although it was recognised that if the Pennine CCGs were not leading there was a need to ensure that they could

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influence. Gifford Kerr advised that currently no one is commissioning Tuberculosis Services. He clarified that at this stage the ask is for support in re-modelling the model and for Pennine clinical expertise to provide leadership into a network model for Lancashire & South Cumbria. It was agreed that Alex Walker and the Chair would commit to having a discussion with Gifford about scoping out the Service. 19:126 Telemedicine (East Lancashire CCG only): Cath Coughlan attended to present this item. Since the establishment of Telemedicine (provided by Immedicare/Airedale NHS Foundation Trust) across East Lancashire, the service has continued to see an increase in patients being supported in their care home setting and has demonstrated collaborative working, with a wide range of health and care professionals, to support patients. Telemedicine has favourable outcomes. The view from local PCNs who fully utilise the service (Hyndburn and Pendle) is that it is valuable in terms of saving GP time. However, there is a question mark as to whether the level of benefits provided by the service, do in fact justify the level of investment, when East Lancashire remains an outlier in terms of the number of hospital admissions from care homes. Although this was an East Lancashire paper, reference was made to the fact that Blackburn with Darwen Clinical Commissioning Group had experience of this service having undertaken an 18 month pilot in the past. Cath added that there is an emphasis in the NHS England Long Term Plan in respect of digital health, and the telemedicine service supports that. The members then proceeded to discuss the item. (Alex Walker joined the meeting at 13.33 during discussion of this item) Several members questioned the accuracy of the costings and predicted savings contained within the report. However, it was recognised that it is difficult when putting together a business case, to calculate an accurate cost per head figure. In Hyndburn there has been positive experience of the service, confidence has increased with care homes. A reduction in calls for GP home visits has been experienced. It was felt that more work could be done to improve consistency of advice given by the service. Cath added that some PCN areas are using the service more than others, the service capacity is being utilised but not equitably. Although there has been a small reduction in avoidable admission, it was considered an expensive solution. The service was originally part of the Care Home Vanguard and care homes with high admissions were the target, with it then being rolled out to other localities. The proposal is now to re-evaluate the service and roll out across East Lancashire. An opinion was expressed that some work is required with care homes to educate them on use of the service, and that there is a question as to whether the service is taking on board care responsibility which should lie with the care homes. Collette Walsh added that the service has not been robustly commissioned in the past and the ask is for a 12 months extension to work with the service to ensure it delivers results. The areas where it is working will not want to lose the service.

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It was commented that the service now needs rigorous evaluation, with an exit strategy drawn up outlining a way of managing activity should the service cease. Alex Walker added that in relation to the national position in respect of conveyance from Care Homes, the overall position is not great in this area. There would be a better dynamic through Primary Care Networks with regards to this service. It is difficult to establish what is making the impact around this as other initiatives are in place or coming on line, for example the Falls Service. Following the joint discussion, as it was an East Lancashire decision, members of the East Lancashire Clinical Commissioning Group Sustainability Committee agreed to: Approve the recommendation to extend the contract for a further 12 months period, on the conditions that:  The offer is standardised across East Lancashire to become a GP Triage model for all localities;  Within 6 months the service must achieve (at least) the national average for unplanned admissions to hospital from care homes.  Within 12 months the service must have moved into the upper quartile.  The service must work with the PCN/Leadership Teams on a PCN/Neighbourhood basis around admission avoidance and reducing length of stay at hospital. Evidence of effectiveness will be jointly monitored by the CCG and the PCN/Leadership Team.  The service will assist the PCN/Leadership Team with the Neighbourhood Integration Accelerator.  The cost envelope must decrease to £485,040 with a 10% tolerance and no reduction in the level of service (unless agreed by contract variation). This is agreed, subject to the following:  Robust evaluation and an exit strategy  6 month performance target to be brought back to Committees in Common  Enhanced dialogue with PCNs around future decisions in relation to the service. 19:127 Pennine Lancashire STEP Service

Angela Thornton attended to present this item.

This was an update from the recommendations from the Committees in Common meeting held in April 2019. Angela advised that all recommendations had been actioned and a 20% reduction in the contract value had been agreed. A robust service specification is now in place, including a number of Key Performance Indicators and the service will be managed robustly. Angela added that previously the service had been high cost and low usage, with the focus on mental health and not the wider criteria originally planned. Angela also advised that from April activity has increased. She also confirmed that notice has been served, the contract will not be renewed. There is a question now in relation to how the funding is utilise going forward and the recommendation is that the service is monitored closely and a report is brought back to Committees in Common in February 2020.

The item was then discussed: Concern was expressed regarding just ending the service, members would like to see work with Primary Care to embed the service in the community.

Angela added that commissioners needed to look at patient profiles and evaluate how those patients can be dealt with in the future. Commissioners are mindful to be working with Primary Care Networks.

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There was support for the funding to be invested into a Primary Care Network

offer and a local solution to replace this service. However, there was also an

opinion expressed that due to the system deficit, it had already been agreed at

previous meetings, that the funding should be re-invested as part of future Mental

Health investment standard requirements.

A member commented that in their opinion this was Social Prescribing as per the NHS 5 year Forward View. A question was asked as to whether there was an overlap with the Integration Accelerator. Collette Walsh responded that this was possibly correct and members would have an opportunity to consider this following the presentation to be given later in the meeting.

Alex Walker added that in his opinion Primary Care Networks needed to be linked, this was definitely linked to Social Prescribing and it was better to look at service provision on a local basis. Members added that they felt that an exit strategy needed to be discussed with Inspire regarding staff.

Members from both committees:  Noted the content of the paper.

 Noted that the recommendation from the April 2019 Committees in

Common meeting have been implemented. A.Thornton  Agreed for a paper to be brought back to the February 2020 meeting. 19:128 Children’s Autistic Spectrum Disorder (ASD) National Institute for Health and Care Excellence (NICE) Compliant pathway for 11-16 year olds

Kirsty Hamer attended to present this item.

The purpose of the paper was to recommend that Pennine Lancashire Clinical Commissioning Groups fund additional provision to meet the National Institute for Health and Care Excellence (NICE) compliance for Autistic Spectrum Disorder (ASD) diagnostic assessments for children aged 11 to 16 years. This would be an 18 month pilot provided by East Lancashire Child and Adolescent Services (ELCAS), whilst a review of therapy services is undertaken and the next phase for the ASD pathway/community neurodevelopmental pathway is undertaken. Kirsty added that gaps in diagnosis for 11 to 16 year olds had been highlighted during the Special Educational Needs and/or Disabilities (SEND) inspection. She added that commissioners had looked if the gaps could be covered within existing services, however, waiting times preclude this.

Members then discussed this item: Members voiced various opinions in relation to staffing for the proposed service:

 There was concern raised with regards to recruiting staff for the service and Kirsty was asked if there was potentially a risk associated with this. Kirsty responded that there was a risk, however in her opinion there is potential to free up staff from other areas.  There was also concern regarding the potential for gaps in staffing at Lancashire Care Foundation Trust (LCFT), if staff were to move to the new service.  An opinion was expressed that maybe it was preferable to have all contracts with one provider, to eliminate the competition element of the risk.  Another member was of the opinion that talent should be supported and if the new service could attract staff, this should be supported.  Praise was expressed in relation to the lead consultant at East Lancashire

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Hospital Trust (ELHT), who is driving this forward.

Kirsty responded that the planned Speech and Language re-design should

address some of the risk/concerns raised.

Members questioned if Lancashire Care Foundation Trust (LCFT) were already being paid for a service that they were not providing. Kirsty advised that technically the Clinical Commissioning Groups are not paying for this particular service, it is a new service. A question was raised regarding the legality of the proposal without going to procurement. Kirsty advised that as it is a pilot/test service, it was a low risk challenge, however she would double check the procurement advice.

A member expressed the need to look at the crossover between providers in relation to age thresholds for patients. There is a need to look at the wider picture in relation to contracting/working across. Members of both Committees agreed to:

 Support the additional funding for an 18 month pilot provided by East Lancashire Child and Adolescent Service (ELCAS) for the 11 to 16 year old pathway  Be provided with an update in March 2020 in relation to the implementation and mobilisation plan – this is subject to obtaining appropriate assurance in relation to procurement advice. In addition members asked for an update to be brought back to Committees in K. Hamer Common in January, 2020. At this point in the meeting, the Chair invited Collette Walsh to present a Section B Confidential item entitled Integration Accelerator (Alliance Agreement).

At 14:56 following the above confidential item, Dr Santhosh Davis and Dr Mark Dziobon left the meeting their departure did not affect quoracy. At 14:58 Kathryn Lord left the meeting, her departure also did not affect quoracy. The Chair then returned to the main agenda and proceeded with the following item. 19:129 Pennine Lancashire Prescribing and Medicines Optimisation Strategy 2019 – 25 and Work Programme 2019-20 Dr Lisa Rogan joined the meeting to present this paper. The Clinical Commissioning Group Medicines Optimisation Strategy provides an introduction and background outlining the rationale and purpose of the strategy. The strategic aims and objectives covering financial and budgetary implications, quality and safety, equity, variation and health inequalities have been outlined along with performance management mechanisms for monitoring expected outcomes. The importance of clinical engagement and leadership has been emphasised and a description of how National Institute for Health and Care Excellence (NICE) guidance will be implemented across the Clinical Commissioning Group along with strategies for managing the introduction of new medicines and decision making in line with the NHS Constitution has been highlighted. Given the frequency of adverse events and emergency admissions associated with prescribed medicines, approaches to addressing safety and quality pertaining to use of medicines have been described. Lisa added that in response to a number of queries from GP practices with respect to the significant workload involved in this year’s prescribing initiative scheme; polypharmacy reviews in particular some minor changes have been

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agreed encourage clinical engagement and enable more pragmatic delivery. The main changes are as follows:  ‘Respiratory Secondary Care Usage’ has been removed.  A relaxation of the ‘Management of COPD exacerbations’ target now means only patients with 4 or more acute issues of prednisolone require review and rescue pack actions plans.  The target for ‘de-prescribing to reduce inappropriate polypharmacy in frailty’ has changed to ‘below England Average or achieve a 5% relative reduction’.  The eligibility for self-care payment is now dependent on practices activating and actively engaging with OptimiseRx rather than a Net Ingredient Cost reduction.  The weighting of the payments for individual areas have been altered to better reflect the workload. Members from both Committees received the report for information.

Dr David White left the meeting at 15:05 at this point East Lancashire Clinical Commissioning Group Sustainability Committee were no longer quorate. Dr Penny Morris left the meeting at 15:07 at this point Blackburn with Darwen Clinical Commissioning Group Commissioning Business Group were no longer quorate. Dr Rakesh Sharma left the meeting at 15:17 during the following item. 19:130 Pennine Lancashire Winter Plan

Elizabeth Fleming attended to present this item, she declared a conflict of interest

in relation to her role being jointly funded by East Lancashire Hospitals Trust

(ELHT), the Chair noted this and asked her to proceed.

The purpose of the paper was to brief the Clinical Commissioning Groups on the position in relation to the winter plan and associated funding for 2019/20. Alex Walker added that compared to previous winter plans, there was a better balance of funding. He advised that both Elizabeth and he had taken part in a national call earlier that day and had been given a directive of measures which are absolutely required to be put in place.

Members then went on to discuss the paper: A query was raised with regards to section 3.1 in the paper:

Discussions are underway to identify disinvestment options to meet the funding gap. The disinvestment options in Pennine Lancashire are being managed by the Finance Resources Group. The opinion was that in the first instance, this should have come to Committees in Common for members to approve delegated decision authority to the Finance Resources Group. Roger Parr advised that this delegation could now be done through Chair’s action.

Members of both Committees present agreed to:  Support the roll out of the Pennine Lancashire Winter Plan and in doing so acknowledge the financial position outlined in relation to funding the ELHT element of the plan, and the ongoing process to identify disinvestment options.

As both Committees were not quorate at this stage in the meeting, these minutes will be circulated to those members not in attendance to seek support for this decision.

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Chair’s Action will be taken in relation to the delegation to the Finance Dr J. Resources Group in respect of scrutinising investments and Randall disinvestments to identify the additional funding required. 19:131 East Lancashire Medicines Management Board Minutes of the meetings held on 19th June 2019 and 21st August 2019 The Minutes of the East Lancashire Medicines Management Board meetings held on 19th June, 2019 and 21st August, 2019 were received for information.

The Chair then moved the meeting to the remaining Section B Confidential items. 19:132 Any other business Risk Register: There were no items for inclusion on the Risk Register. Future meeting dates, time and venue: Members from both Committees present agreed for future meetings to remain on a Wednesday, the Chair asked Elaine Craven to look at proposed dates from January 2020 onwards. 19:133 Date & Time of Next Meeting: The next meeting was confirmed as Wednesday, 20th November, 2019, 1.00 p.m. at Innovation Centre, Haslingden Road, Blackburn.

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NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group

Pennine Lancashire Committees in Common Minutes of the Blackburn with Darwen CCG Commissioning Business Group and East Lancashire CCG Sustainability Committee held on 20th November, 2019 at Innovation House

PRESENT: Blackburn with Darwen CCG Dr Ridwaan Ahmed Clinical Director – Quality & Primary Care Dr Adam Black GP Executive Member Paul Hinnigan Lay Member (Governance) Dr Geraint Jones Lay Member (Secondary Care Doctor – Retired) Dr Penny Morris Medical Director Roger Parr Deputy Chief Executive/Chief Finance Officer Dr Zaki Patel GP Executive Member East Lancashire CCG: David Swift Lay Member (Governance) - Chair Dr Mark Dziobon Medical Director Dr Santhosh Davis Clinical Advisor & Governing Body Member Dr David White Clinical Advisor & Governing Body Member Collette Walsh Deputy Director of Commissioning (Interim) Deidre Lewis Head of Finance

In Attendance: Debra Atkinson Head of Corporate Business Kirsty Hamer Commissioning Lead Children, Families and Maternity Services Elizabeth Fleming Head of Urgent & Emergency Care Stuart Hayton Urgent Care Transformation Manager Judith Johnston Head of Clinical Commissioning Elaine Craven Executive Assistant - Minutes

Min Ref: ACTION 19:141 Welcome and Chairs Update: The Chair welcomed members to the meeting. 19:142 Apologies: Apologies were received from Dr Julie Higgins, Dr John Randall, Kirsty Hollis, Dr Tom MacKenzie, Dr Rakesh Sharma, Alex Walker, Naz Zaman, Kathryn Lord, Lisa Rogan, Jason Newman and Aidan Kirkpatrick. 19:143 Governance: The Chair reminded members of their obligation to declare any interest they may have on any issues arising during the meeting, which might conflict with the business of the Clinical Commissioning Groups. The Chair referred members to the outline definitions in relation to types of interest, attached to the meeting agenda. Declarations of interest: There were no declarations of interest in Part A items. Quoracy: East Lancashire Clinical Commissioning Group Sustainability Committee was quorate. Deidre Lewis was in attendance as the Chief Finance Officer’s nominated deputy. Blackburn with Darwen Clinical Commissioning Group Commissioning Business

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Group was not quorate at this point in the meeting. Roger Parr joined the meeting at 1.10 p.m. (see minute reference 19:146) and at that point both committees were quorate. Collette Walsh was in attendance as the Director of Performance & Delivery’s nominated deputy. 19:144 Minutes of the meeting held on 16th October, 2019 The minutes of the meeting held on 16th October, 2019 were approved as an accurate record by members of East Lancs Sustainability Group. The Chair returned to this item later in the meeting when BwD CBG were quorate, and these minutes were ratified by that group at that stage

19:145 Action Matrix: 19:56 CAMHS – Improving access and crisis support for children and young people with emotional health and wellbeing: Kirsty Hamer updated on this action, she explained that recruitment issues experienced had resulted in a delay, with some staff starting in September and then the remainder due to start on 1st December. To allow for a suitable timeframe over which to measure key performance indicators, a report will be brought to the January Committees in Common meeting. 19:83 Governance Ongoing. 19:88 Mental Health Improvement Plan Collette Walsh agreed to follow up on this action and ensure that an update is brought to the December Committees in Common meeting. Dr Santhosh Davis advised that Clinical Directors were meeting later that afternoon and he would ensure that there was sufficient PCN Clinical Director engagement. 19:72 Tuberculosis Service Review Date yet to be agreed for a meeting, ongoing. 19:130 Pennine Lancashire Winter Plan Chairs action approved by EL. The matter was considered further later in the meeting when BwD was quorate, and was also approved by that Committee

19:146 Child and Adolescent Mental Health Services (CAMHS) Third Sector Contracts 2020/2021 Roger Parr joined the meeting at 1.10 p.m. for this item, from this point both committees were quorate. Kirsty Hamer presented this item. The paper provided a summary of the evaluation of the third sector contracts for Child and Adolescent Mental Health Services (CAMHS) supported through Pennine Lancashire CAMHS Transformation Funding, and a request to continue funding of the third sector contracts for 2020/21. CAMHS is undergoing a redesign aligned with the THRIVE model. It is anticipated that the voluntary sector will be a key part of the CAMHS offer across Pennine Lancashire within THRIVE. The paper therefore recommended that Pennine Lancashire CAMHS third sector contracts are continued during 2020/21 with a view that their offer will form part of the CAMHS model which will commence implementation from April 2020 onwards. Kirsty added that feedback has been excellent and it is recognised that third sector service contracts demonstrate good value for money. Members then went on to discuss the item: A view was expressed, that in line with the Clinical Commissioning Group’s direction

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of travel with regards to service transformation, consultation with Primary Care Networks should be a pre-requisite when considering contract extensions. This should be clear in all papers presented to Committees in Common. Kirsty responded that Primary Care Networks had not been consulted, however, feedback received from GPs was positive. Collette Walsh added that she agreed that it should now be standard practice to consult with Primary Care Networks across all contracts. A suggestion was made that an additional field be added to the report cover sheet to confirm for Committee Members that Primary Care Networks had been consulted. It was also requested that more attention be paid by report authors when completing the report front cover sheet, ensuring that they are completed fully and accurately. An observation was made in relation to the number of schools involved in Place2Be, as the report only highlights the involvement of 4 schools across East Lancashire. It was felt that schools needed to be encouraged to engage and contribute. Kirsty advised that it was difficult to obtain commitment from some schools, however there is an initiative going forward to improve this. Dr Santhosh Davis advised that he attends a forum in Burnley that would be a useful link to schools in that area. The Chair asked for confirmation that the necessary finances were available and Deidre Lewis confirmed that there were funds available in the baseline. Members of both committees agreed to:  Note the contents of the paper;  Approve the funding to continue the third sector contracts from April 2020 until the end of March 2021.

19:147 AGE UK Lancashire – Hospital after care service Elizabeth Fleming and Stuart Hayton attended to present this item. Elizabeth declared a conflict of interest as her role is jointly funded by East Lancashire Hospitals Trust (ELHT). The Committee considered the conflict, and agreed that Elizabeth could present the paper and participate in discussions, noting that she has no voting powers within CiC. The Age UK Lancashire Hospital Aftercare Service helps prevent unplanned acute hospital admissions and also assists hospital discharge for those who are medically fit who may have been at risk of an extended stay without the support. The service supports any adult (18+yrs) who may be vulnerable. A review in 2018 highlighted a decrease in referral rates in 2018 whilst the numbers of patients discharged via the Home First pathway continued to increase as the Home First service principles became more embedded. The contract was extended until March 2020 with a requirement for further review to understand the reasons for a decline in overall referrals in 2018, and to explore opportunities to enable the Hospital Aftercare Service to become fully embedded into hospital discharge processes. In April 2019, a comprehensive service improvement plan was implemented by Age UK Lancashire and the outcomes are outlined in this paper alongside a recommendation for future development. Elizabeth advised that there are Interdependencies between this and other services commissioned. A dip in some activity levels had been experienced previously, however arrangements have been put in place and levels have increased, bringing down some of the unit costs. Services are focused on individuals who are frail and/or are vulnerable. It was noted that the paper has previously been supported at Senior Management Team meeting, and because this service is funded from the Better Care Fund (BwD LA & BwD CCG and LCC & EL CCG monies), with the contract held by EL CCG, that, it will also be considered by Blackburn with Darwen

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Joint Commissioning Recommendations Group, and also through the LCC commissioning governance process. The paper recommended a two year contract extension, with national inflationary uplift and a notice period of 3 months. An opinion was expressed that this looks like an expensive service and a request for PCN stakeholder consultation along with standardised review processes for all commissioned services. A concern was raised in relation to paragraph 5.2 of the report, and the possibility for issues in relation to recruitment and retention if the committees were to only approve a 1 year extension. Collette Walsh suggested that a 1 year extension with an option for a second year (1 +1) would project a positive signal and a good robust offer. Plus this would help with recruitment. Members of both committees agreed to:  Note the content of the paper;  Approve a 1 Plus 1 year contract extension at current contract value with national inflationary uplift applied (to be confirmed when planning guidance is published). 19:148 Contract with PDS Medical for provision of Rossendale Minor Injuries Unit (MIU) Elizabeth Fleming attended to present this item. The contract for the minor injuries unit service at Rossendale Health Centre will come to an end on 31st March 2020. Work is currently underway developing a model for same day primary Care in Pennine Lancashire. As part of this the future configuration of urgent treatment centres and other urgent care facilities will be decided upon. Whilst this work continues to develop it is recommended that the contract for Rossendale Minor Injuries Unit is extended for a period of 2 years until 31st March 2022. Elizabeth added that there will need to be work undertaken with the Rossendale Primary Care Networks in relation to this, and the contract extension will give time for place based conversations in relation to the future of the Minor Injuries Unit. Members then discussed the item: An opinion was expressed that having a local minor injuries unit can actually increase activity and cost. If the facility wasn’t in place, less genuine cases would be more likely to self-care rather than make a long journey to an Accident & Emergency Department. More information was requested in relation to health outcomes. A discussion took place in relation to the procurement process. A view was expressed that definitive timescales and milestones need to be set going forward. Elizabeth advised that by the end of the financial year she would be in a position to bring something back to committees in common. Similar concerns and queries were raised as in agenda item 19:147, in relation to the awarding of a 2 year extension and the need for consultation with Primary Care Networks. In response to a query relating to the notice period on this contract, it was advised that when the contract is extended that this would be 6 months. Discussion continued which included various suggestions in relation to a break clause, conditions, shorter timescales There was a suggestion that a 2 year contract extension could be awarded with a break clause after 1 year, but conditions to work to would need to be made clear.

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Following the joint discussion, as it was an East Lancashire decision, members of the East Lancashire Clinical Commissioning Group Sustainability Committee agreed to:  A 2 year contract extension with caveated 1 year break clause and a 6 month notice period. Current contract value with national inflationary uplift applied (to be confirmed when planning guidance is published).  The above extension on condition that the provider works with Primary Care Networks and Commissioners and aligns with emerging place based offers. 19:149 New Approaches to Joint Responsibilities for Section 117 aftercare – Pennine Lancashire CCGs and Lancashire County Council and Blackburn with Darwen Borough Council Judith Johnston attended to present this item. The report introduced proposed new approaches between Lancashire County Council and East Lancashire Clinical Commissioning Group, Blackburn with Darwen Clinical Commissioning Group and Council for joint responsibilities under the Mental Health Act 1983 Section 117 aftercare. It outlines the implications for the Clinical Commissioning Groups and highlights the opportunities and risks should Committees in Common members recommend adoption of the proposed changes in practice. Judith added that the object is to improve outcomes for patients, and mitigate risks going forward. Roger Parr advised that Blackburn with Darwen Council is yet to respond as they are looking at re-modelling. Members then discussed the item. A query was raised as to what the Section 117 Act says in relation to financial responsibility. Judith advised that although there was no specific detail in the act, there is a framework in place which outlines organisational responsibilities. Roger Parr suggested, to enable closer work with the Council and an opportunity to look at the governance, 1st April would give time to overcome the difficulties of obtaining data and bring back a report to Committees in Common containing the required information. Members from both Committees agreed to:  Defer the item to April 2020 Committees in Common.

19:150 Any other business:

Risk Register: There were no items for inclusion on the Risk Register.

19:151 Date & Time of next meeting:

The next meeting was confirmed as Wednesday, 18th December, 2019, 1.00 p.m. at Walshaw House, Regent Street, Nelson.

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CLINICAL COMMISSIONING GROUP (CCG) Minutes of the Primary Care Commissioning Committee (PCCC) held on Tuesday 17th September 2019 Board Room, Fusion House PRESENT: Mr Graham Burgess CCG Chair Dr Nigel Horsfield Lay Member (Deputy Chair) Mr Roger Parr Deputy Chief Officer /Chief Finance Officer Dr Geraint Jones Lay Member Secondary Care Doctor (Retired) Mr Paul Hinnigan Lay Member Governance

IN ATTENDANCE: Mrs Catherine Lawless Primary Care Support Assistant (Minutes) Mr Peter Sellars Primary Care Transformation Manager Mr David Massey Local Medical Council Mrs Sarah Danson Primary Care Contracts Manager Mrs Barbara McKeowon Primary Care Manager

Min No: 1. Chair’s Welcome

The Chair welcomed everyone to the meeting and gave a short briefing with regards to the content of the agenda.

The Chair reminded members that the meeting will be digitally recorded in line with the Primary Care Co Commissioning Terms of Reference. 2. Apologies for Absence and Confirmation of Quoracy

Apologies for absence were received from: Dr Preeti Shukla, Dr S Gunn, Mrs Kathryn Lord and Sarah Johns. The meeting was confirmed as quorate. 3. Declarations of Interest

The Chair reminded Members of their obligation to declare any interest that they may have on any issues arising at Committee Meetings which might conflict with the business of BwD CCG. The Chair asked members if they would like to declare any Conflicts of Interest (CoI) relating to items on the agenda.

Declarations declared by members of the PCCC are listed in the CCG’s Register of Interests. The Register is available, either via the Secretary to the GB or the CCG website via the following link:

http://www.blackburnwithdarwenccg.nhs.uk/about-us/registers-interests/

The Chair reminded those present that if, during the course of discussion, a CoI became apparent, it should be declared at that point.

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4. Questions from the Public

No questions had been received from members of the public. 5. Draft Minutes of the Meeting held on 23rd July 2019

The minutes of the previous meeting were reviewed and accepted as an accurate record.

RESOLVED That the minutes of the meeting held on 23rd July were approved as an accurate record. 6. Action Matrix

Actions noted.

Item 10 Practice Relocation Proposal. Item completed. Item closed.

Item 14 Physicians Associate Job Description. PS advised that he has fed back the PCCC’s comments whether any development and support is given to new professionals. The Practice Manager has assured the PCCC that there is support and guidance given to their physicians associate on a regular basis and that it is also outlined in their job description. Item closed. 7. Matters Arising

Matters to be discussed as agenda items. 8. Primary Care Update Report

Mr Peter Sellars presented the Primary Care Update report which brought to the attention of members National and Local Primary Care news and information.

General Practice QOEST: PS advised that potential contract changes are being discussed with Pennine Lancashire CCGs’, with the proposal to have a joint Pennine quality element built in to the contract. Discussions are ongoing with regards to the future of the QOEST framework and plan, taking into account the new GMS Contract and Primary Care Network DES.

Blackburn with Darwen Primary Care Network Direct Enhanced Service (PCN DES): PS provided Committee members with an overview of timeframes, milestones and key achievements to date for Blackburn with Darwen Primary Care Networks with regards to the PCN DES.

Linking Services between PCNs - PS advised that all community teams align their caseloads to GP Practices in the PCN footprint where possible. This includes the recent relocation of practices in different neighbourhoods. For patients living outside the neighbourhood a pragmatic approach is taken whereby a district nurse from a different neighbourhood may see the patient. It was noted that this will remain consistent throughout the episode of care and is also consistent with social care providers.

Apex/Insight Workforce Tool: PS advised that 100% of Blackburn with Darwen practices have signed up to the installation of the tool and have received their initial training. To date there are 2 Blackburn with Darwen practices who have completed the installation and training process and a further 8 practices midway through. Apex Insight was temporarily paused in April 2019 whilst NHS England worked through their position on an information governance query. NHSE are now satisfied that the query has been resolved satisfactorily and that they have no concerns. Deployment of the tool to the remaining 13 practices can now commence. The CCG and the Primary Care Network Clinical Leads are now in the process of discussing how they would like the Apex Insight Tool at Enterprise level product be used across Blackburn with Darwen. A demonstration of the Apex/Insight Workforce Tool at Enterprise level is planned for November.

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Online Consultations – MyGP App – PS advised members that the GP Forward View Funds were allocated to Healthier Lancs & South Cumbria Digital Team to purchase a system wide solution for all practices. The product selected is provided from a company called Iplato. The name of the software is MyGP and PreGP. In addition to meeting the NHSE requirements for online consultation, this system also includes multiple functions to assist practices with achieving forthcoming GMS targets for online services and also includes the ability for 2 way messaging, booking and cancelling appointments, ordering medication, data sharing preferences, links to e-referral, symptom checker and NHS Organ donation service. PS advised Committee members that deployment is going well for Blackburn with Darwen with all practices now actively promoting the MyGP App.

Questions and answers followed:

PCN DES - The Chair asked whether discussions are taking place with East Lancashire CCG to ascertain whether their PCN plan of delivery is the same as Blackburn with Darwen’s in order to get uniformity across Pennine Lancashire. In reply PS reminded members that the PCN DES is a National Directive and that all CCGs should be carrying out the same function. In conclusion he advised that he is in regular discussions with East Lancashire CCG Colleagues as to their progress in delivering the PCN DES.

CONCLUSION: That the PCCC noted the Primary Care Update.

9. Primary Care Estates Strategy – PS asked the Committee to note the updated Blackburn with Darwen Estates Strategy and advised of the changes to the document. It was noted that Blackburn with Darwen CCG have undertaken a review of the Primary Care estates across Blackburn with Darwen in order to align the future estate with commissioning service requirements. It was noted that the estate plan adopts a system wide view reinforcing the importance of integrated services within any future Primary Care Estates Development. PS advised that is important that any new estates are fit for the future and are able to provide services within a new model of care. PS advised that the strategy will evolve in the future, ensuring it continues to meet the needs of patients and the healthcare system. PS advised that the development at Bangor Street Health Centre in the North Neighbourhood is coming to an end and that there are plans to hold an open day. Committee members were advised that PS has spoken to the CCGs Communications Team who is going to promote the new health centre across Blackburn with Darwen.

Questions and answers followed:

PH made comment that the document does not mention what estate the CCG currently has and recommended that a baseline assessment should be carried out identifying what estate the CCG currently has and what the CCG plan to have/develop across Blackburn with Darwen over the next five years and asked that the Borough Council be also contacted to ascertain what new building developments are to be carried out across the Borough which will impact on GP practices. RP advised that One Partnerships has carried out a baseline assessment of local assets across Lancashire. Once finalised the baseline assessment report will be used as part of the Pennine Lancashire Estates Strategy to which there will be a Primary Care element contained within the report.

ACTION: RP to provide the baseline assessment at the November meeting of the PCCC.

ACTION: PS to outline the priorities of what the Borough may need over the next five years and advise of any associated costings involved from the baseline. 10. Developing the General Practice Workforce – SD advised that the purpose of the paper is to outline the current position in relation to the Blackburn with Darwen GP workforce footprint and to explore possible approaches for recruiting and retaining GPs across the Borough. SD advised that Appendix 1 provides a detailed analysis of the current Blackburn with Darwen GP workforce position carried out by MLCSU. It was noted that this data is extracted from the NHS Digital Practice Workforce Data submission as of 30th June 2019 and is submitted by Blackburn with Darwen GP Practices. SD advised of the initiatives to try and recruit new GPs to work in Page 3 of 5

general practice nationally and also the possible approaches to try and retain GPs to remain in general practice. SD advised that recognising the need to recruit as well as retain GPs and other health professionals, this paper proposes that a wide ranging approach be undertaken to include all elements contained within the document. SD advised that this would also need to be in alignment with the ICS and NHSE strategic direction plans and be built into a realistic timeframe. In conclusion PH advised that the proposal mentions a Programme Management approach to systematically design clear structures and opportunities in collaboration with primary care employers and that it would also need to be aligned with the ICS and NHS strategic direction. RP advised that discussions have already taken place across the executive team who have agreed that it is a good idea and that they are supportive of the proposal and asked that a Primary Care Teams response be brought to the next meeting of the PCCC. ACTION: PS - Primary Care Teams response to the proposal to the November PCCC meeting outlining next steps, milestones and actions and resources required to deliver.

Questions and answers followed:

The Committee queried whether the quality of the data in appendix 1 is correct as three practices are showing as ranked in the lowest quartile for both GP and Nurses. PS advised that the data is inputted by BwD GP Practices to which a number of practices had been experiencing problems. Practices in September 2019 are again to submit their workforce data. This data will be brought to the PCCCs attention. ACTION: Blackburn with Darwen GP Workforce data to be brought to the next meeting of the PCCC. PS to check the data for the three Blackburn with Darwen practices who are ranked in the lowest quartile.

Discussions followed as to whether GPs who plan to retire/leave the practice are given an exit interview to ascertain why they are leaving, or when they are approaching retirement age is there any discussions undertaken as to when they plan to retire. Committee members were in agreement that this was a good suggestion going forward. ACTION: SD to feedback comments from the Committee to NHSE that a process should be in place around GPs approaching retirement age.

11. Primary Care Quality Processes - SD asked Committee members to note the contents of the paper which is to provide an update in relation to the mechanisms in place to gain the necessary assurances with regards to the quality of GP Primary Care Services commissioned by the CCG. It was noted that the role of the Pennine GP Quality Group is to develop, implement and monitor a Primary Care Quality review process for GP practices across Pennine Lancashire who have been rated as inadequate or requires improvement.

Questions and answers:

PH queried whether the current quoracy arrangements for the meeting are correct as it reads that only one GP needs to be present. ACTION: SD to confirm quoracy arrangements.

Conclusion: That the PCCC noted the contents of the paper. 12. Primary Care Financial Summary – RP asked the Committee to note Primary Care Income and Expenditure as of month 4.

CONCLUSION: That the PCCC noted the Primary Care Financial summary as of month 4. 13 Primary Care Work Plan - PS asked the Committee to note the Primary Care Work Plan and asked that the Primary Care Strategy that is due to be brought to the PCCCs attention in the November be put back until January2020 in order for it to be aligned with the Lancashire & South Cumbria Primary Care Strategy.

CONCLUSION: That the Committee agreed to this amendment and asked that the Lancashire and South Cumbria Primary Care Strategy be shared with PCCC members and to be an item at the November meeting of the PCCC. ACTION: PS to share Lancashire & South Cumbria Primary Care Strategy. Page 4 of 5

AOB Winter Resilience and Planning/Resilience Funding – RP advised that there has been a resource identified of £55k which is part of Pennine Lancashire resilience monies which is being aligned to BwD Primary Care and also a £20K underspend in the Primary Care budget which he advised has to be spent in year and asked that the PCCC give delegated authority to spend this money before year end on a number of schemes.

Conclusion: That the PCCC gave approval to the expenditure and asked for details of the schemes be brought to the Committees attention.

ACTION: RP to provide details of the schemes and their associated expenditure to the next PCCC. 13. Date and Time of Next Meeting The next meeting is scheduled for Tuesday 19th November 12.30 – 2.00 p.m. Board Room, Fusion House.

The Chair thanked everyone for their attendance and input and stated that the meeting would now move into Part 2.

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CLINICAL COMMISSIONING GROUP (CCG)

Minutes of the Audit Committee Meeting held on 20th August 2019 2pm in the Small Meeting Room, Fusion House Evolution Park, Haslingden Road, Blackburn, BB1 2FD

PRESENT: Mr Paul Hinnigan Lay Member – Governance (Chair) Dr Nigel Horsfield Lay Member Dr John Randall General Practitioner (GP) Executive Member

IN ATTENDANCE: Mr Roger Parr Deputy Chief Officer/Chief Finance Officer Mrs Claire Moir Governance, Assurance and Delivery Manager Mr Darrell Davies Anti-Fraud Manager, Mersey Internal Audit Agency (MIAA) Mrs Marianne Dixon Audit Manager, Grant Thornton UK LLP Mrs Anne Holden Corporate Administration Manager, East Lancashire CCG

Min No Item Action By 19.043 Chair’s Welcome

The Chair welcomed everyone to the meeting of the Clinical Commissioning Group’s (CCG’s) Audit Committee (AC) and introductions were made.

19.044 Apologies for Absence and Confirmation of Quoracy

Apologies had been received from Mrs Lisa Warner, Senior Internal Audit Manager, MIAA and Mr John Farrar, Engagement Lead, Grant Thornton UK LLP. It was also noted that Dr Geraint Jones was not present.

The meeting was confirmed as quorate.

19.045 Declarations of Interest

The Chair invited members to declare any interests they may have in relation to items on the agenda.

No declarations of interest were made.

Declarations declared by CCG staff are listed in the CCG’s Registers of Interests. The Registers are available, either via the Secretary to the Governing Body (GB), or on the CCG website via the following link:

http://www.blackburnwithdarwenccg.nhs.uk/about-us/registers-interests/

The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting.

19.046 Draft Minutes of Previous Meetings

19.046.1 Minutes of the Meeting held on 23rd April 2019 The minutes of the meeting held on 23rd April 2019 were reviewed and agreed as an accurate record.

RESOLVED: That the minutes of the meeting held on 23rd April 2019 were approved as an accurate record.

19.046.2 Minutes of the Meeting held on 23rd May 2019 The minutes of the meeting held on 23rd May 2019 were reviewed and agreed as an accurate record.

RESOLVED: That the minutes of the meeting held on 23rd May 2019 were approved as an accurate record.

19.047 Matters Arising

There were no matters arising.

19.047.1 Action Matrix

The Action Matrix was reviewed and the following actions were noted:

Min Ref: 19.062/18.072.1/19.005.1/19.024.1 - Review of Effective Arrangements in Place for Staff to Raise a Concern

Mr Darrell Davies confirmed this related to responses received following the staff survey. He advised there had been no significant increase in the numbers of responses received and felt that going forward there is a need to consider how to better engage with staff to achieve a better response. He pointed out there have always been good levels of people understanding the process. The Action was closed.

Min Ref: 19.025 - Risk Management Report

Mrs Claire Moir confirmed this item was included on the agenda and an update was included in her report.

Min Ref: 19.041 - Integrated Care System

Mr Roger Parr provided an update in respect of the funding provided by the CCG to the Integrated Care System (ICS) and Integrated Care Partnership (ICP) and if this was considered to be providing value for money (VfM).

Following discussion at the previous meeting, Mr Parr had agreed to circulate information to members regarding ICS spend and the input from BwD CCG. However Members did not recall receiving this and it was agreed to check if this was circulated and, if not, issue to Members.

He advised that the majority of ICS funding is central funding and not from CCG allocations. He stated that the CCG is not able to take a view on VfM, but advised that CCGs are kept appraised on activity at ICP level.

The Chair acknowledged it was difficult to measure whether VfM was being delivered, but felt that the CCGs should still review the progress being made by the ICS on the basis that the CCGs are providing some funding, and that the ICS is in effect a committee constituted by the CCGs.

It was confirmed that the ICS have produced an annual work plan which had previously been received by the Governing Body. The Chair proposed that this is reviewed in 12 months to understand what has been successfully delivered against the Plan, to provide a benchmark. As an example, he referred to the contract with the Commissioning Support Unit (CSU) and a similar agreed work plan which the CSU was measured against in terms of achievement.

Page 2 of 10 Minutes approved by the Chair: 16.9.19

ACTION: . Check if Members received the financial information following the last meeting - circulate if not. PM . Bring forward in 12 months’ time to understand what has been achieved and how this is measured.

19.048 Risk Management Report

Mrs Moir presented the Risk Management Report, which provided the AC with an update on the management of risks held on the full Corporate Risk Register (CRR) for May – August 2019 and highlighted key points:

 Strategic Risk Management – Corporate Objectives Following the appointment of a Joint Chief Officer (CO) in January 2019, there was agreement to develop a set of shared Corporate Objectives. These were presented to the Joint GB Development Session in June and subject to minor amendments, were approved and outlined in the report. Work is also ongoing to develop a corporate business plan which will align with the corporate objectives.

Members were reminded that Dr Julie Higgins had attended the last meeting of the AC and had detailed discussion about aligned working, proposing that a joint workshop be arranged to review processes for risk management. Mrs Moir confirmed that a meeting had taken place with the two AC Chairs when it was agreed to develop a joint Risk Management Strategy and produce a composite Risk Register. It was acknowledged that the CCGs remain two statutory organisations and each organisation will retain responsibility for managing their own risks.

 Operational Risk Management Mrs Moir advised that the Governing Body Assurance Framework (GBAF) is managed differently by each organisation. She confirmed that for EL CCG the GBAF holds risks with a rating of 15 and above, whilst BwD CCG set strategic risks against the corporate objectives. Following discussion it has been agreed to adopt a common approach and include risks with a rating of over 15 on the GBAF which would be presented to the GB for review.

Mrs Moir confirmed she was a member of the Risk Management and Compliance Group, which was now a joint meeting across both EL and BwD CCGs and the governance arrangements and Terms of Reference were currently being reviewed.

 Corporate Risk Review: May – August 2019

In July a full review of all risks held on the CRR was undertaken with risk owners to look at target risk ratings. Mrs Moir provided feedback following discussion at the July meeting of the Pennine Lancashire Quality Committee regarding the achievement of the NHS Constitution performance indicators and associated Quality Premium payments. As the financial element of the risks had not been achieved, it was agreed these would be identified separately as a stand-alone risk once the national guidance regarding the Quality Premium payments is published.

There were currently eleven operational risks and six strategic risks held on the Register and full details of the risks were outlined in Appendix 1 of the report. The following risks were reviewed during the reporting period with no change in risk rating:

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 2013/05: Accident & Emergency 4 Hour Standard.  2018/02: Failure of the NW Ambulance Service to adhere to targets outlined in the Ambulance Response Programme.  2016/05: 18 Week Referral to Treatment (RTT).  2016/04: Waiting Times for Suspected Cancer – 62 day wait for first treatment following an urgent GP referral.  2019/01: Mental Health System Pressures impacting on quality & performance of services.  2018/03: Initial Health Assessments (IHA) for looked after children are not being completed within the 20 working day statutory timeframe.  2016/03: Failure to meet the reforms for children with special educational needs and disability (SEND) as set out in the Children’s Act (2014).  2017/03: Failure to achieve the stroke quality requirements for people who have had a stroke being admitted to an acute stroke unit within 4 hours.  2018/01: Loss of residential and nursing home beds for care home sector and impact upon system resilience.

 Risks Closed During the Reporting Period The following risk was approved for closure during the reporting period:

 2015/04: Inability of patients aged 18 years and under to access Tier 4 Mental Health In-patient beds when assessed as requiring that facility.

 Risks Opened During the Reporting Period The following new risk has been opened during the reporting period regarding the possible detrimental impact upon services. The CCGs are involved in ongoing discussion with NHS England to mitigate the risk:

 (265) UK’s exit from the EU (with a deal or no deal) presents unknown risks that may adversely affect healthcare delivery across Pennine Lancashire.

Discussion followed and a number of points were raised.

Dr John Randall requested an example of a risk that would be different for one CCG and not another. Mrs Moir pointed out that 8 out of 9 were shared risks; however, the risk appetite is different across both organisations. Members were advised that BwD CCG included a historic risk relating to stroke, but EL CCG did not have this on their register. The LD review was included for EL, however following a risk assessment it was not deemed to be appropriate to include for BwD. It was also noted that the Registers often held the same risk but with a different risk rating, highlighting different outcomes from different providers etc.

In terms of stroke services, the Chair asked if there was different performance across each CCG. Mrs Moir described the SSNAP measures which contained a number of clinical indicators, confirming that on the whole performance was good, but one element was not, particularly achievement of the 4 hour target. It was noted that a presentation had recently been received at the Committees in Common relating to stroke services. Members were informed that this issue remained on the Risk Register for BwD CCG and will be included on the Risk Register for EL CCG.

The Chair referred to the A&E four hour standard and the initial rating of 20, which currently remained at 20, however by the end of March 2020 was forecast to reduce to a rating of 4.

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Members were advised that East Lancashire Hospitals NHS Trust (ELHT) have agreed with NHS E and CCGs that they will not achieve the 95% target and instead have agreed a series of in month targets to achieve. There is therefore a need to understand what we are measuring against, to understand if the target has been achieved on a monthly basis

The Chair asked that further discussions take place with risk owners to undertake a realistic appraisal and obtain a measurable risk, providing clarity that the revised targets can be achieved. It was noted that assurances will also be monitored through the A&E Delivery Board. A presentation to the last meeting of the Pennine Lancashire Quality Committee outlined issues that contribute to the position and it was recognised there is not an easy solution.

The Chair also made reference to the North West Ambulance Service (NWAS) Ambulance Response Programme which had been rated 16 for the last 5 years and now had a reduced target of 8 by the end of March 2020. Mrs Moir outlined actions taken to try to mitigate the risk which included establishing a Steering Group to deliver improvements in conveyance avoidance. It was also considered there is little the CCG can do directly to influence the risk; however it was felt important that it remains on the Register.

The Chair questioned whether the GB is being provided with realistic information on whether target risk ratings can be delivered. He felt that both CCGs working together to review and standardise current risk processes was a positive way forward.

In terms of next steps, processes would be monitored and further considered through the Pennine Lancashire Quality Committee and a list of initiatives being undertaken to mitigate key ELHT risks on the CCGs’ Risk Registers would be requested.

In conclusion, Members acknowledged the changes set out in the report. It was recognised there are still further refinements to be made to ensure the action plans reflect a realistic target.

ACTION: . Mrs Moir to review the process and take through the Pennine CM Lancashire Quality Committee.

The Chair highlighted the need to ensure the AC is happy with the assurance the GB receives about risks and that the overall performance is reported effectively.

RESOLVED: That the AC noted the content of the report.

19.049 External Audit

19.049.1 Annual Audit Letter 2018/19

Mrs Marianne Dixon presented the Annual Audit Letter which provided a summary of the key findings arising from the work carried out, details of which had previously been seen by the Committee.

Appendix A provided details of reports issued and fees. With reference to the Mental Health Investment Standard, guidance had now been received, the engagement letter had been signed and work had commenced. Mrs Dixon was confident that the work can be done within the fee quoted. It was anticipated the work would be undertaken within the next few weeks and reported on in early September. It was noted that under the Fees heading in Appendix 1, the year should read

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2017/18 and not 2016/17.

RESOLVED: That the AC receive the report and present to the Governing Body for completion.

19.050 Internal Audit

Mr Darrell Davies presented the following documents on behalf of Internal Audit.

19.050.1 Progress Report

The report outlined progress against the Internal Audit Plan for 2019/20 and highlighted key messages.

Since the last meeting of the AC, final reports had been issued in respect of four Post Payment Verification (PPV) visits to GP practices. Mr Davies provided details of the findings and work is ongoing with practices to make any necessary improvements. Members were made aware of a number of concerns which had been identified at one of the practices, confirming that a meeting had been requested with NHS England (NHSE) to discuss in more detail. Based on the evidence, it was considered that this should be further pursued with the NHS Counter Fraud Team, but that it was the responsibility of NHSE to undertake this. The General Medical Council (GMC) was also aware of the position which is being monitoring to understand how this will be taken forward.

The Chair requested that he be kept aware of any NHSE decisions or further action on this matter between meetings of the AC. It was also noted that this issue had been discussed in Part 2 of the Primary Care Co-Commissioning Committee.

The Chair asked if there were any key generic messages to share with all practices.

In terms of future plans and taking into account the issues raised, the Chair asked if consideration had been given to undertaking further visits to different practices.

ACTION: . Mr Parr to liaise with Mrs Lisa Warner to include further PPV visits in RP the current Internal Audit Work Plan; . Mr Peter Sellars, Primary Care Transformation Lead, to issue a PS generic message to all practices outlining good practice.

Work on delivery of the 2019/20 Internal Audit Plan was now underway and details of the current reviews were highlighted. It was confirmed that delivery of the plan is on track.

It was noted that the CCG had requested the review of Safeguarding be postponed to Q4. To compensate for this, the audit of Primary Medical Care Commissioning had been brought forward, in agreement with the Chief Finance Officer.

In terms of follow up work, good progress had been made in addressing recommendations relating to previous audit reviews, with seven of the nine audit recommendations being implemented. The remaining two were partially implemented and there were no outstanding concerns.

RESOLVED: That the AC noted the content of the report.

19.050.2 Head of Internal Audit Opinions 2018/19

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Following the April 2019 Audit Committee, there was an action to provide an anonymised graph of assurance ratings of CCGs.

The report set out a range of CCG Head of Internal Audit opinions provided by Mersey Internal Audit Agency (MIAA) in 2017/18 and 2018/19. The data was split between MIAA overall and Lancashire CCGs.

Mr Davies confirmed that the majority of clients received Substantial Assurance as there are well developed processes in place across the vast majority of organisations.

ACTION: It was agreed the report would be shared with Dr Higgins. RP

RESOLVED: That the AC receive the report and the Action is closed.

19.050.3 Insight Update

The report provided details of MIAA events, briefing notes and benchmarking reports and was presented for information.

RESOLVED: That the AC receive the report for information.

19.051 Anti-Fraud

Mr Davies presented the Anti-Fraud Progress Report which set out the work undertaken during the period April to July 2019 and highlighted key messages.

He had met with Mrs Moir to ensure the fraud risks are incorporated into the risk management process. It was also agreed to populate a number of risk assessment documents to share with the Risk Group to have them formally considered, to raise this standard to Green.

There were ongoing concerns relating to QOF payments. It was noted the responsibility for QOF related activity from a fraud investigation perspective, rests with NHS E and discussions are ongoing with them to take this forward. With reference to the National Fraud Initiative, it was confirmed that all creditor issues had been resolved.

Mr Davies wished to place on record his thanks to Alice Haydock and Alistair Black for their support with the anti-fraud work.

He drew Members attention to the Electronic Staff Record (ESR) self-serve fraud alert regarding a salary diversion email targeting NHS employees across the NW, encouraging staff to log in to a false ESR website. It was noted that some staff in other organisations have been affected by this fraud and work is ongoing to ensure this does not happen again.

In conclusion, Mr Davies confirmed that in terms of delivery, all work was progressing as planned.

RESOLVED: That the AC noted the content of the report. 19.052 Losses and Special Payments

Mr Parr presented the Losses and Special Payments Report for 1st April 2019 – 30th June 2019 which confirmed there had been no losses recorded during the reporting period.

RESOLVED: That the AC noted the Losses and Special Payments recorded for the period 1st April 2019 – 30th June 2019

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19.053 Waivers and Standing Orders

Mr Parr presented the Waivers and Standing Orders report for the period 1st April 2019 – 30th June 2019.

There had been one single tender waiver signed during the period relating to training on Pervasive Cybernetics for Suicide Prevention and Intervention in Lancashire and South Cumbria and ICS funding was received to support this.

There were no questions.

RESOLVED: That the AC noted the Single Tender Waivers recorded for the period 1st April 2019 – 30th June 2019.

19.054 Corporate Registers

Mr Parr presented the Corporate Registers Report, which provided an update on the registers held by the CCG.

The report provided details of changes to the Conflict of Interest (CoI) Registers in respect of Governing Body Members, Staff and Senate. Mr Parr paid tribute to Mrs Pauline Milligan, Governing Body Secretary, for her good work to strengthen the processes, following a review of the Corporate Registers by Internal Audit.

The Chair referred to the GB Register of Interests and queried whether the types of CoI declared were being categorised consistently for all GB members.

ACTION: . It was agreed to review the Types of CoI being recorded to ensure consistency. CM/AH

There were no further questions.

RESOLVED: That the AC noted the content of the report.

19.055 Annual Governance Statement 2019/20 Progress Report

Mrs Moir presented the report which outlined progress against the Annual Governance Statement during the period April to August 2019 under the following headings and key points were highlighted:

. CCG Governance Framework - Following the appointment of the Joint AO and creation of the Medical Director role, changes to the voting GB members have been proposed to maintain a clinical majority. - The BwD CCG Commissioning Business Group and EL CCG Sustainability Committee continue to meet as Committees in Common. At the Joint GB Development Session in August, there was agreement to create a single Commissioning Committee across both CCGs and work is ongoing to progress this.

. Risk Management Framework - Proposals for a joint Risk Management Strategy and Policy were approved at the Joint GB Development Session and a composite Risk Register has been developed for both BwD and EL CCGs.

. Internal Control Framework - In terms of Significant Risks, the top risks included  Achievement of NHS Constitutional Indicators

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 Mental Health system pressures impacting on quality and performance of services. - Regarding internal performance management, meetings of the Finance and Scrutiny Working Group will continue.

The Chair thanked Mrs Moir for her report which provided a good update of an ongoing process.

RESOLVED: That Members received the report and noted progress.

19.056 Draft Audit Committee Annual Report 2018/19

The Chair presented the Draft Audit Committee Annual Report which outlined the role and activities of the Committee over the last 12 months and would be presented to the Governing Body.

One minor amendment was identified at Item 11 of the report to remove the 5th bullet point, which was considered to be a duplication.

Mr Parr thanked all Members for their attendance which highlighted 100% achievement for 2018/19.

RESOLVED: That the AC approve the Draft Annual Report for presentation to the Governing Body.

19.057 Review of Effective of Arrangements in Place for Staff to Raise Concerns

It was agreed this was covered on the Action Matrix.

19.058 Audit Committee Work Plan 2019

The Chair introduced the AC Work Plan 2019 and invited any comments on the content. The Work Plan was presented for information and there were no comments.

A draft of a 2020 plan would be presented to the next meeting.

RESOLVED: That the AC noted the content of the Work Plan 2019.

19.059 Pennine Lancashire Quality Committee (PLQC)

19.059.1 Minutes of the Meeting held on 27th March 2019 19.059.2 Minutes of the Meeting held on 24th April 2019

The Chair introduced the minutes which were presented for information. Dr Nigel Horsfield, Deputy Chair of the PLQC said there were no areas of concern to be highlighted.

RESOLVED: That the AC noted the content of the minutes.

19.060 Primary Care Co-commissioning Committee (PCCC)

19.060.1 Minutes of the Meeting held on 19th March 2019 19.060.2 Minutes of the Meeting held on 21st May 2019

The Chair introduced the minutes which were presented for information and there were areas of concern to be highlighted.

The Chair pointed out that the AC only receive Part 1 minutes and questioned

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whether the Committee should also see Part 2 minutes to provide oversight of discussions at a key committee.

Mr Parr advised that any issues arising from Part 2 of the PCCC are considered in the Serious Incident Report presented to the Governing Body.

It was noted that Part 2 of the EL CCG Primary Care Co-commissioning Committee minutes are presented to Part 2 of the GB.

ACTION: The Chair asked for this to be further considered through the Executive Team, to ensure that the GB is receiving all of the information it RP needs.

RESOLVED: That the AC noted the content of the minutes.

19.061 Any Other Business

No further business was discussed.

19.062 Date and Time of Next Meeting

The next meeting of the AC was scheduled to take place on Tuesday 26th November 2019 at 2 p.m. in the Board Room, Fusion House.

As Mr Parr and Dr Randall were giving advance apologies, the Chair asked that another date be arranged.

ACTION: Mrs Milligan to re-arrange the next meeting. PM

The Chair thanked everyone for their attendance and input and the meeting closed at 3.15pm.

Page 10 of 10 Minutes approved by the Chair: 16.9.19

NHS EAST LANCASHIRE CCG PRIMARY CARE COMMITTEE

Minutes of the Meeting held on Tuesday, 15 October 2019, 2pm

.19

.8.19 .9.19

Members Title .6.19

.5.18

.10.19 .11.19 .12.19

10.4.19 23.7

1 20. 17.

19 17 15 Dr Aliya Bhat GP, Hyndburn  A A  A  A Melanie Crabtree Practice Manager Representative A    A   Dr Julie Higgins Chief Officer A A A A A A A Kirsty Hollis Chief Finance Officer    A  A  Kathryn Lord Director of Quality and Chief Nurse    A A A A (Interim) Dr Tom Mackenzie GP Locality Lead    A  A  Michelle Pilling Lay Member, Quality & Patient  A    A A Engagement & CCG Deputy Chair David Swift Lay Member, Governance   A     Alex Walker Director of Commissioning (Int)  A A     Naz Zaman Lay Member, Equality Inclusion        Chair Attendees Title

Debra Atkinson Head of Corporate Business  A    A A    Lynsey Beniston Healthwatch Lancashire - A A A Lisa Cunliffe Primary Care Development Mgr        Sarah Danson NHSE    A   3pm  Jackie Forshaw NHSE A A A A A A A Peter Higgins Local Medical Committee A A A     David Massey Local Medical Committee    A A A A Cllr Lian Pate Health and Wellbeing P’ship ------Richard Robinson CCG Clinical Chair A A A A A A A Collette Walsh Head of Integrated Care & Deputy       A Director of Performance In Attendance Caroline Marshall Attended for Kathryn Lord     Debbie McCann Executive Assistant – Notes        Min ACTION Ref: 19:218 Welcome & Chairs Update The Chair welcomed all members to the meeting and a round of introductions was made.

19:219 Apologies Apologies were received as listed above.

19:220 Governance

. Declarations of Interest: Melanie Crabtree declared an indirect interest in item 6.1 Neighbourhood Integration Accelerator and item 6.2, Primary Care Network Support Requirements. Melanie remained in the meeting but did not participate in the discussion.

. Quoracy: The meeting was quorate [6 members required]

- In the absence of Kathryn Lord (Interim Director of Quality & Chief Nurse), Caroline Marshall (Head of Quality) formally deputised.

19:221 Minutes of the meeting held on 17 September 2019 At minute reference 19:202, it was noted that the last paragraph with regard to the two year contract should be removed and placed in the Part 2 minutes.

Page 1 of 4 Minutes Approved by the Chair :

With this amendment, the minutes of the meeting held on 17 September 2019, were approved as an accurate record.

19:222 Action Matrix The Action Matrix was reviewed and updated.

19:223 Matters Arising Nothing to note.

19:224 Neighbourhood Integration Accelerator Alex Walker presented slides and a report requesting (in principal) approval for the implementation of a neighbourhood Integration Accelerator Pathfinder across Pennine Lancashire and associated funding to ensure there is sufficient clinician capacity to enable this to happen.

The Integration Accelerator will:

- Accelerate the development of self directed teams which provide a timely response for core general practice - Provide care 24/7, to patients who have multiple, complex needs and place a high demand on system resources - Explore how practices can manage rising demand - Move care closer to home and ensure that funding follows - Ensure that social prescribing is fully embedded into new ways of working

An Alliance Agreement will be utilised to enable providers to work even closer together and maximise the opportunities presented by the pathfinders. The agreement would be signed by all parties and added as a contract variation to existing contracts. All members are equally valued and have equal say in decision making and the Commissioner is part of the alliance and shares in the risk. All parties will have a collective approach in relation to the impact on services and sharing of risk and reward.

Based on each practice treating cohorts of 15 patients per week there is the potential to improve outcomes for 6630 patients in East Lancashire and 2990 in Blackburn with Darwen per annum.

Outcomes include:

- Improvements in health and wellbeing - Patients are better informed - The needs of families and carers are considered - Improved care co-ordination and increased staff motivation - Reduction in hospital attendances and admissions - Increased community resilience

Pump priming has been identified for clinician hours and there are indicative budgets to help clinicians to decide how best to utilise the funds available. This is an opportunity for Primary Care Clinicians and Secondary Care to work together to develop appropriate pathways to manage more care in the community.

The Integration Accelerator is a means to accelerate the pace of

Page 2 of 4 Minutes Approved by the Chair :

transformational change, embed population health management and utilise new ways of working.

Approval is sought to enable the CCGs, PCNs, and Community Services to align staff and ensure there is sufficient financial resource for clinical engagement. The governance of the pathfinders will be via the new Community Integrated Care Board, Primary Care Committee, the East Lancashire LCP and the Blackburn with Darwen LiCP.

Alex advised that communication will be circulated to Primary Care Networks requesting expressions of interest. Three PCNs will be required.

Kirsty Hollis confirmed that funding is part of the 2018/19 surplus non recurrent resource and therefore ringfenced Primary Care funding will be utilised.

Approved.

19:225 Primary Care Network Support Requirements Alex Walker advised the need for a strategic management Lead (8a) and also project management support (4) to aid development and growth of the PCN organisations. Job descriptions for both roles have been sent for banding and will go out for recruitment on an 18 month fixed term contract hosted by a GP Practice.

19:226 Primary Medical Care Commissioning and Contracting: Contract Oversight and Management Functions Review Terms of Reference The Primary Medical Care Commissioning and Contracting Internal Audit Framework for Delegated CCGs provides a framework for delegated CCG’s to undertake an internal audit of their primary medical care commissioning arrangements. The audit framework is to be delivered as a 3-4 year programme of work to ensure this scope is subject to annual audit in a managed way within existing internal audit budgets. This will focus on the following areas:  Commissioning and procurement of services  Contract Oversight and Management Functions  Primary Care Finance  Governance (common to each of the above areas) In 2019/20 the review of Contract Oversight and Management Functions is to be undertaken and a report setting out the terms of reference for the Primary Medical care Commissioning and Contracting Contract Oversight and Management Functions Review was circulated for information and reference. The final report will be reviewed through Audit Committee. 19:227 Quarterly Contractual Changes Report Sarah Danson, NHSE provided the Committee with a summary of the contractual changes for the previous quarter (July 2019 – September 2019) where Contract Variations have been processed to reflect a

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change to a Practice’s existing contract.

Members received the report and noted the partnership changes and practice mergers outlined.

19:228 Any Other Business There was no further business.

19:229 Date & Time of Next Meeting The next meeting was confirmed as Tuesday 19 November 2019, 2pm Meeting Room 3, Walshaw House.

RESOLUTION: “That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.” (Section 1[2] Public Bodies (Admission to Meetings) Act 1960.

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NHS EAST LANCASHIRE CCG PRIMARY CARE COMMITTEE Minutes of the Meeting held on Tuesday, 19 November 2019, 2pm

.6.19 Members Title .8.19 .9.19 .5.18 2. 8 10.4.19 23.7 .19 1 20. 17. 15 .10.19 19 .11.19 17 .12.19

Dr Aliya Bhat GP, Hyndburn  A A  A  A  Melanie Crabtree Practice Manager Representative A    A    Dr Julie Higgins Chief Officer A A A A A A A A Kirsty Hollis Chief Finance Officer    A  A  A Kathryn Lord Director of Quality and Chief Nurse    A A A A A (Interim) Dr Tom Mackenzie GP Locality Lead    A  A   Michelle Pilling Lay Member, Quality & Patient  A    A A  Engagement & CCG Deputy Chair David Swift Lay Member, Governance   A      Alex Walker Director of Commissioning (Int)  A A     A Naz Zaman Lay Member, Equality Inclusion         Chair Attendees Title

Abigail Askew Local Medical Committee  Debra Atkinson Head of Corporate Business  A    A A  Lynsey Beniston Healthwatch Lancashire - A A   A  A Lisa Cunliffe Primary Care Development Mgr         Sarah Danson NHSE    A   3pm   Jackie Forshaw NHSE A A A A A A A A Peter Higgins Local Medical Committee A A A      Cllr Lian Pate Health and Wellbeing P’ship ------Richard Robinson CCG Clinical Chair A A A A A A A A Collette Walsh Head of Integrated Care & Deputy       A  Director of Performance In Attendance Caroline Marshall Nominated Deputy – K Lord     A Deidre Lewis Nominated Deputy – K Hollis  Debbie McCann Executive Assistant – Notes         Min ACTION Ref: 19:241 Welcome & Chairs Update The Chair introduced Abigail Askew who attended to represent the Local Medical Committee and welcomed all members to the meeting. A round of introductions was made. 19:242 Apologies RATIFIED Apologies were received as listed above.

19:243 Governance . Declarations of Interest: None declared for Part 1 of the meeting.

. Quoracy: The meeting was quorate [6 members required]

- In the absence of Kirsty Hollis (Chief Finance Officer) Deidre Lewis (Deputy Chief Finance Officer) formally deputised. - In the absence of Alex Walker (Interim Director of Commissioning), Collette Walsh (Head of Integrated Care) formally deputised.

19:244 Minutes of the meeting held on 15 October 2019 The minutes of the meeting held on 15 October 2019, were approved as an accurate record.

Page 1 of 2 Minutes Approved by the Chair : 19:245 Action Matrix The Action Matrix was reviewed and updated.

19:246 Matters Arising Nothing to note.

19:247 Extended Access Lisa Cunliffe provided a brief update in relation to the CCG Commissioned GP Extended Access Service including Building resilience in Primary Care: Winter 2019/2020 and the relocation of the extended access service in Burnley.

Following approval from the Primary Care Committee, 17.9.19 for additional extended access capacity in East Lancashire to support resilience over Winter 2019/2020 the CCG has agreed a variation on the service specification with the provider to increase extended access clinics on Friday, Saturday, Sunday and Monday in the Hyndburn locality from 1 November 2019 to 31 March 2020. The CCG are also negotiating with the provider to consider further increases to the day capacity through the vulnerable winter months across the system.

The CCG is also developing a benchmarked dashboard of out of practice activity with a view to arranging PCN based peer review sessions aimed at developing a deeper understanding of the challenges and using this intelligence to shape future transformation and commissioning plans. Concern was noted from Peter Higgins with regard to work overload for the PCNs. A communication plan to support changes to service delivery models is also being developed.

Proposals are currently being considered to relocate the extended access service in Burnley from the 3rd floor of the St Peters Centre in Burnley to the ground floor.

Following discussion the following points were noted:

. Extended Access is required for GPs to deal with patients referred back for tests/referrals . Demand in Primary Care needs to be considered and a feedback mechanism is neededRATIFIED to monitor information . Feedback is to be reported back to the Primary Care Committee.

Members noted progress to date.

19:248 Any Other Business There was no further business.

19:249 Date & Time of Next Meeting The next meeting was confirmed as Tuesday 17 December 2019, 2pm Meeting Room 1, Walshaw House.

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REPORT Agenda Item: 5.2 Reporting Group: Integrated Health and Care Partnership Leaders’ Forum Meeting Date: 18 November 2019 Report Title: Pennine Lancashire A&E Delivery Board Highlight Report: November 2019 Agenda Item: 090/19 For: To receive and comment  For approval and sign off For discussion and recommendations Lead: Damian Riley Strategic Clinical Lead East Lancashire Hospitals Trust

Recommendations

Members of the Partnership Leaders’ Forum are requested to note the content of this report, provide any comments and raise any questions to the Chair of the Pennine Lancashire A&E Delivery Board.

Winter Planning

The finalised system Winter Plan was presented by Stuart Hayton. This had been submitted to NHSE in October. The board were asked to note the priorities highlighted within the plan and to acknowledge that the funding gap of £1M outlined within the report remains unresolved and was now for consideration by the Finance and Resilience Group.

A Winter Plan exception report was also presented to the board highlighting the progress of the winter schemes. The board received assurances that all schemes were either live or on track to go live on the scheduled dates.

The board also received a presentation from the Urgent Care team illustrating a hot spot analysis undertake with a range of services to look at days when the system experienced days of high demand. This was agreed to be a very useful piece of work having been utilised for several planning exercises to date.

The board were also informed that a request had been received from NHSE for Pennine Lancashire to develop a Winter Delivery Agreement involving system partners. The board were assured that a timely response would be sent back to the ICS confirming that we would be able to complete an agreement and that the agreement itself would be brought back to a future meeting.

Mental Health

Tanya Hibbert gave an overview of developments in the mental health system. It was reported that there would be no additional mental health beds for this winter but that recruitment of extra staff was underway and going well. A new development around the management of frequent attenders was also highlighted.

REPORT Agenda Item: 5.2 Perfect Week

The Perfect Week had run in early November across ELHT. Catriona Logan presented an overview of the main learning points and discussed these with board members. A number of successes were highlighted and also areas requiring attention. A further perfect week is scheduled for January 2020.

Planning to safely reduce avoidable ambulance conveyance – Workshop October 2019

The notes and action plan from last month’s AEDB workshop were presented by Stuart Hayton. These focused on actions in the main areas of mental health, health care professional calls and intermediate tier work. An update against the plan was requested at a future AEDB.

Performance

The system Plan on a Page was presented along with the performance report relating to the months of September and October 2019. Four hour performance during September 2019 was 85.16%, below the 89% trajectory. For October this was 84.04% against the same trajectory target.

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common

Joint Communication and Engagement Report Agenda Report Title: 5.3 (Quarter 3 – October – December 2019) No: Meeting Date: 15th January 2020 Summary of Report: This report provides an analysis of the communication and engagement activities undertaken by the CCGs, and Communication and Engagement team over the 3rd Quarter (October to December) 2019. Report Recommendations: Note the content of the report. Feedback any comments or suggestions in relation to communication and engagement, and comment on future plans listed in the report. Financial Implications: None Procurement Implications: None Report Category: Tick Support and recommend/forward the report. Approve the recommendations outlined in the report. x Debate the content of the report. Receive the report for information. x Author: David Rogers, Head of Communication and Engagement Lucie Higham, Deputy Head of Communication and Engagement Report supported & approved by your Senior Lead? Y Presented By: Kirsty Hollis, Deputy Chief Officer Other Committees None Consulted: Has a PIA been completed in respect of this report? Privacy Impact Assessment N (PIA) If Yes, please attach If No, provide reason below. Has an EIA been completed in respect of this report? Equality Impact Analysis N (EIA) If Yes, please attach If No, provide reason below. Data Protection Impact Is a Data Protection Impact Assessment Required? N Assessment Have any risks been identified / assessed? N Risks: Conflict of Interest: Is there a conflict of interest associated with this report? N Has any clinical engagement/involvement taken place as part Y Clinical Engagement: of the proposal being presented. Patient Engagement: Have patients been involved in the drafting of this report? Y Privacy Status: Can the document be shared Y

CCG Corporate Objectives :

To commission the best quality and effective services to deliver optimal healthcare CO1 x outcomes for our local population. Ensure the balance of our health investment reflects our population’s needs and keeps CO2 x the population well. CO3 Deliver the 10 year strategy by engagement with the population we serve and ensure we commission services that meet local needs with a clear focus on population health x management strategies. CO4 We will focus on population health outcomes through helping to deliver successful Integrated Care Partnerships and ensure decisions, provision and access to local x services is based on the needs of our population. 1

CO5 As local health leaders, we will focus on increasing life expectancy across Pennine Lancashire to be at, or above, the national average in the next 10 years. x

BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP EAST LANCASHIRE CLINICAL COMMISSIONING GROUP

Agenda Item No: 5.3

Blackburn with Darwen CCG Governing Body & East Lancashire CCG Governing Body Meeting in Common

15 January, 2020

COMMUNICATION AND ENGAGEMENT REPORT

1 Introduction

1.1 This report provides an analysis of communications and engagement activity by the Communication and Engagement Team over the last quarter (October – December 2019).

2 Purpose / Background

2.1 The Communication and Engagement Team operates as one team across both CCGs. This has achieved economies of scale and avoided unnecessary duplication.

3 Communication and Engagement Report - October – December 2019

3.1 This report provides a summary of activity on communications and engagement between 1 October 2019 and 31 December 2019. It covers a wide range of activity, including:

 Engagement, encompassing stakeholder management  Proactive and reactive media relations  Integrated communications  Design and marketing  Website and digital media  Campaigns  Staff communication and engagement  Future work

4 Overall assessment

4.1 During this quarter the focus has been on the implementation of this year’s Winter Campaign, one of the busiest times of the year for the Communications and Engagement Team. The team have significantly ramped up the communication to support the pressures on the system, particularly around urgent care and primary care. During this time, the team have also been working closely with the PCNs and delivered the first PCN-wide campaign for Self Care week (18-24 November 2019).

5 Proactive and Reactive Media Management

5.1 The Communications Team has continued to be proactive in terms of media management. However, it should be noted that we were subject to guidance as a result of the General election. This restricted some of our activities. 3

5.2 During the last quarter, we produced 26 press releases and responded to eight press queries. As this is the first joint report for the CCGs, we can produce more comparative data each consecutive quarter.

6 Website

6.1 During the last quarter, there were 22,121 page visits to Blackburn with Darwen CCG website and 11,947 to East Lancashire CCG website. The top three most visited pages for Blackburn with Darwen were the Homepage – 13,025, Latest news & events – 3,388 and News – 2,277. For East Lancashire, the top three most visited pages were the Homepage – 3,718, Contact us – 723 and Governing Body Members – 474.

7 Integrated system communications

7.1 During the last quarter, the Pennine Lancashire Communication and Engagement Team (CCG and ELHT communication and engagement teams) has continued to work together across all aspects of the service. The two teams meet weekly to discuss integration and joint ways of working, while the two heads of service meet weekly to plan and review joint work, and collaborative endeavours. The two teams have also agreed to co-locate and work together every Monday, one week based at Royal Blackburn Hospital site and one week at Walshaw House. This collaborative approach is helping to improve communication, save time, reduce duplication of effort, improve working relationships and provide a better experience for people who use health and social care services.

8 Design and marketing

8.1 The communication and engagement team has delivered a number of design projects during the last quarter including:

- Blackburn with Darwen Corporate Power Point template - Safeguarding awarness - Integrated Care awareness - PCN page for CCG websites - Set up Facebook page for Great Harwood PPG - Christmas Greeting for staff & stakeholders - Button Battery awareness

9 Digital media

9.1 The Communication and Engagement Team has continued to use its digital channels effectively, particularly in relation to signposting members of the public to appropriate services, gathering soft intelligence, and building engagement. This is one of the major strengths of the team, with increasing growth in engagement and insight month on month (see Appendix 1). In the last quarter, we significantly ramped up the promotion of inappropriate attendances to A & E and self care messaging.

9.2 Facebook engagement (Likes, or followers, shares)

Facebook engagement for the CCGs has continued to increase rapidly through interaction and by posting stories of relevance and salience to our followers. The current following for Blackburn with Darwen is 2,499 and East Lancashire following 4

has 2,561. In relation to the size of the two organisations, we have one of the highest reaches for an NHS organisation in the North West and one of the highest levels on engagement in the country.

9.3 Twitter Engagement (Followers)

Twitter engagement for the CCG has also continued on its upward trajectory too and currently stands at 4,443 for Blackburn with Darwen and 6,299 for East Lancashire. We continue to build engagement through interaction and by posting stories of relevance and salience to our followers.

9.4 Video

During the last quarter, the team have continued to expand the use of video and we have produced a number of clinical awareness videos including Treating & Preventing Wounds, National Hate Crime Awareness Week 2019, Manor House Nursing Home and Prevent Training Video. In addition, we supported the PCN Academy in the development of video products for the successful MSK events.

10 Campaigns and marketing

10.1 The Winter campaign including promoting the flu vaccination and children’s flu immunisation was a major focus for this quarter. The team worked closely with partners across the health and social care system and the PPGs and partners in each locality to maximise promotion. The Protect Your Family campaign was featured on the local radio and on digital screens to enhance coverage.

The team also worked with partners across the health and social care system to deliver the Self Care week campaign, which was promoted widely particularly across all PCNs. Promotional packs were pulled together and distributed to all frontline teams. This was widely promoted on all partner social media channels.

11 Engagement, Insight and Market Research

11.1 The team has continued to engage with primary care stakeholders through the GP bulletin in East Lancashire and regular communications using GP Net in Blackburn with Darwen. They have also engaged with stakeholders using the East PPG newsletter and the Patient Partners e-bulletin.

11.2 A proposal and plan for ongoing dialogue to support place based planning has been agreed. Called “Community Conversations” (see Appendix 2). This will focus on what matters to people in their communities about health and health services. This builds on partnership work with Blackburn and Lancashire Healthwatch and will support planning in localities for future service redesign and development. The proposal, which has been signed off by senior managers, executive directors and PCN leads will represent a two-pronged approach: firstly a look back at existing data and soft intelligence from surveys and engagement, and also allowing for continuous dialogue in each of our communities. The proposal will be a significant opportunity to support the objectives of the CCGs, particularly, the move towards a “shift left”.

11.3 The last quarter was very busy in terms of engagement activity and there were a number of high profile projects supported by the team. Engagement was carried out over a number of weeks in phthalmology community satellite clinics to capture 5

patients’ views about the proposed relocation of four weekly satellite ophthalmology service eye clinics. A full report has been pulled together capturing the views of patients and will be reviewed before a final decision is made. Patients representatives have been recruited and are involved in the co-production of the redesign of the Pennine Lancashire DVT service. They helped design a patient survey to capture the views of the current service and results will feed into the new service specification.

A number of surveys were carried out as part of the ‘Your Services, Your Say’ campaign which is a wider review of services across Pennine Lancashire including Bowel & Bladder, Heart Failure Nursing Service and Home First Service.

The team are also currently recruiting patient representatives to support the coproduction of the new CAMHS trailblazer in Blackburn with Darwen and the redesign of the MSK service in Pennine Lancashire.

11.4 The team are currently preparing for the next annual Integrated Assessment Framework assessment of Patient and Public Involvement (PPI). NHS East Lancashire CCG achieved a rating of “outstanding” last year and Blackburn with Darwen were “good”. The team are working towards retaining the rating in East and securing outstanding” for Blackburn. East Lancashire has been named as excellent example of good practice in this year’s guidance document for all CCGs to follow, and the CCG is being showcased at an NHSE&I event for the North West in January.

12 Healthier Pennine Lancashire (previously Together a Healthier Future)

12.1 The Together a Healthier Future, the integrated care partnership (ICP) across Pennine Lancashire, has recently refreshed its strategic narrative, delivery focus and delivery infrastructure. A decision was made to move from being known as Together a Healthier Future to the more up-to-date, clearer and simpler Healthier Pennine Lancashire. The name Healthier Pennine Lancashire provides a better understanding of the vision and emphasises that the ICP is a partnership of organisations from across the Pennine Lancashire footprint. Healthier Pennine Lancashire also aligns with the well-established Healthier Lancashire and South Cumbria Integrated Care System (ICS) brand reinforcing the commitment to the joint aims of the integrated care plans for the system.

13 Staff Engagement

13.1 The Communications Team continues to support staff messages with a weekly bulletin as well as supporting the monthly staff briefing sessions. The monthly staff brief is now delivered as a joint brief across Blackburn with Darwen and East Lancashire and delivered in person from alternative sites.

Every year, the CCGs nominate a Christmas charity for staff to donate too. This year local Foodbanks were chosen and the communications team organized a collection across both CCGs and arranged delivery to the Foodbanks in the six areas. The donated items were very well received and letters of thanks have been sent to the CCGs.

The team also promoted a number of awards won by teams in the CCGs including General Practice and Medicines Management, both internally and externally. A number of campaigns were also promoted internally to staff including Hate Crime 6

week and the White Ribbon domestic violence initiative,

A successful festive staff brief and quiz was also held in December and feedback from staff has been very positive. The team are now working on the first joint staff away day which will be held at the Dunkenhalgh Hotel in Hyndburn on January 28, 2020.

A process to support staff feedback has been established and a response log created to describe action taken in response to feedback received. This will be included in future reports.

14 Conclusion

14.1 Key priorities for the coming quarter for the communication and engagement team are to:  Continue to support the developing primary care neighbourhoods  Mobilise “community conversations” and support place-based planning  Lead on co-production as part of redesign across the Healthier Pennine Lancashire programme areas

15 Recommendations

15.1 The Governing Body is requested to:

 Note the contents of the report;  Feedback any comments or suggestions in relation to communications and engagement activity and comment on future plans;  Receive a further report at its meeting in April 2020.

David Rogers Head of Communications and Engagement

7 Appendix 1 Digital Report

1. Introduction

1.1. Social media is a fast, inexpensive, and effective way to reach a wide audience. It allows us to get personal with our audience, and form a bond of trust with them. By replying to the concerns or comments of our followers and asking for their opinions, we enhance their satisfaction with us while getting more traffic for our site, further promoting our business.

1.2. The CCGs effectively use a combination of Facebook, Twitter and the website to reach a wide audience. We deliberately use Facebook to provoke debate amongst the users, and push out important messages as the majority of our target audience use this channel. Twitter is used more to broadcast information to stakeholders, peers and other organisations and raise the profile of the CCG.

2. Facebook

2.1. Blackburn with Darwen CCG’s Facebook page currently has 2,499 people who follow the page; East Lancashire’s page has 2,561. As the images below demonstrate this continues to steadily grow.

Blackburn with Darwen:

East Lancashire:

2.2. On average between the two CCGs the majority of people who like our page are women (84%), with the most common age bracket being 35 – 44. It is encouraging to note that we are reaching a small number of followers who are aged between 13 and 17, and over 65. This is in line with national trend.

Blackburn with Darwen:

East Lancashire:

2.3. Overall, 297 posts were posted to Facebook during the period October to December 2019.

2.4. As the images on post reach below demonstrate, this was at its highest during the Christmas and New Year period as well as the beginning of December. This was strategically planned with a number of key messages such as information about pharmacy opening times, the dental emergency helpline, encouragement around flu vaccination and keep well messages.

Blackburn with Darwen:

East Lancashire:

2.5. The images that follow are just a small example of some of our far reaching and more successful posts during this period.

3. Twitter

3.1. The differences between Facebook and Twitter are that Facebook networks people while Twitter networks ideas and topics. Facebook allows you to write a book (not that anyone is going to read it). Twitter limits to 280 characters per tweet. Facebook allows likes and friends while Twitter's call to action is to follow.

3.2. East Lancashire CCG’s Twitter page has 6,299 followers whilst Blackburn with Darwen has 4,443 so potentially any tweet that is posted has the prospect of reaching at least this number of Twitter followers (more if re-tweeted).

3.3. The demographic of followers is quite evenly split between females 48% and males 52%. Similar to Facebook, the most common age range of follower is between 25 to 54 and again, it is encouraging to note that we have followers aged under 18 and over 65.

3.4. During this reporting period, there were a total of 220 tweets creating 147,900 impressions (impressions are the number of times users saw the tweet on Twitter).

3.5. The following images demonstrate some of our top tweets during this period.

Appendix 2

Community Conversations – an opportunity for ongoing dialogue and insight into the concerns of our communities (Place based planning)

Background/context

Over the last few weeks, the communication and engagement team has been involved in discussions about service redesign, and service transformation focussed on urgent care, primary care, extra (viz intermediate) care, the development of primary care networks, and unscheduled care developments.

These discussions have led to a recognition that the CCGs need to adopt a more place-based approach to the development of services, particularly recognising the emerging primary care networks, but equally noting that many of the service redesign and transformation ideas will, as they develop, have an impact on people and communities within particular localities.

While commissioners, and to some extent, providers have considered the technicalities of their proposals around for example, urgent care or intermediate care, they have not involved patients, the public and other stakeholders as early as we, or guidance would recommend. This is often due to an understandable desire to have a sense of what is achievable, viable and affordable before exposure to public scrutiny. However, most antipathy, legal challenges, and opprobrium are typically brought against organisations when they don’t involve people at an early stage, and appear to have a fixed and formed view of the direction of travel.

Engaging with the public and stakeholders, with an open mind regarding developments is not only the right thing to do, but represents good quality engagement and consultation.

While there is a need for commissioners to have worked up some options, the engagement and consultation framework that we work towards recommends that we involve patients and the public as early as possible, and with an open mind to receiving their views. In other words, we do not present people with a “fait a compli” rather we seek their views on options and give the feedback on these options due consideration. Furthermore, good practice suggests that we seek to involve people as early as possible, and co-produce our ideas and options with people, particularly service users. The evidence is clear that when service users, staff, the public and stakeholders are involved early and coproduce as equal partners, the outcome is often more successful, acceptable and sustainable. Typically it can be more cost effective too.

Our experience of engagement suggests that there is a significant risk of us and partner organisations “over engaging” with people which can result in “engagement fatigue” and confusion. There is some evidence that coupled with a lack of feedback about how engagement has been used by organisations to develop services, people disengage and become cynical about our intentions and motives. This creates a cycle of cynicism which defeats attempts to develop services before they are even started.

Failure to engage with us can be a notable risk for mobilisation and delivery of services ultimately. Where we have cynicism, low or few responses to our engagement, it means that we have less insight and fewer ideas to help us evolve our proposals. A lack of response means that there is a lack of ownership and this can translate longer term to misuse of and misunderstanding of services as they develop. Ownership and coproduction of our proposals can lead to support and proper use, in the long term helping to manage demand and promote appropriate service use.

Both CCGs are supported by one communication and engagement team. The CCGs were assessed by NHS England for our quality of engagement (patient and public involvement) over the last year and achieved ratings of “good” (BwD) and “outstanding” (East). The combination of communication and engagement (including community research) expertise means that the CCGs can support highly effective engagement through a variety of innovative and standard engagement methods.

Proposal

During the course of the discussions referred to above, we have recommended that rather than engage patients on each topic (urgent, primary, intermediate care etc), which could confuse and encourage disengagement, the CCGs working in partnership with our partners in the Pennine Lancashire system begin a process of ongoing dialogue with communities about what matters to them, and the kind of support they need to be healthy and well.

This type of deliberative, ongoing community style conversation can amass significant insight and feedback that can be analysed and fed into discussions about services in each area. It is rooted in the lived experience of people and starts with their experiences, insight and views – an essential aspect of coproduction.

This approach has a powerful benefit when one considers the governance around engagement and consultations. The decision to formally consult on major service change is usually made by the statutory body responsible which is the Health Overview and Scrutiny Committee in BwD and at Lancashire County Council. A parallel conversation would need to be had with NHS England, and the ICS.

In the likely event that the CCGs would need (as is our statutory duty) to take proposals to the health overview and scrutiny committees (HOSC), having undertaken engagement which has informed these proposals, could mitigate against having to undertake formal, and typically up to twelve week consultations.

A model of continuous engagement and dialogue would also potentially provide HOSCs, H&WBs, with reassurance about our intentions more widely.

The proposed approach

In other areas, there has been a concerted effort to explore “community conversations”.

There are many examples of general conversations, of which Wigan and Doncaster have been recognised as good models, as well as specifically focused community conversations such as the Bolton’s Big Conversation approach to explore smoking and alcohol. In Wigan, this approach was used to explore the “Wigan Deal” and is described in a Kings Fund report as good practice. In Doncaster, these conversations have been developed as “Doncaster Talks” and have used deliberative online approaches alongside community engagement.

The idea of ongoing proactive engagement to hold conversations with the community typically encompasses three discrete goals:

1. Generating actionable insight to facilitate coproduction for commissioners, providers, the VCFS and other stakeholders 2. Generating public awareness of and interest in health, self-care and the best use of services and other community 3. A constant and continuous “temperature check” of the concerns and interests of our communities

Methodology

The proposal seeks to employ a human-centred qualitative method to gathering insight that helps inform the design and development of services.

This will be structured into a mixed method approach, tailored to each community and locality.

It seeks depth and breadth of insight and will be triangulated with existing data through desktop analysis.

Engagement for depth of insight:

To obtain a level of depth of insight, we will conduct two approaches – focus groups and ethnographic engagement for depth.

In each locality we will run at least 2/3 focus groups (possibly more, for example, one focus group for each GP practice in the primary care network), as well as ethnographic interviews.

The focus groups will be run with people from each community recruited from GP practices working with the practice PPGs and managers to support this.

The ethnographic interviews will be carried out with individuals in each community. These interviews will take place in cafes, homes and community centres, and we will also spend time with people to learn more about their lives and how living in the area impacted on their health and wellbeing. The broad aim of these interviews will be to understand the behaviours, motivations and barriers that exist around health and wellbeing in the locality. These could focus on specific health conditions and behaviours that are identified as priorities within each PCN, by the CCGs, and across the ICP.

We would use a campaign approach with the branding along the lines of “Hyndburn Says” etc, and we would use the campaign to support the engagement, raise awareness and recruit focus group and ethnography participants. The interview questions will be grouped around three themes:

1. People: understanding the role of others in shaping health and wellbeing, and driving behaviours and outcomes. 2. Places: understanding how living in different parts of Pennine Lancashire has an impact on health and wellbeing. 3. Assets: understanding the role of infrastructure, resources and services on people’s health and wellbeing.

Engagement for breadth

We are proposing to maximise our use of online and social networking engagement as we have, which when combined with our partners means that we have considerable reach into our communities and across Pennine Lancashire.

We will use this to promote our existing online engagement tools as well as adopting an innovative approach using a chatbot platform developed for this purpose, and Learnlive which uses broadcast and chat facilities for wider engagement.

In previous consultations and engagement in East Lancashire, we provided each GP practice and key stakeholders with a small selection of questionnaires with pre-paid envelopes for patients and service users to complete. This option will be available to enhance our breadth of engagement.

Harnessing the power of local community conversations

The final element of our breadth engagement is simply to encourage conversations within the community about our approach and the interview questions. We would hope to harness the energy and enthusiasm of the follow groups to support this alongside communication and engagement, and commissioning and service provider teams. Training in interview technique, data collection and analysis will be given:

 GP practice PPGs  GP practice staff  Community Connectors  Care Navigators  CVS /social prescribing initiatives  INT and other community based staff

Again, we would use a campaign approach with the branding along the lines of “Hyndburn Says” as mentioned above, and we would use the campaign to support the engagement, raise awareness and drive people to the online platforms to elicit their views and insights. The interview prompts will be grouped around the three themes:

Triangulation

Alongside this work we will identify, review and analyse existing engagement reports, research and surveys to identify themes and feedback arising from these. Analysis will be undertaken using the people, places, assets framework, and localised.

Once analysis is complete this will be drawn into a themic grid to enable us to triangulate against the ongoing conversations in each area.

Potential timeline

Subject to agreement, we will work with Hyndburn Central PCN in the first instance to launch this approach and test the methodology. The insights arising from the process will be used to inform developments in the community served by Hyndburn Central PCN.