Agenda Item No: 12.2
REPORT TO: GOVERNING BODY
MEETING DATE: 28 January 2019
REPORT TITLE: Chief Officer’s Report
SUMMARY OF REPORT: This report provides an update on issues of interest pertinent to Governing Body members which have taken place since the last formal Governing Body Meeting held in November 2018. REPORT RECOMMENDATIONS: Members are requested to note the updates within this report and ratify the adoption of the polices included in section 9 of this report. FINANCIAL IMPLICATIONS: None. REPORT CATEGORY: Tick Formally Receipt x Action the recommendations outlined in the report. x Debate the content of the report Receive the report for information AUTHOR: Debra Atkinson Head of Corporate Business Report supported & approved by your Senior Y Lead PRESENTED BY: Dr Julie Higgins Chief Officer OTHER COMMITTEES/ N/A GROUPS CONSULTED: EQUALITY IMPACT ANALYSIS Has an EIA been completed in respect of this report? N (EIA) : If yes, please attach If no, please provide reason below: Not required RISKS: Have any risks been identified / assessed? N CONFLICT OF INTEREST: Is there a conflict of interest associated with this N report? CLINICAL ENGAGEMENT: Has any clinical engagement/involvement taken Y place as part of the proposal being presented. PATIENT ENGAGEMENT: Has there been any patient engagement associated Y with this report? PRIVACY STATUS OF THE Can the document be shared? Y REPORT:
Which Strategic Objective does the report relate to Tick
1 Commission the right services for patients to be seen at the right time, in the right place, X by the right professional. 2 Optimise appropriate use of resources and remove inefficiencies. X 3 Improve access, quality and choice of service provision within Primary Care X 4 Work with colleagues from Secondary Care and Local Authorities to develop seamless X care pathways 1
Agenda Item No: 12.2
East Lancashire Clinical Commissioning Group Governing Body Meeting
28 January 2019
CHIEF OFFICER’S REPORT
1. Introduction
1.1 This report provides an update on issues of interest pertinent to Governing Body members which have taken place since the last formal Governing Body Meeting in November 2018.
2. NATIONAL UPDATES
2.1 £1 billion savings on medicines bill in 2019
A new 5-year deal has been finalised with the pharmaceutical industry to give patients faster access to new medicines.
The NHS is expected to save around £930 million on its medicines bill across the UK under a new deal agreed with the pharmaceutical industry. Patients will also have access to new medicines up to 6 months earlier.
The government and the Association of the British Pharmaceutical Industry (ABPI) have reached a final agreement in the voluntary scheme for branded medicines pricing and access, which will begin on 1 January 2019 and last for 5 years.
In 2019, the following savings are predicted for the NHS medicines bill:
England: £744 million Scotland: £93 million Wales: £56 million Northern Ireland: £37 million
The scheme is designed to keep growth in the branded medicine bill predictable and affordable by placing a 2% cap on the growth in sales of branded medicines to the NHS. Pharmaceutical companies will repay the NHS for spending above the 2% cap.
Other measures to keep the cost of medicines affordable to the NHS include simplifying price controls, and faster and more flexible commercial discussions between the NHS and pharmaceutical companies.
The scheme will see the newest and best-value medicines made available to patients on the NHS more quickly through: earlier identification of the most promising medicines being developed earlier commercial discussions with industry faster assessments of the clinical and cost-effectiveness of new medicines by the National Institute for Health and Care Excellence (NICE)
Further information via: https://www.gov.uk/government/news/nhs-to-save-1-billion-on-its- medicines-bill-in-2019 2
2.2 Funding to upgrade NHS services in England
The Health and Social Care Secretary Matt Hancock announced in December £963 million of extra funding for health facilities across England.
Stopping sending money to the EU after EU Exit means we can invest more in domestic priorities including our NHS. A total of 75 projects will receive funding to upgrade facilities so that more people can be treated and more can be done to prevent ill-health in the first place.
Almost £800 million of the funding will go to projects outside London in order to improve access to care across the country.
Funding has been given to five trusts in the north west of England, of which two are in Lancashire and South Cumbria; £12.9m to Blackpool Teaching Hospitals NHS Foundation Trust for the Fylde Coast emergency department and critical care scheme £8.1m to Lancashire Care NHS Foundation Trust for the Fylde Coast Integrated Acute Mental Health Hub.
The investment came ahead of the launch of the ong-term plan for the NHS. The long-term plan is the biggest ever funding increase for the NHS and will see its budget increase by £20.5 billion every year by 2023 to 2024.
More information via: https://www.gov.uk/government/news/1-billion-of-funding-to-upgrade- nhs-services-in-england
2.3 Brexit Operational Readiness Guidance for the Health and Care System
Guidance has been released from Sir Chris Wormald, the Permanent Secretary. This follows from the Secretary of State, Matt Hancock’s, letter on Governments preparations for a March 2019 ‘no deal’ scenario, which focussed on supply chain implications and boarder planning assumptions to industry and the health and care system.
The EU Exit Operational Readiness Guidance has been developed and agreed with NHS England and NHS Improvement to set out local actions that providers and commissioners of health and adult social care service should take to prepare for the EU exit.
NHS England and NHS Improvement are to establish regional and national teams to enable rapid support on emerging local incidents and escalation to the new Operational Response Centre.
The letter confirms that delivering the delivering the deal remains the government’s top priority and is the best ‘no deal’ mitigation. But in line with the government’s principal operational focus on national ‘no deal’ planning, actions must be taken locally to manage risks of a ‘no deal’ exit.
Within East Lancashire work has already begun in support of this, through the Business Impact Analyses (BIA) undertaken by CCG managers, in assessing critical functions for business continuity in case of a major incident and, through collation of information for the submission of the Emergency Preparedness, Resilience and Response (EPRR) Core Standards (in October 2018).
Next steps are to review the CCGs business continuity management system, along with partners and providers, and escalate any significant issues that may arise from a ‘No Deal’ exit. Every service can potentially be affected by one or more of the above and there are no exceptions to completing a revised Business Impact Analysis with immediate effect.
3 There is support available for all teams to complete these; The [Pennine Lancs CCG] EPRR Task & Finish Group will coordinate the responses.
Further operational guidance will be provided to support the health and care system to prepare for the UK leaving the EU before 29 March 2019.
Further information via: https://www.gov.uk/government/publications/brexit-operational- readiness-guidance-for-the-health-and-social-care-system-in-england
2.4 Chief Medical Officer – Annual Report 2018: Better Health Within Reach
Professor Dame Sally Davies’s tenth report as Chief Medical Director was published on 21 December 2018. The report is independent of the government and is aimed at government regulators, policy makers and healthcare professionals. The recommendations are targeted at specific organisations. The report has been developed with the help of expert academic input.
There are 4 main sections in the report, discussing: health as the nation’s primary asset the health environment we live in and build together using emerging technologies to improve health for everyone effective planning for the future
The report concludes that there are reasons to be optimistic but that greater effort to improve the health environment is required – it should be easier to take the healthy option.
Further information via: https://www.gov.uk/government/publications/chief-medical-officer- annual-report-2018-better-health-within-reach
3. NHS England
3.1 NHS Executive Group
NHS England and NHS Improvement have announced the appointments to their new senior leadership team, the NHS Executive Group. As part of closer working arrangements between the two organisations, NHS England and NHS Improvement will share the new combined management group chaired by the two Chief Executives.
Appointments were announced as follows;
NHS Executive Group: NHS Chief Financial Officer – Julian Kelly National NHS Medical Director – Professor Stephen Powis Chief Nursing Officer – Ruth May Deputy Chief Executive, NHS England – Matthew Swindells National Director for Emergency & Elective Care – Pauline Philip National Director for Strategy & Innovation – Ian Dodge National Director for Transformation & Corporate Development – Emily Lawson
Recruitment is underway for the remaining positions on the NHS Executive Group: Chief Commercial Officer Chief Improvement Officer Chief People Officer Chief Provider Strategy Officer
Strong leaders will head up seven regional teams, integrating NHS England and NHS Improvement. They will play a major leadership role in geographies, making decisions on how best to assure performance and support improvements, as well as supporting local system transformation. 4
The regional directors will support the development and identity of sustainability and transformation partnerships and integrated care systems, and will be responsible for proactively sharing learning from local areas across the national health and care system.
The seven regional director appointments we are announcing today are: Richard Barker – NHS North East and Yorkshire Regional Director Dale Bywater – NHS Midlands Regional Director Anne Eden – NHS South East Regional Director Bill McCarthy – NHS North West Regional Director Elizabeth O’Mahony – NHS South West Regional Director Ann Radmore – NHS East of England Regional Director Sir David Sloman – NHS London Regional Director
Bill McCarthy, NHS North West Regional Director, sent an introductory email to North West CCGs. He said “I am delighted to have been appointed Regional Director for the North West and am looking forward to working with you all.”
NHS England and NHS Improvement will be cutting running costs by a further 20%. The NHS Executive Group is set to hold its first meeting in January 2019, with the new national and regional directors expected to formally lead their integrated directorates by April 2019.
3.2 Children’s Hospices
NHS England will increase funding for children’s hospices to as much as £25 million a year, chief executive Simon Stevens announced in December.
Medical advances mean the NHS can help seriously ill children and young people with more complex health issues live longer, more fulfilling lives.
NHS England’s hospice grant programme currently provides £11 million a year for children’s hospices, helping to provide care and support to children and their families close to home in their final days.
Over the next five years, as part of the NHS long term plan, additional funding will be available each year, increasing by up to £7m a year by 2023/24, if Clinical Commissioning Groups also provide additional match funding.
NHS England continues to work with other national organisations and charities through our National End of Life Care programme to support people, including providing guidance on specialist palliative care.
NHS England funding will ramp up over the next five years so that up to £25 million is spent on hospices by 2023/24.
3.3 Support for Veterans
A new dedicated crisis service will provide intensive support to scores of the most vulnerable former soldiers, sailors and air men and women battling alcohol, drugs and mental health problems, NHS England chief executive Simon Stevens announced in December.
It is part of a series of measures to ramp up bespoke services for veterans, backed by £10 million of investment, to ensure that specialist health support for veterans is available across the country.
The NHS will expand the new ‘Transition, Intervention and Liaison Service’ (TILS) and roll out veteran-friendly GP surgeries and hospitals as part of efforts to make sure those who
5 have served their country get specialist help they deserve in every part of the health service.
There are around 2.6 million veterans living in the UK and around one in 20 will suffer from Post-Traumatic Stress Disorder. A smaller number will have severe and complex mental health needs.
Intensive support will be available around the clock to help them throughout their use of NHS services and will help address rising demand for care.
More veterans will be referred each year to the expanded Transition, Intervention and Liaison Service which has already helped almost 5,000 ex-service personnel and their families with the move back to civvy street since it was launched in April 2017.
TILS is designed to help tackle early signs of mental health difficulties and also includes help with alcohol and drug abuse along with social support such as help with employment, housing, relationships and finances.
More than 100 GP surgeries and dozens of hospitals have already signed up to a “Veteran Aware” scheme that makes sure doctors, nurses and other NHS staff take into account what former servicemen and women may have been through when treating them. Others are being encouraged to join up.
In East Lancashire the November Governing Body meeting started with a talk from the East Lancashire Veterans in Communities Charity who outlined the work they do supporting veterans in the community and they brought with them 2 veterans who shared their personal experiences and the support they have received and how valuable this has been for them. The CCG has funded this charity for 6 years now through social prescribing grants.
3.4 Evening and Weekend General Practice Appointments
All patients across England can now access general practice appointments in the evening and weekends, NHS England announced in December.
The extended access means that patients will be able to see a doctor, nurse or other member of the practice team at a time convenient to them – providing an estimated nine million extra appointments per year.
The weekend and evening service is available across the country more than three months ahead of schedule and will help ease pressures on the NHS over winter.
Extended appointments will either be available through designated local NHS services and in some cases a patient’s own GP practice.
The service is being publicised through national press and broadcast to ensure patients are aware of the extra appointments. Evening and weekend appointments will be offered in addition to other services such as out of hours GPs and NHS 111 that offer access to clinicians at any time day or night.
3.5 Missed General Practice Appointments
NHS England are urging patients to cancel appointments rather than just not show up. More than 15 million general practice appointments are being wasted each year because patients do not turn up and fail to warn surgeries that they will not be attending.
There are around 307 million sessions scheduled with GPs, nurses, therapists and other practice staff every year and 5% – one in twenty – are missed without enough notice to invite other patients. That works out as around 15.4 million missed slots.
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Of these, around 7.2million are with busy family doctors, which adds up to more than 1.2 million GP hours wasted each year – the equivalent of over 600 GPs working full time for a year.
Each appointment costs an average of £30, putting the total cost to the NHS at more than £216 million pounds on top of the disruption for staff and fellow patients.
4.1 Opening the Door to Change: NHS safety culture and the need for transformation
The Secretary of State for Health and Social Care asked has requested that the Care Quality Commission (CQC) works with NHS Improvement to look at issues in NHS trusts that contribute to Never Events taking place.
Never Events are incidents with the potential to cause serious patient harm or death that are wholly preventable if national guidance or safety recommendations are followed.
The CQC wanted to understand what makes it easier or harder for the people and organisations in the NHS to prevent Never Events. They wanted to see what could be learned from other industries and countries.
The review sought to answer 4 questions: How do trusts regard existing guidance to prevent Never Events? How effectively do trusts use safety guidance? How do other system partners support the implementation of safety guidance? What can we learn from other industries?
Conclusions outlined in the report were: Never Events continue to happen despite the hard work and efforts of frontline staff. Staff are struggling to cope with large volumes of safety guidance, they have little time and space to implement guidance effectively, and the systems and processes around them are not always supportive. Where staff are trying to implement guidance, they are often doing this on top of a demanding and busy role that makes it difficult to give the work the time it requires. In terms of the wider system, we have found that the different parts at national, regional and local level do not always work together in the most supportive way. There is a lot of confusion about the roles of different bodies and where trusts can go to get the most appropriate support. Education and training for patient safety could be significantly improved. Staff are either not getting the training they need at undergraduate level or they are not given the time to do appropriate levels of training on patient safety once they have entered their clinical careers. Everyone who has a role in health care or who receives health care in England should recognise the importance of making patient safety a top priority and the extent of the cultural change needed to make this a reality.
Further information via: https://www.cqc.org.uk/publications/themed-work/opening-door- change
5. Healthwatch England
5.1 Annual Report In his first annual report to parliament as the Chair of Healthwatch, Sir Robert Francis has looked beyond health and social care performance statistics to explore how people are experiencing care day to day across England.
7 Drawing on evidence from over 400,000 people, over the last year Healthwatch has looked at what people are saying about GPs, community services, hospitals, social care services and mental health support, as well as issues that are common to all four areas of care.
Over the course of the year, the network shared over 2,000 reports with local services and decision makers about the improvements people would like to see.
From the hundreds and thousands of stories gathered by Healthwatch in the last year, it has identified four themes which people commonly experience across all services; Better information to make the right choices Easier access to support Improved conversations Well-coordinated services.
Further information via: https://www.healthwatch.co.uk/report/2018-12-13/our-annual- report-201718
6. North West Ambulance Service NHS Trust
6.1 Announcement
The Trust has announced that following the retirement last year of Derek Cartwright, Chief Executive, that Daren Mochrie, currently the Chief Executive of South East Coast Ambulance Service will join the Trust on 01 April 2019.
Daren has worked in the NHS since the age of 17. He has extensive experience of managing ambulance services in both rural and urban settings. Prior to joining South East Coast Ambulance Service, Daren was Director of Operations for the Scottish Ambulance Service and the lead for ambulance provision in the 2014 Commonwealth Games in Glasgow.
7. Lancashire and South Cumbria
7.1 Joint Committee of CCGs
The Joint Committee of CCGs (JCCCG) is made up of GPs and Lay Members from each of the CCGs in Lancashire and South Cumbria (L&SC). Chief Executives from Lancashire County Council, Blackburn with Darwen Borough Council, Blackpool Council, representatives from district Councils, local Healthwatch are not members of the committee but attend the meetings.
A workshop was held on Thursday 06 December from 1 pm at Preston Business Centre with a focus on adult mental health, out of hospital services, reducing running costs and individual patient activity.
The January meeting which was due to be held in public was stood down. The focus of the meeting was to be around the NHS Long Term Plan which had originally been timed for release in December.
The next meeting, is due to be held on Thursday 07 February 2019.
Further details via: https://www.healthierlsc.co.uk/joint-committee-ccgs
7.2 Lancashire Care NHS Foundation Trust
Appointments
Following a rigorous appointment process Caroline Donovan has been appointed as the new Chief Executive; her start date is still to be confirmed. She is currently the Chief
8 Executive at North Staffordshire Combined Healthcare NHS Trust and has been in the role since 2014.
Dr Richard Morgan, Deputy Medical Director, will act as Interim Medical Director following the retirement of Professor Max Marshall at the end of March 2019. He will take up the post on a interim basis until the appointment of a substantive Medical Director. There will be a gradual hand over of responsibility to Dr Morgan prior to Max’s departure.
Paul Lumsdon will continue as the interim Director of Quality & Nursing until a new substantive appointment is made following the retirement of Dee Roach, Executive Director of Nursing & Quality at the end of December 2018.
8. Pennine Lancashire
8.1 Appointment
Members will be aware that the CCGs were able to formally confirm my appointment as Chief Officer, effective from 01 January 2019.
I’d like to place on record my thanks to the two CCGs previous Accountable Officers, Mark Youlton and Dr Penny Morris. As a GB we wish Mark a long and happy retirement, and I’m pleased that Penny has taken the role of Medical Director at Blackburn with Darwen CCG.
8.2 Health Service Journal Awards
The CCG was pleased to congratulate East Lancashire Hospitals Trust, which won the ‘Creating a Supportive Staff Culture Award’ at the 2018 Awards. The ceremony was held in London in November 2018.
The CCG recognises that this was a tremendous achievement for the trust in light of the Keogh Review in 2013; when it was placed in special measures and the impact on staff was said to have been significant.
To improve the results of the national staff survey from significantly below the national average to an above average score of engagement and place the trust in the top 20% of organisations on 16 key measures of staff satisfaction, demonstrates the amount of hard work that the trust has undertaken to improve staff engagement, satisfaction and morale.
8.3 Blackburn with Darwen Borough Council
It has been announced that the council’s Chief Executive, Harry Catherall, the unitary authority’s longest serving chief Officer will retire next Easter after a successful 40 year career in local government.
Earlier this year he celebrated the council being named the National Local Authority of the Year in the prestigious Municipal Journal Awards.
He will officially hand over in May to his deputy, Denis Park, who he has worked closely with throughout his 21 years at the council.
I am sure you join me in wishing Harry a long and happy retirement.
9. East Lancashire CCG
9.1 2017/18 CCG Assessments for Mental Health, Dementia, Learning Disabilities & Diabetes NHS England has formally written to the CCG about the assessments undertaken by independent panels for clinical priority areas for the CCG. They thanked the CCG for the hard work in these vital areas of care.
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The assessments are based on the relevant clinical indicators used in the overall CCG IAF, and are in addition to the headline assessment of the CCG of 2017/18 that was published in July. They provide a snapshot of the CCGs performance in these clinical priority areas compared with other CCGs and, where relevant, whether the CCG is meeting national ambitions. To make the assessment more meaningful and as accurate as possible the latest data from 2017/18 is used (most of which was available in autumn).
The headline ratings are; Mental Health – Requires improvement Dementia – Outstanding Learning Disabilities – Requires improvement Diabetes – Good
A series of actions are in place to improve the position on the Mental Health and Learning Disabilities assessment outcomes.
9.2 Good News
New Year’s Honours List
The New Year’s Honours list for 2019, was published on 29 December 2018, recognising the outstanding achievements of people across the United Kingdom. The honours list continues to demonstrate the breadth of service given by people from all backgrounds and from all across the UK.
In total 1,148 people have received an award:
1018 candidates have been selected at British Empire Medical (BEM), MBE and OBE level: 358 at BEM, 422 at MBE and 238 at OBE; 70% of the recipients are people who have undertaken outstanding work in their communities either in a voluntary or paid capacity; 544 women are recognised in the list, representing 47% of the total; 12% ofhe successful candidates come from a BAME background; 4% of the successful candidates consider themselves to have a disability (under the Equality Act 2010); 5% of recipients identify as being LGBT.
This list highlights a range of extraordinary responses to a number of significant and traumatic events - honouring those who have overcome personal loss, helped rebuild communities and whose expertise and dedication showcase the very best of the UK.
In the NHS’s 70th year, dozens of NHS staff have been recognised in the 2019 New Year’s Honours list, including 15 leading nurses, an array of doctors, dentists, physiotherapists and other health professionals, and those who led the response to terror attacks and major incidents.
England’s outgoing Chief Nurse, Professor Jane Cummings, is one of the many awardees from a nursing background, receiving a CBE for her contribution to the NHS over the course of her career.
Locally East Lancashire residents have also been recognised: John Clough, from Nelson, whose daughter Jane was murdered by her ex partner in 2010, received an MBE for services to Victims Domestic abuse Mel Goodship, from Colne, who lost her teenage son James in a drowning accident in 2014, was given the same award for ‘services to educating young people on the dangers of open water’
10 Former East Lancashire health boss Ian Woolley, 86, also received the MBE while June Steele, 79, was awarded the British Empire Medal (BEM) for services to netball and the community in Blackburn and Darwen Great Harwood-born Susan Scurlock, founder and Chief Executive of Burnley- based education provider Primary Engineer, receives an MBE British Transport Police officer PC Mark Renshaw, from Blackburn, who was one of the first on the scene of the May 2017 Manchester Arena bombing, was awarded the BEM
9.3 Policies and Procedures
The following policies have been reviewed, approved and disseminated in line with the policy ‘An Organisation wide Policy for the Development and Management of Policy and Procedural Documents’:
Title of Policy Summary of Procedures and Treatments not Normally Funded Risk Management Policy and Strategy Business Continuity Plan Adoption Policy Absence Management Policy Career Break Policy Disciplinary Policy Grievance Policy Harassment and Bullying at Work Policy Induction Policy Job Evaluation – Bandings and Review Policy Managing Work Performance Policy Maternity Policy Parental Leave Policy Shared Parental Leave Policy Paternity Leave Policy Professional Registration Policy Retirement Policy Secondment Policy Substance Misuse Policy Temporary Promotion Policy Training and Development Policy Organisational Change Policy Continuing Healthcare (CHC) Choice and Equity Policy Freedom to speak up – Raising Concerns (Whistleblowing) Policy
10. Stakeholder Engagement
10.1 Since taking up the post of Chief Officer the following meetings and engagement with our key stakeholders have taken place:
January AOs, CEOs and STP Execs Meeting A&E Delivery Board meeting SEND Partnership introduction meeting with Hilary Fordham Professor Dominic Harrison, Blackburn with Darwen Borough Council Integrated Care Partnership meeting with Price Waterhouse Coopers 11 CCG Chairs Partnership Leaders Forum NHSE Check and Challenge session Lancashire SEND partnership Board
11. Recommendations
11.1 Members are asked to: Note the updates in this report Ratify the policies in Section 9.
Dr Julie Higgins Chief Officer
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