NHS Castle Point & Rochford / NHS Southend Clinical Commissioning

NHS Castle Point & Rochford / NHS Southend Clinical Commissioning Group Board Meeting Part I Agenda 27th May 2021 from 3.00pm

Action Papers Lead Time Page No.

GENERAL BUSINESS Welcome and apologies for 1. To note Verbal Chair absence - 5 mins Declarations of interest and review To note 2. Attached Chair - of Register of Interest 3 5 Minutes of the meeting held 25th To 3. Attached Chair March 2021 approve - 5 mins 6 13 Action Log and Matters Arising from 4. To note Attached Chair last meeting (not on Agenda) 14 5. Questions from the Public To note Verbal Chair - SYSTEM REPORTS Nic Adams, 6. Board Assurance Framework To note Attached 5 mins - Governance Lead 15 23 Rachel Hearn, 7. Patient Story To note Presentation Executive Director of 10 mins - Nursing Joint Committee Update, 20 May 8. To note Verbal Chair 5 mins 2021 - PLACE REPORTS Tricia D’Orsi, NHS 9. Alliance Director Update To note Attached 10 mins - Alliance Director 24 34 Mid & South Essex System To Mark Barker, Joint 10. Attached 10 mins - Financial Planning Update approve CFO 35 47 Nic Adams, 11. Policies Across MSE To note Attached 10 mins Governance Lead 48-52 Lorraine Coyle, Deputy 12. Patient Safety & Quality Report To note Attached 10 mins - Chief Nurse 53 105 Performance Report Tricia D’Orsi, NHS 13. a) Acute To note Attached 10 mins - Alliance Director 106 134 b) Non-Acute Summary of Discussion held at: a) M&SE CCG Patient Safety Lorraine Coyle, Deputy & Quality Committees Chief Nurse 14. in Common To note Attached 10 mins 135-140 b) Finance & Performance Mark Barker, Joint Committees in CFO Common FOR INFOMATION Minutes from: a) Joint Executive Committee – 01/04/21, 15/04/21 and 06/05/21 b) CP&R Patient and 15. Community Reference To note Attached Chair 140-164 Group – 19/01/21 and 16/03/21 c) Southend Patient and Community Reference Group – 16/02/21

16. Any Other Business To note Verbal Chair

Action Papers Lead Time Page No.

Date/time of next Part I Board 17. Meeting: To note - Thursday, 29 July 2021 at 3.00 pm

Quoracy: CP&R Gov Body - 8 Governing Body Members, including 5 clinicians Southend Gov Body - 6 Governing Body Members, including 3 clinicians CONFLICT OF INTEREST REGISTER - NOVEMBER 2020 Direct or Last Name First Name Current Positon(s) held in the CCG Declared Interest Type of Interest Indirect Date of Interest Action taken to mitigate risk COMMENTS Interest

From To Financial Interest Financial Non-Financial Professional Interest Personal Non-Financial Interest to Publish Consent Andole Dr Sreeman Secondary Care Consultant Asst Medical Director NHSE ✓ All on- ✓ CQC Specialist Advisor ✓ going Clinical Reference Group, Neurosciences, ✓ NHSE/I ✓ Stroke Consultant, Kings College Hospital. MBRACE-UK, confidential enquiry into ✓ Maternal Deaths and Morbitity - Committee Member. Medical Director East of England ✓ Ambulance Trust Barker Mark Chief Finance Officer N/A N/A N/A N/A N/A N/A N/A N/A ✓ Barusya Dr Kate Governing Body Member GP Partner North Avenue Surgery ✓ Direct April 2019 Present ✓ Clinical Lead for Maternity and CYP & Sessional GP IC24 OOH ✓ Direct May 2018 Present DMO Appraiser, NHS England ✓ Direct Oct 2013 present ✓ Clincial Supervisor, ARU Medical School Direct Nov 2018 Present ✓ Director, Barusya Company Ltd Direct Aug 2008 Present ✓ Medical Advisor, SBC Adoption Panel Direct April 2019 Present

Chaturvedi Dr Krishna Governing Body Member Sessional GP ✓ Direct ongoing ✓ Clinical Executive Committee Chair Doherty Steve Board Member - Practice Manager Practice Business Manager, Audley Mills ✓ Direct Current ✓ Representative Surgery Secretary, Audley Mills Eye Services Ltd ✓ Direct Current Secretary, Audley Mills Medical Education Centre Ltd ✓ GP Healthcare Alliance Direct Current

D'Orsi Patricia Deputy AO / Chief Nurse N/A N/A N/A N/A N/A N/A N/A N/A ✓

Freeman Tracey Lay Member Governance Interim Finance Sepcialist, Maldon District ✓ Direct May 20 Oct-20 ✓ Council Garcia-Lobera Dr José Chair GP Partner, Pall Mall Surgery ✓ Direct Present not be part of the ✓ Commissioning process/ Trustee, Southend United Community and ✓ Direct Present decision where conflict may Education Trust occur

Gibson Janis Lay member Public & Patient Castle Point Association of Voluntary ✓ Direct 2015 Present ✓ Engagement Services, Chief Executive Officer Estuary House Association, Non-Executive Director Direct 2017 Present Brother in law director of KPMG Social Prescribing ✓ Indirect Meeting room hire to the CCG ✓ ✓ Indirect Oct 19 Present

Gupta Sunil Governing Body Member GP at Rushbottom Lane Surgery ✓ Direct 1995 Present ✓

Non Executive Director of Essex Equip Ltd ✓ Direct Nov 2017 Present

GP Trainer ✓ Direct 2004 Present Examiner for the Royal College of General ✓ Practitioners (RCGP) Direct 2004 Present ✓ Member of the Board of the Essex Faculty of the RCGP Direct Jun 2013 Present ✓ Member of the East of England Clinical Senate Council & Vice Chair Direct Oct 2013 Present

GP Advisor for Care Quality Commission ✓ inspections of General Practices Direct Sept 2014 Present

✓ GP Advisor as part of the RCGP Special Measures Support Team Direct Oct 2014 Present

Gupta Sunil Member of the Conservative Party ✓ Direct 2016 Present ✓

Representative of the Essex Faculty at the United Kingdom Council of the Royal ✓ College of General Practitioners Direct Nov 2015 Present

Member of CCG Improvement and Assessment Framework Panel for Dementia ✓ Direct Apr 2016 Present Non Executive Director of Essex Equip Ltd ✓ Direct 2017 Present Member of the NICE Quality Standards Advisory Committee ✓ Direct May 2016 Present Chair of South East Essex Dementia Steering Group ✓ Direct 2018 Present Representative of the Royal College of General Practitioners on the National ✓ Patient Safety Response Advisory Panel Direct May 2018 Present Direct or Last Name First Name Current Positon(s) held in the CCG Declared Interest Type of Interest Indirect Date of Interest Action taken to mitigate risk COMMENTS Interest

From To

Financial Interest Financial Non-Financial ProfessionalInterest Personal Non-Financial Interest to Publish Consent Gupta Sunil Vice Chair of East of England Clinical Senate ✓ Direct Jan 2017 Present ✓ Council

✓ Member of the General Practice Curriculum Direct May 2017 Present working group for Anglia Ruskin University

Member of the Advisory Committee on ✓ Resource Allocation Direct Aug 2017 Present

Associate Postgraduate GP Dean in Health Education East of England ✓ Direct Feb 2018 Present Member of Essex Health and Wellbeing ✓ Board Direct Mar 2018 Present

Wife is Consultant Community Paediatrician for PROVIDE in Mid Essex ✓ Indirect 2016 Present

Gupta Sunil Member of the Essex Primary Care Inter- ✓ Direct Oct 2015 Present ✓ Professional Centre for Workforce Development Steering Group ✓ Representative of the Essex Faculty at the Direct Nov 2015 Present United Kingdom Council of the Royal College of General Practitioners

Member of CCG Improvement and ✓ Direct Apr 2016 Present Assessment Framework Panel for Dementia

Member of the Essex Primary Care ✓ Workstream Group Direct May 2016 Present

Member of the NICE Quality Standards ✓ Advisory Committee Direct May 2016 Present

Member of the Expert Reference Group on ✓ the Achieving Better Access to mental Direct July 2016 Present Health Services by 2020: Dementia Care Services

Representative of the Royal College of ✓ General Practitioners on the National Patient Safety Response Advisory Panel Direct Nov 2016 Present

Gupta Sunil Member of the Geneal Practice Curriculum ✓ Direct May 2017 Present ✓ working grop for Anglia Ruskin University

Member of the Advisory Committee on ✓ Resource Allocation Direct Aug 2017 Present

Associate Postgraduate GP Dean in Health Education East of England ✓ Direct Feb 2018 Present Member of the Midlands and East GP Forward View Stakeholder Group ✓ Direct Mar 2018 Present

Wife is Consultant Community Paediatrician for PROVIDE in Mid Essex Indirect

✓ Hadley Sharon Governing Body Member/ Clinical Lead GWER in Respiratory ✓ Indirect Aug 18 ongoing ✓ Work in a salaried capacity for EPUT as a provider of medical services to Brockfield Indirect ongoing ✓ House Secure Mental Health services Houston Dr Brian GP Governing Body member & Clinical Partner at Highlands ✓ Direct Present ✓ Lead Wife works for EPUT Care coordination ✓ Indirect Daughter is a registrar doctor A&E Basildon ✓ Indirect Kamdar Dr Mahesh GP Governing Body member Locum GP in Member GP Practice ✓ 2018 Present ✓ Khan Dr Fahim Clinical Lead for Planned Care Planned Care Lead for Referral and Peer ✓ Review ✓ Ongoing Khan Dr. M GP Governing Board member Member of practice which is a shareholder Financial 2014 ✓ Rizwan in GP Healthcare Alliance Ongoing Partner of member practice of CCG - Dr Financial 2003 Khan and partners, Rushbottom Lane surgery, Benfleet 2019 Member of practice that is part of Benfleet Financial Ongoing Primary Care Network Partners and employee’s at Dr Khan and Indirect 2014 partners are board members of GP Ongoing Healthcare Alliance GP Educator lead for EU doctor recruitment for the STP – employ EU GPs via the scheme Indirect 2017 Ongoing

Kuriakose Dr Biju Governing Body Member GP Partner, GP Trainer, GP Tutor, GP ✓ Direct Current ✓ Research Champion

✓ Share Holder GP Healthcare Alliance Direct Current ✓ Wife works as Psychiatrist (Old Age) for Direct Current EPUT at Crystal Centre Chelmsford Indirect Current Lansley Jacqui Director of Integration & Partnerships N/A N/A N/A N/A N/A N/A N/A N/A Direct or Last Name First Name Current Positon(s) held in the CCG Declared Interest Type of Interest Indirect Date of Interest Action taken to mitigate risk COMMENTS Interest

From To Financial Interest Financial Non-Financial Professional Interest Personal Non-Financial Interest to Publish Consent Liebmann Dr Rachael Secondary Care Clinician Trustee Royal College of Pathologists - ✓ Direct 2009 Present ✓ Charity Consultant Histopathologist Queen Victoria ✓ Direct 2015 Present Hospital NHS Foundation Trust - NHS Provider Specialist Trust ✓ Group Medical Director The Dorcotrs Laboratory and Health Services Laboratoies Direct 2017 Present Husband - Chief Executive Young Epilepsy - Indirect 2014 Present ✓ Charity Husband - Trustee Royal College of Paediatrics and Child Health ✓ Indirect 2016 Present

McKeever Anthony Joint Accountable Officer/Executive Lead Director Macs et al Ltd, through which ✓ for Mid & South Essex ICS contract with NHS as interim ✓ Sep-00 present Metcalfe Mark Governing Body Member GP Partner in member practice of CCG ✓ Direct 2011 Ongoing ✓ GP practice part of GP healthcare Alliance and Crouch Valley Federations ✓ Direct 2014 Ongoing Director of Onyx Medical Limited (Medical Education Company) ✓ Direct 2017 Ongoing

Ng Dr Kelvin Governing Body Member None ✓ Clinical Lead for Prescribing

Orhewere Mary, Dr Consultant in Public Health Medicine, N/A N/A N/A N/A N/A N/A N/A N/A ✓ SBC Ozturk Dr Sami Governing Body Member Locum GP in CPR / Southend area ✓ Direct 01.09.19 Present ✓ GP Appraiser - NHSE EOE ✓ Ad-hoc private GP Consultations Oakdin ✓ Direct March 17 Present Clinic, Billericay ✓ Covid 19 Antibody testing Direct Jan 2020 Present

Saville Dr Lucy Governing Body Member GP Partner Audley Mills ✓ 2005 Present ✓ Medical Advisor for Foster Agency ✓ 2014 Present Husband Consultant Anaesthetist /Critical 2019 Present Care ✓ Showell Dr Daniel Public Health Consultant Employed by ECC who is a partner with the ✓ ✓ Direct 2013 Present ✓ CCG on multiple issues. Siddiqui Dr Kashif Governing Body Member GP Partner, St George's Medical Practice, ✓ Direct September Preseny ✓ Benfleet. Practice is a Member of GP 2012 Stratford Pauline Lay Member JamesHealthcare Currell, Alliance, Associate Benfleet Director PCN, of accepts ✓ ✓ Operations is married to my second cousin.

Syed Dr Taz Governing Body Member Wife Louise is a health visitor for Virgin in ✓ Indirect 2016 Present ✓ Named GP Safeguarding Children Basildon Clinical Lead - Quality & Digital GP at Pall Mall Surgery ✓ Direct On-going Wier Dr John External/Impartial GP N/A N/A N/A N/A N/A N/A N/A N/A ✓ Williams Simon Director of Partnerships & Integration N/A N/A N/A N/A N/A N/A N/A N/A ✓ NHS Castle Point and Rochford CCG/ NHS Southend CCG Part I Governing Body Meeting in Common 25th March 2021, 3pm – 5.00pm MINUTES Agenda Item 03

Attendees from Southend CCG: Dr Jose Garcia-Lobera (JGL) GP Governing Body Chair NHS Southend CCG Dr Kate Barusya (KB) GP Governing Body NHS Southend CCG Dr Brian Houston (BH) GP Governing Body NHS Southend CCG Dr Krishna Chaturvedi (KC) GP Governing Body NHS Southend CCG Dr Kelvin Ng (KN) GP Governing Body NHS Southend CCG Dr Taz Syed (TS) GP Governing Body NHS Southend CCG Becky Pollard (BP) Interim Public Health Consultant Southend Public Health Attendees from CP&R CCG: Dr Sami Ozturk (SO) GP Governing Body NHS CP&R CCG Dr Biju Kuriakose (BK) GP Governing Body NHS CP&R CCG Dr Mahesh Kamdar (MK) GP Governing Body NHS CP&R CCG Dr Lucy Saville (LS) GP Governing Body NHS CP&R CCG Dr Riz Khan (RK) GP Governing Body NHS CP&R CCG Dr Mark Metcalfe (MM) GP Governing Body NHS CP&R CCG Attendees that sit across both Southend and CP&R CCGs: Anthony McKeever (AM) Joint Accountable Officer Mid & South Essex CCGs Janis Gibson (JG) Lay Member, Patient Engagement NHS CP&R and Southend CCGs Pauline Stratford (PS) Lay Member, Primary Care NHS CP&R and Southend CCGs Tricia D’Orsi (TD) NHS Alliance Director NHS CP&R and Southend CCGs Mark Barker (MB) Chief Finance Officer Mid & South Essex CCGs Simon Williams (SW) Director of Integration & Partnerships NHS CP&R and Southend CCGs Dr Rachael Liebmann (RL) GP Governing Body NHS CP&R and Southend CCGs Lorraine Coyle (LC) Deputy Chief Nurse NHS CP&R and Southend CCGs Hayley Waggon (HW) Executive Assistant (Minutes) NHS CP&R and Southend CCGs In Attendance Claire Routh (CR) Head of Communications NHS CP&R and Southend CCGs Michelle Angell (MA) Associate Director of Performance NHS CP&R and Southend CCGs Nicola Adams (NA) Associate Director of Corporate Governance NHS Thurrock CCG Kaltrina Bajrami (KB) Communication & Engagement Officer NHS CP&R and Southend CCGs Caroline McCarron (CMc) Associate Director of CYP NHS CP&R and Southend CCGs Apologies Dr Kashif Siddiqui Cllr Egan Tracey Freeman Rachel Hearn Danny Showell

Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group 1. Welcome and Apologies 1.1 SG welcomed everyone to the meeting in common of the Southend and CP&R CCG Governing Body.

1.2 Apologies were noted as above.

2. Declarations of Interest 2.1 Members of the Committee were reminded of their obligation to declare any interest they may have on any issue arising at committee meetings which might conflict with the business of CP&R/Southend CCG and that declarations declared by members of the Committee are listed in the CCG’s Register of Interests. The Register is available either via the Committee Secretary to the governing body or the CCG website at the following link: https://castlepointandrochfordccg.nhs.uk/about-us/key-documents/2508- declarations-of-interest-governing-body/file or https://southendccg.nhs.uk/about- us/key-documents/320-nhs-southend-ccg-governing-body-declarations-of-interests- register/file

3. Minutes from 26.11.2020 3.1 The minutes from the Governing Body held in November 2020 were agreed as an accurate reflection of the meeting.

4. Action Log 4.1 The action log was updated as below:

Item 021 – Maternity SIs – LC provided an update and assured that Quality Leads were working with SUHFT. Close.

5. Patient Story 5.1 The patient story was from two mothers who shared two very different birthing experiences. One had a home birth, whilst the other had a hospital birth.

5.2 The patient story was well received by Governing Body Members. LC thanked the mothers for sharing their story and stated that it was good to hear that mothers are receiving good care and that this supports the improvements that the Trust are trying to achieve. It was agreed that the key to success is continuity of care and communication.

6. Board Assurance Framework (BAF) 6.1 TD presented the BAF and advised the Governing Body members that we will be resuming this from April onwards. The CIMT Risk Register has already been received by Governing Body Members.

It was acknowledged that prior to this lockdown Governance Leads had done a lot of work to provide the new updated version of the BAF.

6.2 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the BAF.

7. Central Incident Management Team Update 7.1 AMC presented the CIMT Update and informed Governing Body members that pressures we have seen in previous reports had abated in recent weeks. Back in January 2021 our local hospitals had 40% of the Covid in-patients for the whole of the region. There has not been a need to take many decisions outside of the normal board meeting framework over the last month or so. This report highlights the key

Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group things but in particular the fabulous vaccination work being carried out not only by the national programme but also by our local PCNs/GPs. Our local MPs have also paid tribute to this remarkable achievement. Due to the possibility of supply of vaccinations likely to be a little more constrained, the focus will be on completing cohorts 1-9 and 2nd doses.

We now need to start to focus on the recovery and restoration of services within the hospital and community. The greatest pressure is around elective care and waiting lists. The Trusts are focussing on the highest clinical priorities and also reviewing the long waiters to ensure there has been no patient harm.

Next couple of weeks will be directed towards expanding capacity, not just critical care, but also in relation to independent sector providers and also in relation to bringing in additional facilities.

7.2 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the CIMT Update paper.

8. Integrated Care System Update 8.1 AMC informed the Governing Body that a white paper had been produced by the Government, which states that the NHS needs to move towards an Integrated Care System. It was felt that this a continuation of the journey that we have already been on locally. An ICS will ensure that services are more integrated, care is more personalised and tailored to the needs of our local communities.

Legislation will be brought in that will ask for an ICS to be implement from 1st April 2022.

8.2 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the ICS update.

9. Financial Plan 2021/22 9.1 MB presented the Financial Plan for 2021/22, which was taken as read. However, he explained that much of the focus for 2020/21 had been around Covid-19, which has meant there has been some delay in receiving our planning guidance for 2021/22.

Historically Mid and South Essex have had a deficit and initial plans show an underlying system net deficit of around £103m. We are however still awaiting guidance and oversight from NHSE as to what the final plan should be based upon, draft set of budgets can be found in Appendix A.

9.2 JGL questioned the service line budget for cardiovascular surgery and whether there had been any clinical input and whether this also included areas of prevention.

MB informed that clinical input has been sought to ensure that there is end to end costing. Since this paper was written there has been a meeting of the Senior Finance Leadership Group who have reviewed allocations across the service lines and will ensure that this goes directly to services. Draft will be shared to ensure that there is adequate check and challenge.

9.3 SW queried two services lines for Primary Care Services and other programme services and what they included.

MB informed that Primary Services included NHS 111 (the lions share) £1.50 per head, GPIT and LCS. Other programme services are for the transformation of support

Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group services/pilots etc.

9.4 The Castle Point & Rochford and Southend CCG Governing Body members APPROVED the Financial Plan for 2021/22.

10. Joint Committee MSE MOC 10.1 SW presented the MSE Medicines Optimisation Committee update paper, which was taken as read. There was mention in the paper regarding patient transport, which was noted as an error.

SW explained that there had been an impact on meetings due to Covid-19, however there was a Committee in November where the Terms of Reference and ethical framework were approved and various decisions were made regarding prescribing.

At the December Committee there were some new drugs added to our formulary along with a number of pathways that were approved.

At the March Committee guidelines were issued around the prescription of Dexamethasone for the treatment of Covid-19.

It was felt that this demonstrated a good, clear, collaborative piece of joint working.

10.2 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the MSE MOC.

11. Communications & Engagement 11.1 JG presented the Communications & Engagement Update paper, that was taken as read. She highlighted that during the major incident response the Communications Team had worked across Mid and South Essex as part of the engagement workstream. The media interest during this period has been extensive, including regional interest from BBC Look East and BBC Essex and regular briefings with MPs and Councillors. Patient engagement, which has been imperative, also continued during this time and with extensive support given to the Vaccination programme.

JG also brought to the Governing Body members attention the February Insight Bulletin and the use of an Equality Impact Assessment.

JG asked that formal thanks to the Communications Team for their incredible work during this difficult time be noted.

11.2 JGL agreed and stressed how beneficial for clinicians working through the pandemic the information has been, keeping them abreast of issues has been.

11.3 PS raised a query around the use of electronic communications during the pandemic, which has been very effective, but how are we reaching those without access to digital communications.

JG explained that there had been various other ways, including inserting communications into pharmacy bags and building relationships with Community groups.

11.4 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the Communications and Engagement Update report.

Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group 12. NHS Alliance Director Report 12.1 TD presented this report which is aimed at ensuring that Governing Body members are kept sited on the various initiatives that are happening both at Place and system.

One area in particular to highlight was the BP@Home pilot and also that it was imperative that we continued to promote the importance of a Flu plan.

She also explained that the south east Essex Alliance, which is a forum that includes a number of different stakeholders, is maturing with the support of the Voluntary Sector, Health Watch, all Health providers and PCNs. This forum has been identifying local priorities and thinking about how we can deliver services more effectively in the future.

Over the last week there has been a CQC partnership review for mid and south Essex that focussed on Learning Disabilities, with a number of interviews having taken place.

12.2 JG raised that there was an opportunity for the use of social prescribers to support the PCNS. LC and JG will discuss this possibility further outside of this meeting.

12.3 Due to some technical difficulties JGL was unable to raise some questions concerning the Alliance Director report and these were sent after the meeting as below:

• Whzan telehealth solution for care homes There are some figures about the reduction of A&E attendances and non-elective admission comparing care homes with or without Whzan that are very positive. Would be possible to check the numbers of previous years because the enhance service for care homes did clearly show reduction on those parameters and will be good to see a longer trajectory?

Response – Care Home data was sent to Governing Body members that is being used to track Whzan vs homes without, compared to 19/20 baseline data. We will request A&E attendance/NEL admissions from care homes data prior to this period.

• SystmOne “FrEDA” (Frailty, End of Life and Dementia Assessment) template is now waiting for the digital application installation to promote its use across the system. This was previously approved and installed on SystmOne, can you explain what is different now and do we know if the wider system is using it, other than community services?

Response – Both the Acute and Social Care are being encouraged to use, with Southend Borough Counil already accessing and taking part in the workstream group. Once pilot complete in South East Essex we will look to roll out across the MSE which will enable a more consistent multi-organisational and live data input capture to enable the development of population health level of oversight of frailty.

• Palliative EOL Care. It mentions PEACE document to be used widely in our system. Is this the final agreement as other parts of our system did prefer TEP?

Response - It has been agreed that the PEACE document is the preferred option for Advance Care Plans but TEP can be used if preferred.

• Havens Hospice. What is the risk with the forthcoming retirement and how confident are we with continuity of the provision of safe and responsive care?

Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Response – Risk is high and we acknowledge the lack of Palliative Care consultants. Succession process has begun to ensure that Hospice and Community cover will be delivered safely and effectively. Business case is currently being developed with a mix of hospital, community and hospice work.

• Page 72. 4.4 Locality Integrated Networks. I think that this should be brought to the Joint CEC for update on progression, clinical involvement and clear examples of real benefits for patients and clinicians.

Response – paper will be taken to Joint CEC in May.

12.3 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the NHS Alliance Director Update report.

13. Constitution Update 13.1 Nicola Adams, Associate Director of Corporate Governance for Thurrock CCG presented the Constitution Update paper, that was taken as read. She explained that a paper had previously been brought to the Governing Body for minor approvals which included the new Joint Executive Team appointments. The Constitution was subsequently sent to NHSE for their approval, which was returned with a few queries relating to how things were worded and we have made these minor changes. In addition to this a piece of work has been carried out across the MSE around the terms of reference for statutory committees. Audit & Risk, Remuneration and Primary Care Commissioning Committees Terms of Reference have been reviewed, along with the CCG financial limits to ensure that these are harmonised across the 5 CCGs to enable effective decision making.

If approved by the Governing Body today the constitutions will then be resubmitted to NHE for approval.

13.2 There were no questions or comments raised by members of the Governing Body.

13.3 The Castle Point & Rochford and Southend CCG Governing Body members APPROVED the Constitutional Changes presented in today’s paper.

14. Quality Report 14.1 LC presented the Quality Report and explained that this was to give the Governing Body as an oversight of potential issues around patient quality and safety. A Patient, Safety and Quality Committee in Common across MSE has been established, where issues are further scrutinised.

14.2 JGL raised the following questions:

• Page 231. Mistake with MRSAB on Thurrock numbers. - with all the information about infections. Is there any trend, concern or learning? Are we better or worse than before? • Page 236. 3.3, It says “no harm has been declared in 1256 reviews. Low harm has been declared in 17 cases” is this right? • Is there anything that we can learn in terms of infection rate and anything that can be identified as an improvement for the Acute services and can we ensure that the figures identified have gone through the right channels.

LC informed that there is an Infection Prevention Control team which sits across MSE and she would speak to them regarding these questions.

Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Action: LC to feed back at the next meeting regarding infection control queries LC

14.3 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the Quality Report.

15. Performance Report 15.1 MA presented the Performance Report, that was taken as read and highlighted the salient points.

Services have been severely impacted by Covid, particularly on RTT and Cancer, but the Acute Trust are working hard to progress the back log. They have insourced independent sector providers who are prioritising cancer patients. This is being continuously monitored by the System Oversight Group.

There has also been an impact on IAPT services and we are unlikely to meet our targets.

There is also considerable pressure on A&E services.

A number of solutions to help within the Care Homes have been established with various initiatives and the support from local GPs through virtual consultations.

13.2 PS asked whether a report could be produced that showed where we are with the action plans that sit alongside the performance report so that we could be assured with what is being done to assist recovery.

MA informed that a regular progress report against the undertaking will be brought to the meetings regularly going forward.

13.3 The Castle Point & Rochford and Southend Governing Body members NOTED the Performance Report.

15. SEND Update 15.1 CMc presented the SEND update, that was taken as read and explained that this report give an overview of the key priorities for children and young people across the HCP and Place. The Voice of the Child programme is being considered with everything that is being done.

ASD diagnostics backlog has been challenging but significant progress is now being made with a new pathway for children over 5. The under 5 pathway has been reviewed and has a multi-disciplinary approach.

The Lighthouse Child Development Centre has been closed due to Covid, but we are arranging for additional clinics to be held to bring the backlog down.

There has been significant challenges to children and young people going back to school and we are working closely with partners and stakeholders around the issues that are coming to light.

13.2 PS noted that there is a lot of mapping of services and asked whether once the work had been completed would it be possible to produce a simpler diagram for patients and parents as to what services are available for easier access and understanding.

13.3 The Castle Point & Rochford and Southend CCG Governing Body members NOTED

Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group the SEND Report.

15. Annual Accounts Delegation 13.1 MB requested as in past years for the Annual Accounts and Report to be delegated to the Audit & Risk Committee for review and scrutiny and to then recommend to the Governing Body for approval.

13.2 The Castle Point & Rochford and Southend CCG Governing Body members APPROVED the Annual Accounts Delegation to the Audit & Risk Committee.

15. AOB 13.1 The minutes from other Committees were NOTED by the Governing Body members.

13.2 MB informed members that we are expecting a forecast outturn of a break even position. Working with colleagues across system to ensure we smooth out deficits where they exist and identify areas of protected funding for services. The Governing Body will be kept up dated of progress.

13.2 JGL mentioned a patient experience that he had been informed off, where a dementia resident who had been non-verbal for some time, had been given a robotic cat and was now speaking a few words, which brought the care home staff and dementia nurse to tears. He wanted members to know the impact that these types of initiatives were having.

13.3 TD informed Governing Body members that a long standing member of staff, Cathy Cunningham, had retired after 20 years of service to the NHS. It was agreed that a letter of thanks would be sent from the Governing Body to Cathy. Action: Letter from the Governing Body thanking Cathy Cunningham for her TD long service to be sent.

13.3 There being no further business, the meeting was adjourned at 16.45pm

Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group ACTION LOG

Agenda Item: 04 GOVERNING BODY in Common - As at 26.11.2020

Log Action Date Due Lead RAG Status Date No: Added By closed Details of action required Mtg Date Return Exec Lead Details if completed or reason for delay/deferral - if date completed move to 'Closed' tab 022 Letter of thanks to CC on her retirement to be 25.03.2021 - TD Complete. Close 27.05.2021 sent from Gov Body members. ITEM 06 BOARD ASSURANCE FRAMEWORK Agenda Item 06

MSE Board Assurance Framework and Corporate Risk Register

Board Meeting 27 May 2021

Purpose of Report: To provide the CCG Governing Body with an update on the risks facing the MSE CCGs via the Board Assurance Framework and Corporate Risk Registers.

Recommendations and The Committee are asked to DISCUSS and NOTE the updated BAF. decision/actions:

Executive Summary The risk management process was stood down in December 2020 in (including financial impact): response to further wave of the COVID-19 pandemic and re-started again from April 2021.

Risks have been reviewed with risk owners and have been updated accordingly. Following the planning guidance for 2021/22, new workstreams and risks have been added where appropriate to reflect the delivery requirements of the new financial year. Key CCG Committees (such as quality and finance) have reviewed the risks associated with their responsibilities during the month, that are now reported to the Governing Body.

The attached report includes: - Dashboard showing the associated number of risk and project delivery ratings against each of the CCG strategic objectives, with a summary of the red rated risks associated with those objectives. (note that a number of red rated risks will be associated with more than one strategic objective. - BAF showing a summary of the key workstreams / risks that are red rated in terms of current risk rating and also for project delivery. - Detailed spreadsheet show the full assurance information relating to the red rated risks.

There are currently 19 risks flagged on the register as ‘Extreme’ rated (scoring 15 or above) as follows: Risk Workstream Area Score To achieve the Constitutional Standard for referral to 25 treatment (RTT). Service Provision of high risk medicines. 20 Palliative and End of Life Care 16 Acute Trust Maternity performance - Section 31 CQC 16 Warning notice published The CCG will continue to work in partnership with education and care to become fully compliant with the 16 Children and Families Act 2014 in relation to Special Education Needs and Disability (SEND).

Cover paper for use during COVID-19 pandemic across Mid and South Essex The CCG will continue to work in partnership with education and care to become fully compliant with the 16 Children and Families Act 2014. (Tier 4 Services).

Community Bed Management & Reconfiguration (including 16 stroke rehabilitation)

Control of Income and Expenditure across the System 16

Elective Recovery 16 Independent Sector Providers (ISP) 16 Transformation / Re-organisation Costs 16 Capital Resource Limit 16 Acute / Provider Quality Assurance 16 Mental Health Acute / Provider Quality Assurance 16 To achieve cancer performance in accordance with 15 Constitutional Standards. To achieve diagnostic (DM01) performance in accordance 15 with Constitutional Standards Infection Prevention and Control 15 Integrated Care System 15

Written by/Presented by: Nicola Adams, Associate Director of Corporate Governance, Thurrock CCG

Executive Director NHS Alliance Directors Sponsor:

Non-Officer/Board CCG Chairs and Audit Committee Chairs Sponsor:

Fit with CCG Strategic N/A Objectives?

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this MSE Audit Committees 25/05/2021 document).

Reports Submitted to Board only: Date signed-off by Executive Team. (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick ✓ ) ✓

Has the Equality/Quality/Privacy Impact Assessment ✓ been carried out and issues addressed?

Cover paper for use during COVID-19 pandemic across Mid and South Essex Details of Stakeholder, Patient N/A & Public Engagement:

Risks / Link to BAF: None BAF Ref:

N/A

Conflicts of Interest: None

Escalation: None To the Board To another Committee To the BAF/CRR

Cover paper for use during COVID-19 pandemic across Mid and South Essex Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership Clinical Commissioning Groups

MSE Strategic Objectives Dashboard 20/05/2021

No. Distilled Strategic Objectives Risk Rating Delivery Overview of risks and delivery No. Distilled Strategic Objectives Risk Rating Delivery Overview of risks and delivery

Key risks highlighted relate to Community Bed Management & Reconfiguration and Infection 1 Ensure services are organised to respond to and meet COVID 19 requirements. Ensure services are organised to respond to and meet COVID 19 requirements. 6 9 2 4 11 2 Prevention & Control

Key risks highlighted relate to cancer and diagnostic performance against constitutional standards, 2 ImproveImprove access access to to services services for for patients patients in inline line with with NHS NHS Plan Plan requirements. requirements. 1111 2626 88 1313 2828 44 Acute Trust maternity performance, SEND, Tier 4 services, Community Bed Management & Reconfiguration and the financial aspects of Elective Recovery.

MakeMake a astep step change change in inaddressing addressing inequalities inequalities and and quality quality priorities priorities to deliver to deliver outcomes outcomes in accordance in accordance with Key risks highlighted relate to Acute Trust maternity performance, SEND, Tier 4 services, Community 3 99 2121 88 88 2424 66 Bed Management & Reconfiguration and, Infection Prevention & Control and the Acute and Acute constitutionalwith constitutional standards. standards. Mental Health Provider quality assurance.

Key risks highlighted relate to control of income & expenditure across the system, financial impact of 4 AchieveAchieve key key statutory statutory financial financial duties duties including including delivery delivery of theof the system system financial financial control control total. total. 11 44 66 00 1010 00 elective recovery, transformation / re-organisation costs, capital resource limit and independent sector provider costs.

TransformTransform and and strengthen strengthen Community Community and and Primary Primary Care Care Services; Services; developing developing and and strengthening strengthening PCNs PCNs to Key risks highlighted related to SEND, Their 4 services, Community Bed Management & 5 77 1717 55 88 1818 33 bringto bring care carecloser closer to home to home and avoidand avoid hospital hospital admissions. admissions. Reconfiguration and transformation / re-organisation costs.

StrengthenStrengthen partnership partnership working working across across MSE MSE and and within within localities localities to deliver to deliver a broad a broad range range of VFM of VFM Integrated Key risks highlighted related to SEND, Their 4 services, Community Bed Management & 6 1010 2020 88 88 2626 44 Reconfiguration, control of income & expenditure across the system, independent sextor provider ServicesIntegrated strengthening Services strengthening prevention and prevention early intervention. and early intervention. costs, capital resource limit and Infection Prevention & Control.

ExpandExpand and and embed embed an an increased increased range range of ofdigitally digitally delivered delivered services services to support to support better better access, access, efficient efficient 7 33 1313 00 55 99 22 There were no key risk issues lighlighted however two areas had red rated project delivery. servicesservices and and self-care. self-care.

AddressAddress workforce workforce challenges challenges within within the the system system and and support support our our staff staff to deliver to deliver the thevision vision across across the healththe 8 77 66 00 55 88 00 There were no key risk or project management issues highlighted. andhealth care and partnership care partnership for mid and for southmid and Essex. south Essex.

AchieveAchieve system system and and organisational organisational transformation transformation to streamlineto streamline decision decision making, making, improve improve VFM VFM and andbetter They key risks highlighted related to control of income & expenditure across the system, independent 9 66 99 22 77 1515 00 supportbetter supportnew commissioning new commissioning models. models. sector provider costs, transformation / re-organisation costs, and the capital resource limit.

Page 1 of 1 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups

Plan Risk & Delivery Updated: Thursday 20th May

Risk Owner / Risk Target Risk Strategic Residual Residual Risk Project Red Work-stream BAF ID Workstream Area Responsible Risks to delivery of objective (Blockers) Impact Milestone Deadline Enablers Score / Objectives Likelihood Risk Score Rating Delivery Rating Officer Rating Appetite To achieve cancer performance in accordance with Patient Safety & Harm, Patient Experience, Inequality, Planning Guidance Cancer Care CANC01 2 Karen Wesson 5 3 15 Partnership Working, People Resources 5 Constitutional Standards. Acute Hospital Demand, Service Delivery submission May 2021 To achieve diagnostic (DM01) performance in Patient Safety & Harm, Patient Experience, Acute Hospital Planned Care PLAC01 2 Karen Wesson 5 3 15 30/06/2021 People Resources 5 accordance with Constitutional Standards Demand, Inequality, Service Delivery All list "P" (priority To achieve the Constitutional Standard for referral Patient Safety & Harm, Service Delivery, Patient Experience, Partnership Working, People Resources, Planned Care PLAC02 2 Karen Wesson 5 5 25 coded) 100% coded 5 to treatment (RTT). Acute Hospital Demand Comms & Engagement by June 2021 None Identified Patient Safety & Harm, Acute Hospital Demand, Finance, Partnership Working, Finance, People Planned Care PLAC06 Service Provision of high risk medicines. 3 (awaiting JET Patient Experience, Reputational Damage, Inequality, 4 5 20 01/09/2020 4 Resources, IT Infrastructure, Legal appointment) Claims & Complaints, Service Delivery Ageing Well AGEW07 Palliative and End of Life Care 5 Karen Wesson Patient Experience, Inequality, Service Delivery 4 4 16 30/06/2021 None Identified 4 Patient Safety & Harm, Patient Experience, Regulator Acute Trust Maternity performance - Section 31 Maternity Services MATS02 2, 3 Rachel Hearn Penalties, Reputational Damage, Claims & Complaints, 4 4 16 30/06/2021 Partnership Working 0 CQC Warning notice published Inequality * Re-inspections due 18mths following initial inspection. Southend - April 2021, Thurrock - due now. Essex - 2022. * Transforming Care trajectories (monthly) The CCG will continue to work in partnership with Tricia D'Orsi * CETRs - in place Children, Young education and care to become fully compliant with Reputational Damage, Patient Safety & Harm, Patient CYP03 2, 3, 5, 6 4 4 16 montored monthly Partnership Working, People Resources 4 People the Children and Families Act 2014 in relation to SEND SRO at Experience, Inequality, Regulator Penalties 90% CETR before Special Education Needs and Disability (SEND). place admission target. * LD Register metrics < 25yrs March 2021 * Neuro - Review March 2021 * Autism WT - March 2021 (NHSE/I metrics expected.

The CCG will continue to work in partnership with Patient Safety & Harm, Service Delivery, Acute Hospital Tricia D'Orsi / Unplanned Care UNPC07 education and care to become fully compliant with 2, 3, 5, 6 Demand, Patient Experience, Inequality, Safeguarding, 4 4 16 01/11/2021 Partnership Working 4 Rachel Hearn the Children and Families Act 2014. (Tier 4 Services). Reputational Damage Service Delivery, Patient Experience, Acute Hospital Primary and Community Bed Management & Reconfiguration - 1, 2, 3, 5, 6 Dan Doherty Demand, Inequality, Patient Safety & Harm, Regulator 4 4 16 30/06/2021 Partnership Working, People Resources, Finance, Estates, Comms3 & Engagement, Legal Community Care (including stroke rehabilitation) Penalties Online Consultations, Video Consultations, Call- Digital Reputational Damage, Service Delivery, Inequality, Staffing, DITR01 Recall Systems for annual reviews, and messaging, 2, 1, 7 Peter King 3 3 9 01/12/2021 Finance, IT Infrastructure 3 Transformation HR, OD, Patient Safety & Harm including SMS Staffing, HR, OD, Reputational Damage, Patient Safety & Digital Peter King / DITR03 Digital First Primary Care 5, 6, 7 Harm, Finance, Service Delivery, Acute Hospital Demand, 3 4 12 01/03/2022 Partnership Working, People Resources 3 Transformation William Guy Patient Experience Control of Income and Expenditure across the Finance, Patient Experience, Patient Safety & Harm, Monthly, and as at Finance FIN01 4, 6, 9 CFO 4 4 16 Partnership Working, People Resources 4 System Reputational Damage, Service Delivery 31/3/22 Control of Income and Expenditure across the Monthly, and as at Finance FIN02 4, 6, 9 CFO Finance, Service Delivery, Reputational Damage 4 4 16 Partnership Working, People Resources 8 System 31/3/22 Finance FIN06 Elective Recovery 2, 4 CFO Finance, Reputational Damage, Patient Experience 4 4 16 31/07/2021 People Resources, Finance, Partnership Working 4 Finance FIN07 Independent Sector Providers (ISP) 4, 6, 9 CFO Finance, Patient Experience 4 4 16 31/07/2021 Partnership Working, Finance 8 Finance FIN10 Transformation / Re-organisation Costs 4, 5, 9 CFO Finance, Reputational Damage 4 4 16 31/12/2021 Human Resources, Finance, People Resources 8 Finance FIN11 Capital Resource Limit 4, 6, 9 CFO Reputational Damage, Finance 4 4 16 31/03/2022 Human Resources, Finance, People Resources 4 Governance and Patient Safety & Harm, Safeguarding, Patient Experience, Partnership Working, Comms & GOSD11 Infection Prevention and Control 1, 3, 6 Rachel Hearn 5 3 15 30/06/2021 5 Statutory Duties Reputational Damage Engagement Governance and Patient Safety & Harm, Patient Experience, Inequality, GOSD12 Acute / Provider Quality Assurance 3 Rachel Hearn 4 4 16 30/06/2021 Partnership Working, IT Infrastructure 4 Statutory Duties Claims & Complaints, Reputational Damage Sept 2021 Patient Safety & Harm, Patient Experience, Inequality, Governance and GOSD15 Mental Health Acute / Provider Quality Assurance 3 Rachel Hearn Claims & Complaints, Reputational Damage, Safeguarding, 4 4 16 ongoing People Resources, Partnership Working 4 Statutory Duties Staffing, HR, OD TBC ongoing Governance and Patient Safety & Harm, Patient Experience, Claims & GOSD13 Management of Serious Incidents (SIs) 3 Rachel Hearn 3 4 12 30/06/2021 People Resources, Partnership Working 3 Statutory Duties Complaints, Reputational Damage Governance and GOSS15 Integrated Care System 9 Jo Cripps Reputational Damage, Staffing, HR, OD 5 3 15 30/06/2021 People Resources, Partnership Working 5 Statutory Duties Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership May 2021 Clinical Commissioning Groups

Risk Owner / Description (Actions Planned to support delivery) Success Measures Strategic Locality Senior System/Place Risks of objective not being Enablers Current Workstream Area Workstream Objective System/Place Clinical Lead (Controls) Milestone Deadline (Assurance - 2nd line of Trend Assurance - 3rd line of defence Governance / reporting route Plan

Objectives Specific Responsible Op Lead delivered Score (Gap in control) Performance Rating Rating BAF BAF ID PM3 Ref Inherent (Assurance - 1st line of defence) defence) Appetite Officer (SRO) Likelihood Likelihood Risk (Impact) Residual Risk Work-stream Inherent Risk System Delivery Delivery System Project Delivery Date Date Risk Added Target Risk / Score April 2021 Update - Plan for MSEFT has been shared and signed off by Cancer Alliance and Specialised Commissioning Demand (2ww) MacMillan GP are working with practices to encourage referrals to return to pre-COVID-19 levels Patient videos have been developed to encourage confidence to get systems investigated Hospital tightening up processes to ensure patients are seen within the Maintaining access to rapid, early 2week timeframe. 2 week wait To achieve cancer performance in David Walker / Patient Safety & Harm, Patient Finance & Performance diagnostics cancer surgery and other Planning Guidance Partnership Working, People 31 day standards Papers from Performance Delivery Cancer Care accordance with Constitutional 2 System ALL Karen Wesson Donald Karen Hull Experience, Inequality, Acute 5 5 25 31, 62 and 104 day Below Standard 3 15 5 A ↔ Committee, Clinical Forum / treatments. submission May 2021 Resources 62 day standards Oversight Group, Cancer Board

Standards. CANC01 McGeachy Hospital Demand, Service Delivery Capacity and flow across system including use of IS and TIer 2 services is Committee being used (Tier 2 supporting diagnostic pathway) 104 day waiting patients Chemotherapy at Home now operational to support treatments Backlog recovery plan in place to return at a minimum to pre-COVID-19 numbers (181 for 62 day).

104 - Harm review and recovery plan to get to zero 104 day waiting patients by 28 February 2021, acknowledgement that maybe some unavoidable patients but these will be minimal and mitigated as far as practical. - this has been delivered April 2021 Update Maintaining access to rapid, early Plan to recover the standard and meet the planning guidance To achieve diagnostic (DM01) Patient Safety & Harm, Patient Finance & Performance diagnostics ensuring all patients have James Buschor asks is being developed for submission at end of May 2021. Planned Care performance in accordance with 2 System ALL Karen Wesson Experience, Acute Hospital Demand, 5 4 20 30 June 2021 People Resources Achieving the DM01 3 15 5 A ↔ None Identified Committee, Clinical Forum / their diagnostic within 6 weeks of / Emily Hughes Additional capacity being scoped to help recover, plan being

Constitutional Standards PLAC01 Inequality, Service Delivery Committee

referral. 14/08/2020 developed as per national ask re Community Diagnostic Hubs, this is a national ask that systems are required to respond to.

Reduce 52week waiting patients April 2021 Update Reduce backlog for patients waiting Patient Safety & Harm, Service Planning submission ask is to reduce all long waiting patients so All list "P" (priority In line with trajectory Commissioning Forum / To achieve the Constitutional Standard James Buschor Partnership Working, People Planned Care Intiital focus of highly challenged 2 System ALL Karen Wesson Delivery, Patient Experience, Acute 5 5 25 that by end of H1 (first 6 months) no patients are waiting over coded) 100% coded by maximising use of capacity 5 25 5 R ↔ None Identified Committee, Finance & for referral to treatment (RTT). / Emily Hughes Resources, Comms & Engagement specialties (T&O, Ophthalmology, PLAC02 Hospital Demand 98weeks. The current plan achieves this. This inlcudes all June 2021 available. Performance Committee Urology, Endoscopy, Skin). 14/08/2020 urgent (P1 and 2) being treated then patients chronologically.

October 2020 Update - further update pending October 2020 Current arrangements for Warfarin and DMARDS is unstable Effective Shared Care Ineffective (GP Practice presribing and pharmacy giving notice, returning To work with other stakeholders to Zafiat Quadry / Patient Safety & Harm, Acute arrangements with GPs and performance and None Identified Hospital Demand, Finance, Patient patients to acute hospital). Partnership Working, Finance, ensure adequate access to and Prescribing lead Denise Acute, actively engaging. worsening. NHSE highlighted unsafe service. Clinical Forum / Committee, Planned Care Service Provision of high risk medicines. 3 Place/System ALL (awaiting JET Experience, Reputational Damage, 4 3 12 Engagement with acute trust and primary care to agree shared 01 September 2020 People Resources, IT Infrastructure, 5 20 4 R ↑ monitoring of high risk medicines e.g. Board Members Rabbette / (2017) Quality Committee PLAC06 appointment) Inequality, Claims & Complaints, care protocols to support DMARDS and Warfarin. This is on- Legal

Warfarin and DMARDs 14/08/2020 Paula Wilkinson Having a successful service to No service to Service Delivery going and proving difficult. manage anti-coag. manage anti-coag There are varying services across the system, which has (December 20) highlighted a need to review and re-design services. April 2021 Update Five Key areas of work identified for Lynne Smith / There is a Pallaitve and End of Life programme in place to Palliative and End of Life Care Finance & Performance Eleanor Patient Experience, Inequality, explore and reduce variation in offer to the population. Paper To define workstream Ageing Well Palliative and End of Life Care 24/7 model of care, protocols & clinical 5 Place ALL Karen Wesson 4 4 16 30 June 2021 None Identified TBA 4 16 4 A ↔ Committee, Clinical Forum / Sherwin / Service Delivery being presented to Joint Executives on the 11 May 2021 for outcomes.

guidelines, training and education, AGEW07 Committee, Quality Committee

01/10/2020 Emma Branch support to develop Business Case to equalise offer to the bereavement, clinical outcomes. population.

April 2021 Update Outcome of diagnostic still awaited. Draft Maternity To support the MSEFT in their governance structure has been circulated for comment. Bi- Acute Trust Maternity performance - Karen Berry, Patient Safety & Harm, Patient improvement journey for maternity Experience, Regulator Penalties, weekly Basildon quality assurance visits remain in progress to Formal lifting of the warning Maternity Services Section 31 CQC Warning notice 2, 3 System Rachel Hearn Children's 4 4 16 30 June 2021 Partnership Working In Progress 4 16 A ↔ Quality Committee services at all sites, but with a specific Reputational Damage, Claims & test assurance relating to the Maternity Improvement Plan and notice published MATS02 Leads Complaints, Inequality focus on Basildon. 01/12/2020 Ockendon requirements. Monthly quality assurance visits maintained on Southend and Broomfield Maternity sites to ensure consistency of safe and effective care delivery.

April 2020 Update Neurodevelopmental pathway * Work to rectify areas of significant * Business cases for all Alliances have been approved. Mid and concern identified by CQC and Ofsted south Essex business case currently being developed to address * Re-inspections due Report. the Autism backlog. 18mths following initial * Transforming care agenda - to inspection. Southend - * Provider reset group have agreed to develop a resource pack * Awaiting deliver the ambitions of and meet April 2021, Thurrock - * Re-inspection Opinion and a universal referral approach across MSE. Inspections ECC SEND inspection - need for national targets for Children and due now. Essex - 2022. * Admissions to Tier 4 Beds for * QB test business case has been approved and funding improvement Young People with LD and Autism. * Transforming Care Children with ASD/LD The CCG will continue to work in identified to implement across mid and south Essex. * 2 Children waiting Thurrock / Southend SEND *Deliver Care, Education and trajectories (monthly) * Completion rate for CETR pre- partnership with education and care to Tricia D'Orsi * Bosa Autism Assessment is being shared across partners. * CETRs - in place Inspection - praised., ECC SEND Treatment Reviews (CETRs) for those Reputational Damage, Patient Safety admission * TBC Children, Young become fully compliant with the Children's * Pan-Essex Neurological group has completed a mapping montored monthly 90% Partnership Working, People inspection - Areas of significant CYP at risk of admission and monitor 2, 3, 5, 6 System/Place ALL & Harm, Patient Experience, 4 4 16 * LD Register (Primary Care) 4 16 4 R ↔ Quality Committee People Children and Families Act 2014 in SEND SRO at Leads exercise to understand the variation across the Essex County CETR before admission Resources concern. CYP03 Inequality, Regulator Penalties * TBC and maintain mechanisms for target. * Completion of LD Annual

relation to Special Education Needs and 01/08/2020 place footprint. Consistent report requirements have been agreed Southend SEND - Areas of identification( Risk register) Healthchecks (Primary Care) * Approx 30-48% Disability (SEND). across the pan-Essex footprint and being negotiated with * LD Register metrics < significant concern. *To ensure CYP age 14+ with LD are on Target 67% trajectory providers. 25yrs March 2021 Thurrock SEND - Areas of significant the GP register and recieve annual * Neuro - Review March * Autism waiting lists for General SEN * TBC concern for the Local Authority. health checks 2021 diagnosis * LD Healthcheck implemention plans in place and being * Implement new neurodevelopmental * Autism WT - March progressed. pathway working with system partners 2021 (NHSE/I metrics * Progress continues through the Children's Partnership Boards *Reduce the waiting times for CYP expected. on the deliver of the Written Statement of Action (WSOA). Autism Diagnosis. * Southend currenting under re-inspection. Thurrock have had external review of progress against WSOA. March 2021 On-going discussion with NHSE and wider partners. Formal communication being sent to NHSE, SpecCom raising Reduction of blue light TBA March 21 - CQC review of LD concern from CCG and Safeguarding Chairs that there is a lack incidents relating to Children partnerships awaited. The CCG will continue to work in To ensure there is sufficient Tier 4 of duty of care in there not being sufficient provision for Tier 4 with Complex Care Needs partnership with education and care to provision for children across MSE and Lorraine Coyle Patient Safety & Harm, Service Tricia D'Orsi / Delivery, Acute Hospital Demand, services. (requiring Tier 4 provision). Review at Quality Surveillence Unplanned Care become fully compliant with the that processes exist to provide wrap 2, 3, 5, 6 System/Place ALL (system lead 4 4 16 01 November 2021 Partnership Working 4 16 4 R ↔ Quality Committee Rachel Hearn Patient Experience, Inequality, Managing care on a case by case basis. Group. Feb 21 - concerns raised. Children and Families Act 2014. (Tier 4 around care packages until beds are UNPC07 for quality LD) Safeguarding, Reputational Damage 01/03/2021 Currently refresing the escalation process. Vacant Tier 4 bed provision 2 Children MSE (30 Services). are commissioned by NHSE. Overseen by Patient Safety and Quality Committee across MSE available to meet curren needs nationally) Safeguarding Children Boards. Feb and at Place level. (Target 0). awaiting Tier 4 21 - concerns raised. Awaiting outcome of discussion with NHSE regarding long-term beds. plan for service provision.

April 2021 Update Exploring optimum pathways, bed numbers and configuration Service Delivery, Patient Experience, across sub-acute, community and strok rehabilitation. Community Bed Management & Optimise patient flow and Gerdalize Du Partnership Working, People Primary and Acute Hospital Demand, Inequality, Business case in development for strok rehab and sub-acute Adequate capacity for out of Reconfiguration (including stroke independent outcomes for older 1, 2, 3, 5, 6 System/Place ALL Dan Doherty Toit / Stephanie 4 3 12 30 June 2021 Resources, Finance, Estates, Comms In progress 4 16 3 A ↔ None Identified Quality Committee Community Care Patient Safety & Harm, Regulator model. hospital patient flow. & Engagement, Legal rehabilitation) people through bedded facilities Dawe Penalties 29/04/2021 Considering variation of use of Brentwood Community Hospital. Mid-Essex pilot for recovery at home commencing 17th May 2021.

Page 1 of 3 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership May 2021 Clinical Commissioning Groups

April 2021 Update Risk ratings have been reset for 2021/22 as the start of a new financial year. Clearly assigned budgets and both individual and organisational ownership of approved plans. SFLG agenda item, national guidance and FAQs. Oversight at SFLG and F&P in common. In progress, Finance, Patient Experience, Patient Proposed system operating budget. Monthly Reporting of financial Control of Income and Expenditure Achieving the Financial Envelope Monthly, and as at Partnership Working, People currently a gap in Financial Systems Internal Audit - Finance & Performance Finance 4, 6, 9 System/Place ALL CFO CCG Chairs DCFOs Safety & Harm, Reputational 4 4 16 Revised plan submitted to NHSE. position, both by organisation 4 16 4 A ↔ Resources

across the System across the system. FIN01 31/3/22 meeting the Substantial Assurance. Committee Damage, Service Delivery Increasing financial governance post crisis. and HCP.

01/04/2021 target. Assessment of system deficit and required savings target. SEPB oversight of efficiency programme System finances on track to deliver financial envelope. PwC engaged to review underlying deficit and drivers of deficit at MSE once complete the plan would be to roll out across the system. Systemwide capital group established.

April 2021 Update Risk ratings have been reset for 2021/22 as the start of a new financial year. Clearly assigned targets and scheme leads supported by project management infrastructure SLFG commissioned external report to review and capture new pathway/clinical practice emerging from Covid-19 crisis. In progress, Monthly Reporting of financial Control of Income and Expenditure To achieve System Savings - including Finance, Service Delivery, PwC engaged to review underlying deficit and drivers of deficit Monthly, and as at Partnership Working, People currently a gap in Financial Systems Internal Audit - Finance & Performance Finance 4, 6, 9 System/Place ALL CFO CCG Chairs DCFOs 4 4 16 position equating to breakeven 4 16 8 A ↔ Reputational Damage Resources

across the System corporate overheads. FIN02 at MSE, once complete the plan would be to roll out across the 31/3/22 meeting the Substantial Assurance. Committee against budget, or better

01/04/2021 system. target. Assessing opportunities. Increasing financial governance post crisis. SEPB oversight of efficiencies programme Establishment of benefits realisation group. The establishment of the System Efficiency Group looking at pan-Essex efficiency opportunities.

April 2021 Update NEW RISK added. Recovery plans include MSE, insourcing and ISPs. Financial impact of the elective Affordable activity included within baseline plans submitted. recovery to national standards. (Local Elective Recovery Framework incentivises activity. health and care system has substantial Finance, Reputational Damage, People Resources, Finance, Gap in finances Finance & Performance Finance Elective Recovery 2, 4 System/Place ALL CFO CCG Chairs DCFOs 4 4 16 Including cost pressure due to mobile capacity to delivery 31 July 2021 Maximising capacity 4 16 4 A ↔ None Identifieds. Patient Experience Partnership Working

elective waiting times over 12 months. FIN06 Committee recovery. Subject cost to oversight and review.

Historic problem made worse due to 01/04/2021 Review productivity opportunities, via Connect/PwC to covid). minimise additional elective recovery expenditure (demand and capacity review). Discussions on-going with Region.

April 2021 Update NEW RISK added. Worked with Independent Sector Providers (ISP)s to ascertain capacity to address RTT backlog, with clear expectation that ISP Contract affordability - £26m cost order book will need to flex with confirmation of funding. pressure if all capacity is utilised. Nationally £1bn for RTT recovery and national targets. Currently on Finance & Performance Finance Independent Sector Providers (ISP) National funding not confirmed. 4, 6, 9 System/Place ALL CFO CCG Chairs DCFOs Finance, Patient Experience 4 4 16 31 July 2021 Partnership Working, Finance Maximising capacity 4 16 8 A ↔ None Identified.

FIN07 NHSEI understand local RTT recovery plan. target. Committee (potentially to merge this risk with

01/04/2021 NHSEI supportive of local approach. FIN06 when risk sufficently reduces) Proceeding elective activity at risk with ISPs, risk value £26m. No minimum financial commitment agreement with ISPs. Monthly reporting to be provided to F&P In Common, along with financial risk update.

April 2021 NEW RISK added. Appointment of JET officers. Delay to formal merger of CCGs. Delay to staff reconfiguration. Senior interim appointments to progress. Workstreams in place. Minimising the financial consequences Robust internal financial governance arrangements to continue of transformation change and to operate with clearly defined delegations and minimising impact of re-organisation Human Resources, Finance, Finance & Performance Finance Transformation / Re-organisation Costs 4, 5, 9 System/Place ALL CFO CCG Chairs DCFOs Finance, Reputational Damage 4 4 16 accountabilities. 31 December 2021 TBA TBA 4 16 8 A ↔ None Identified.

on fianncial control in the CCGs. FIN10 People Resources Committee Financial plans to F&P In Common.

Resourcing transition to support the 01/04/2021 Financial Plans to be submitted to NHSEI. development of place. Financial Review of business cases at CIMT and SFLG. Reinstatement of Procurement Committee review and support for proposed system changes Increase post-covid financial governance. Robust internal financial governance arrangements to continue to operate with clearly defined delegations and accountabilities.

April 2021 Update NEW RISK added. SFLG agenda item, national guidance and FAQs. Oversight at SFLG and F&P in common. Proposed system operating budget. Ensuring health and care system does Revised plan submitted to NHSE. Human Resources, Finance, Finance & Performance Finance Capital Resource Limit 4, 6, 9 System/Place ALL CFO CCG Chairs DCFOs Reputational Damage, Finance 4 4 16 31 March 2022 TBA TBA 4 16 4 A ↔ None Identified.

not exceed capital resource limit. FIN11 Increasing financial governance post crisis. People Resources Committee

01/04/2021 Assessment of system deficit and required savings target. System finances on track to deliver financial envelop. PwC engaged to review underlying deficit and drivers of deficit at MSE. Systemwide capital group established.

April 2021 Update Infection Incidence: April 2021 MRSA bacteraemia MSE system MRSA (0 tolerance) 28 at year end 28 at year end which is a 10% reduction on 2019-20. Cdiff (y/e ceiling) within tolerance Our patients are protected from 12 cases have been considered as hospital acquired. Coronavirus (Outbreaks) TBC avoidable infections by robust implementation of published Infection Patient Safety & Harm, C diff MSE system Managed outbreaks, nationally July 2020 Governance and Prevention & Control guidelines by all Safeguarding, Patient Partnership Working, Comms & Infection Prevention and Control 1, 3, 6 System/Place ALL Rachel Hearn Chris Patridge 5 4 20 265 year end against ceiling of 296 which is 28% reduction on 30 June 2021 set ceiling breach avoided, All 3 15 5 A ↔ CQC reviewed MSE assurance Quality Committee Statutory Duties involved in delivering patient care. Experience, Reputational Engagement

GOSD11 2019-20. nosocomial infections framework and were satisfied. Infections may include, but are not Damage MSEFT ceiling for C diff. 2020-2021 is 185. 139 cases reported at investigated, all learning limited to: MRSA, Cdiff, iGAS, year end. implemented. Coronavirus. Good collaborative working More detailed information can be viewed in the annual IPC between Providers and report. Specialist Teams.

Page 2 of 3 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership May 2021 Clinical Commissioning Groups

April 2021 Update Reset and recovery will remain the focus in Q1. Oversight of April 2021 both acute and community providers continues through both Provider CQC reports. Awaited CQC report into Maternity services Ensuring the care provision for Patient Safety & Harm, Patient formal and informal mechanisums. Covid stop the clocks for SI's at BTUH - Inadequate (August 2020) Governance and residents is safe, effective, good Place Chief Experience, Inequality, Claims & have been ceased with normal reporting timesframes resumed. Partnership Working, IT Acute / Provider Quality Assurance 3 System/Place ALL Rachel Hearn 4 4 16 30 June 2021 Cancer and RTT Harm Reviews Completed 4 16 4 R ↔ Quality Committee Statutory Duties quality and value for money as defined Nurses Complaints, Reputational Routine quality assurance vists will be resumed and have been Infrastructure

GOSD12 completed and learning shared Awaiting outcomes from further within the NHS Constitution. Damage scheduled through both Q1/2 in conjunction with our provider across the system. inspections in September. organisations. The DDoN have been aligned to reset workstreams to oversee the quality impact of any proposed changes to service delivery.

April 2021 Update H&S Executive Prosecution - Ensuring the Mental Health care Patient Safety & Harm, Patient Mental Health Task Force to review MH commissioing Sept 2021 competant workforce escalated to Crown Court (pending) provision for residents is safe, Experience, Inequality, Claims & arrangments. established positive Governance and Mental Health Acute / Provider Quality Place Deputy People Resources, Partnership Quality Committee, Clinical effective, good quality and value for 3 System/Place ALL Rachel Hearn Complaints, Reputational 4 4 16 Oversight of high profile independent investigation. ongoing relationships TBC 4 16 4 R ↔ Independent Investigation recently Statutory Duties Assurance Chief Nurses Working Forum / Committee

money as defined within the NHS GOSD15 Damage, Safeguarding, Staffing, Return CQRG to BAU post wave 2 covid. TBC established governance commissioned by parliament on Constitution. 09/02/2021 HR, OD Develop robust governance and contract management ongoing framework inpatient services for MH (2 year arrangments. report). To deliver the national ask of April 2021 Update developing an NHS ICS Body and Mike ICS Programme Board established. Governance and Health & Care Partnership in Reputational Damage, Staffing, People Resources, Partnership Integrated Care System 9 System/Place ALL Jo Cripps Thompson / 5 3 15 Workstreams established and developing project plans for the 30 June 2021 TBA TBA 3 15 5 A None as yet. Statutory Duties accordance with legislation and best HR, OD Working

GOSS15 Phil Reid close down of the five MSE CCGs and the creation of the new

practice guidance to commence on 1st 01/04/2021 ICS NHS Body and Health and Care Partnership. April 2022.

Page 3 of 3 ITEM 09 ALLIANCE DIRECTOR REPORT Agenda Item 09 NHS Castle Point & Rochford / NHS Southend Clinical Commissioning Group Governing Body meeting Part 1 - 27th May 2021

NHS Alliance Director Update

Purpose of Report: To update the Governing Body on matters arising in South East Essex.

Recommendations and The Governing Body members are asked to note the work taking decision/actions: place in South East Essex.

Executive Summary As detailed within the main body of this report a considerable (including financial amount of progress has been made in addition to the Covid-19 impact): incident response. There has been a number of initiatives put in place to support our population during these unprecedented times and support for frontline staff to manage the increasing demand on services. There is unprecedented demand across Primary Care and plans are being developed to support our members practices.

Written by/Presented Various South East Essex Leads by:

Executive Director Tricia D’Orsi, NHS Alliance Director, South East Essex Sponsor:

Non-Officer/Board Sponsor:

Fit with CCG Strategic Compliance with CCG Constitution Objectives?

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this document).

Reports Submitted to Board only: Date signed-off by Executive Team. (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by x the Chief Finance Officer? (Please Tick )

Has the Equality/Quality/Privacy Impact x Assessment highlighted any issues?

If yes, describe how they are resolved:

Details of Stakeholder, Patient & Public Engagement:

Risks / Link to BAF: BAF Ref:

Conflicts of Interest: N/A

1. Introduction

This report is being brought to the Governing Bodies as a standing item to note the progress of work across the South East Essex Place.

2. Update from Primary Care Networks

At the start of the new contract in April 2021, two Southend Primary Care Networks (PCNs) merged to form one Network (North Road Plus and Southend Central). This new PCN is now called Southend Victoria which takes into account the local geography. North Road Plus PCN exprienced difficulties with recruitment to the Additional Roles Reimbursement Scheme (ARRS) and it is anticipated that Southend Victoria, being a much larger PCN (population 59.5k), will provide a more attractive employment offer.

PCNs continue to deliver the Covid Vaccination programme through the Local Vaccination Sites (LVS) and is reinforcing trusted relationships between the member practices. We are starting to note that there are a high number of DNAs and will be working with the local populations to encourage uptake of the vaccine in all priority age groups and communities.

All PCNs were offered CCG-facilitated development sessions. All CPR PCNs opted to go for in-house development and have been asked for their written plans on their progression through the maturity matrix. Southend PCNs had their first development session facilitated predominantly by CCG Associate Directors on 11th May. These sessions covered the following: • Review of the Vision & Values; • Identification of other key stakeholders to join the Network • Governance on a wider footprint • Community Assets and Community Engagement • Review of DES specification

The feedback on these sessions were varied and therefore further work will need to be undertaken with the Clinical Directors for future follow up sessions. Follow up sessions are planned for the next two in-house Time to Learn dates (6th July & 5th October).

Population Health Management The PCN Clinical Auditors have attended a training session hosted by AGEM on the GEMIMA system which will support Clinical Directors and member practices with an understanding of the use of resources as well as identifying patients with rising risk to focus on. Local baseline data has been received from all PCNs in relation to the locally commissioned population health contract.

As the wave 3 pilot site for population health management there is development of the plan to ensure effective roll out.

3. Enhanced Health in Care Homes

Areas of note:

PCN DES for care homes – The Care Sector Hubs have reviewed the DES relating to care homes to ensure that PCNs are able to deliver the range of services needed.

Medicines Management – The 25% target for proxy access for care homes has been exceeded by some margin in both Southend and CPR. Some PCNs/GP practices are also individually working with their care homes to ensure proxy access is available.

4. Integrated Care

FRAILTY The Frailty Delivery Group (FDG) reconvened in March 2021 to track progress and monitor the delivery of key projects and initiatives that were either launched, or continued during the COVID crisis and which support the agreed objectives for the improved management of Frailty in south east Essex. These include:

• The Discharge to Assess “Community In-Reach Pull Model” (or “FRED” trial) led by Newton Europe. Whilst this remains out of scope of the FDG’s delivery, the pilot is a key enabler piece to the programme and is included in the delivery plan as an interdependency. The admission avoidance principles behind the model aim to address the readmission rate at SUHFT, improve the identification of Frailty and champion the “Home First” standard.

• The SystmOne “FrEDA” (Frailty, End of Life and Dementia Assessment) template is now live in SystmOne and can be used by any professional in SEE as part of an MDT assessment. The template is based on the domains of the Complex Geriatric Assessment and includes live electronic referral links and coding to inform an outcome performance dashboard for this population group.

• A DSCRO template has been agreed between AGEM and EPUT to form the basis of a SEE Frailty Dashboard, which will pull from FrEDA and the Care Coordination service in order to achieve the nationally expected population health oversight of frailty and permitting capture of critical outcome data that has been historically missing from traditional data sets for this population group.

• The development of a new anticipatory care model through the Transformation of Care Coordination, which will form the foundation of a population health model for frailty. The service is fundamental to the development of Locality Integrated Networks and an intrinsic component of both the emerging intermediate care model in south east Essex and the development of an Electronic Frailty Care Coordination System (EFraCCS).

HAVENS HOSPICE Key updates: • Palliative Care Consultant job specification is waiting for the NHS Deanary to approve before Haven’s can advertise for replacing Palliative Care Consultant due to forthcoming retirement.

LOCALITY INTEGRATED NETWORKS

Locality development work has been paused since late Autumn during the system-wide response to the Covid pandemic. • Locality Integrated Network development identified as a SEE priority in the first draft of the Place Plan. • Commitment within the CCG to restart Locality development work in earnest.

• Internal CCG meeting schedule set up with Primary Care Team to ensure primary care development, population health management and Locality Integrated Network development are aligned and understood as a single programme of work. • Documentation bringing together an overview of the priorities and health workforce for each Locality has been developed and will inform conversations with the Clinical Directors to identify those PCNs that are keen to accelerate integrated working and new models of care. • Asset-based session planned with CEC members on Thursday 20 May to explore how they would like to support this work and how they would like partnership working with EPUT and Adult Social Care to evolve. • Further CEC workshop planned for June 2021, inclusive of EPUT and the SEE clinical directors to broaden conversations and intentions for partnership working.

RESPIRATORY In addition to the business as usual needs identified in 2019/20, respiratory services in 2020/21 are at the forefront of the response to the COVID-19 pandemic, compounding existing service delivery challenges. The current programme priorities are:

• The programme structure has successfully been streamlined to consist of three clinical oversight and delivery groups (Integrated Breathlessness Hubs, Community Management, COVID Care), reporting into a Programme Collaborative. • These groups are currently at a scoping phase aligning delivery plans to regional Clinical Network and national Long-Term Plan milestones. • Recruitment is due to begin for an MSE System Clinical Lead for Respiratory. • Following the release of new national guidance, the reset of COVID-safe respiratory diagnostic tools is an MSE system priority. • Place-based evaluation of backlogs against national recommended prioritisation processes is ongoing to identify those with most urgent need. • Regional Pulmonary Rehab monies has been allocated to MSE c.£106k for planning Pulmonary Rehab waiting list management – current waiting times can exceed 12 months • MyCOPD and My Asthma app roll out continues

Covid Care Additional coronavirus-specialist services have been developed, in line with national instruction and supported by NICE guidelines which, if planned sustainably, can provide further benefit in accelerating the HCP Respiratory Transformation Programme objectives. Work programme led by a Covid Care Oversight Group with two delivery groups sitting underneath:

1. Covid Pathway delivery Group – covers post-COVID pathway, Long Covid Assessment Clinics and management 2. Covid Oximetry at Home and Covid virtual ward

Long COVID clinics • MSE-wide virtual Long Covid Assessment Clinic with MDT review has been established in line with the NHS England model. • To date clinic has received 375 referrals, assessed 174 people and discharged 35 of these to appropriate specialist services. • Working with regional commissioners and service leads to review current Chronic Fatigue Services and ensure capacity can meet demand, as this is a key service destination for onward referral from the Long Covid clinic.

• Working with clinical leads to develop clear peer-to-peer communications which clarify the clinic model and its remit. • Working with people with lived experience of Long Covid to inform patient-facing information. • Finalising service specification and commissioning arrangements for the 2021/22 clinic provision to ensure the allocated £460k central funding provides optimum value for money and patient outcomes.

COVID Oximetry at Home and COVID Virtual Ward • Activity is reflecting that COVID-specific need is rapidly reducing. • Dedicated Remote Monitoring Task and Finish Group is being established to consider how to make best use of pulse oximetry and virtual ward developments as part of a business as usual offer and in support of seasonal pressures. This will feed into the Respiratory Community Management clinical oversight and delivery group.

5. Mental Health

SE Essex mental health system pressures

A significant increase in demand for mental health support in SE Essex has recently started to be reported from EPUT community mental health teams, third sector organisations and primary care. This appears to be consistent across all age ranges (children and young people, working age adults and older people) and reflects the rising tide of demand predicted as a consequence of the pandemic. Concerns about the impact of this demand on secondary care mental health services and the rest of the system have been raised with EPUT.

Transformation Plans

An MSE system transformation plan has been produced for approval by NHSE and the MSE HCP System Leaders Executive Group. This collates all of the system wide and individual place plans for mental health transformation, and seeks to reconcile these against the additional recurrent and non-recurrent £19.2m funding available in MSE in 2021/22. This plan is based on the recruitment of an additional 462.5 WTE staff to work in mental health services in MSE in the current year.

For SE Essex this plan includes proposals for increasing the number of primary care mental health staff in each PCN, and additional staff in the SE Essex Recovery College and Trauma Alliance and a dedicated mental health team for rough sleepers.

Rethink Workshops

A series of four workshops have been arranged to bring together organisations, professionals, service users and carers from across south east Essex to develop a shared vision and roadmap for the further transformation of local mental health services. The aim will be to build on the successful work done so far, but acknowledge and explore the very real problems facing our local system, to co-produce a shared plan for the changes we will make over the next 2-3 years. These workshops will be facilitated by Rethink Mental Illness, a leading national charity focused on the needs of people with severe and enduring mental health problems. Rethink will bring an external perspective to our local setting, together with their extensive experience of major mental health service change and development programmes in other parts of England. The first workshop will take place on 27 May.

6. Children & Young People

SEND Southend Local Area Re-Visit - In October 2018 and September 2019 respectively, Southend and Essex were subject to separate Local Area SEND inspections, jointly carried out by the Department for Education, CQC and NHS England, to judge the effectiveness of the area in implementing the SEND reforms as set out in the Children and Families Act 2014. The outcome reports noted clear strengths within the respective local areas however, areas of significant weakness were also noted resulting in a requirement for both areas to have a Written Statement of Action (WSOA) and re-visit within two years.

The re-visit for Southend took place from Wednesday 5th May to Friday 7th May. The report will be received within 28 days of the re-visit completion, publication on the Ofsted/CQC websites will follow within 33 days for the re-visit completion.

Emotional Wellbeing & Mental Health (EWMHs) – Publication of the procurement tender notice for the Southend, Essex & Thurrock Child & Adolescent Mental Health (CAMHs) service was published on Tuesday 4th May 2021, the closing date is 11th June 2021. Governance approval via the Governing Bodies will be sought in September with formal award to the successful bidder in October 2021. Mobilisation will follow with a go live date for the new service of 1st April 2022.

Autism Spectrum Disorder (ASD) Diagnostic Assessments – A dedicated initiative to clear the backlog of ASD diagnostic assessments has been approved across the five CCGs in Mid & South Essex. This significant investment will enable the delivery of approx. 1,000 diagnostic assessments during 2021/22 over and above core commissioned activity. Backlog assessment numbers for south east Essex are considerably lower than in partner CCGs due to the continued local focus and commitment to reduce waiting times and improve the experience for children, young people and families.

Interim Director appointment for Children’s & Learning Disability Services – This new role, reporting directly to the Mid & South SRO for Children & Young People (Tricia D’Orsi), will provide strategic leadership for children’s and learning disability services across Mid & South Essex, supporting transformation and improvements to services as set out in the Long Term Plan. 7. CHC

The continuing health care team completed all the back-log assessments before the end of March 2021. The team are now focusing on the Business as usual and the Discharge to Access referrals. NHS England have also restarted the reporting on the 28 days checklists. For the month of April both Castle Point and Rochford and Southend achieved over 80% for this return. This is in line with NHS England’s requirements.

Both teams are also working closely with the other three CHC Team to support the delivery of the Transformation work for CHC.

8. Medicines Management

Key updates within Medicines Management:

• 2021-22 Prescribing Incentive Scheme has been circulated to all GP practices across SEE – there was a tight turnaround following the re-establishment of business as usual • GP practice visits are underway – annual visits were paused during 2020 but have been resumed virtually for 2021 • Authorisation of community pharmacy COVID vaccination site – assurance visit undertaken recently and site has been ‘signed off’ to start to receive Pfizer vaccine • Good learning shared across all COVID local vaccination sites to improve delivery of the service and minimise risks/errors • Mid and South Essex Medicines Optimisation Committee functioning well and outputs being shared, discussed and implemented across SEE. SEE Medicines Management Team have a key, active role in this • Drug and Therapeutics Committee outputs continue to support local GP practices – recently developed documents supporting with conducting Structured Medication Reviews and implementation of the national patient safety alert on steroid cards • Safe prescribing of controlled drugs and appropriate antibiotic usage a key focus for GP practice support from MMT

9. South East Essex Alliance

The initial draft of the South East Essex Place Plan has been shared with Mac McKeever. This plan will now need to be developed with the collaboration with all stakeholder over the next two months. Feedback was positive.

A number of business critical interim roles have been appointed to across Mid & South Essex to ensure progress can be made prior to the full consultation and movement towards an ICS footprint. A full HR led process has been undertaken for a number of roles and has resulted in a number of staff members being recruited into these interim posts. These interim posts will be in place for the next 6 months and will drive forward the Place plan within within South East Essex from a Health perspective.

10. Digital and Technical Solutions

10.1 BP@Home The BP@Home initiative is currently being piloted in South East Essex and the MSE HCP ICS is now a national trailblazer for this programme which is to be upscaled across MSE. There has been very positive feedback from patients and clinicians across south east Essex and GPs are keen to audit the benefits going forward. The BP@Home app is now ready to be launched for south east Essex residents and all practices participating in the scheme will receive a QR code for their patients. Evaluation underway, benefits anticipated reduction in heart failure/stroke following clinical invention and medicine reviews.

10.2 Interactive Therapy Pets

Building on the work undertaken with care homes and day centres in relation to the utilisaiton of interactive / robotic therapy pets, this model has been recently extended to support schools within South East Essex and has seen significant benefits for those children with special educational needs and disbaliites. Teachers are reporting that the cats are aiding communication, providing sensory input which supports self-regulation and encouraging and supporting social communication. They are also being used to support play therapy and development of speech in some of the schools.

10.3 Reusable Magic Painting Books

1,300 of these reusable mess free books are being sent out across Mid and South Essex and already provided to care homes and some schools within South East Essex. The benefits are significant for those with dementia, Parkinsons and autism where painting and drawing can become frustrating as individuals struggle to keep within the lines. The books are reusable and the CCGs are receiving very good feedback where these have been received.

10.4 Interactive Tables

• Happiness Programme - 20 interactive magic tables provided across MSE. Proven to improve the lives of those living with Dementia, the Happiness Programme supports interaction with loved ones, carers and other residents. By using to project light on to a surface – this could be a table, floor, ceiling or even someone’s bed – hands, arms or feet that move through the light, are able to change and move images as well as interact with a wide variety of tailor-made games.

• Rainbow Tables – 40 provided, fantastic for interacting with larger groups of residents/patients and their families/carers, provides interactive games, crosswords, exercise programmes, zoom call facility and TV/Films.

• Reminiscence Interactive Therapy: The ICS in MSE purchased 15 specialist interactive therapy devices to support secondary care, days centres and care homes across MSE, including LD homes. A recent case study from Addenbrookes demonstrates a 60% of falls on the wards where this has been utilised.

• Benefits from interactive tables identified to date a reduction in anti-psychotic medication and falls and improvements realised with mood, anxiety, aggression and nutritional / fluid intake – full evaluation of MSE pilots underway. These are now being piloted within day centres, care homes and acute settings within south east Essex.

10.5 Motiview

• The ICS purchased 12 Motiview bikes, licences and Smart TVs to support residents to be more physically and cognitively active within a number of care homes across MSE. By using an exercise bike, video and sound, the users can take cycle trips through familiar surroundings and childhood memories. When not in use for Motiview the Smart TV can be used for Zoom calls with family and friends as well as other exciting activities. These have been provided to acute facilities and care homes within south east Essex place.

10.6 Linking Charities to SystmOne

Work is progressing to support local charities to access SystmOne through a south east Essex pilot. A site survey is under development and will be sent out to TrustLinks, Rape SOS and Change Grow Live this week so that this work can be progressed.

10.7 Raizer Chairs and Whzan

Roll out of both of these continues. Oral Health and ISTUMBLE apps are being added to the Whzan Blue Boxes. Raizer chair training is being rolled out, 6 sessions between 27.05.21 and 03.06.21.

10.7 IT/Digital Update

Key Deliverables Over last three months ✓ Digital Primary Care Strategy work concluded. Going to SLEG for sign-off in June. ✓ ICS Digital Strategy work concluded. Signed off by SLEG in May. ✓ Tablets for Care Homes programme completed. ✓ GPIT Futures clinical systems bridging contracts put in place for all GP practices. ✓ Contract extensions awarded to iPlato, AccuRX, Away from My Desk, Doctorlink, and EE SMS services. ✓ Ardens Clinical Templates system procured. ✓ Maternity Cover for Head of Digital Transformation post secured – starts 24th May. ✓ Queensway Fire Incident – site reopened. ✓ Office 365 for GP practices – testing completed. ✓ SystmOne for PCN Hubs project continuation.

Key deliverables due over the next three months o Digital PMO / Governance / clinical leadership team established. o Digital Transformation team recruitment. o Ardens rollout. o MSE Hospital ‘Acute Care Portal’ rollout to all GP practices. o Clinical systems review start. o SystmOne for PCN Hubs programme continued. o 2021 GPIT Refresh programme start.

11. Conculsion

The Governing Bodies are asked to Note the content of this report and acknowledge the significant work that is being undertaken by CCG staff and partner colleagues to improve services for the local population. ITEM 10 MID & SOUTH ESSEX SYSTEM FINANCIAL PLANNING UPDATE Agenda Item 10 MID & SOUTH ESSEX SYSTEM FINANCIAL PLANNING UPDATE

Castle Point & Roochford CCG and Southend CCG Governing Body Meeting

27th May 2021

Purpose of Report: The purpose of this paper is to update the Governing Body on the progress on setting 2021/22 financial budgets, national guidance and updates relating to the planning process and the submission of the 2021/22 H1 (6 months April to September) financial plan.

Recommendations and For approval decision/actions:

Executive Summary As reported to previous meetings of the Joint CCG Finance & (including financial Planning Committee and to the System Leaders Executive Group impact): (SLEG), over the past 2 years the focus has moved towards developing system led plans and monitoring performance on a system level.

The system is progressing the work to develop the ability to be able to report internally on a system service line basis, moving away from the traditional reporting on categories of income and expenditure which, while required for national and statutory financial reporting, do not provide the format of information needed to fully understand and manage resources within the system. The 2021/22 budgets have been developed to support both the national reporting methodology and the internal service line budget reporting. Following submission of our financial plans, the service line budgets will be refreshed over the coming weeks.

Initial plans were developed in advance of the publication of system financial envelope to understand what our expected Q1 system budget may look like as advised in January. Planning guidance was received with the extension of the current financial arrangements beyond just Q1 for H1 (April to September 2021) and confirmation of the system funding envelope. Arrangements for the remainder of the financial year are subject to on-going discussion with central Government.

The planning guidance confirmed the extension of the 2020/21 financial arrangements for H1 along with confirmation of the system funding envelope for H1. The envelope includes funding for IS services which have returned to the responsibility of CCGs and the delegated Primary Care funding for all five CCGs (previously only CPR and Southend CCGs had delegated primary care funding responsibilities).

The previous draft position for the system, assuming delivery of £6.7m of efficiencies, identified a potential system deficit of £11.9m which needed to be addressed in order to deliver a balanced financial plan. We also had a number of outstanding funding issues that were raised with NHSE/I; those issues have largely been agreed by NHSE/I and resulted in further allocations of £16.6m to the system, including £5.4m to correct the allocation shortfall for Southend CCG. These funding allocations have allowed the system to deliver a balanced financial plan and this was confirmed in the final financial plan submission, made on 6th May. No separate CCG financial plans are required although Provider Trusts can submit a non-mandatory additional detail return.

This plan also showed each CCG delivering a balanced financial position – this required the transfer of system funding between organisations (both CCGs and Trusts), with the movements for all CCGs summarised below:

(£0.2m) B&B CCG (£1.4m) CPR CCG £2.8m Mid Essex CCG £1.2m Southend CCG £0.8m Thurrock CCG (£3.2m) transferred from system growth allocation

As a result of these transfers, the financial plan for both Castle Point & Rochford CCG and Southend CCG for 2021/22 H1 (April to September 2021) is a balanced plan in line with the funding envelope. This is shown on slide 5 of the attached presentation.

This system position is not without risks (as set out in the accompanying presentation) and includes efficiency and cost reduction stretch targets of £17.5m:

£6.7m System cash releasing efficiencies £5.4m EPUT stretch target to deliver financial balance £2.5m MSEFT hosted system target to deliver system balance £2.7m CCG shortfall in IS funding

The planning guidance sets out that “We need to be ambitious and plan to recover towards previous levels of activity and beyond where possible” and the financial settlement provides for an elective recovery fund to support this. To support this achievement 150% of the baseline 2019/20 capacity with Independent sectors (IS) for MSE has been secured and additional mobile facilities across MSEFT have been contracted to support T&O and ophthalmology long waits. Elective recovery funding is expected to be available to systems that exceed 85% of the threshold 2019/20 activity levels in financial terms.

Written by/Presented Author: Jason Skinner by:

Executive Director Mark Barker Sponsor:

Non-Officer/Board N/A Sponsor:

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this document). Senior Finance Leaders Group / Senior Leaders Executive Group / Joint CCG Finance & Performance Committee

Yes No N/A

Have any financial implications been signed off by ✓ the Chief Finance Officer? (Please Tick  )

Has the Equality/Quality/Privacy Impact ✓ Assessment been carried out and issues addressed?

Details of Stakeholder, N/A Patient & Public Engagement:

Conflicts of Interest: N/A

Escalation: To the Board Also taken to Senior Leaders Executive Group, recognising To another Committee that the financial plan submission is made on a system basis. To the BAF/CRR: 2021/22 H1 Financial Plan Progress Update

System Overview Please note all numbers quoted in this slide deck are for 6 months only to be comparable to the Half 1 (H1) System Finance Envelope. System Envelope

The system has System envelope funding - 2021/22 H1 been issued a H1 envelope funding: £000 financial envelope CCG allocations 837,751 of £1,036.5m for System top-up - indicative 64,550 M1-M6 (H1). Covid funding 41,885 Total H1 envelope funding 944,186 A further £16.3m of FYE adjustment: MHIS (2,637) System SpecComm genomics/complex knees adjs 327 Development Total H1 funding adjusted 941,877 Funding (SDF) has Transfer of SDF embedded in CCG allocations (3,549) been confirmed, of Transfer of specialised high cost drugs and devices to NHSE (447) which £4.9m is Additional funding for rollover period (Acute IS, Delegated Primary Care, Growth, CNST) 98,633 specifically for Draft H1 system envelope funding 1,036,514 Mental Health. SDF Funding £000 In addition to the System development funding - MH 4,890 envelope providers System development funding - Other 11,363 generate income for Total SDF funding 16,253 services delivered to patients registered out of the Prior to any local due-diligence the national team estimated that MSE ICS would start with a system and for £23.5m deficit which would require closing in the H1 plan. We have identified £16.6m of private patients. funding issues which were discussed with NHSE/I at a national level and have now been agreed and funded, leaving a nationally predicted deficit of £6.9m for the system to resolve above the minimum expected efficiencies. 3 System position (as at 6/5/21)

System The system position has been developed using the planning 2021/22 H1 Financial Plan Overview Total submissions for CCGs and headline updates for EPUT and MSEFT. Allocation - core services 919,707 Top-up 80,450 Allowing for external income of £271m and the receipts of covid 44,709 the £16.6m allocation issues (included in core allocation for Southend CCG and system top-up for EPUT and MSEFT), growth 8,287 the total system income is £1.340bn. Total envelope 1,053,153 Based on a starting point of Q3 expenditure levels uplifted System development funding - MH 4,890 for inflation, underlying cost pressures and other expected System development funding - Other 11,363 movements, our expenditure plan of £1.338bn leaves a Intragroup transfers 0 locally calculated surplus of £2.6m before system Trust other income 270,837 investments. Funding corrections (now resolved) 0 Total income / allocation 1,340,243 Early discussions with the SLEG and HCP Board considered investments at a system level (£22.5m for H1) which have necessitated ‘squeezing’ to contribute towards closing the Expenditure -1,337,624 gap. Investments at system level are proposed at £9.3m for System surplus / (deficit) 2,619 H1. System investments are off-set by a 0.5% efficiency challenge, leaving the system currently with a balanced Investments -9,321 system plan. Efficiencies 6,701 System surplus / (deficit) 0 This plan is contingent on delivery of the efficiencies assumed and a position that does not include contingency funds. These are detailed further in this presentation. CCG positions (as at 6/5/21)

QH8 06Q 07G 99E 99F 99G System £m System Mid Essex Thurrock B&B CPR Southend (Mid) CCG allocations 1,069.4 293.6 133.2 213.9 146.2 152.9 129.6 NHS Providers within the system -565.2 -119.1 -58.6 -94.9 -82.7 -86.2 -123.7 NHS Providers outside the system -103.5 -35.1 -17.6 -31.4 -9.1 -10.3 0.0 Non-NHS Providers -91.5 -37.8 -18.5 -23.1 -6.6 -5.5 0.0 Continuing care services -51.3 -16.8 -7.6 -7.0 -7.4 -12.5 0.0 Primary care services -19.4 -6.4 -2.3 -5.6 -2.5 -2.5 0.0 Primary care prescribing -100.2 -32.6 -13.1 -22.7 -16.3 -15.5 0.0 Primary care co-commissioning -88.7 -28.8 -12.6 -19.4 -13.5 -14.4 0.0 Other programme services -38.4 -13.5 -1.2 -7.2 -6.4 -4.2 -5.9 Running costs -11.2 -3.5 -1.6 -2.5 -1.7 -1.7 0.0 Total CCG expenditure -1,069.4 -293.6 -133.2 -213.9 -146.2 -152.9 -129.6 Net position 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Within the system financial plan set out on the previous slide, each CCG and Trust within the system, including CPR and Southend CCGs, delivers a balanced financial plan.

The table above sets out the position by CCG, with both MSEFT and EPUT also delivering a balanced financial plan within this position. It should be noted that the System funding in the final column (the majority of which relates to covid and top-up funding which is passed to provider trusts) is hosted by Mid Essex CCG.

As noted elsewhere in this presentation, the balanced position is predicated on achievement of the system efficiency challenge and delivery of the £2.5m system stretch held by MSEFT. Further detail

Key Investments Analysis of Other Investments

Original Current Bed Bureau 0.1 System Contingency - Removed in the ( 4.3) 0.0 Community IDTs 0.1 latest draft, but should ideally be 0.5% New National model for Adult Critical System Innovation Fund - Included Care transfers 0.1 originally at 0.25% of allocation, reduced ( 2.2) ( 1.0) New estates team 0.2 by 50% for H1 Urgent Community Response Team Contribution to Establishing ICS (MSE ( 1.0) ( 1.0) (UCRT) 0.3 Partners/ Digital/ BI) EWMS - LTP/CCF 0.3 Community beds investment (full year ( 4.3) ( 4.3) NOACs - South Essex repatriation 1.5 impact £8.6m) GPSoC cost pressure 0.1 Critical Care beds - Nil as now included ( 5.3) 0.0 Additional 20/21 items managed within covid costs alongside ACT 0.5 Other identified investment cost - Now excludes any contingency for ( 5.5) ( 3.0) 3.0 unquantified investments.

( 22.5) ( 9.3) Key Assumptions

The following key assumptions have been made in arriving at the • The forecast excludes additional costs associated with system financial plan: Elective Recovery Framework (ERF), as per the planning guidance that asks for costs to be included at the affordability level. A separate memo figure is • COVID costs across the system for H1 are currently provided which sets out the costs of the ambition for the identified at £36.7m against the covid envelope of £42.2m system – this is currently c.£40m and additional funding (£41.9m plus £0.3m growth). There are a further £9.9m of will be provided if this activity is undertaken costs outside of the covid funding envelope assumed to continue with the external funding source. This figure excludes the community beds investment which is shown • Inflationary pressures have been modelled in line with separately under the potential investments on the summary the national planning guidance throughout. (and which is £4.2m for H1) • Contract values are fully aligned between partners • Spend against the additional funding of £98.7m that covers within the Mid & South Essex system. costs new to H1 is largely as per the allocation, summarised below: • The contract values include the transfer of covid and – £18.0m Acute IS funding top-up funding from Mid Essex CCG as system funding – £3.7m CNST high growth host to Trusts which includes the corrected funding – £62.7m Delegated primary care (inc. growth) issues totalling £16.6m (£5.2m to Southend CCG, – £3.4m MHIS funding £9.5m for EPUT and £1.9m for MSEFT). – £2.9m Trust lost income funding – £8.0m Other growth • MSEFT are acting as hosts for the system growth and unallocated system covid funding. The trust also hosts • We anticipate possible savings of c.£1m against this funding the remaining £2.5m stretch target needed to deliver the balanced financial plan.

• Mid Essex CCG are acting as hosts for the system efficiencies and investments. Risks

Whilst there is greater clarity with the receipt of the financial • Neither the workforce nor the financial plans reflect the guidance there is also more clarity on the risk exposure for the potential consequences of the impact of a further covid wave. system which needs to be highlighted. This would result in a stretch on the availability of workforce and a cost pressure to the plan that has currently been • The achievement of additional financial support from the ERF submitted. remains a significant system risk. There are three risks Mitigations: Designing services to try and protect green capacity, associated with the ERF. hence offsite capacity through IS and mobile theatres. – The system must pass 5 gateway criteria to access the ERF – Activity must be delivered as a minimum to the same case mix • In order to deliver the improvement in the current plan, this as the baseline period to achieve the value prescribed by our has involved the delay or revision of system investment baseline. All system activity is taken into account, including plans. This may impact of service delivery and ICS ambition. community and Tier 2 where consultant led. Similarly the system financial position means that no – The system is putting in place additional stepped capacity to contingency has been provided for. National guidance accelerate recovery, including wrap around care. If activity is suggests this should be included at 0.5% of system funding not delivered this will leave a significant financial pressure. which at the minimum would be c. £4.2m for the system. Mitigations: Programme Management of the IS and mobile theatre Mitigations: Priority is on recovery and establishing ICS. Investment programme to ensure maximum performance. Activity modelling to on recovery has been included within the financial plans and system ensure clear line of sight on performance delivery. partners are asked to mitigate financial risks in so far as possible.

• Whilst every effort will be made to ensure employed staff, • Financial plans across the system include expected cash volunteers and bank first are the means to deliver the release efficiencies of £6.7m based on 0.5% of gross system required activity, realistically there will be a need to maintain turnover. This is before any additional recovery plans to close the use of agency capacity. This has been reflected within the the gap. Delivery of cash efficiencies is a challenge whilst in financial plan, however there will be some staff groups across recovery the system, such as anaesthetists where premium costs are Mitigations: System efficiency programme board has been likely to increase. established which is overseeing the system efficiency opportunities. Mitigations: All agency rates above cap reviewed. Long lines of work being established where possible to secure capacity. Actions

Given the national messaging for H1 financial envelopes, it is expected that systems will present a balanced plan in the first instance, albeit that there is recognised risk due to the ERF. M&SE H&CP have delivered a balanced plan in line with this national expectation.

System partners continue to review their plans to ensure that the budget plan is as realistic as possible and that all commitments on the system can be managed within the plan as developed.

It is proposed that any emerging financial gap during the year is shared proportionately between system partners based on expenditure plans where partners will be required to live within a more constrained financial envelope. This approach is not sustainable and encourages silo working, however this will be necessary as a last resort.

Further work will continue over the next few weeks to ensure that the financial plans remain aligned with the final system workforce, activity and performance plans which are due later in May to NHSE/I. ITEM 11 POLICIES ACROSS MSE Agenda Item 11

Policies across MSE

CCG Governing Body 27th May 2021 via Microsoft Teams

Purpose of Report: For the extension of policies which have expired or expire before the end of the financial year or are now due for review, to 31 March 2022.

Recommendations and The CCG Governing Body is asked to NOTE the decisions of the Audit decision/actions: Committee and Remuneration Committee to extend CCG policies so that policies are in date up to 31st March 2022.

Executive Summary A review of Policies across each of the CCGs in mid and south Essex (including financial impact): has shown a number of the policies to have passed their review date.

Given the impact of the pandemic on business as usual work and the anticipated move to an Integrated Care System it was not considered appropriate to harmonise the policies at this time. However, assurance was required, particularly at a time of such significant change, that policies are fit for purpose.

A review of the policies was undertaken to see if it would be appropriate to ‘roll over’ or extend the policies until 31st March 2022. The review included whether or not the policies remain fit for purpose and are reflective of any changes in legislation / guidance that would require a more in-depth update of the policy.

As a result of the review process, policies were categorised as: - Roll over (into correct format) with a new end date of 31st March 2022, expired policies that require no changes. - Roll over (into correct format) with a new end date of 31st March 2022, expired policies with a number of minor changes. In accordance with the CCGs Policy for Policies, these could be approved by the sponsoring committee without requiring ratification by the CCG Boards. Minor suggested changes are for example updates to reflect new Board structures. - Extend policies that are currently in date and do not need any changes to 31st March 2022. - Significant update of the policy required, consequently the policy was not extended/rolled over and would be reviewed at a later date.

Notwithstanding the requested extension, policy leads have been asked to ensure that policies within their remit continue to meet legislative requirements.

HR policies have been reviewed by the Remuneration Committee with recommendation to roll over policies as recommended by HR. Non-HR policies have been reviewed by the Audit Committee. Appendix A sets out each of the policies by CCG to be considered by the Audit Committee. Detailed policies have not been attached but are available upon request and are accessible on the CCG intranets.

Written by: Nicola Adams, Associate Director of Corporate Governance (Company Secretary), NHS Thurrock CCG

Executive Director Mark Barker, Chief Finance Officer Sponsor:

Non-Officer/Board Audit Committee Chairs Sponsor:

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this CCG Remuneration Committee 14/05/2021 document). CCG Audit Committee 25/05/2021

Reports Submitted to Board only: Date signed-off by Executive Team. N/A (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick  ) 

Has the Equality/Quality/Privacy Impact Assessment  been carried out and issues addressed?

Details of Stakeholder, Patient N/A – there are no fundamental changes and therefore no external & Public Engagement: engagement is required.

Risks / Link to BAF: N/A BAF Ref:

Conflicts of Interest: N/A

Escalation: N/A To the Board To another Committee To the BAF/CRR APPENDIX A

Castle Point & Rochford CCG and Southend CCG

Policy Title Policy Area Review Date Comments Fire Safety Corporate 01/09/2021 Health & Safety Policy Corporate n/a This Policy has been reviewed by our H&S Experts, would request approval of amended policy (app 2) Communications & Engagement Strategy Corporate 01/05/2021 Comms Lead has confirmed policy extension. Conflict of Interest Policy Corporate 01/03/2020 Counter Fraud & Corruption Policy Corporate 01/072021 Legal Services Protocol Corporate 01/09/2021 Sustainability Policy Corporate 01/11/2019 Governance Lead approved extension, no changes required. Media Policy Corporate 01/05/2021 Mobile Phone Policy Corporate 01/03/2020 Probationary Policy Corporate 01/03/2020 Adverse Incident Reporting Policy Corporate 01/03/2020 Parachute Policy, Urgent contract for primary Primary Care 01/05/2020 Primary Care, has agreed extension, no changes required. medical care provision or caretaking policy Domestic Abuse Policy Quality 01/01/2020 Designated Nurse agreed extension, no changes required. Safeguarding Children Supervision Quality 01/11/2019 Designated Nurse agreed extension, no changes required. Nursing & Midwifery Revalidation Quality 01/04/2020 Deputy Chief Nurse agreed extension, no changes required. Joint CHC Service Operational Policy Quality 01/09/2020 CHC Lead agreed extension, no changes required. CHC Dispute Policy Quality 01/04/2021 CHC Lead agreed extension, no changes required. Serious Incident Framework Quality 01/11/2020 Designated Nurse agreed extension, no changes required. Deprivation of Liberty Quality 01/01/2021 Designated Nurse agreed extension, no changes required. Budgetary Control Policy Finance 01/06/2021 Capital Accounting Policy Finance 01/06/2021 Cash Management and Forecasting Policy Finance 01/06/2021 Finance agreed extension, no changes required. Journal Good Practice Guidance Finance 01/06/2021 Month End Reporting Procedures Finance 01/06/2021 VAT Procedures Finance 01/06/2021 HR Policies

Policy Name Expiry Date HR Recommendation Absence Management Policy January 2020 Rollover Dignity at Work May 2021 Rollover Disciplinary Policy December 2020 Rollover plus minor changes Flexible Working Policy January 2021 Rollover Fostering Policy January 2020 Rollover Managing Investigations March 2020 Rollover plus minor changes Managing Performance March 2020 Rollover plus minor changes Special Leave Policy January 2021 Rollover plus minor changes Freedom to Speak Up March 2020 Rollover plus minor changes Work Experience January 2021 Rollover Stress Management Policy January 2021 Rollover Management of Leavers January 2021 Rollover ITEM 12 PATIENT SAFETY & QUALITY REPORT Agenda Item 12 NHS CASTLE POINT AND ROCHFORD CCG AND SOUTHEND CCG PLACE QUALITY & PATIENT SAFETY REPORT

Quality and Safety Group May Report Part 1.

Purpose of To provide the members with a local patient safety and quality update and Report: to provide assurance that any significant risks or issues are being appropriately managed in relation to SEE area. (Appendix are the committee papers presented to the Patient Safety and Quality Committee)

Recommendations Members of the QSG are requested to note the report and seek additional and assurance if required. decision/actions:

Executive Key Issues/Headlines Summary 2.0 Domestic Abuse Bill 2020- The Safeguarding Leads are currently (including financial working closely with the partners within the system and safeguarding impact): Boards to ensure in both Essex County Council and Southend Borough Council the new legislative requirements are implemented within timeframe.

3.0 Workforce- Due to vacancy factor and sickness within the quality team there has been workforce pressures experienced. As part of encouraging system working and to mitigate risks a mitigation plan has been put in place.

4.0 Complaints -The Parliamentary and Health Service Ombudsman has issued its NHS Complaints Standards, which are currently being piloted with identified organisations and they will go live from April 2022 across the NHS. These do not replace the Complaint Regulations 2009. 5.0 Care Homes (SEE) (Covid 19 Outbreaks or Exposure) – No outbreaks or exposures for this reporting period.

Written Lorraine Coyle Deputy Chief Nurse NHS CPR and NHS Southend CCG by/Presented by:

Executive Director Rachel Hearn, Executive Director of Nursing Mid and South Essex CCGs. Sponsor:

Non-Officer/Board N/A Sponsor:

Approval Route: Group/Committee Date (List Groups/Committees N/A that have reviewed this document). Yes No N/A

Have any financial implications been signed off by ✓ the Chief Finance Officer? (Please Tick  )

Has the Equality/Quality/Privacy Impact ✓ Assessment been carried out and issues addressed?

Details of Stakeholder, Insert as appropriate Patient & Public Engagement:

Conflicts of Interest: Conflicts of Interest for any agenda item must be declared at start of the meeting in order that the Chair may determine any required management of the conflict.

National Standard

Key Issue 1

Key Issue 2

Time scale for benefits to be realised

Risk – BAF NHS CASTLE POINT AND ROCHFORD CCG AND SOUTHEND CCG LOCAL QUALITY & PATIENT SAFETY REPORT

1. Purpose

This report provides an overview of key patient safety and quality issues for all services over which NHS Castle Point and Rochford CCG and Southend CCG has direct oversight and/or any services where the CCG is the lead on behalf of the Mid and South Essex CCGs.

2.0 Domestic Abuse Bill 2020

2.1 There has been a delay in the Domestic Abuse (DA) Bill 2020 receiving royal assent, however, Local Authorities have been advised to go ahead with implements ion of the new duties from 1st April 2021.

2.3 The legislation aims to change the understanding of and response to domestic abuse and contains several new legal requirements for Local Authorities and the NHS will, where appropriate, be required to support the discharge of these functions. The new law will establish the office of Domestic Abuse Commissioner who will hold Government, Local Authorities and public bodies to account for tackling domestic abuse. Each local authority is setting up a DA Board to have oversight of the implementation and delivery of the regulations.

2.4 The key changes will:

• introduce a statutory definition of domestic abuse that with be expanded to include economic (rather than financial) abuse. Children will be described as victims of domestic abuse rather than witnesses • create new domestic abuse protection notice and protection order that will offer longer term and more flexible protection to victims • extend extraterritorial jurisdiction over specified offences as required by the Istanbul Convention • place the guidance underpinning the DV Disclosure Scheme (also known as ‘Clare’s Law’) on a statutory footing • prohibit cross-examination in person in specified circumstances in family and civil proceedings. • Introduce mandatory polygraph examinations of high-risk DA offenders on licence to generate a higher quality and quantity of offender licence monitoring information. • create a legislative assumption the DA victims are to be treated as eligible for special measures in the criminal court on the grounds of fear and distress. This will also extend to civil and family courts. • protect security of tenure for victims of domestic abuse • introduce a statutory duty on tier one local authorities in England to support victims and their children in DA safe accommodation and a duty on tier 2 authorities to co-operate with tier one in the fulfilment of their duties. • amend the Housing Act 1996 to give those fleeing DA priorities need for accommodation secured by the local authority. • provide clarification that consent to serious harm for sexual gratification is not a defence in law. 2.5 The Safeguarding Leads are currently working closely with the partners within the system and safeguarding Boards to ensure in both Essex County Council and Southend Borough Council the new legislative requirements are implemented within timeframe.

3.0 Workforce 3.1 Due to vacancy factor and sickness within the quality team there has been workforce pressures experienced. As part of encouraging system working and to mitigate risks the following has been put in place to ensure a consistent safe service is in place:

• Reviews of current workplans in all areas reviewed. • The Head of Nursing will now have overall management responsibility of the CHC Team. This is to facilitate the departure of the other Head of CHC who shared the role. • Deputy Chief Nurse is overseeing Team and adult safeguarding until new post holder commences on the 1 June 2021. • Designate Nurses from Mid Essex CCG are currently overseeing and supporting the Assistant Safeguarding Nurse on all children and looked after children cases • The Looked After Children cover will remain in place until the new LAC Nurse commences on the 2 August 2021

4.0 Serious Incidents & Never Events

4.1 There are no recorded serious incident outstanding for NHS Castle Point and Rochford CCG.

4.2 There are 2 serious incidents outstanding for NHS Southend CCG One incident is currently under independent review and the other incident the full report is due 28 April 2021; both incidents relate to media interest.

5.0 Complaints April 2021

5.1 There is one outstanding formal complaint for NHS Castle Point & Rochford CCG, which relates to NHS Funded Care and is currently under investigation.

5.2 There are two outstanding formal complaints for NHS Southend CCG, which relate to commissioned services and NHS Funded Care; both are currently under investigation

5.3 There have been many patient concerns raised for both CCGs in relation to the NHS COVID Vaccination Programme.

5.4 The Parliamentary and Health Service Ombudsman has issued it’s NHS Complaints Standards, which are currently being piloted with identified organisations and they will go live from April 2022 across the NHS. These do not replace the Complaint Regulations 2009. More details can be found at: https://www.ombudsman.org.uk/complaint-standards

6.0 Care Homes (SEE) (Covid 19 Outbreaks or Exposure)

There are no current outbreaks in SEE for this reporting period

7.0 Recommendation/s

Members are requested to note the contents of the report Agenda Item 12 - Appendix A JOINT COMMITTEE QUALITY & PATIENT SAFETY REPORT

1 Patient Safety

Infection Prevention and Control (IPC)

National Standard Health and Social Care (Safety and Quality) Act 2015 – Reducing Harm in Care.

Key Issue 1 Rising Healthcare Associated Infections, Meticillin Resistant Staphylococcus Aureus Bacteraemia (MRSAB) and Clostridioides difficile infection (CDI), against Zero tolerance/set objective ceiling expectations respectively.

Key Issue 2 SARS-CoV-2 (Covid-19) cases per 100,000 are reducing. However, with lockdown measures easing there is a public health concern raised by the UK Health Security Agency (UKHSA) that cases may rise. Emerging Covid-19 variants continue to cause concern.

Time scale for National standard was not achieved for 2020/21 financial year. benefits to be realised

1. Purpose

This report provides an overview of the current Healthcare Associated Infection (HCAI) performance across the Mid & South Essex (MSE) health economy. Data provided details Meticillin Resistant Staphylococcus Aureus Bacteraemia (MRSAB) and Clostridioides difficile infection (CDI) cases. Reported nosocomial outbreaks of Covid-19 are also included.

2. Background

HCAI data is collated via reporting from the Mid and South Essex Foundation Trust (MSEFT) (Basildon, Broomfield and Southend Hospitals) and the Data Capture System (DCS). The zero- tolerance ambition for healthcare associated MRSAB was set in 2014, the post infection review (PIR) process changed in 2018 whereby only organisations above agreed thresholds were required to undertake a PIR. However, the PIR process was continued across the MSEFT via local agreement to ensure robust clinical reviews and subsequent learning are captured.

MRSAB – All CCG Cases (Acute and Community)

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Year end BB CCG 0 1 1 0 0 0 0 1 1 0 0 1 5 CPR CCG 0 0 0 1 0 1 0 1 0 0 0 0 3 MECCG 0 1 0 2 0 3 0 0 2 0 1 1 10 SCCG 0 0 0 0 0 0 1 0 0 0 0 0 1 TCCG 0 1 0 1 1 0 0 0 1 2 0 1 7 Total 0 3 1 4 1 4 1 2 4 2 1 3 26 Post 48 hours - Acute cases

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Year end Broomfield 0 0 0 0 0 1 0 1 1 0 0 0 3 Southend 0 0 0 1 0 0 1 1 0 0 0 0 3 Basildon 0 0 1 1 0 0 0 1 1 0 0 2 6 Total 0 0 1 2 0 1 1 3 2 0 0 2 12

Clostridioides difficile infection (CDI) – All CCG Cases (Acute and Community)

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Year end BBCCG 3 3 4 5 8 6 3 6 3 2 1 3 47/63 CPRCCG 5 3 5 9 3 3 3 5 5 5 2 4 52/43 MECCG 3 5 7 7 10 12 10 6 8 7 6 12 93/136 SCCG 5 3 7 2 2 6 2 4 3 4 4 3 45/47 TCCG 0 1 3 3 5 1 3 3 1 3 3 2 28/23

Acute Cases

Broomfield Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Year end HOHA 1 2 2 2 3 1 2 2 2 5 1 2 25 COHA 1 1 0 0 0 3 1 1 0 1 1 0 9 Total 2 3 2 2 3 4 3 3 2 6 2 2 34/83

Southend Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Year end HOHA 4 0 6 3 2 5 3 7 0 1 3 1 35 COHA 3 4 3 4 2 1 1 1 4 1 0 3 27 Total 7 4 9 7 4 6 4 8 4 2 3 4 62/51

Basildon Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Year end HOHA 1 0 1 3 3 4 2 2 3 0 1 2 22 COHA 0 2 2 4 5 2 0 1 1 2 1 1 21 Total 1 2 3 7 8 6 2 3 4 2 2 3 43/51 NB: It is important to note that data may vary due to late notification or identification of a case found on the DCS where notification from the hospital has not been received.

Healthcare Associated Infection process

Following discussion with the MSEFT IPC leads it is proposed that review of HCAI going forward will be via monthly IPC harm free care reviews.

Summary of learning from HCAI:

As outlined in previous reports learning from CDI and MRSAB cases remains unchanged with no new emerging themes. Cross organisational work will aim to address common themes identified from RCAs and PIRs. Further work is required to strengthen and embed practice to address recurrent issues such as inappropriate stool sampling etc. Outbreaks and Periods of Increased Incidence (PII)

Investigations underway into:

• Klebsiella Species – Covid Critical Care Unit - Basildon Hospital • Serratia marcescens– Covid Critical Care Unit (CCCU), Basildon Hospital • MRSA outbreak – Burns Service – Broomfield Hospital

Nosocomial Covid-19 outbreaks

Nosocomial outbreaks have significantly reduced commensurate with the national decline in infections. However, the IPC team continues to support outbreak meetings as and when required. There are no new or ongoing outbreaks affecting the MSEFT.

Social Care support

Outbreaks across the social care sector are also reducing, subsequently the frequency of care sector hub meetings has decreased to twice weekly. The IPC team continue to respond and support when requested. The IPC nurse for Southend Borough Council care homes is undertaking IPC audits as per the planned programme or work.

3. Key points to note

• Emerging SARS-CoV-2 variants of concern and or interest.

4. Next steps

• Ensure the IPC annual workplan is progressing to support the reduction of HCAI. • Further review of HCAI with provider organisations to capture learning for dissemination.

Serious Incidents and Never Events

National Standard The Serious Incident Framework (published 27/03/2015) sets out that Provider focussed internal investigations should be completed within 60 days of the incident being reported.

Key Issue 1 Number of outstanding serious incident investigations across Mid and South Essex Foundation Trust (MSEFT).

Key Issue 2 Timeliness of investigation during Covid-19 pandemic.

Time scale for benefits This is an ongoing process and this paper provides the current position. to be realised

1. Purpose

To provide the committee with an oversight of Serious Incident (SI) investigation and learning across the providers.

2. Background

There was a total of 37 Serious Incidents (SIs) reported in February and March 2021, the StEIS categories for these incidents and the location are as follows: Basildon Broomfield Southend FEBRUARY 2021 - Incidents by StEIS Category and Site EEAST Total Hospital Hospital Hospital Abuse/Alleged Abuse of Adult Patient by Third Party 01001 Diagnosis Incident Including Delay Meeting SI Criteria 11002 Healthcare/Infection Control Incident Meeting SI Criteria 10001 Maternity/Obstetrics Incident Meeting SI Criteria - Baby Only 02002 Maternity/Obstetrics Meeting SI Criteria - Mother Only 10001 Sub-Optimal Care of Deteriorating Patient Meeting SI Criteria 20002 Surgical/Invasive Procedure 20002 Treatment Delay Meeting SI Criteria 10113 Total 8411 14

Basildon Broomfield Southend March 2021 - Incidents by StEIS Category and Site Total Hospital Hospital Hospital Abuse/Alleged Abuse of Child Patient by Third Party 1 0 01 Adverse Media Converage or Public Concern about the Organisation or the Wider NHS 1 0 01 Diagnosis Incident Including Delay Meeting SI Criteria 1 0 01 Maternity/Obstetrics Incident Meeting SI Criteria - Baby Only 1 0 01 Maternity/Obstetrics Meeting SI Criteria - Mother Only 0 0 11 Medication Incident Meeting SI Criteria 0 1 01 Pressure Ulcer Meeting SI Criteria 0 2 02 Slips/Trips/Falls Meeting SI Criteria 2 0 24 Sub-Optimal Care of Deteriorating Patient Meeting SI Criteria 0 2 02 Surgical/Invasive Procedure 1 0 01 Treatment Delay Meeting SI Criteria 3 1 26 VTE Meeting SI Criteria 0 2 02 Total 10 8 5 23

During March 2021, 16 cases were closed or de-escalated. At month end this left a balance of 151 open SIs across the organisations, 52 of these are currently subject to a Stop the Clock (STC), 9 of which are with the Health Service Investigation branch (HSIB).

Of the remaining cases, 45 are not currently due for submission and the remaining cases are in progress. The MSEFT currently have 10 cases under extension, and 9 breaching.

3. Key points to note:

• There are 7 SIs for 2019/20 which remain open (5 x MSEFT, 1 x Independent Sector and 1 x IC24.) • A letter from the Executive Director of Nursing was issued on 31.12.2020 in relation to the Covid-19 outbreaks and SIs. Cases that were due for completion from 31.12.2020 onwards were reviewed; where appropriate a STC was applied if delays are due to the pandemic. At the end of March, a STC has been applied to 52 cases. • Targeted Quality Assurance (QA) Visits have been undertaken and will continue in relation to the recently reported Never Events. • For all SIs reported the 72-hour report is scrutinised to ensure that immediate learning has taken place. • Fortnightly meetings are taking place between the Acute Commissioning Team (ACT) and the Associate Director for Patient Safety / Head of Patient Safety to discuss SIs across the MSEFT and there are plans in place to complete those under an extension, STC and those that are breaching. • Six weekly SI review meetings are undertaken with the 3 hospital sites within the MSEFT. • Focus for all investigations remains the recommendations and learning; areas of concern are placed on the action plan tracker and monitored by the Patient Safety and Quality Team (Acute Commissioning) at six weekly meetings with the 3 hospitals. • The MSEFT has now established a Directors Review Group which reviews incidents across all three sites to identify serious incidents. This should offer consistency of approach. Invasive Group A Streptococcus bacterial infection (iGAS)

Progress Update:

• Provide - all actions for the recommendations relating to Provide are complete. • MECCG – three actions relating to the five recommendations assigned to the CCG are now complete. Two are not yet due. • MSEFT – since the last update three more actions have been completed meaning that thirteen of the recommendations have now been implemented. One is not yet due but is partially complete, which leaves four being overdue at the time of this update.

TOTAL PROVIDER COMPLETE OVERDUE NOT DUE RECCOMENDATIONS

Provide CIC 9 9 0 0

MSEFT 18 13 4 1 (partial)

Mid Essex CCG 5 3 (see note 0 2 below)

Based on current information, actions overdue/partially completed relate to: • MSEFT - review of clinical systems; engagement with the integrated discharge team; review of swabbing protocols to ensure testing and reporting is streamlined; review approach and policy relating to use of unfamiliar medical equipment.

The Patient Safety and Quality team continues to liaise with MSEFT and MECCG to monitor progress and update the action plans.

Review of SIs at year end

There have been 257 SIs raised during 2020/21 of which 9 have subsequently been voided leaving a total of 248 for the year (311 cases raised for the 2019/20 year). This includes a total of 8 Never Events:

Broomfield Southend Basildon Ramsay TOTAL Springfield 2 0 5 1 8

These consisted of • wrong site Surgery – dermatology x 3 • wrong block x 1 • retained foreign object x 3 • mismatched parts during orthopaedic surgery x 1

Of the remaining SIs reported, the top reported categories are as follows:

Basildon site: reported a total of 112 Sis: • Maternity incident – baby only x 19 (17% of the site reported incidents) • Diagnostic incident x 17 (15.2%) • Surgical invasive procedures x 16 (14.3%)

Broomfield Site: reported a total of 68 SIs • Maternity incident baby only x 11 (16.2% • Sub optimal care of the deteriorating patient x 10 (14.7%) • Treatment delay x 9 (13.20%) Southend Site: reported a total of 56 SIs • Sub optimal care of the deteriorating patient x 7 (12.5%) • Treatment delay x 7 (12.5%) • VTE x 6 (10.7%)

Further information is available on request.

4. Next steps

• Application of Covid STC ended on 31st March 2021, trajectory for completion of backlog to be discussed with MSEFT. • Continue with fortnightly meetings with the MSEFT to review outstanding incidents and STCs. • Work with MSEFT new Director of Governance to ensure that SIs are raised in a timely way and that levels of harm are consistently reviewed across the group. • To continue to work with the MSEFT on action plans and gathering or robust evidence supporting the MSEFT Evidence Assurance Group (EAG).

Harm Reviews – Referral to Treatment 52 Week Waits

National Standard NHS England established an operational standard to ensure that no- one waits more than 52 weeks from referral to treatment (RTT) and that 52-week breaches should trigger a review process.

Key Issue 1 Ensure that the RTT review process is sustained on all three hospital sites, as a business as usual model for completion within 60 days.

Key Issue 2 As an outlier within the Trust, Broomfield hospital needs to move to a full electronic process.

Time scale for Anticipated at the end of Quarter 1, 2021. benefits to be realised

1. Purpose

To provide an update on the number of 52-week breaches and related harm review position across the MSEFT.

2. Background A risk stratified approach for completing harm reviews is in place with a 100% of RTT harm reviews being completed in 3 key areas: dermatology; ophthalmology and colorectal.

3. Key points to note

3.1 Panels

Southend: As from 1st April 2021, the ACT team have stepped down 100% attendance at panels and going forward will attend monthly to ensure sustainability of the process going forward.

Basildon: The formal panel is now up and running and the ACT are in 100% attendance.

Broomfield: Work is ongoing to move towards a fully electronic system, to be in line with the other two sites. The ACT remain in 100% attendance at all panels.

The MSEFT RTT Task and Finish group is due to recommence mid-April 2021 and this will help with the final alignment and embedding of the processes across all three sites. 3.2 Harm Review data (as of 31st March 2021).

NHSE/I Undertakings were served against the Trust and required completion of all 52-week breach harm reviews in the areas of ophthalmology, dermatology and colorectal from April 2019-January 2021 by the 31st March 2021. All harm reviews relating to the undertakings were completed within the agreed timelines.

The overall MSEFT completion rate of risk stratified areas of RTT harm reviews was 100% for 2019/20 and 97% for 2020/21.

Harm reviews for February and March 2021 are required to be completed by the end of April and May 2021 respectively, as there is a 2-month period before a harm review becomes overdue; this period is classed as ‘business as usual’.

3.3 Harm review outcomes

In total there have been 2,952 cases of no harm identified through RTT harm reviews since April 2019. A total of 19 cases of harm have been identified (10 in Dermatology and 8 in Colorectal and 1 in Ophthalmology). Of the 19 cases, 18 were low harm and 1 case was moderate harm which was identified within ophthalmology. This case was investigated as an internal incident and is now closed, Duty of Candour was performed. Harm is still to be identified in 7 cases from 2020/21 (dermatology and ophthalmology pathways); these are all currently going through the Executive Review Group (ERG) process. The themes and learning from all RTT harms reviews are to be collated in a 3 monthly report and fed back to specialties for action, this report is due in June 2021.

4. Next steps

• Oversight monitored via the monthly Quality Improvement Board (QIB)and reported to the System Oversight Assurance Group. Review and summary of RTT Undertakings to be presented at May 2021 QIB to discuss learning and review risk stratification areas moving forward. • Patient Safety & Quality team working with Medical Director at Broomfield to gain full assurance in the Broomfield panel, and assist in the transfer to a full digital system. • RTT harm review progress is summarised by the sites into a weekly report to the MSEFT Executive Group where progress, trajectory, concerns and mitigations are escalated.

Cancer Quality (to include Harm Reviews)

National Standard 100% of patients waiting longer than 104/63 days from urgent referral for suspected cancer to their first definitive treatment receive a root cause analysis (RCA) of the delay and a clinical harm review.

Key Issue 1 Ensure that the Cancer harm review process is sustained on all three hospital sites, as a business as usual model for completion within 90 days.

Key Issue 2 To establish a coordinated approach to oversee the quality issues affecting cancer services and seek assurance that plans are in place to address these.

Time scale for Anticipated at the end of Quarter 1, 2021. benefits to be realised

1. Purpose

To provide an update on cancer waiting times (104+ days) and related harm review processes. 2. Background

104+ BREACHES The MSEFT submits data for each hospital site on a weekly basis; please see graph below for data w/c 5th April 2021.

Graph 1 below provides detail of the trajectory for 104+ cancer breaches. Cancer Waiting Times 104+ Total Reported Breaches December 2020 - 5th April 2021 140

-10 Jan Jan Jan Jan Apr Feb Feb Feb Feb Dec Dec Dec Dec - - - - Mar Mar Mar Mar Mar ------04 11 18 25 05 01 08 15 22 07 14 21 28 Broomfield Southend Basildon01 08 Total15 22 29

3. Key points to note

3.1 Panels

Southend & Basildon: As from 1st April 2021, the ACT team have stepped down 100% attendance at panels and moving forward will attend monthly to ensure sustainability.

Broomfield: Work remains ongoing to move towards a fully electronic system, to ensure alignment with the other two sites. The site is aware of the need to move to a full virtual panel to enable attendance of Specialist Commissioning and Macmillan GPs.

3.2 Undertakings - update

Undertakings from NHSE/I were served on MSEFT which required completion (by the end of Feb 2021) on all harm reviews identified from April 2019-Nov 2020. All harm reviews during this time period were completed and the Trust delivered the undertakings requirement.

3.3 Harm Review data (as of 31st March 2021).

The overall MSEFT completion rate for Cancer harm reviews was 100% for 2019/20 and 95% for 2020/21, there are 177 harm reviews outstanding, 35 are overdue, 96 are not required to be completed until the end of April and 46 are not due for completion until the end of May.

The 35 cases which are now classified as overdue (December reviews) are from the Broomfield site. This is being addressed with the Medical Director for the service and has been escalated within the MSEFT.

Harm reviews for January and February 2021 are not due for completion until the end of April and May 2021 respectively as there is a 3-month period before a cancer harm review becomes overdue – this period is classed as ‘business as usual’.

3.4 Electronic Cancer Harm Review System (CHARM)

The MSEFT is working with the company that produced the software system that is used to track Mortality reviews to produce a system for tracking cancer harm reviews. The system is being developed with users to ensure that it mirrors the process in place within the organisation. The system will be call CHARM. This will input information from the relevant systems such as Somerset to allow for real time dashboards. It is planned that the system will also be used for RTT harm reviews in time. The system will draw themes visibly from Harm Reviews to include service improvement work. It will provide a reliable platform to analyse and learn from the reviews, this will help inform service and quality improvement changes.

3.5 Themes and Learning – April 2019 – 4th March 2021 The themes and learning from all cancer harms reviews are collated in a quarterly report that is presented to MSEFT Cancer Committee and fed back to tumour site leads for action.

In total there have been 2,221 cases of no harm identified through cancer harm reviews since April 2019. As of the 4th March 2021 a total of 26 harms have been identified (18 low, 6 moderate and 2 severe).

3.6 Common themes for delays

• All those living with a Learning Difficulty (LD) should be identified from initial referral pathway from primary care and supported by an LD CNS to link with GP Practice Nurse. It has been identified that no easy read material is available. The Macmillan GP and Associate Director of Nursing for Cancer are working closely to create a leaflet.

• Delays in pathway when investigations needed outside of the cancer pathway. Communication has been sent from Medical Director to clinicians to highlight need for urgency when a patient is on cancer pathway when referring on/out.

• Historic delays over all pathways with wait for Oncologist OPA. The harm review panels have seen improvements and waiting times have improved.

• General COVID delays stemming from patient isolation for 14 days prior to treatment, shielding, patient choice, telephone OPA and treatment at private facilities.

3.7 Royal College of Surgeons (RCS) – Southend Urology Review

The Royal College of Surgeons review of urology specialist services took place in November 2020, following a request by Specialist Services Commissioning. The report was received on 26th February 2021 and set out 4 urgent recommendations to address risks and 6 additional recommendations aimed at supporting improvement.

The actions in response to these four key actions have been included in the MSEFT Cancer Improvement Plan, which is reported as part of the undertaking’s assurance report to the Trusts Finance and Performance Committee, for its oversight and review. Assurance and updates will be provided to the new the Cancer, Palliative Care & End of Life Quality Assurance Group (CPQAG) as discussed in section 3.8.

3.8 Quality Surveillance Information System (QSIS)

MSEFT successfully submitted an off-line version of QSIS as requested to NHSE on 31st December 2020, a summary of this is tabled below. The information submitted was for 2019/2020 was for individual sites prior to the formation of the MSEFT, therefore much of the submitted data has been superseded.

The main areas of low compliance with the KPIs are around the Lung and Acute Oncology pathways. A business case has been developed for a single MSEFT Acute Oncology (AO) group which is planned to be brought together during 2021. 3.8 Cancer Quality Governance

There are a number of forums where Cancer Quality issues are discussed, A coordinated approach for oversight of the quality issues affecting cancer services and assurance was tabled at the Mid & South Essex Health & Care Partnership Cancer, Palliative Care and End of Life Board. The approach aimed to reduce the burden of duplicate meetings, reporting and decrease the clinical time required to attend meetings. A single meeting called the Cancer, Palliative Care & End of Life Quality Assurance Group (CPQAG) was proposed for oversight and assurance. The Board agreed to the implementation and it is anticipated that this group will mobilise in May 2021. It will oversee a number of plans which will report into relevant Programme Delivery Groups and the MSE Cancer, Palliative Care and End of Life Care Board. 4. Next steps

• Sustainability of Cancer harm reviews will continue to be monitored via the monthly Quality Improvement Board. • To work with primary and secondary care to mobilise the CPQAG. • Monthly updates will be provided to the Mid and South Essex Cancer Delivery Group. • Monthly meetings with the MSEFT Deputy Director of Nursing – Cancer, Palliative Care and End of Life to seek assurance with processes and provide professional peer review, support and challenge. • Patient Safety and Quality representatives within the ACT will continue to attend panels.

Acute – Quality Contract Oversight

National Standard The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009

The National Clinical Audit and Patient Outcomes Programme

NICE Guidelines

Key Issue 1 Delay in response to patient complaints and changes to the Patient Experience Team.

Key Issue 2 Alignment of processes across the 3 sites for the adoption of NICE guidance and Local/National clinical audit.

Key Issue 3 Quality Assurance Visits to maternity at Basildon following the outcome of the CQC visit in 2020.

Time scale for This is an ongoing process and this paper provides the current position of benefits to be the progress made. realised

1. Purpose

To advise the committee of local updates surrounding Patient Experience/Complaints, local and national clinical audit and the adoption of NICE guidance and the outcome of Quality Assurance Visits.

2. Background

In direct consequence of the COVID-19 outbreak the following occurred:

• Whilst complaints continued to be addressed it has been noted that response times have increased due to limited access to clinical staff. • The Patient Advice and Liaison Services (PALS) continued, however face to face contact was suspended to reduce the potential of spreading infection. • The Patient Experience and Complaints teams also had a number of vacancies over the last year following the consultation on the service. • Local clinical audits were suspended with the exception of those directly relating to COVID-19. • All National Audits were suspended. • Only NICE guidance pertaining directly to the care of patients with COVID-19 was being published. The CCGs have commenced a programme of quality assurance visits to maternity following feedback from the CQC and dermatology and ophthalmology, in light of the never events in these services.

3. Key points to note

Patient Experience/ Complaints/ PALS:

The Associate Director of Patient Experience is now in post and the Head of PALS & Complaints and the Head of Patient Experience roles have all been successfully appointed to. However, there remain two vacancies within the PALS & Complaints Teams at Basildon and Southend. These are both being recruited to.

Performance for responding to formal complaints within the agreed 40 working day timeframe for the month of February (last reported data) was - Basildon 53%, Broomfield 54%, Southend 39%, giving an overall response rate for the Trust of 47%.

Local Clinical/National Audit and NICE Guidance:

All 3 sites report that their programmes are recovering from the effects of the COVID crisis.

NICE guidance is being implemented across the Trust and this is coordinated through the Trust’s NICE Implementation Group which meets on a quarterly basis and is attended by a member of the ACT.

Local audits are being registered and undertaken with the trust moving to a new operating model to monitor and report these.

Some national audits (e.g. Hip Fractures) are being merged across the 3 sites. Some will remain site specific where that site solely hosts a speciality.

Quality Assurance Visits Visits continue as part of the ongoing programme to maternity at Basildon with complimenting visits to the maternity units at Broomfield and Southend. All 3 units have received Out of Hours (OOH) visits in the last 2 months. The visits were undertaken as follows:

• Maternity Basildon 24/02/2021, 11/03/2021 (OOH), 24/03/2021, 12/04/2021 • Maternity Southend 15/04/2021 (OOH) • Maternity Broomfield 22/03/2021 (OOH)

Key points to note

Maternity Basildon: All areas have been visited by the team. The focus has been on establishing if there has been ongoing improvement regarding previous findings. Discussions with staff indicate that there is slow improvement and patient feedback has generally been good. A full report outlining the findings is available from the ACT.

Out of Hours Visits: Focus on all 3 sites was around night staffing, support, escalation of emergencies, access to medical staff working culture and security overnight. The Maternity Commissioner was able to observe handover at all 3 sites and time was spent in all areas. Immediate feedback was given to the midwife in charge on each occasion with more detailed feedback being given to the Trust both verbally and via written report as described above.

4. Next steps

• Maternity visits across the MSEFT will continue to take place on a regular basis and the ACT will be supporting these. • A normal programme of Quality Assurance Visits will resume (conditions permitting) in Q2 2021/22. • A visit is being planned for Brentwood Community Hospital, provisionally planned to be undertaken during May 2021. • The ACT will continue to support the trusts NICE Implementation Group.

Care Quality Commission Acute Trust

National Standard Providers of NHS services are required by law to be Care Quality Commission (CQC) registered. In order to ensure that registered providers meet a set of fundamental standards for quality and safety, the CQC as the regulator, monitors and inspects, publishing what they find and summarise as a rating. Additionally, the CQC issues performance notices as appropriate and has the ability to place a provider in special measures.

Key Issue 1 The latest Basildon maternity inspection report was published by the CQC on 19 November 2020 (following the Inspection on the 18 September 2020); maternity services were rated as ‘Inadequate’.

Key Issue 2 Broomfield and Southend hospitals received ratings of “requires improvement” from visits undertaken in 2019, published in 2020.

Time scale for benefits As per actions for improvement. to be realised

1. Purpose

The purpose of this report is to summarise the latest position as presented by the MSEFT through its governance structure, and the approach being taken in relation to their improvement plans following the latest CQC inspections of Southend, Basildon and Broomfield Hospitals.

2. Background

Basildon Hospital Maternity Services: A Section 29A was issued on 26/06/2020; a Section 31 issued on 24/06/2020 and a Section 64 issued on the 02/07/2020. The CQC undertook an unannounced visit on 12/6/20 where they found serious concerns in relation to the 6 SIs involving babies born in poor condition. The CQC report issued confirmed the maternity service rating of inadequate overall with the safe, effective and well-led domains all individually rated as inadequate. The CQC made a further announced visit to Basildon Maternity Unit on 18/09/2020 with some areas of improvement noted around storage of records and completion of WHO checklist. However, there were concerns raised about culture, handovers, adherence to PPE guidance and incomplete prescription charts.

Core services inspections were published in March 2020 for Broomfield and Southend (both rated Requires Improvement) and Basildon (rated Good) in 2019, leading to a combined rating of ‘Requires Improvement’, the latest maternity rating does not alter the overall rating for MSEFT.

3. Key points to note

MSEFT have identified a total of 119 overarching actions being tracked across the 3 sites. Each action includes a number of more detailed actions for each site and core service.

Additionally, maternity services have a Maternity Improvement Plan (MIP) which encompasses all activity related to the oversight of issues, concerns and actions including those that relate to findings from the Ockenden Report (published December 2020). Please see maternity report for further detail.

MSEFT have reported to the Clinical Quality Review Group (CQRG) - April 2021, as being on track to meet the due dates within the action plan. The table below shows the status of the overarching CQC action plan as at 11/03/2021, as presented to MSEFT Quality Governance Committee:-

An MSEFT assurance and improvement framework is in place to ensure there is a robust review of evidence submitted and that actions are only closed off when evidence is approved as providing sufficient assurance.

The Conditions and Warning Notice Oversight Group (CNOG) is responsible for monitoring completion against any condition notices and has been trialled with maternity services.

The Evidence Assurance Group (EAG) is the overarching group to consider the evidence from any actions, enforcement actions or requirement notices that are being proposed for closure. Following a discussion at the Evidence Assurance Group meeting on 5 March 2021, it was agreed that actions should only be rated as ‘blue’ (complete with evidence), once the evidence has been reviewed by EAG and signed off as providing assurance for closure. The CQC action plan has been refreshed to adopt these new ratings and this has resulted in 13 MUST take, 15 SHOULD take and 4 other actions being changed from ‘blue’ status to ‘green’ status.

Over the coming weeks, MSEFT CQC improvement plan will be refreshed and realigned against the new care group and divisional structure. This will aim to improve shared learning and ensure that improvements are implemented trust wide rather than site based.

The majority of actions to address the MUST and SHOULD take actions were implemented either before or during the first COVID pandemic wave. Assurance is therefore required that the improvements have been sustained following the pandemic or a reassessment is required to determine whether any further action is now required.

The latest report from the CQC for MSEFT was into Infection Prevention and Control, published on 8th April 2021. The report does not impact on ratings and was largely favourable with 2 SHOULD take actions:-

• The Trust should monitor the use of the COVID-19 regime form to ensure the form is consistently completed across the wards. • The Trust should continue to work on the review of the trust infection prevention and control policies and associated audit programmes to unify these across the three locations.

Full report available at MSEFT IPC CQC Report

Next steps

The ACT continue to link and work with the MSEFT team to provide support, professional challenge and gain assurance through attendance at meetings, targeted Quality Assurance Visits (QAV) and CQC style visits.

MSEFT remains formally joined to the Maternity Safety Support Programme (MSSP). The diagnostic report has been received and MSEFT are currently reviewing recommendations to highlight any that have not been considered through previous review processes. The ACT continues to undertake fortnightly QAVs to Basildon maternity unit which, are scheduled to continue. Visits to other maternity sites, including night visits have also been undertaken. A comprehensive risk assessed programme of QAV is due to recommence shortly.

2. Maternity

National Standard To reduce the number of Maternal deaths, Stillbirths, Neonatal deaths and brain injuries by 50% by 2025 The Maternity ambition has extended to include reducing pre term births from 8% to 6%.

Key Issue 1 The Maternity Services Support Programme report has been received by MSEFT, report is under review for factual accuracy. Actions to form part of Maternity Improvement Plan

Key Issue 2 A Section 31 notice must take and should take actions remains in place for the MSEFT.

Time scale for benefits Priorities and Operational Planning Narrative submission due 6th to be realised May 2021.

1. Purpose

To provide the Committee with oversight of the Local Maternity and Neonatal System (LMNS) safety and transformation work in progress across all maternity providers and relevant stakeholders.

2. Background

The February report provided details of the communication toolkit published for ethnic minority women, Black Asian and Minority Ethnic (BAME) women, confirming that this terminology is no longer to be used. A new audit has been requested by region relating to compliance against the 4 national asks relating to this group, these are pathway management, effective communication, the requirement to offer vitamin D supplements and rationale for use, and effective data capture.

In March 2021 guidance was issued that informed maternity services of the national priorities for operational planning providing a template for submission. In addition to this, Maternity services were also required to provide information against the numerical plans and evidence to support national and regional assurance

The plan requests that Maternity Services bid for funding up to £1.8 million however it has yet to be understood if MSEFT is considered to be one provider, or three site providers of Maternity Services as this would significantly alter the amount of money that may become available. All bids will be considered alongside the supporting plan and evidence submitted.

MSEFT Maternity Services continue to work towards the delivery of all actions as detailed in the Section 31 notice.

3. Key points to note

• The Ockenden assurance tool was presented at the LMNS prior to submission. • The Ockenden evidence portal will open late April for submission and National review. • A Continuity of Carer survey was sent from the National team to Maternity services with and was completed by MSEFT. • The audit for ethnic minority 4 National asks has been completed and awaits sign off by MSEFT. • The Ethnic minority toolkit was presented at the LMNS for discussion. • A Maternity Assurance Committee has been commenced monthly, the LMNS Senior Responsible Officer is in attendance. This forum monitors delivery against key performance indicators and compliance against regulatory plans. All maternity risks are reviewed and submitted evidence is scrutinised • MSEFT currently have no CQC actions overdue or at risk of becoming overdue. Actions are continually tracked for updates.

4. Next steps

• Bi- weekly quality assurance visits continue to be undertaken, these have included a night visit to each site. • For each visit the inspection focus on findings from the CQC & Ockendon reports. • The MSE LMNS buddied up with Suffolk and North East Essex LMNS to implement processes for peer review and support. • Complete and submit Operational Planning guidance and bid submission. • The MSEFT have scheduled a table top exercise to review the section 31 to request exit.

3 East of England Ambulance Services

National Standard Providers of NHS services are required by law to be Care Quality Commission (CQC) registered. In order to ensure that registered providers meet a set of fundamental standards for quality and safety, the CQC as the regulator monitors and inspects, publishing what they find and summarise as a rating. Additionally, the CQC issues performance notices as appropriate and has the ability to place a provider in special measures.

Key Issue 1 East of England Ambulance Trust - well led inspection resulted in enforcement action from the CQC

Key Issue 2 The CQC recommendation that service is placed into special measures has been realised.

Key Issue 3 East of England Ambulance Trust have published their latest quality report for review.

Time scale for benefits As per actions for improvement to be realised Section 29A warning – 28th November 2020

Purpose

This paper reports on the current quality concerns relating to East of England Ambulance Service (EEAST) and reporting on the actions being taken to address the findings as recently published following an inspection by the Care Quality Commission (CQC). Additionally, the trust has published its latest quality report and this paper summarises the findings.

1. Background

The CQC undertook a 'well led' inspection of the Trust on the 15 July 2020. Following this visit, the CQC served a notice under section 31 of the Health and Social Care Act 2008 to impose conditions on the Trust Regulated activities: transport services; triage and medical advice provided remotely and treatment of disease, disorder or injury.

Suffolk CCGs are the lead commissioners for this service and Mid and South Essex have direct input for Essex.

2. Key points to note

CQC During the Oversight and Assurance Group held on 01/04/2021 the following update was given on the progress made by EEAST with its Quality Improvement Programme (QIP) since the CQC inspection: • Progress against the CQC QIP continues to be balanced with the progression and development of the long-term improvement plan. There has been continued progression and completion of actions across all conditions. • A key focus has been review of the conditions and the action plans associated with them to produce a ‘plan on a page’ or driver diagram, which begins to indicate progress to date, areas of focus, and aspects that will transition into one of the five themes within the long- term plan. There has been good progress on the development of the driver diagrams for 11 conditions. • Of the 171 actions, 60% are complete, with a further 22% rated green or green-amber in terms of confidence in delivery. Areas of lower confidence (amber or amber red rating) have increased this month to 18%, and the lower confidence rating relates to delivery to timescales - due to a combination of factors such as the time taken for robust collaboration, or reviews of work to strengthen the outputs based on feedback or the culture expertise.

Next Steps:

• ‘Final’ QIP for conditions established based on the driver diagrams to supplement the improvement and transformation and ensure delivery on actions. • Clear dashboard to monitor alongside the long-term improvement plan.

Quality Report The report produced by EEAST looks at their entire area but is broken down by CCG/STP. For the purpose of this paper only information pertaining to Mid and South Essex CCGs (i.e. relating to patients who are registered with GPs in this area) will be reported on and only if there has been any change since the previous report.

a) Serious Incidents (SIs): Year to date EEAST have raised 6 SIs for the MSECCGs area which equates to 0.0003% of the local call volume. SIs are monitored for the CCGs by the Acute Commissioning Team who will escalate any concerns locally.

Non-conveyance data collection and development of care bundle has commenced in a trial area and the plan is to roll out widely by the end of the financial year, upon successful completion of the trial. This is aimed to inform the risk management of safely discharging patients.

Proposed actions: • Focused work on non-conveyance data collection. • Embed Learning from Deaths process through the organisation.

b) Infection Prevention and Control (IP&C): The cleaning schedules have increased by 1%.

Clinical waste compliance and cleanliness of consumable stores were the largest areas for improvement within the audits.

Quality assurance have been restricted in quantity in line with reducing movement but also to facilitate training and monitoring of COVID working safely Marshalls who are continuing to assess the working safely guidance. The information is being reviewed weekly to address non-compliances and ensuring risk assessments are up to date. The Trust average compliance with the working safely audit is 96% for February which is 7% higher than in January.

Actions taken /proposed: • Continued monitoring of working safely and addressing issues with staff and managers to improve compliance where necessary. • Initiate plan to reintroduce the quality control function and increase QA figures.

c) Patient Experience: In February 2021 (last available data) EEAST received 4 complaints for the MSECCGs area, representing 0.024% of its call volume. In total, year to date, the trust has received 66 complaints for the MSECCGs area, representing 0.031% of its call volume. This is equal to the Trust average for each STP area.

The Patient Experience team remains committed to achieve improved turn-around times for complainants. This has been demonstrated in recent improvements in the number of complaints closed within the Trust’s 25-day target which has improved from 12.73% in May 2020 to 52.63% in February 2021.

Actions taken/proposed • All new complaints continue to be acknowledged within the 3 working day timeframe. Complainants have been informed that due to the current public health emergency, the trust may not be able to provide a response with its 25 working days timescale. All open and on-going cases have also been informed of the possible delays. The team continue to work with Investigating Officers to ensure that responses are provided within 25 days wherever possible at this time. • Trust policy has been reviewed to reflect the complexities within different complaints with defined new investigation and closure timeframes – this has come into practice from 01 April 2021.

d) Safeguarding: Safeguarding training compliance has decreased in all areas beneath the 90% KPI. This is due to the on-going demand placed upon staff because of Covid-19 and the current demand on operational performance. The trust remains above the 85% KPI for PREVENT training.

In February the trust completed the delivery of three management passport training sessions, focusing on 3 new policies: Allegations against staff, Adult Safeguarding and Children’s Safeguarding. Over 250 managers were successfully trained across these sessions.

The trust continues to work on the enforcement notice received from the CQC and making good progress, this focuses on allegations against staff and policies & procedures. They are reporting weekly through their improvement board and meeting the targets set.

The trust is on target to implement the Child Protection Information Sharing (CP-IS), launched on the 31st March 2021. Training packages and communications have been planned so that all operational areas are aware of the launch and their responsibilities surrounding CP-IS.

Actions taken/ proposed: • Monitoring of capacity within the team during the current pandemic. • CQC enforcement notice and evidence collation submitted to the Trust’s Improvement Board. • Working with external stakeholders/designate specialists regarding the Trust’s safeguarding policies.

3. Next steps

The Acute Commissioning Team will continue to work with the Trust, lead commissioners and other stakeholders to monitor progress of the CQC action plan and review other quality indicators as they are submitted by the Trust. This will include the system wide resumption of CCG led Quality Assurance Visits later this year. 4 Integrated Care 24

National Standard Providers of NHS services are required by law to be Care Quality Commission (CQC) registered. In order to ensure that registered providers meet a set of fundamental standards for quality and safety, the CQC as the regulator monitors and inspects, publishing what they find and summarise as a rating. Additionally, the CQC issues performance notices as appropriate and has the ability to place a provider in special measures.

Key Issue 1 Implementation of Think 111 programme in context of rising demand.

Time scale for benefits This is an ongoing process and this paper provides the current position to be realised of the progress made.

1. Purpose

The purpose of this report is to provide the committee with an update on the position of the Integrated Care 24 (IC24 - formally NHS 111 and Out of Hours) service for the population of the five CCG’s across mid and south Essex.

2. Key points to note

The patient, and staff, qualitative survey is being gathered at this time. Questions are being asked of patients directed to A&E by 111, A&E staff and also clinical staff manning the 111 Clinical Advisory Service (CAS). At this time, and in light of Coronavirus processes, this is a paper-based exercise with on-line option. All referred patients are assessed by the CAS prior to final outcome. Findings from the survey will be used to inform future experience surveys. This will include face to face structured interviews when it is safe to do so.

The demand on the 111 service has returned to higher levels than contract. In part this is due to concerns expressed by patients over rare clot risk which may be associated with Covid 19 vaccination.

Monthly Quality and Call Reviews continue with no concerns identified. Calls reviewed in March concerned patients calling where safeguarding concerns may have been present. Safeguarding lead colleagues joined the team to offer expert review the team raised no concerns about call handler or clinician response. April call review will focus on calls where an emergency ambulance was dispatched without clinician review (Category 2 ambulance). It is hoped colleagues from EEAST will join for this.

3. Next steps

Ongoing work to deliver, assess and act upon survey findings. Agenda Item 12 - Appendix B Mental Health Exceptions Report

Part I Board Meeting, 27 May 2021

Purpose of Report: To provide a summary of Quality and Safety, Commissioning, Contracting and Finance information for the Mental Health contract.

Recommendations and The Governing Body is asked to receive and note the content of this report decision/actions: for information and assurance purposes and to request any additional information.

Executive Summary This report includes updates for the mental health contract across the (including financial impact): MSE.

Each section defines the key risks and next steps.

Written by/Presented by: Presented by: Lorraine Coyle Deputy Chief Nurse

Executive Director Rachel Hearn – Director of Nursing MSE Joint Committee Sponsor:

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this None document).

Yes No N/A

Have any financial implications been signed off by the Chief Finance Officer? (Please Tick )

Has the Equality/Quality/Privacy Impact Assessment X been carried out and issues addressed?

Details of Stakeholder, Patient None & Public Engagement:

Conflicts of Interest: Conflicts of Interest for any agenda item must be declared at start of the meeting in order that the Chair may determine any required management of the conflict. MSE MENTAL HEALTH EXCEPTIONS REPORT

Purpose This report provides an overview of key quality and safety, commissioning, contracting and finance issues for the Mental Health Contract delegated to Thurrock CCG as coordinating commissioner on behalf of the Mid and South Essex Health and Care Partnership.

QUALITY & PATIENT SAFETY

Quality & Patient Safety Lead – Stephen Mayo National Standard Operational Pressures Escalation Levels Framework

Key Issue 1 During March 2021 EPUT Mental Health Services have experienced capacity and demand bed pressures.

EPUT are reporting OPEL 2

Due to COVID19 outbreaks there have been ward closures and staffing pressures with various reported hot spots across inpatient services, as of 01.04.2021, there are no ward closures in place, however bed closures remain in place.

Time scale for benefits to A Winter Plan is in progress with a variety of key actions that will be be realised implemented as soon as possible. Commissioners and Providers are working collaboratively on solution management. Additional bed capacity has been procured.

Key Points to Note: The CCG Mental Health Lead Nurse, Infection Prevention Control Nurse and EPUT colleagues have undertaken quality visits of wards at Basildon Mental Health Unit and Rochford Hospital in April 2021 with current bed closures. It was identified that beds were closed due to social distancing measures, the transitory nature of Mental Health patients testing home leave as part of their care plan and general estates work taking place.

The consequence of the reduced beds within EPUT is impacting on a number of patients being placed out of area. This is being oversight of this is being held at EPUT CQRG where a review has been requested.

SERIOUS INCIDENTS National Standard Serious Incident Framework (published 27/03/2015) which sets out that Provider focussed internal investigations should be completed within 60 days of the incident being reported.

Key Issue 1 There are a number of outstanding queries with EPUT which is being managed through regular meetings with EPUT Head of Patient Safety.

Key Issue 2 CCG oversight of a number of high-level Serious Incidents and Level 3 independent investigations and external.

Time scale for benefits to Positive progress and benefits are being realised due to the collaborative be realised management and reduction in numbers of any outstanding reports a number of closures have been achieved. Ongoing work continues.

Key Points to Note There are currently 29 active serious incidents reported by EPUT Mid & South Essex Mental Health Services being managed by Thurrock CCG.

Update on Patient Safety Incident Response Framework (PSIRF) EPUT are now gone live with PSRIF reporting following agreement from their board and sign off from NE Essex & Suffolk CCG (the lead CCG) and NHSEI. To ensure patient safety and quality oversight MSE CCG will continue with twice monthly Serious Incident update meetings to cover existing Serious Incidents and future PSIRF management.

Care Quality Commission (CQC) There have been no identified CQC visits within EPUT establishments during March 2021

KPI and Reporting requirements for EPUT EPUT are reporting sub optimal compliance figures in relation to patients on S117 aftercare who have received an annual review of their care plan. The CCG is also aware of a Parliamentary Health Ombudsman report on this issue published April 2021.

A service improvement plan has been requested which will be monitored monthly via CQRG

Mental Health Taskforce Update A decision was taken to review the systems and processes within CCG’s covering Essex for the commissioning of mental health services as provided by Essex Partnership University NHS Trust only, to better understand the completeness of mental health commissioning the focus and opportunity will need to capture the whole population needs across Essex.

See below the work plan to review specific commissioned pathways.

The initial Terms of Reference have now been expanded to • strengthen the governance process to enable oversight and delivery of the recommendations • to broadened to the contracting of mental health services across Essex and finally • strengthen the links with the incident review process

Recurring Themes • To create stronger, more cohesive links between CCG departments. • To create more joined up learning, surveillance and information sharing pan Essex. • To incorporate all partners in co-production including users of services and families/carers.

Taking these recommendations forward West, MSE and North East Essex Accountable Officers and senior Mental Health commissioners have met to discuss system alignment for addressing he recommendations. An options appraisal will be presented back to the AOs in July for further consideration.

Parliamentary Independent investigation As previously reported to QSG, Dr Geraldine Strathdee had been appointed as the independent chair for a review of quality and safety issues within EPUT Mental Health services. This review commenced from 01.04.21 and is anticipated to take 2 years to complete. The first steps in this review process will be to develop terms of reference in partnership with involved families and relatives. It is reported that the complexities of engaging with families may impact on the timescale. COMMISSIONING - PLACE AND SYSTEM

MID ESSEX Commissioning Lead: Irene Lewsey

PLACE Early Intervention in Psychosis (EIP) Current staff recruitment has been delayed due to COVID.

SYSTEM Dementia Diagnosis Rate National Standard National Target 67% Currently 61.%

Key Issue 1 BBCG and Mid Essex CCG

Time scale for benefits to be realised

Key Points to Note The pandemic has had a big impact on people with dementia it is estimated that between 25% and 40% of COVID deaths were people with dementia.

Mid Essex CCG A review of Primary Care Registers is required to ensure numbers accurately reflect the numbers of dementia patients registered.

Three diagnosis pilots are in situ – dementia nurse supporting primary care diagnosis, the outcomes of the primary care diagnosis are demonstrating that: • diagnosis is able to be made quickly • only those more complex go to Memory Assessment Services (MAS) • reduce the waiting times in the MAS clinics • reduce the requirement for CT scans • upskilling Primary Care, which has increased the numbers being referred to the nurse within primary care • starting to have an impact.

BBCCG has the highest number of patients awaiting a diagnosis. There is a pilot is currently being undertaken around diagnosis in Primary Care There are two issues within BBCCG • EPUT coding • Pathway for diagnosis - the process has not changed since the introduction of MAS - working to “gold standard” requesting a high number of scans, and consultant led.

Next Steps BBCCG • Meeting has been arranged to discuss pathway with consultants. • Remedial Action Plan is being developed • Review admin pathway and S1 access ensuring all diagnosis is recorded asap. • Review Memory Nurses supporting diagnosis in Primary Care.

Spending review monies will allow us to test this model across the MSB. SOUTH EAST Commissioning Lead: Hugh Johnston

PLACE IAPT access performance in Castle Point and Rochford remains below the LTP trajectory due to the impact of COVID. Similarly, the dementia diagnosis rate in Castle Point and Rochford is below the target. A plan to improve diagnosis of dementia in primary care has been developed using additional funding allocated to CCGs for this through the comprehensive spending review.

The CCGs performance against the standard for 40% of people with severe mental illness to have received a full set of physical health checks is seen as exemplary. NHSE at both a regional and national level are engaging with the lead commissioner to seek information about and learning from the approach that has been used.

SYSTEM Personality Disorder National Standard There is no national LTP or other standard relating to the treatment and care of people with personality disorders or complex needs beyond their inclusion in the requirement that 370,000 people should be receiving care in new models of integrated primary and community care for people with SMI, including dedicated provision for groups with specific needs (including care for people with eating disorders, mental health rehabilitation needs and a ‘personality disorder’ diagnosis).

Key Issue 1 The Mental Health Taskforce that has been established to review mental health commissioning and quality assurance processes includes a workstream on personality disorders. This workstream has made recommendations relating to the need for CCG departments to work more closely together whilst articulating and incorporating local differences.

These recommendations complement individual place and MSE level plans for wider changes to community mental health services that will also impact on provision for people with personality disorders as well as plans and developments relating specifically to services for people with personality disorders.

Time scale for benefits to New service models are being implemented in all 4 places, but are at be realised different stages of development. Proposals for investment and development in community mental health services for people with severe mental illness, including personality disorders, are being submitted to NHSE. These proposals will be implemented in 2021/22.

Key Points to Note Specific services to meet needs for some people with personality disorders are in place in Mid and South East Essex. These are intensive support services for small numbers of very high intensity service users (Mid and South East) and a South East Essex Trauma Alliance to increase the knowledge, understanding and support available for people who have experienced trauma across primary care and the third sector.

A new service offer for people with personality disorders has been developed within EPUT. This PD&CN model was co-produced with clinicians, commissioners, VCS organisations (e.g Haven Project), service users, carers and other partners through workshops, feedback/working groups. National guidance, other NHS Trust models, international and service user/carer/family research were all considered in the context of local data, deprivation statistics and needs.

Various elements of the model have been piloted successfully aiming to establish trauma-informed interventions throughout the pathway, from place-based to specialist teams.

The new Personality Disorder and Complex Needs pathway offers: • A bespoke KUF-based staff training programme. • An Essex-wide specialist PD&CN MDT provides interventions to the most complex cases, supports overall care co-ordination and facilitates the PD&CN training. • Partner/stakeholder engagement, incl. local authority, county council, drug & alcohol, IAPT, DWP and other IPS stakeholders, community-based organisations and MH providers through a Steering Group to ensure coordination and integration of services. • Establish a multi-agency clinical team in each locality (incl. in-patient, Perinatal, LCMHT, IAPT, OPMH, EDS, social care, IPS and LA partners) meeting virtually to discuss new case referrals, consultation, and coordinate signposting of PD&CN cases to treatment and care coordination. • Identify PD&CN Leads throughout all EPUT and partner services/teams to ensure integrated needs-based care through the whole pathway • Enhanced clinical skills training (e.g DBT, SCM, EMDR, Mentalisation). • Brief in-patient admissions, targeted toward stabilisation, and transitioned through Home Treatment teams to LCMHTs or place-level ICNs. • A range of innovative initiatives, e.g. telehealth, modularised interventions, PHC-based support, psychoeducation groups and trauma-focused therapy. • A service user network established, in partnership with community organisations such as The Haven, and facilitated by a dedicated Expert by Experience role in the central specialist MDT, providing user support and engagement opportunities in collaboration with wider community assets and resources.

Next Steps Plans submitted to NHSE as part of the MSE HCP bid for mental health transformation funding.

Severe Mental Illness (SMI) Health Checks National Standard Deliver annual physical health checks to at least 302 000 people with SMI nationally in line with set trajectories. This equates to at least 65% of those on SMI registers. Deliver tailored outreach and engagement for people with SMI, increasing access to physical health checks (to meet existing commitments) and ensuring uptake of flu and covid 19 vaccinations, in every ICS.

Key Issue 1 SMI Health check trajectories were reduced for 2020/21 to 40%. Performance trajectories now need to increase to at least 65% of those on SMI registers receiving annual physical health checks, as per national standard.

Time scale for Performance expected to improve in Q1 given a) amendments to QoF which benefits to be further incentivise health check activity across primary care; and b) the realised mobilisation of primary care MH staff in both Thurrock and Mid Essex who will focus on annual health checks as part of role remit.

Key Issue 2 A tailored outreach and engagement approach has been agreed across MSE, with AGEM support.

Time scale for Work has commenced, with focussed activity due throughout April and May 2021. benefits to be realised

Key Points to Note Key Issue 1 SMI Health check trajectories MSE figures are showing and improving picture towards the target of 40%. There is significant variability across CCGs – with CPR and Southend both achieving over 40% for Q4 2021.

Key Issue 2 A tailored outreach and engagement approach has been agreed across MSE, with AGEM support. GP Practices will run reports identifying those on SMI registers who have yet to take up offer of Covid Vaccine. These patient lists and contact details will be collated and forwarded to Providers (EPUT and Trustlinks in South East Essex; Provide in BB and Mid Essex; and MIND in Thurrock) who will contact people with SMI to encourage vaccine uptake.

Next Steps • MSE Recovery Action Plan to monitor progress towards trajectory, and impact of improvement initiatives.

BASILDON & BRENTWOOD Lead Commissioner: Alfred Bandakpara-Taylor

PLACE NHS Basildon & Brentwood CCG continues to see some improvements in IAPT to its access targets with individuals entering treatment for psychological services. The service reports as over-achieving the 6 and 18 week waiting time targets with 97% of all patients receiving their treatments within the 6 week timeframe and all within the 18 week target. Reliable improvement rates continue to be comfortably above plan. The service has gone to great lengths to upskill practitioners in this regard and this shows with performance figures which have now held at these levels towards the end of the year.

We have mobilised in west Basildon PCN as part of our (integrated primary community care) IPCC with Wickford as the next PCN in line to have MH Integrated Teams embedded as part of the SMI Transformation Programme integrating care at point of delivery and delivering person-centred and holistic support as well as enabling a more responsive approach to mental health needs by end Q2.

Innovation through Covid Like others, our services has had to adapt its modes of delivery to allow for continued performance under the constraints of working remotely. As well as being very swift to adapt to remote delivery, our commissioned IAPT is now delivering the following • Limbic digital ‘Chat-bot’ triage facility embedded within service website. • The service virtual reality provision (needle phobia) only one within the system has proved successful, with the first patients recovered sufficiently to receive their Covid vaccination in the period.

SYSTEM

Eating Disorders National Standard Delivering a NICE concordant eating disorder service in line with national guidelines and as per one of the key recommendations from The Parliamentary and Health Service Ombudsman (PHSO, 2017) publication ‘Ignoring the Alarms: How NHS Eating Disorder Services are Failing Patients’ is to achieve parity between CYP EDS and adult EDS. In response, NHS England (NHSE) has proposed testing the same waiting times that now exist in children’s and young people’s eating disorder services in adult eating disorder services setting targets for receipt of treatment within (4) four weeks from first contact for standard cases and within one week for urgent cases.

Key Issue 1 Medical monitoring. “Ignoring the Alarms, How NHS Eating Disorder Service are Failing Patients”: a report from the Parliamentary Health Service Ombudsman (2017) is very clear that patients die from the physical health complications of eating disorders and that the medical care of our patients must be properly led and co-ordinated throughout treatment and across all settings.

The 2021 report on avoidable ED deaths notes that the number one failing was lack of commissioned eating disorder service and lack of SLA between primary and secondary care.

Time scale for benefits to Engagement with EPUT with letter of Intent sent out with commitment of be realised funding for dietician and consultant post planed for end Q1 21/22, with development of FREED model by end Q4.

Key Points to Note Project group for delivering on the Eating disorder transformation work set up with partnership engagement and to be clinically led focusing on medical monitoring, FREED early intervention and severe & enduring eating disorders pathway.

Next Steps Escalate any risks through appropriate groups such as CQRG, MSE Eating Disorder and EPUT Executive team.

At-Risk Mental State (ARMS) and Early Intervention in Psychosis (EIP) National Standard Delivering the access and waiting time standard (53%) for all people aged 14-65 experiencing first episode psychosis (including that associated with trauma or substance misuse). The standard is also relevant for people at high risk of psychosis ('At-Risk Mental State'). By 2023/24, 60% of people experiencing first episode psychosis should commence a National Institute for Health and Care Excellence (NICE)-recommended package of care within two weeks of referral.

Key Issue 1 Transform services to the ambition rating of NCAP level 4.

Time scale for benefits to Work has commenced to with an ask for an action plan to be developed to be realised be taken through the EIP group and to agree and get sign off.

Key Points to Note The NHS Long Term Plan and the LTP Mental Health Implementation Plan 2019/20- 2023/24, make it clear that a comprehensive EIP service should ensure that people, including children and young people, with an at-risk mental state have to access to evidence-based care and support. Currently the system is at different places with the ambition to mobilising an ARMs service.

Next Steps EIP Recovery Action Plans to be reviewed and refreshed. Agreed for EPUT to pull together a uniformed action/template for updating internally - to pull all action plans together to have 'as one' action plan.

THURROCK Lead Commissioner: Jane Itangata

PLACE This section of the report is under development.

SYSTEM This section of the report is under development.

Improving Access to Psychological Services (IAPT) National Standard IAPT Access target

Key Issue 1 Covid pandemic adversely impacting on IAPT access target.

Time scale for benefits to Adequate capacity is in place to meet the anticipated surge in demand be realised and service should be back on trajectory by Q2

Discharge Actions National Standard Zero inappropriate bed days

Key Issue 1 Significant bed pressures due to covid related increased acuity and activity, DTOC and LOS.

Time scale for benefits to Both operational and transformation plans developed and phasing in to be realised build resilience. Ambition is to meet standard Q2 2022-23

Integrated Primary and Community Care Mental Health (IPCCMH) National Standard SMI-PHCs

Key Issue 1 Ongoing work required to meet target trajectory

Time scale for benefits to Ambition is with the significant targeted transformation actions and be realised increased capacity in PCNs, system will be back on trajectory from Q3

Funding Bids

National Standard SMI-Transformation Bid Crisis Transformation Bid

Key Issue 1 Successful £2.055m and £533k respectively

Time scale for benefits to N/A be realised

Individual Placement and Support Services (IPS) National Standard Ensure 32 000 people nationally have access to Individual Placement and Support services through delivery against ICS trajectories, in line with fidelity of model.

Key Issue 1 IPS services in Basildon and Brentwood, Mid Essex, Castle Point and Rochford, and Southend are commissioned via an ECC-hosted contract and provided by EPUT in partnership with EmployAbility. IPS provision in Thurrock is commissioned through Inclusion MPFT. The ECC contract mobilised in July 2020. The Inclusion MPFT contract commenced in April 2019. ECC Access targets are currently under review. The commissioners are working with ECC, and EPUT the lead Provider as part of this review.

The Covid restrictions have impacted on service delivery with services asked to increase job retention. Fidelity self-assessment was undertaken by EPUT in Feb 2021 in which it received Fair. Improvement plan is currently underway to target these areas and will be monitored through monthly contract meetings.

Time scale for benefits to Access targets for 2021/22 remain in place, with performance trajectories be realised expected to be met by the Provider.

Next Steps As of 1st April, IPS data will flow through Mental Health Services Data Set (MHSDS). Ongoing work with Essex County Council required in order to get assurance regarding the reliability of Provider data within contract reporting.

Suicide Prevention National Standard Zero Suicide Ambition

Key Issue 1 Suicide prevention training for MSE GPs has been procured to upskill GPs and staff within a Primary Care setting as part of our Wave 3 Transformation.

Work is also taking place to increase the utilisation of the depression diagnosis pathway that has been co-produced and implemented across the MSE.

Time scale for benefits to The wave 3 programme runs to March 22/23 be realised

Key Points to Note • The Wave 3 suicide prevention transformation programme is a 3-year programme running from 2019/20 to 2022/23 • The programme is led by MSE partners including; Health Commissioners & Providers, Local Authority, Police, Ambulance and VCSE partners • The Suicide Prevention Wave 3 Programme is underpinned by the following workstreams; o Community Fund Workstream – Local Enterprising to access hard to reach groups o Primary Care Workstream – Training and pathway development o Secondary Care Workstream – Zero suicides ambition across Essex. Enhance inpatient therapeutic offer o Self-Harm Toolkit Workstream – Develop and roll out self-harm toolkit

Suicide prevention is a Local Authority responsibility and they lead the strategic direction against reducing suicides across the MSE. This work is governed by the SET board. The wave 3 transformation programme is one component of all the suicide prevention work taking place across the MSE.

Next Steps • Further promotion of the Training to GPs across the MSE. • Further promotion of the depression diagnosis pathway across the MSE

PERINATAL MENTAL HEALTH

Commissioning Lead – Helen Farmer National Standard NHS LTP requirements: • Access target of 10 % by 2022/23 • Extending Community Service from Preconception to 24 months after birth • Expanding evidence based psychological services within the specialist team • Ensuring partners of women accessing the specialist team receive evidence-based assessment and signposting for their mental health needs. • Maternity Mental Health Service 2022/23

Key Issue 1 The delivery model and impact of the pandemic has reduced the number of referrals during 2020 leading to challenges in delivering the access target requirement although the referral data is indicating recovery.

Time scale for benefits to The PNMH business case outlines a 3-year programme aligned with be realised investment.

Key Points to Note

• The LMS and MH commissioners have agreed that the development of the MMHS will be coordinated and overseen by the SET wide PNMH steering group • Partners have agreed to developing a Mid and South Essex PNMH stakeholder group which will report to the LMS. • Parents 1st have been commissioned to lead a coproduction project to develop the peer support model of PNMH events are being held in April 2021 with the ambition to pilot the model in 2021. • Commissioners are working with the communication team to develop a SET wide PNMH resource utilising NHSE Fair Share Allocation, this will be supported by the Essex PNMH clinical network • Spotlight training for PNMH will restart but explore alternative delivery approaches • PNMH service has now established the 5 hubs aligned with the maternity provision and teams local teams established. Recruitment campaigns have been successful although as a relatively new field staff require training, supervision and support before realising full benefit of additional resource within the workforce

Next Steps

• Implement peer support model pilot • Design and co-produce resource ( web site) • Complete spotlight GP training events • Continue with recruitment and training • Codesign the MMHS and seek approval for the business case with the opportunity to pilot early sites in MSE

CONTRACTING

Contracting Lead: Jo Gansbuehler National Standard Key Performance Indicators and Quality Reporting as per contractual arrangements

Key Issue 1 There are no issues to be raised

Time scale for benefits to N/A be realised

Key Points to note There are no escalations to report at the current time.

Next Steps Further development of this section of the report for the next meeting.

FINANCE

Finance Lead: Lee Bushell

National Standard Mental Health Investment Standard (MHIS)

Key Issue 1 MHIS represents the minimum level of CCG baseline investment in Mental Health services for the financial year.

Time scale for benefits to 31 March 2022 be realised

Key points to Note: • Mental Health Investment Standard (MHIS) audits for 2019/20 now completed by KPMG, with clean audit opinions having been received for all five CCGs across MSE. • All MHIS Compliance statements and final audit opinions posted to CCG websites, in line with central deadlines, on 15 April 2021. • Mental Health Investment funding for 2021/22 now published via NHS England • Service developments, based on assessed need, and with agreed recruitment profiles, are being costed with EPUT (and other smaller Providers), for inclusion within the final planning submission on 6 May 2021.

Next Steps: Each CCG needs to submit financial plans indicating areas of spend on Mental Health services to demonstrate meeting the MHIS for 2021/22 by 6 May 2021.

Recommendation The Governing Body is asked to: Note the contents of the report and seek any additional assurance required Agenda Item 12 - Appendix C LEARNING DISABILITY PROGRESS UPDATE APRIL 2021

Purpose of This report provides an update and progress to date across the MSE system in Report: relation to commissioned services to support individuals with learning disabilities. South East CCGs are currently the responsible commissioners on behalf of the Southend, Thurrock and Essex Collaboration of CCGs. Through delegated responsibility Essex County Council provide the commissioning oversight to the services commissioned. Quality system oversight is overseen by the Deputy Chief Nurse, South Essex CCGs. Members of the Patient Safety and Quality Committees meeting in common are requested to note the f updates set out below.

Recommendations Members are requested to note the report. and decision/actions:

Executive The members are to consider the following highlights of the report: Summary (including financial • Learning Disability Annual Health Check position- across the impact): system. Performance is currently as of end of March 2021 was between 72% and 50%. Work is taking place to see how this can be improved across the system within the coming year. • ELDP – The ELDP partnership meetings have been re-instated as part of the contractual arrangements. . The ELDP have confirmed that the ACE component of the service will now come under the umbrella of EPUT as of 1st April 2021. • LeDer Review Update – The LeDer review for 2020-2021 was successfully achieved and all reviews completed within the agreed timeframe. A review of the overarching themes will be shared at a future PSQ. • New LeDer Policy- highlighted within the report the key elements that will affect the system and how this is currently being discussed and managed. • Draft Quality Strategy Workshop for Learning Disability. This took place on 15 April 2021. This was a successful event and further work will take place to ensure we get the voice of the patient as part of coproduction piece of work to take place.

Written Lorraine Coyle, Deputy Chief Nurse CP&R CCG/SCCG by/Presented by: Phil Brown Associate Director Transforming Care Rebekah Baillie Head of Transforming Care Commissioning. Manager.

Executive Director Rachel Hearn, Executive Director of Nursing Mid and South Essex CCGs. Sponsor:

Non-Officer/Board N/A Sponsor: Approval Route: Group/Committee Date (List Groups/Committees N/A that have reviewed this document).

Yes No N/A

Have any financial implications been signed off by ✓ the Chief Finance Officer? (Please Tick  )

Has the Equality/Quality/Privacy Impact ✓ Assessment been carried out and issues addressed?

Details of Stakeholder, Patient & Public Engagement:

1. Purpose

1.2 This report provides an update and progress to date across the MSE system in relation to commissioned services to support individuals with learning disabilities. South East CCGs are currently the responsible commissioners on behalf of the Southend Thurrock and Essex Collaboration of CCGs. Through delegated responsibility Essex County Council provide the commissioning oversight to the services commissioned. Quality system oversight is overseen by the Deputy Chief Nurse South Essex CCGs. Members of the Patient Safety and Quality Committees meeting in common are requested to note the following updates.

2. Learning Disability Annual Health Checks

2.1 There continues to be a national drive from NHS England and NHS Improvement as part of the NHS Plan (2019) to increase the number of patients with Learning Disabilities to go to their GP Practices and have this vital annual health check. Financial support has been given to PCN to support the completion of the annual health checks through the primary care impact funding and GP enhanced payment.

2.2 NHS England has set CCGs a national target of 67% of patients on GPs’ LD Registers having annual health checks completed this year. Within the system there currently continue to be variability in performance in the uptake of LD Health checks. The end of year position highlights that three CCGs within the system just didn’t hit the agreed target. (please see fig 1.)

Fig1. Percentage of LD Annual Healthchecks per CCG (week ending Friday 30 March 2021

No. of No. of No. of No. of No. Achieved at Annual Total AHCs CCG AHCs AHCs AHCs AHCs Same Point Last Target (based Completed Q1 Q2 Q3 Q4 Year on 67%) B&B 85 103 191 269 648 649 791

Thurrock 3 52 160 177 392 328 355

CP&R 38 34 152 221 445 342 484

Southend 7 92 275 386 760 720 737

Mid 33 95 271 498 897 838 1022

NE 54 185 417 942 1598 1293 1342

West 101 29 196 374 700 573 548

Total 321 590 1662 2867 5440 4743 5278

2.3 All areas performed as well or better than last year despite of COVID. Overall across the Transforming Care Partnership performance exceeded the 67% target. B&B, CP&R and Mid fell short of the target 3.0 LeDer Review Update

3.1 The retrospective reviews are now all up-to-date and the sign off of the reviews are now complete for this financial year. Themes will be analysed and an update presented at the next committee meeting.

3.2 New LeDer Policy -Impacts for Southend Essex and Thurrock LeDer programme April 2021

3.3 NHSE have reviewed the scope and function of LeDer programme and have commissioned a new provider to deliver a fresh web-based platform and operational process for the notification and completion of reviews. The policy is therefore both strategic and operational.

3.4 Timeline

1st March Bristol LeDer System closes to new notifications 2021 23rd April List or reviewers for transfer to new system required by NHSE 2021 List of cases for transfer to new system required by NHSE 30th April Bristol LeDer System closes to all activity. Read only access remains in 2021 the interim Mid May Training roll out to reviewers begins 2021 1st June New LeDer Web based system opens in testing mode 2021 30th June End of Year Report required at Boards for public access 2021 Sep 2021 3-year strategy for LeDer implementation and workforce strategy required by NHSE Sep 2021 Autism only reviews start Mar 2022 New regional workforce structures in place

3.5 Key Changes

• The focus of responsibility has shifted from CCGs to ICSs (but does not reflect the involvement of Local Authorities). • The new system has an algorithm which halts some reviews at the initial stage with some local learning only. Other reviews will progress to full review and quality panel. • Quality Panels should be held at an ICS level with grading and recommendations formed by the panel not the reviewer. The panel should consist of sufficiently senior and locally appropriate managers to assure implementation of the agreed recommendations. • From September 2021 the system will be opened to autism only reviews. • Direct Access to Primary Care records must be enabled locally to ensure timely completion of reviews • Reviewers must be employed by NHS or LA with access to encrypted NHS or LA laptops and phones to comply with clarified IG rules. They must have a dedicated reviewer role and not carry out reviews on top of existing work commitments. • ICSs should come together to form a pooled regional team of reviewers to provide capacity and efficiencies of scale with one senior reviewer managing the team and liaising with the LACs for each ICS. 3.7 Impacts for SET

3.8 The practicalities for handover of operational systems are being managed by Local Area Contact

3.9 The impact of autism only reviews are currently unknown. Engagement with diagnostic services, autism only health and social care services will be needed to ensure appropriate notifications, data recording and analysis, engagement with people with autism and suitable representation at quality panel. Training will be needed for LeDer reviewers. This will be managed by the Health Equalities team and LAC.

3.10 Access to System One is in progress and funding has been identified.

3.11 LeDer is currently delivered on a Transforming Care footprint and permanent reviewers have been funded on this basis by the Collaborative Forum, ahead of any additional funding by NHSE. This has been widely welcomed by Essex Carers Network, Director for Public Health and Chair of LeDer Steering Group, LD Clinical Quality Lead and others as enabling integrated working across Health and Social Care and a well-attended and effective Steering Group.

3.12 In the last year SET had 32% of the LD deaths across East of England region. The Collaborative Forum has funded 2.0WTE permanent reviewers and NHS funding has been used to build up a team of independent reviewers to tackle backlogs, spikes in deaths (such as the COVID pandemic). 3-year funding is in place to enable a move to an increased permanent team with a senior reviewer across the TC footprint.

3.13 However the TC footprint covers

a) Mid and South Essex ICS b) North East Essex, which is part of Suffolk and North Essex ICS c) West Essex, which is part of Herts and West ICS. 3.14 NHSE will hold a meeting with SROs to discuss the regional workforce issues in May. It is recommended the SET Health Equalities Board are putting forward an agreed view on local arrangements.

4.0 Draft Quality Strategy Workshops- Learning Disability

4.1 on 15 April the first of a number of workshops took place to seek the views of the MSE Draft Quality Strategy. Members of multiagency attended with a health discussion including how best to take coproduction forward to allow wide consultation on this strategy. This was a successful workshop generating valuable ideas. This also ensured that the quality priorities that relate to learning disabilities were accurate and aligned. Thanks to all staff groups that attended this workshop.

5.0 Recommendation

5.1 Members are requested to note the contents of the report. Agenda Item 12 – Appendix D

PART I BOARD MEETING, 27 MAY 2021 ADULT SAFEGUARDING SYSTEM REPORT

Purpose of Report: To provide the Board with an adult safeguarding system quality and patient safety update and to provide assurance that any significant risks or issues are being appropriately managed.

Recommendations and Members of the Board are asked to note the report and seek decision/actions: additional assurance if required

Executive Summary This paper includes updates, where applicable, on the following areas: (including financial impact): 1. Case Reviews 2. Safeguarding Concerns 3. National Themes 4. Regional Themes 5. Local Themes 6. Managing Emerging Risks

Written by/Presented by: MSE Designated Nurses Safeguarding Adults

Executive Director Rachel Hearn – Executive Director of Nursing Mid & South Essex Clinical Sponsor: Commissioning Groups

Non-Officer/Board N/A Sponsor:

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this document). N/A

Yes No N/A ✓ Have any financial implications been signed off by the Chief Finance Officer? (Please Tick ) Has the Equality/Quality/Privacy Impact Assessment been ✓ carried out and issues addressed?

Details of Stakeholder, Patient Nil & Public Engagement:

Conflicts of Interest: Conflicts of Interest for any agenda item must be declared at the start of the meeting in order that the Chair may determine any required management of the conflict

Recommendations Financial implications of Liberty Protection Standards (LPS implementation and requirements of the new Domestic Abuse (DA) Bill to be registered and taken into consideration National Standard Regulation 13: Safeguarding service users from abuse and improper treatment - Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care Act (2014). Mental Capacity (Amendment) Act (2019)

Time scale for benefits to be Progress report at next Quality and Patient Safety Committees in realised Common related to above issues

Risk – BAF • Implementation of LPS • Domestic Abuse Bill MSE Adult Safeguarding PSQ CiC highlight report April 2021

Case Reviews National Themes There are no new referrals for Adult Safeguarding Case The Domestic Abuse Bill will come reviews in Mid and South Essex since the last report. into law once royal assent has been Safeguarding Adult Reviews (SAR’s) given. CCGs will need to co-operate with local authorities in the discharge Eight SARs in total. One published and CCG of the new duties. recommendations are currently being addressed. Four in progress, one with the family, one to be appointed to a LPS Code of Practice consultation is reviewer, one learning review at the planning stage. due to be launched early Summer with which all health and social care Domestic Homicide Reviews (DHR’s) practitioners need to be engaged. Two DHR’s in progress. Serious Incidents (SI’s) Three new SI’s reported, 2 involved adults with Learning Regional Themes Disabilities, 1 regarding discharge from hospital As national safeguarding adult themes and legislation are translated regionally and locally, there will be competing priorities. Safeguarding Concerns These will need to be managed carefully to ensure that the required outcomes are achieved. Care Sector South West - currently one home of concern in relation to culture and leadership safeguarding issues highlighted by CQC. CQC, Essex County Council and the CCG met and have a plan in place for unannounced visits over the Local Themes coming weeks to establish the level of risk and address with the provider. Anticipated surge in safeguarding Thurrock - CCG and Thurrock Safeguarding Team working adult concerns as Covid restrictions jointly to support 3 Residents who have been assessed to decrease. There is a recognition not have capacity to consent to the Covid19 vaccine, with locally that all national priorities best interest meetings taking place. require a working together approach alongside safeguarding children and looked after children.

Managing Emerging Risks Implications of changes to legislation The Domestic Abuse Bill may embed the requirement for statutory implementation of Independent Domestic Abuse Advisors in Acute Hospitals, consistent funding options need to be fully explored. Implementation of Liberty Protection Safeguards will also have financial implications for Clinical Commissioning Groups. Care Sector Hubs will remodel to focus on a proactive safeguarding and quality response, with the ability to increase in frequency as required. Agenda Item 12 - Appendix E PHARMACY AND MEDICINES OPTIMISATION Part I Board Meeting, 27 May 2021

Purpose of Report: To provide the Board with an update on pharmacy and medicines optimisation.

Recommendations and The Board is asked to: decision/actions: • Note the content of the report • Note that the Patient Safety and Quality Committees meeting held on 11 May 2021 endorsed the “Memorandum of Understanding between NHS England/Improvement East of England and CCGs on the safe use of Controlled Drugs”. • Approve the proposal that Rachel Hearn, Executive Director of Nursing and Quality for the five M&SE CCGs, is recognised as the Controlled Drugs Responsible Officer for the CCGs.

Executive Summary There is a multitude of performance information relating to (including financial prescribing and the frequency of publication varies depending on impact): the data source and collection regimes. With that in mind, the content of the report is predominantly driven by data that is published nationally, but will be supplemented with local data and intelligence where appropriate.

Written by/Presented Simon Williams, Director of Partnerships and Integration for SEE by: CCGs and system lead for Medicines Optimisation

Executive Director Rachel Hearn, Director of Nursing and Quality Sponsor:

Non-Officer/Board Sponsor:

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this document).

Yes No N/A

Have any financial implications been signed off by the Chief x Finance Officer? (Please Tick  )

Has the Equality/Quality/Privacy Impact Assessment been x carried out and issues addressed?

Details of Stakeholder, Patient & Public Engagement:

Conflicts of Interest: None identified Pharmacy and Medicines Optimisation – Executive Summary

There is a multitude of performance information relating to prescribing and the frequency of publication varies depending on the data source and collection regimes. With that in mind, the content of the report is predominantly driven by data that is published nationally, but will be supplemented with local data and intelligence where appropriate.

There are four guiding principles for medicines optimisation which the CCG Pharmacy and Medicines Optimisation strategic objectives align to. The four principles are:

1. Aim to understand the patient’s experience 2. Evidence based choice of medicine 3. Ensure medicines use is as safe as possible 4. Make medicines optimisation part of routine practice

The diagram below is adapted from the Royal Pharmaceutical Society Medicines Optimisation principles wheel and describes how the objectives of Mid Essex CCG’s Medicines Optimisation Strategy correlate with these guiding principles.

The purpose of this report is to give the CCG Board a brief overview of the performance and quality of Pharmacy and Medicines Optimisation in Mid and South Essex, in relation specifically to controlled drugs and drugs of dependence (as described by principle 3 below). Executive Summary This report has been written to focus specifically on performance metrics for each CCG on controlled drug and drugs of dependence prescribing.

To provide some background on the Governance around this, each provider organisation is required to have in post a CD Accountable Officer (CDAO). There is a lead CDAO at NHS England for each region who is responsible for the management of controlled drugs within their region. As CCGs, we are responsible bodies and our role is to support the CDAOs to ensure that controlled drugs are managed safely and effectively within legislative requirements and governance frameworks. In place is a Memorandum of Understanding document between CCGs and NHS England in order to detail the responsibilities of both CCGs and NHS England to ensure that controlled drugs are managed appropriately and responsibilities are clear.

It is proposed that Rachel Hearn, Executive Director of Nursing and Quality for the five M&SE CCGs recognised as the Controlled Drugs Responsible Officer for the CCGs.

The CD and drugs of misuse metrics for each CCG along with the trend over the previous 12 months can be seen in the tables below. The metrics are those which NHS England are interested in the CCG performance on. Commentary on the metrics for each CCG is provided in the text that follows the tables. Strategic goal - Reducing the risk of dependence or misuse of prescribed medicines

Description B&B CP&R Mid Southend Thurrock Change Rank Change Rank Change Rank Rank Chang Rank Period from within from within from within Change within e from within last all last all last all from last all last all month CCGs month CCGs month CCGs month CCGs month CCGs CDs duration ≤30 days Feb-21 93.46 92.29 94.80 93.14 93.09 No of patients taking more than 120mg Feb-21 247 60 177 40 304 79 168 37 117 18 equiv morphine per day No. of unique patients prescribed both pregabalin and an opioid concurrently in the Feb-21 2.696 49 3.151 65 4.289 102 4.119 99 1.968 16 same month and measure No. of unique patients (normalised) No. of unique patients prescribed both gabapentin and an opioid concurrently in the Feb-21 2.497 37 2.439 35 2.329 32 2.455 38 2.104 27 same month and measure No. of unique patients (normalised) No. of unique patients prescribed both a benzodiazepine and an opioid concurrently Feb-21 2.107 18 2.205 23 4.194 105 2.763 46 1.406 7 in the same month and measure No. of unique patients (normalised) Opioids items per 1,000 patients Feb-21 44 26 63 29 23 Fentanyl IR items per 1,000 patients Feb-21 1 3 4 2 0

Q4 Description Target Q1 20 - 21 Q2 20 - 21 Q3 20 - 21 Q4 20 - 21 19 - 20 Basildon & Brentwood CCG Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb CDs duration ≤30 days 92.66 92.79 92.96 92.84 92.93 93.18 92.90 93.04 93.08 92.97 93.01 93.46 No of patients taking more than 120mg equivalent morphine per 282 290 262 273 283 267 277 260 263 266 256 247 day No. of unique patients prescribed both pregabalin and an opioid concurrently in the same month and measure No. of unique 2.753 2.741 2.811 2.765 2.754 2.743 2.782 2.791 2.725 2.731 2.684 2.696 patients (normalised) No. of unique patients prescribed both gabapentin and an opioid concurrently in the same month and measure No. of unique 2.574 2.622 2.673 2.646 2.582 2.538 2.578 2.582 2.591 2.567 2.490 2.497 patients (normalised) Number of unique patients prescribed both a benzodiazepine and an opioid concurrently in the same month and measure No. of 2.103 2.233 2.289 2.224 2.074 1.969 2.008 2.051 2.097 2.110 2.078 2.107 unique patients (normalised) Opioids items per 1,000 patients 52 50 49 50 54 45 51 48 45 50 46 44 Fentanyl IR items per 1,000 patients 1 1 1 1 1 1 1 1 1 1 1 1 Q4 Description Target Q1 20 - 21 Q2 20 – 21 Q3 20 - 21 Q4 20 - 21 19 - 20 Castle Point & Rochford CCG Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb CDs duration ≤30 days 91.48 91.92 91.74 92.27 92.46 92.38 92.34 92.29 92.57 92.34 92.69 92.29 No of patients taking more than 120mg equivalent morphine 189 189 173 193 201 203 199 191 173 196 194 177 per day No. of unique patients prescribed both pregabalin and an opioid concurrently in the same month and measure No. of 2.945 2.835 2.809 2.93 3.013 3.091 2.982 3.055 3.02 3.11 3.107 3.151 unique patients (normalised) No. of unique patients prescribed both gabapentin and an opioid concurrently in the same month and measure No. of 2.363 2.363 2.393 2.379 2.405 2.603 2.545 2.557 2.322 2.425 2.424 2.439 unique patients (normalised) Number of unique patients prescribed both a benzodiazepine and an opioid concurrently in the same month and measure 2.276 2.12 1.988 1.965 2.063 2.295 2.341 2.186 2.138 2.259 2.332 2.205 No. of unique patients (normalised) Opioids items per 1,000 patients 30 30 27 28 33 33 32 29 27 30 30 26

Fentanyl IR items per 1,000 patients 2 2 2 2 3 5 1 3 3 5 2 3

Q4 Description Target Q1 20 - 21 Q2 20 – 21 Q3 20 - 21 Q4 20 - 21 19 - 20 Mid Essex CCG Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb CDs duration ≤30 days 99% 94.26 94.56 94.59 94.66 94.63 94.38 94.66 94.56 94.67 94.47 94.69 94.80 No of patients taking more than 120mg equivalent morphine 393 400 401 392 407 384 406 400 341 360 340 304 per day No. of unique patients prescribed both pregabalin and an opioid concurrently in the same month and measure No. of 3.872 3.886 3.852 3.884 3.878 4.166 4.124 4.161 4.456 4.012 4.296 4.289 unique patients (normalised) No. of unique patients prescribed both gabapentin and an opioid concurrently in the same month and measure No. of 2.435 2.508 2.555 2.511 2.53 2.476 2.478 2.448 2.437 2.37 2.378 2.329 unique patients (normalised) Number of unique patients prescribed both a benzodiazepine and an opioid concurrently in the same month and measure 3.709 3.858 4.002 4.046 3.915 3.776 4.379 4.365 4.345 3.664 4.201 4.194 No. of unique patients (normalised) Opioids items per 1,000 patients 60 65 61 62 61 71 65 61 68 72 69 63

Fentanyl IR items per 1,000 patients 3 5 6 5 5 5 5 5 4 6 4 4

Q4 Description Target Q1 20 - 21 Q2 20 – 21 Q3 20 - 21 Q4 20 - 21 19 - 20 Southend CCG Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb CDs duration ≤30 days 92.06 92.76 92.44 92.72 92.92 93.09 93.11 92.86 93.00 93.04 93.22 93.14 No of patients taking more than 120mg equivalent morphine 214 220 191 192 207 201 196 190 196 189 176 168 per day No. of unique patients prescribed both pregabalin and an opioid concurrently in the same month and measure No. of 3.146 3.025 3.156 3.188 3.157 3.121 3.224 3.181 3.189 3.243 3.303 4.119 unique patients (normalised) No. of unique patients prescribed both gabapentin and an opioid concurrently in the same month and measure No. of 2.108 2.089 2.115 2.141 2.064 2.112 2.019 1.97 1.918 1.947 1.997 2.455 unique patients (normalised) Number of unique patients prescribed both a benzodiazepine and an opioid concurrently in the same month and measure 2.239 2.265 2.583 2.534 2.348 2.361 2.337 2.407 2.468 2.369 2.432 2.763 No. of unique patients (normalised) Opioids items per 1,000 patients 41 37 34 35 36 32 34 34 34 37 30 29

Fentanyl IR items per 1,000 patients 2 3 3 3 3 2 4 2 2 2 2 2

Q4 Description Target Q1 20 - 21 Q2 20 – 21 Q3 20 - 21 Q4 20 - 21 19 - 20 Thurrock CCG Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb CDs duration ≤30 days 92.88 93.22 93.30 93.52 92.83 93.09 93.30 93.35 93.35 93.14 93.14 93.09 No of patients taking more than 120mg equivalent morphine 149 160 143 139 154 155 148 143 137 140 122 117 per day No. of unique patients prescribed both pregabalin and an opioid concurrently in the same month and measure No. of 2.013 1.977 1.963 1.936 1.945 1.862 1.931 1.915 1.941 1.911 1.886 1.968 unique patients (normalised) No. of unique patients prescribed both gabapentin and an opioid concurrently in the same month and measure No. of 2.202 2.256 2.278 2.203 2.204 2.229 2.236 2.206 2.304 2.26 2.166 2.104 unique patients (normalised) Number of unique patients prescribed both a benzodiazepine and an opioid concurrently in the same month and measure 1.343 1.56 1.568 1.547 1.435 1.353 1.413 1.369 1.393 1.421 1.420 1.406 No. of unique patients (normalised) Opioids items per 1,000 patients 32 30 27 27 31 29 30 29 29 30 25 23

Fentanyl IR items per 1,000 patients 0 0 0 0 1 0 0 0 0 0 0 0 Commentary The number of patients taking equivalent of 120mg morphine or more has reduced and shows an improvement based on February 2021 data for all CCGs. It is important to note that this data is only looking at individual drug presentations and does not include patients who may be taking multiple opioids at lower doses which could equate to over 120mg/day or more.

Mid Essex CCG is an outlier with regards to the prescribing of pregabalin with opioids in comparison to the other CCGs. This has been a longstanding issue where pregabalin was historically prescribed by the local pain clinic and patients have been difficult to withdraw pregabalin. The increase over the past 12 months is likely a result of the pregabalin patients being initiated onto an opioid rather than opioid patients being initiated on pregabalin.

There is work to be done on addressing the number of patients taking a benzodiazepine alongside an opioid within mid Essex. Resources have been developed to support patients taking benzodiazepines to reduce and withdraw. However, some more targeted guidance for patients taking benzodiazepines and opioids concurrently will be needed.

The metric for opioid items per 1000 patients has improved for all CCGs in February. However, this may be due largely to the fact that February is a shorter month and so the next report will give a better indication of true direction of travel for each CCG. The mid Essex value for this metric is reflective of the problems faced in successfully commissioning a service to manage patients taking high dose opioids. All CCGs incorporate the safer management of Controlled Drugs within their prescribing incentive schemes and report to practices on their progress with CD prescribing.

In mid Essex this is done as part of the monthly quality dashboard sent to practices which includes the percentage of controlled drugs prescribed for 30 days or less as a total of all schedule 2-4 controlled drug prescribing as well as the number of patients taking more than 120mg morphine or equivalent daily. The data is broken down to practice level.

In south-east Essex there is a target in the prescribing incentive scheme for the current year to reduce the number of patients co-prescribed above 120mg oral morphine equivalent with gabapentinoid and/or benzodiazepine. The target is zero patients for all practices. This is reviewed and reported to practices monthly on the prescribing incentive scheme dashboard, which is broken down to practice level.

The current incentive scheme for south-west Essex includes the request for practices to review patients taking 120mg morphine or equivalent and Basildon and Brentwood CCG have just commissioned a nurse led service with one PCN reviewing patients taking high dose opioids and other drugs of dependence. This service started in April 2021 so would expect to see a reduction in the number of patients over the course of this financial year. Thurrock CCG commission a pharmacist led service via IAPT for reviewing patients on high dose opioids and benzodiazepines/ Z drugs (zopiclone, zolpidem, zaleplon) with a view to reducing doses and eventually discontinuing. All CCGs have on their websites resources for practices to support them with managing patients taking controlled drugs and also other drugs of dependence. As well as this mid Essex and south-east Essex CCGs commission e-learning packages on dependence forming medicines from PrescQIPP and encourage prescribers to complete this e-learning. South-west Essex CCGs are currently reviewing the PrescQIPP e-learning packages with a view to making them available to prescribers.

In 2019, all CCGs worked with NHS England East CDAO team to reduce and ideally stop ketamine and pethidine prescribing within primary care. This initiative resulted in a number of patients stopping these medications which was a notable achievement.

In Mid Essex the CCG medicines management team have supported prescribers to manage these patients using recognised principles such as the use of an opioid contract to highlight the agreement from both patient and prescriber when a patient is taking opioids and agreeing a treatment plan and exit strategy should the opioid not be successful in managing the patient’s pain.

Both south-east Essex, and south-west Essex have reported some successful interventions where the medicines management team worked with the practice as part of an MDT approach and were able to successfully reduce patient’s consumption of controlled drugs and drugs of dependence.

NICE published Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain on April 7th 2021. This guideline states that the following should not be used in the management of chronic pain in those over 16 years old: • antiepileptic drugs including gabapentinoids, unless gabapentinoids are offered as part of a clinical trial for complex regional pain syndrome • antipsychotic drugs • benzodiazepines • corticosteroid trigger point injections • ketamine • local anaesthetics (topical or intravenous), unless as part of a clinical trial for complex regional pain syndrome (see the recommendation for research on pharmacological interventions) • local anaesthetic/corticosteroid combination trigger point injections • non-steroidal anti-inflammatory drugs • opioids • paracetamol.

In response to this guideline, all five CCGs will be reviewing their guidance on the management of chronic pain and updated guidance will be taken through the MSE Medicines Optimisation Committee for approval.

There are areas where each CCG have shown improvement in reducing the consumption of high dose opioids and drugs of dependence either directly working with individual practices to improve patient care or indirectly by developing useful tools and resources to assist prescribers to achieve this aim. The next step will be pooling these achievements to build further on improving this goal collectively. ITEM 13 PERFORMANCE REPORT

Agenda Item 13a

PART I BOARD MEETING, 27 MAY 2021

PERFORMANCE REPORT - ACUTE CONSTITUTIONAL PERFORMANCE

Purpose of Report: To provide the Board with an overview of the:

• Planning process for recovery of capacity, activity, and the significantly increased waiting list backlog sizes and any submissions made. • Groups where actions, escalation and system working exists ensuring challenge, progress and assurance of recovery for Cancer and Elective Care (RTT and Diagnostics). • Update on the performance and position of the acute Constitutional Standards.

Recommendations and Members of the Board are asked to note the report and seek decision/actions: additional assurance if required.

Executive Summary This paper includes updates, where applicable, on the following (including financial areas: impact): • Planning process, planning round and submissions for performance. • Demand on services. • Constitutional Standards (to include but not exclusive to): o Referral to Treatment (RTT) o Diagnostics o Cancer Standards • Integrated Urgent Care • Stroke - as a quarterly standard this will be updated in the next report. • Integrated Urgent Care (NHS111) • Advice and Guidance • East of England Ambulance Services standards

Written by/Presented James Buschor – Head of Performance and Planning by: Karen Wesson – Director Commissioning and Performance

Executive Director Tricia D’Orsi, NHS Alliance Director Sponsor:

Non-Officer/Board Sponsor:

Approval Route: Group/Committee Date

Cancer Programme Delivery Group Fortnightly Wednesdays

System Planning and Delivery - Planned Weekly Wednesdays Care

System Restoration, Planning and Weekly Wednesdays Performance Meeting

Have any financial implications been signed off by Yes No N/A the Chief Finance Officer? (Please Tick ) X

Has an Equality/Quality/Privacy Impact x Assessment been carried out?

Details of Stakeholder, NHS England and Improvement Patient & Public Cancer Alliance Engagement: Patient Representatives Clinical Leads from MSEFT, Primary Care, Macmillan GPs Operational Leads MSEFT Commissioning/Performance Leads Acute Team and Place representatives Communication Lead for Cancer Communication Team supporting RTT Independent Sector Providers Tier 2 Service Providers

Conflicts of Interest: None identified

PLANNING:

The first draft of the planning round was submitted to region on 4 May 2021 with feedback expected the week commencing 17 May. The final plan is then due to be submitted to region on 28 May for further review and feedback ready for final submission on 3 June.

For activity and performance this submission is asked to cover the period April - September 2021 referred to as ‘H1’ in the guidance. Whilst the country is in the recovery phase of the COVID-19 pandemic, the ask within the plan for performance is focused on activity, demand and backlog numbers rather than percentage performance.

The MSEFT plans aim to recover activity levels to support the system meeting the Elective Recovery Funding (ERF) asks. The plans also include additional capacity to support performance and waiting times recovery for patients with the longest waits, including mobilising Braintree, Vanguard mobile theatres, Insourcing and inter-provider transfer of patients to the agreed additional capacity support within our local Independent Sector Providers.

Not meeting the ERF asks is a significant financial risk to the system. These risks are monitored by the Finance and Performance Committees in Common via the risk log and the detail for activity is reported in the finance papers to the committees. The performance plans are covered within this report.

Whilst the development and submission of the plan is led by the weekly system Restoration, Planning and Performance Group, the reporting and progress of the plans is led by the weekly System Planning and Delivery Planned Care Group; with oversight via the System Oversight and Assurance Group (SOAG).

CONSTITUTIONAL PERFORMANCE: ACUTE

Cancer Standards

National Standard/ Local Objective

Planning Guidance Ask: Cancer: • Recovery of demand\referral rates • Restart screening programmes • Reduce number of patients waiting over 104days and 62 days for treatment. • Thurrock Lung Health Checks (TLHC) and Rapid Diagnostic Centre (RDC) implementation Palliative and End of Life Care: Increased number of patients on EOL register

Key Issue 1 Non-compliance with Cancer Constitutional Standards

Key Issue 2 Number of patients waiting over 62 days (backlog) on a 62-day pathway is greater than the 118 sustainable size.

Key Issue 3 There are a number of patients waiting over 104+ days on a cancer 62-day pathway.

Key Issue 4 Ongoing completion of harm reviews.

Time scale Backlog recovery trajectory for patients waiting 104+ days is being for benefits developed. to be realised Trajectory towards backlog recovery for patients waiting 62+ days has been submitted as part of the planning round.

Compliance with the 62-day cancer constitutional standard is reliant on the cancer backlog recovery.

Risk – BAF • MSE2020:0005, MSE2020:0009

1. Purpose

To provide the Board with an update on cancer waiting times, performance against Constitutional Standards and plan. To advise the Board of the progress and mitigations. 2. Background

The assurance and actions taken to support delivery is overseen by the Cancer Delivery Group (Clinical Pathway Leads and Macmillan GPs) and Cancer Board (Chair David Walker and Donald McGeachy), with some components at the Elective Care Programme Board (Clinical Lead Jose Garcia). This is supplemented by a number of other sub-groups e.g. outpatients, Tier2, Independent Sector providers etc.

Each programme of work has clinical support from the pathway leads within MSEFT, Macmillan GPs and patient representation to ensure feedback.

There is system engagement with NHSE/I EOE Cancer Alliance South to ensure robust response and recovery progress. 3. Performance

• Cancer 2 week wait referrals The following table summarises the monthly performance against the 93% standard, for patients being seen by a specialist within two weeks following an urgent GP referral, during 2020/21 to date (Apr-20 to Mar-21).

The following graph shows referral volume for March being greater than pre-COVID-19 average and March 2019.

MSEFT have raised that significantly high referrals volumes have been received recently for skin and breast. A separate working group with wider system colleagues (feeding back into the Cancer Programme Board) has been set up to further analyse and ensure all pathways are being maximised and standard continues to be met.

• Cancer 62 days The following table summarises the performance against the 85% standard, for patients to start treatment from an urgent referral for suspected cancer within 62 days, during 2020/21 to date (Apr-20 to Mar-21).

The cancer 62-day standard is measured on treatment and thus a key metrics required to recover this standard is to reduce the backlog (number of patients waiting over 62 days) to a sustainable size of 118 and eliminate the backlog of patients waiting 104+ days.

The following graph shows performance in terms of the 62-day backlog size. The submitted plan is to reduce the backlog to 163 by the end of H1. As at week ending 09/05 the backlog is 264 patients (month end plan for May 2021 = 234).

The following graph shows performance in terms of the 104+ day backlog size for patients waiting on a 62-day pathway. As at week ending 09/05 the backlog is 66 patient’s which is a reduction to the backlog size at the beginning of January. A recovery trajectory to ensure no patients wait above 104+ days on a 62-day pathway is required.

Referral to Treatment (RTT)

National Standard/ The RTT standard is a key performance standard indicating how Local Objective trusts are delivering on a patient's right to receive treatment within 18 weeks of being referred to a consultant-led service.

Key Issue 1 High number of patients with an RTT pathway greater than 52 weeks within MSEFT.

Key Issue 2 Planned care activity not meeting plan.

Key Issue 3 Number of patients waiting over 98+ and 104+ weeks on an RTT pathway.

Key Issue 4 Completion of harm reviews in line with agreement with Regulators.

Time scale for MSEFT working to submitted planned care capacity, activity levels benefits to be and subsequent RTT 52+ week wait recovery trajectories. realised MSEFT working to meet the regional commitment to have zero patients waiting 98+ weeks on an RTT pathway by end of H1.

Risk – BAF MSE2020:0011, MSE2020:12

1. Purpose

To provide the Board with an update on RTT waiting times, performance against Constitutional Standards and plan. To advise the Board of the progress and mitigations. 2. Background

The operational oversight of the RTT recovery is led and coordinated via the weekly System Planning and Delivery Planned Care Group. This is a system group that meets with the operational leads to understand the challenges and actions required to deliver the recovery trajectory and expectations. Reporting and progress of plans is via this group whilst oversight is via the System Oversight and Assurance Group (SOAG).

3. Key points to note

The system has identified five key priority specialties that will make an impact on the recovery of the RTT performance these are: • Orthopaedics • Ophthalmology • Dermatology • Urology • Paediatrics

The CCGs have identified clinical leads for each specialty to support this work.

4. Performance

The following table summarises the performance against the RTT standard, of 92% of patients to be seen and treated within 18 weeks when referred into a consultant led elective service, during 2020/21 to date (Apr-20 to Mar-21).

As at week ending 09/05, the RTT backlogs at MSEFT are as follows: • Patients waiting 52+ weeks: 6,869 • Patients waiting 78+ weeks: 2,024 • Patients waiting 98+ weeks: 423 • Patients waiting 104+ weeks: 224

As part of the weekly System Planning and Delivery - Planned Care Group work programme, an RTT recovery model has been developed by specialty to:

1. Calculate number of treatments required for patients waiting 98+ weeks in order to reduce this backlog cohort to zero by end of H1 as per regional commitment. 2. Calculate number of treatments required for patients waiting 90+ weeks in order to reduce this backlog cohort to zero by end of H1. 90+ weeks has been set as a trigger point allowing eight weeks to book any patient in whose wait ‘tips’ into 90+ weeks before they reach 98+ weeks to ensure no patient waiting 98+ weeks is sustained. 3. Reduce the number of patients waiting 52+ weeks as per submitted plan. 4. Calculate number of treatments required for patients waiting 78+ weeks in order to reduce this backlog cohort to zero by end of March 2022.

The model is built up from each specialty i.e. the overall MSEFT position is a summation of each specialty and an overview of the assumptions/variables and recovery actions used was given in last Finance & Performance Committees in Common performance paper for reference.

For 98+ weeks, the following three graphs show the scale of the challenge. The first graph shows the trend to the position of 423 patients and the required trend to reduce to zero by end of H1. The second graph shows the number of clock stops which would need to increase to 77 per week based on a ‘tip in’ rate of 56 patients per week shown against the actual ‘tip in’ rate in the third graph.

For 90+ weeks the following three graphs show a similar challenge to the above 98+ week plan with 130 clock stops required based on a ‘tip in’ rate of 86 patients per week.

In terms of 52+ week trajectory the numbers are coming down fast since week ending 21/03/2021 as per the following graph.

The decrease is due to the reduction in referrals at the beginning of the pandemic at exactly this time last year, shown in the graph below. The blue forecast line was calculated before Covid so could be taken as BAU.

The impact of the drop in referrals is a low ‘tip in’ rate a year later as shown in following graph.

As can be seen in the two graphs above, the referrals received jumped back up from June 2020 onwards to an average of circa 25,000 per month. Therefore, it is expected the low ‘tip in’ rate may only last for this month and maybe a little next month, before rising. This expectation is backed by the following graph showing demand (additions) being greater than treatments from June 2020.

Clock stops are below modelled plan shown in the following graph. If the ‘tip ins’ do increase, the current clock stop rate could equal the potential new ‘tip in’ rate, therefore potential to holding a position of around 6,000 breaches (or worse, the position increases) rather than continue to decrease. Assuming before COVID-19 pandemic there was not a growing 52+ week issue, and the growth seen was caused by having ceased elective activity, the additional capacity in the plan (which exceeds BAU) supports reducing the potential 6,000 breaches above meeting demand. Also, the plan has inherent risks, such as high planned care activity levels over winter.

MSE FT on average treat/stop circa 4,000 patients/clocks per week so without any prioritisation of clinical need and just treating patients chronologically both the backlogs described above could be cleared relatively quickly. The complexity of recovery lies in triaging patients based on clinical need and a priority on waiting time.

The following actions are being undertaken and reported against at the weekly System Planning and Delivery - Planned Care Group.

• Very long wait PTL meetings at patient level to ensure patient specific plans in place to book patients in and to ensure no patient waiting over 98 weeks from end of H1.

• Priority patients (whose intended procedure is categorised as priority 1 and priority 2)

to be identified and scheduled first.

• Service leads validating all patients with an RTT wait in a backlog above (whose procedure are categorised as priority 3 or 4 by specialty) against the Service Restriction Policy.

• Indicate for these specialties, if patients listed meet the clinically evidence criteria for the procedure, then an alternative more appropriate pathway to be sought or removal of patient from the list needs to occur in order to release capacity for patients meeting clinical need.

• Operational leads and service managers to review their theatre capacity to understand how quickly the patients waiting can be slotted in.

• Operational leads and service managers to identify efficiencies to increase proportion/number of treatments for patients with an RTT wait in a backlog above through: • Optimise capacity for chronological booking after prioritisation. • Ensure Inter-provider transfers to identified additional capacity at Independent Sector Providers are strictly transferred in chronological order for priority 3 and 4 procedures. • Identify any opportunities for Tier II provider capacity.

Diagnostics

National Standard/ The Diagnostic operational standard that less than 1% of patients Local Objective should wait 6 weeks or more from referral for a diagnostic test

Key Issue 1 Not achieving the diagnostic standard (DM01); this has impact not only on patient experience having to wait a long time and will impact on the 52-week performance

Key Issue 2 Expectation for zero patients waiting 13+ weeks.

Time scale for Planning Round Ask: benefits to be realised Community Diagnostic Hubs planning round requirement for submission of requirement template.

Diagnostic activity plan being developed to be submitted in planning round submission.

Risk – BAF MSE2020:0010

1. Purpose

To provide the Board with an update on Diagnostic Standard, performance against Constitutional Standards and plan. To advise the Board of the progress and mitigations. 2. Background

The operational oversight of diagnostic recovery is led and coordinated via the weekly System Planning and Delivery Planned Care Group. This is a system group that meets with the operational leads to understand the challenges and actions required to deliver the recovery trajectory and expectations. Reporting and progress of plans is via this group whilst oversight is via the System Oversight and Assurance Group (SOAG).

3. Performance

The following table summarises the performance against the diagnostic standard, that 99% of patients should have their diagnostic test within 6 weeks of referral, during 2020/21 to date (Apr-20 to Mar-21).

The COVID-19 pandemic has significantly impacted diagnostic services.

The following graphs outline the challenge now faced by the system to support recovery. This is in terms of the significant step change in the increased size of the 6+ and 13+ week backlogs (number of patients waiting over 6 and 13 weeks) seen from April 2020 whilst activity has significantly reduced during the COVID-19 pandemic.

Diagnostics impacts on both cancer and Referral to Treatment performance. The system has worked to maximise capacity where possible through the use of Tier 2 services and additional scanners being brought to the local sites to help support recovery of the standard.

Diagnostic activity recovery plans have been submitted in the planning round submission. Additional capacity also being sought to aid recovery.

New prioritisation guidance has been released and being worked through feeding into the weekly System Planning and Delivery Planned Care Group.

Advice and Guidance:

National Standard/ Increased use of Advice and Guidance to support demand Local Objective management expectation is for turnaround time for response is 2

working days

Key Issue 1 Variation across CCGs in using Advice and Guidance

Key Issue 2 Response times greater than expected 2 working days

Time scale for Ongoing benefits to be realised

Risk – BAF MSE2020:0013

1. Purpose

To provide the Board with an update on Advice and Guidance, performance and usage. To advise the Board of the progress and mitigations. 2. Key points to note

System capacity to support recovery has been through collaborative working with MSEFT to ensure turnaround times improve to meet the standard, improve primary care confidence in using service as know will get a response.

3. Performance The following graph shows the monthly number of requests made from MSE CCG practices showing there has been a significant increase in number of requests made in March-2021 (circa 2,000).

The 95th centile response time performance for MSEFT is circa 23 weeks (note March-21 data is incomplete as response times not calculated for open requests).

Ambulance Standards

National Standard/ Arrival to handover times should be below 30 Local Objective

Key Issue 1 Flow within the MSEFT sites has a direct impact on ambulance handover times which in turn means that the ability for ambulances to get back “on the road” is impacted

Time scale for Ongoing benefits to be realised

Risk – BAF MSE2020:0024

1. Purpose

To provide the Board with an update on Ambulance arrival to handover times.

2. Key points to note

Performance in this area is overseen by the MSE Urgent and Emergency Care Board.

3. Performance

Integrated Urgent Care (NHS 111) Standards:

National Standard/ 95% of calls should be answered within 60 seconds. Local Objective

Phase 3 plan asked Implementation of Think NHS111 as per national ask for:

Key Issue 1 COVID-19 has had a direct impact on the performance and call response times

Time scale for Ongoing benefits to be realised

Risk – BAF MSE2020:0019, 0020

1. Purpose

To provide the Board with an update on NHS111 performance. To advise the Board of the progress and mitigations. 2. Background

Governance: In addition to formal contractual performance. Due to the changing asks for NHS111; Mid & South Essex Think 111 Programme Board. This has two subgroups: Think 111: Acute Subgroup/Think 111: IUC sub group, both have been established to ensure implementation of the initiatives to reduce the demand, congestion and overcrowding of Emergency Departments.

3. Key points to note

This programme went live as planned on 1 December 2020. A briefing was given via the Partnership Brief across the Health and Care Partnership, GP Bulletin and will continue to be monitored and reviewed as the new model is live.

4. Performance

The following table shows the monthly performance for calls answered in 60 seconds.

Emergency Department Standard

National Standard/ 95% of people should be managed within 4 hours of arrival at the Local Objective department.

Key Issue 1 Performance is currently not meeting the standard and this will be

reviewed via the UEC Board for MSE Health and Care Partnership

Time scale for Ongoing benefits to be realised

Risk – BAF

1. Purpose

To provide the Board with an update on emergency department performance against Constitutional Standards. 2. Background

Performance in this area is overseen by the MSE Urgent and Emergency Care Board.

3. Performance

MSEFT ED 4hour performance is 89.5% at the latest reported position (April 2021):

Agenda Item 13b

PART I BOARD MEETING, 27 MAY 2021

PERFORMANCE REPORT – NON-ACUTE CONSTITUTIONAL PERFORMANCE

Purpose of Report: To provide an overview of Performance against the non-acute constitutional standards that are delivered at an MSE system level and via the Alliances/CCGs.

To provide an overview of delivery against 2020/21 and 2021/22 planning and performance trajectories.

To provide the Board with assurance that actions to support recovery of performance are in place and having an impact on recovery.

Recommendations and Members are asked to note the report and seek additional decision/actions: assurance if required.

Executive Summary This paper includes updates on the following areas: (including financial impact): 1. Constitutional standards • IAPT access, waiting times & recovery • Health checks for people with Learning Difficulties • EWMHS access & Eating disorders

2. Delivery against 2021/22 performance trajectories • Out of area placements • Health checks for people with Serious Mental Illness • Dementia Diagnosis • Perinatal Mental Health services • Individual Placement Services • LeDeR • LD inpatient beds • GP appointments • Personal Health Budgets • Social prescribing referrals • Personalised Care & Support Plans

BAF references will be reviewed following release of the latest version.

Written by/Presented Emma Timpson – Director of Planning & Performance, Basildon & by: Brentwood CCG

Executive Director Tricia D’Orsi, NHS Alliance Director Sponsor:

Non-Officer/Board Sponsor:

Approval Route: Group/Committee Date

Physical Health Implementation Group 28/04/2021 CYP Collaborative Commissioning Forum Mental Health Intelligence Group 08/04/2021 ELDP 07/05/2021

Yes No N/A

Have any financial implications been signed off by X the Chief Finance Officer? (Please Tick  )

Has the Equality/Quality/Privacy Impact x Assessment been carried out and issues addressed?

Details of Stakeholder, Patient & Public Engagement:

Conflicts of Interest: None identifed

Mental Health and Transforming Care Standards

National The following Mental Health Standards are being delivered through local Standard/ Alliance/Place teams: Local Objective IAPT Access: Patients entered psychological therapies 2020/21 Q4 achieve a rate of 6.25%

IAPT Recovery: Patients moving into recovery >= 50% IAPT Waiting: 1st Appointment within 18 weeks >= 95% IAPT Waiting: 1st Appointment within 6 weeks >= 75% IAPT In-treatment pathway waits over 90 days <= 10% Dementia diagnosis rate >= 66.7% Annual physical health check for people with serious >= 40% mental illness Number of people accessing Individual Placement and 332 Support (employment) services

The following Mental Health Standards are being delivered at a system wide level via EPUT:

Number of inappropriate Out of Area Placement (OAP) 0 bed days for adults Early Intervention in Psychosis Services (EIP) patients >= 56% started treatment within 2 weeks Number of women accessing specialist perinatal >= 6.08% (850 Mental Health services women)

The following Mental Health Standards for Children and Young People are being delivered at a system wide level via NELFT:

Improving access to community Mental Health services >= 35% for Children & Young People Eating Disorder Service: Urgent cases starting >= 95% treatment <= 1 week Eating Disorder Service: Routine cases starting >= 95% treatment <= 4 weeks

The following Standards related to Transforming Care for people with learning disabilities are being delivered through local Alliance/Place teams:

Annual physical health check for people with learning 3,822 (>= 67%) disabilities

The following Standards related to Transforming Care for people with learning disabilities are being delivered at a system wide level via Essex LD Partnership:

Number of adults with learning disabilities and/or 13 autistic spectrum that are in inpatient care for mental and/or behaviour healthcare needs (CCG Funded placements) Learning Disability Mortality Review Programme – 100% Completion of reviews within 6 months of notification.

IAPT Standards

National Standard/ IAPT services should deliver against the following national Local Objective standards: IAPT Access: Patients entered psychological Q4 achieve a rate therapies of 6.25% IAPT Recovery: Patients moving into recovery >= 50% IAPT Waiting: 1st Appointment within 18 weeks >= 95% IAPT Waiting: 1st Appointment within 6 weeks >= 75% IAPT In-treatment pathway waits over 90 days <= 10%

Key Issue 1 IAPT referrals are increasing to near Covid-19 levels but improvements in access are not yet sustained across all areas. Performance against the Q4 access standard is unlikely to be achieved.

Time scale for Q1 2021/22 benefits to be realised

Risk – BAF

1. Purpose

To provide the Board with an update on performance against the IAPT constitutional standards.. 2. Background

IAPT performance was set by NHSE as a system wide target. Each CCG commissioning arrangements are slightly different and there are four different providers delivering services within the system. CCGs locally reported IAPT performance to their CCG Finance and Performance Committees.

All commissioners and IAPT providers are represented on the Mental Health Intelligence Group where performance is discussed.

3. Performance

IAPT referrals fell during the second wave of Covid-19 in December 21 but have since recovered and are now tracking above Pre-Covid levels. There has been ongoing communication and engagement with primary care, schools, other referrers and via the local media. Local recruitment plans have been enacted including the increase in trainee numbers in line with regional expectations.

The latest access rate has followed the referral trend. Whilst the access recovered to its highest level in March 2021 to 1.77% it fell below the target level of 2.08% and therefore the Q4 target of 6.25% was not achieved.

STP Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Referrals 1,124 1,585 2,161 2,646 2,390 2,715 2,884 2,787 2,216 2,762 2,685 3,321 Access Rate 0.67% 0.75% 1.10% 1.44% 1.35% 1.47% 1.48% 1.68% 1.39% 1.56% 1.32% 1.77% Target 2.08% 2.08% 2.08% 2.08% 2.08% 2.08% 2.08% 2.08% 2.08% 2.08% 2.08% 2.08%

Howerver, waiting time targets have continued to be consistently achieved with >95% seen in within 18 weeks and 75% within 6 weeks by all CCGs there was varied performance on the recovery target of >50%. Thurrock CCG was the only Place in Mid and South Essex to deliver on and above the IAPT Recovery Target of 50%, every single month in 2020-21.

4. Actions

• Local CCG recovery action plans are in place with the individual providers. The issues to be addressed in each area vary from model of delivery to level of investment. • Mid Essex presents with the highest risk due to historical investment issues which resulted in a lower access trajectory. This has therefore meant MSE is not at a position to deliver against the Access target. Discussions are on course with the CCG to remedy the position and mitigate the likely cost pressures in order to bring Mid Essex to the same level as the other services. The ambition is Mid will be in a position as with other Places to meet the Q4 Access target. • Comms Plans are being developed to provide tailored approaches that will meet the diverse communities. • Plans are being developed to ensure each service can evidence delivery against 2 new KPIs relating to focused access and recovery for those over 65yrs and BAME communities, reducing inequalities.

Health checks for people with Learning Disabilities

National Standard/ 67% of patients aged 14 or over on the GPs Learning Disability Local Objective Register receive a health check.

Key Issue 1 The number of health checks undertaken for people with Learning Disabilities has increased, although delivery of the 67% target remains at risk as Primary Care capacity is directed to support the Covid vaccination programme.

Time scale for Health checks to be undertaken for 3,822 people with Learning benefits to be Disabilities by March 2021, equating to 67% of those on the LD realised register.

Risk – BAF

1. Purpose

To provide the Board with an update on performance against the Learning Disabilities Health checks standard. To advise the Board of the progress and mitigations. 2. Background

Learning Disabilities Health checks trajectory agreed with NHSE for delivery by March 2021 was based upon 3822 people on the LD register having a physical health check. The national target is to achieve 67% of those on the LD register.

Locally a monthly extract from SystmOne based on Practices use of Snowmed coding populates a dashboard that enables more timely monitoring of performance down to a Practice level. It should be noted that SystmOne covers 98% of Practices.

3. Performance

As a result of Covid-19 face to face consultations were reduced in primary care to protect patients and staff. This resulted in a reduction in the number of physical health checks that were undertaken in the first 6 months of 20/21. The number of checks has been increasing since October 2020 and stepped up significantly in March 2021.

The overall performance per CCG was that Castlepoint and Rochford CCG and Mid Essex CCG meet the 67% trajectory. Despite Covid the actual performance was higher in all across the system compared to 2019-2020 performance.

4. Actions

Oversight of this target is via the Health Equalities Board and LD Steering group. Discussions have commenced regarding the further improvements required to meet the 2021/22 target of 75%. The senior team are meeting with the Alliance Director and Lead for LD across the CCGs to discuss ways to increase performance, spread good practice and seek assurance of mechanism for oversight. The utilisation of the investment from NHSE for transforming care funding to support innovation into LD healthchecks and enhanced physical health checks for this group of patients is currently being agreed. There is a piece of quality work being considered as whilst uptake is better, there needs to be assurance confirmed that quality of the health checks is consistent across the system.

Health checks for people with Serious Mental Ilness

National Standard/ 60% of patients on the GPs SMI Register receive a health check. Local Objective

Key Issue 1 As at Q2 there has been no significant improvement in number of health checks undertaken for people with Serious Mental Illness.

Time scale for SMI Health checks to be undertaken for 40% of people with SMI by benefits to be March 2021. realised

Risk – BAF

1. Purpose

To provide the Board with an update on performance against the SMI Health checks standard. To advise the Board of the progress and mitigations. 2. Background

SMI Health checks trajectory agreed with NHSE for delivery by March 2021 was 40% of people with SMI have a physical health check, compared to the standard of 60%.

Performance against the target is reported to individual CCG Finance and Performance Committees. The Physical Health Implementation Group (PHIG) brings together commissioners and EPUT to review performance, recovery plans and collaborate on schemes.

Local commissioning arrangements are in place to support Practices in delivering the checks either through a Local Enhanced Service as in Basildon & Brentwood CCG and Thurrock CCG or from support of other providers such as EPUT in South East Essex who provide a SMI physical health outreach team.

3. Performance

As a result of Covid-19 face to face consultations were reduced in primary care to protect patients and staff. This resulted in a reduction in the number of physical health checks that were undertaken in Q1 of 2020/21. MSE figures for March 2021 indicate achievement of 25% against a reduced 20/21 target of 40%. Q4 position has not been confirmed, but expected to be less than 30%. There is significant variability across CCGs, although CPR and Southend CCGs both achievied over 40% for Q4 2021.

4. Actions

MSE Recovery Action plan in place and monitored through PHIG. Coding inaccuracies within EPUT system have been identified, which impact on data transfer to Primary care; work ongoing to improved data reliability. Commissioning models are being compared across CCGs to improve performance across MSE. Performance trajectories for 2021/22 have been agreed to deliver 60% of those on SMI registers receiving annual physical health checks, as per national standard.

Emotional Wellbeing Mental Health Service Children and Young People:

National Standard/ At least 35% of children with a diagnosable mental condition receive Local Objective treatment from an NHS funded community mental health service

Key Issue 1 The deliverability of the EWMHS revised access trajectory to deliver compliance against the 35% target.

Time scale for EWMHS access rate of 35% achieved by March 2021 benefits to be realised

Risk – BAF

1. Purpose

To provide the Board with an update on performance against the Emotional Wellbeing Mental Health Service (EWMHS) access standard. To advise the Board of the progress and mitigations. 2. Background

The original Phase 3 plan submitted to NHSE on 21 September 2020 set a trajectory for the achieving an EWMHS access rate of 23.4%. Following discussions between NHSE, host commissioner (West Essex CCG) and NELFT this was revised to achieve the 35% national target.

A Recovery action plan was submitted to NHSE with a trajectory to deliver the 35% across the Essex system. There is variation in the target between the seven individual CCGs within Essex, with forecast overperformance offsetting projected under delivery in Basildon & Brentwood CCG, Castle Point & Rochford CCG and Thurrock CCG.

Eating Disorders is split into two categories by NHSE, these are urgent (to be seen within one week) and routine (to be seen within four weeks).

3. Performance

Based on accumulative figures Februarys data shows MSE is achieving 28.44% against the financial year end CYP MH access standard of 35%. Self referrals and GP referrals are down approx. 20% which has impacted on the referral rates required for the access targets. These are now starting to rise.

For eating disorders urgent for mid and south the total is 97.1%. There is been a 350% increase in Essex. For eating disorders routine target is 100%.

For urgents starting treatment – Q1 2020 compared to Q4 2021 – 167% increase across MSE footprint which is greater than Essex at 150%. The current target is achieved at 100%.

For routines starting treatment – Q1 2020 compared to Q4 2021 – 215% increase for MSE – greater than Essex at 210%

4. Actions

The Southend, Essex and Thurrock CYP EWMHS Collaborative Commissioning Forum (CCF) is monitoring recovery of performance and implementation of the recovery plans by NELFT. Further communications and engagement has gone out to GP and schools.

Funding has very recently been received from NHSE for an eating disorder home treatment team, this will further support the urgents along with the community eating disorder team.

Out of Area Placements – Adult Mental Health

National Standard/ Out of Area placements will be elimated for acute mental health care Local Objective for adults by the end of 2020/21.

Key Issue 1 The number of out of area placements increased as a result of the impact of Covid-19 increasing bed occupancy.

Time scale for Out of area placements will be zero by end of March 2021 benefits to be realised

Risk – BAF

1. Purpose

To provide the Board with an update on performance against eliminating out of area placements. To advise the Board of the progress and mitigations. 2. Background

The elimination of Out of Area Placements (OAP) for acute mental health care for adults by end of March 2021 was set out within the Five Year Forward View for Mental Health.

During Covid-19 mental health inpatient bed occupancy reduced to 85% due to the need for service users to socially distance in communal spaces. Coupled with the increased demand for mental health inpatient beds has resulted in an increase in out of area placements.

As a result of the impact of Covid-19 a revised trajectory was agreed with NHSE to eliminate OAP by end of September 2021.

3. Performance

The reported position OAP position continued to increase month on month to 560 bed days in February 2021. More recent local reporting indicates that currently there are 23 patients placed out of area compared to the trajectory of 27 for April 2021.

4. Actions

There are plans in place to mitigate operational pressures and implement a transformative MH accommodation offer to reduce dependence on OAP provision through 2021/22. The NHSE support programme to improve capacity and flow will be integral to the wider improvement plans.

Dementia Diagnosis rate

National Standard/ Dementia diagnostis target is that two thirds of people with dementia Local Objective are diagnosed.

Key Issue 1 Covid-19 has significantly impacted upon the number of patients with a recorded dementia diagnosis.

Time scale for Recovery of performance during 2021/22. benefits to be realised

Risk – BAF

1. Purpose

To provide the Board with an update on performance against the dementia diagnosis target. To advise the Board of the progress and mitigations. 2. Background

The number of patietns with a recorded diagnosis of dementia decresed during the first wave of Covid-19. This was as a result of the increase number of deaths in dementia patients and reduction in referrals to memory assessment clinics as fewer people attended in Primary Care.

3. Performance

The MSE diagnosis rate as of March 2021 is 59.7% against the target of 67%. Nationally the diagnosis rate has fallen to 61%.

Mid Essex CCG hasseen a high number of patients that have been deducted from the dementia diagnosis register which has impact on the target. This is currently under investigation to understand why this occurred and that it does not relate to a previous data recording issue. Basildon and Brentwood CCG has the highest number of patients awaiting a diagnosis and a recovery action plan is being implemented.

4. Actions

Mid Essex and Basildon and Brentwood CCGs are undertaking pilots with demential nurses supporting primary care diagnosis. The expected outcomes are that this will reduce delay in diagnosis, enable patients and their carers to be directed to support services and minimise referrals with only the most complex going into the memory assessment referral service.

Evaluation of these pilots will take place in July 2021. ITEM 14 SUMMARY OF DISCUSSIONS HELD AT COMMITTEES IN COMMON

Agenda Item 14a

Part I Board, 27 May 2021

SUMMARY OF DISCUSSIONS HELD AT THE M&SE CCG PATIENT SAFETY AND QUALITY COMMITTEES MEETING HELD IN COMMON, 9 MARCH 2021 Purpose of Report: To provide the Board with a summary of discussions held at the M&SE CCG Patient Safety & Quality Committees meeting held in common on 9 March 2021.

Recommendations and The Board is asked to note the content of the report. decision/actions:

Executive Summary The five M&SE CCG patient safety and quality committees (or equivalent) (including financial impact): and the JC PSQ Sub-committee meet in common on a bi-monthly basis. The report below provides a summary of discussions held on 9 March 2021.

Written by/Presented by: Lorraine Coyle, Deputy Chief Nurse

Executive Director Rachel Hearn, Executive Director of Nursing and Quality Sponsor:

Non-Officer/Board Nathalie Wright, Lay Member (Patient and Public Engagement) Sponsor:

Fit with CCG Strategic Strategic Objective 3: Make a step change in addressing Objectives? inequalities and quality priorities to deliver outcomes in accordance with Constitutional Standards.

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this The minutes of the PSQ CiC meeting held on 9 March 11/05/2021 document). 2021 were approved at the meeting on 11 May 2021.

Reports Submitted to Board only: Date signed-off by Executive Team. (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick ✓ ) X

Has the Equality/Quality/Privacy Impact Assessment X been carried out and issues addressed?

Details of Stakeholder, Patient N/A & Public Engagement:

Risks / Link to BAF: BAF Ref:

Conflicts of Interest: None identified.

Escalation: To the Board To another Committee To the BAF/CRR

This report sets out the key discussions held at the Patient Safety & Quality (PSQ) Committees meeting held in common on 9 March 2021:

• The minutes of the previous meeting held on 9 December were approved, subject to a minor amendment. • An early draft of the new Quality Strategy was submitted to members for review and comment upon. A series of workshops will be held to further develop the strategy. It is anticipated that an updated draft will be submitted to the CCGs’ PSQ committees in the summer. • The committee reviewed the PSQ risks on the Board Assurance Framework. The risks have recently been reviewed again in readiness for the May round of CCG Board meetings. • An NHS Patient Safety Update was reviewed, which focused on infection prevention and control guidance, the Ockenden review of maternity services, Never Events, epilepsy medicines used in pregnancy and COVID-19 (C-19) oximetry at home,. • The Acute Commissioning Team update highlighted that there were 20 MRSA cases recorded to the end of 2020, with 2 further nosocomial outbreaks identified since the report was produced. A learning report had been requested to understand the causes. The preliminary findings of a Care Quality Commissioning (CQC) inspection at Basildon Hospital relating to infection prevention and control was largely positive. The report also confirmed that the second wave of C-19 had adversely impacted upon the reset of elective care, referral to treatment times and cancer services. • The Essex Partnership University NHS Trust (EPUT) mental health (MH) update report advised that an interim MH quality lead had been appointed to support the Thurrock Nursing Team. Key Performance Indicators (KPIs) for a number of MH services were of concern and would be flagged at the next Clinical Quality Review Group meeting. The committee were advised that following a CQC inspection at the Linden Centre, the CCG MH nursing team had visited one of the wards and were assured that all actions had been implemented and progress was sustained. The Mental Health Commissioning Task Force had been established to review the pan-Essex mental health contracting and commissioning arrangements and was progressing well. Several recommendations had been generated with sub-group meetings set up to implement these. • The Learning Disability (LD) update report highlighted that performance against LD healthchecks required improvement. The CCGs had received assurance from Primary Care Networks that they would focus on performing the checks. Retrospective Learning Disabilities Mortality reviews (LeDeR) for 2019/20 had been cleared and assurances had been received from the Central Support Unit (CSU) that the 2018/19 backlog would be completed by March 2021. It was noted that an increase in LeDeR review investigations was expected as a result of the pandemic.

• The Basildon and Brentwood CCG update report highlighted that Ghyll Grove Care Home would be closing and work was ongoing to place a small number of CHC funded patients in appropriate accommodation. • The Thurrock CCG update report highlighted that audits of care homes in response to the pandemic were progressing well and all deferred continuing health care assessments had been completed. The vaccination programme rollout was also progressing well. The quality and primary care teams were providing support to a GP practice which had received a rating of ‘inadequate’ following a CQC inspection. • The Castle Point and Rochford and Southend CCG update report highlighted that the quality and primary care teams were also supporting another GP practice in this area which had received an ‘inadequate’ rating from the CQC. • The Mid Essex CCG update report confirmed that community providers had completed their actions regarding the Invasive Group A Streptococcus action plan. The Deputy Director of Nursing was working with the Mid & South Essex Hospitals NHS Foundation Trust (MSEFT) to ensure completion of their actions within the agreed timeframe. • The committee were invited to provide comment on the draft revised MSEFT Patient Access Policy. • The committee were also invited to comment on the Children and Young People Neurodevelopment Pathway Programme. • The patient story video detailed the experiences of two patients who had used maternity services at MSEFT during the C-19 pandemic. • The committee supported revised PSQ Terms of Reference for submission to Boards for approval. • The committee approved revised Terms of Reference for the Serious Incidents and Never Event Panel. • The committee approved the draft review of its effectiveness for 2020/21.

Recommendation:

The Board is asked to note the content of the report and seek any further assurance required.

Agenda Item 14b

PART I BOARD, 27 MAY 2021

FINANCE & PERFORMANCE COMMITTEES IN COMMON UPDATE

Purpose of Report: To provide the Board with a summary of issues discussed at the Finance & Performance Committees (F&P) in Common meeting on 21 April 2021.

Recommendations and The Board is asked to note the contents of this report. decision/actions:

Executive Summary Routine finance and performance monitoring reports were received with (including financial impact): no issues identified as requiring escalation to the Joint Committee and/or CCG Boards. No commissioning or contracting reports were reviewed that require Joint Committee approval.

Written by/Presented by: Mark Barker, Joint Chief Finance Officer

Executive Director Mark Barker, Joint Chief Finance Officer Sponsor:

Non-Officer/Board John Gilham, Lay Member (Governance) and Chair of F&P Committee Sponsor:

Fit with CCG Strategic Objective 2: Improve access to services for patients in line with NHS Plan Objectives? requirements. Objective 4: Achieve key statutory financial duties including delivery of the system financial control total.

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this N/A document).

Reports Submitted to Board only: Date signed-off by Executive Team. (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)

Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick ✓ ) X

Has the Equality/Quality/Privacy Impact Assessment X been carried out and issues addressed?

Details of Stakeholder, Patient & Public Engagement:

Risks / Link to Boad Relevant F&P risks from the BAF are reviewed at BAF Ref: Assurance Framework (BAF): each meeting

Conflicts of Interest: None identified

Escalation: N/A To the Board/Committee/BAF

FINANCE & PERFORMANCE COMMITTEES IN COMMON UPDATE

Purpose

To provide the Board with a summary of the issues discussed at the Finance & Performance Committees in Common meeting on 21 April 2021.

Key Points

The following issues were discussed: • Financial and Performance Risks – the Committees in Common agreed the proposed 2021/22 financial risks for inclusion in the Board Assurance Framework. • Month 12 Finance Report – the Committees in Common received a verbal briefing on the year end financial position and noted that SE Essex CCGs were expecting to report breakeven, Thurrock a surplus of circa £20k, Basildon & Brentwood CCG a surplus of approximately £150k and Mid Essex CCG a surplus of approximately £411k. • JCT Finance Report – the Committees in Common received a report on the Month 11 JCT financial position and noted the key risks in relation to Independent Sector Provider contracting arrangements. • Contract Planning 2021/22 – the Committees in Common received an update on the 2021/22 Contract Planning Round. • Elective Recovery Framework (ERF) – the Committees in Common received a briefing on the framework and were advised that the two key financial issues were a potential cost pressure of £24.3m if Independent Sector Provider capacity was utilised fully and approximately £16.8m additional expenditure in the MSEFT elective recovery plan. These costs would be mostly offset by additional funding received from ERF. Members asked for future updates to provide a clear timescale for recovery and noted that system elective income could not be fully estimated at this time as national elective thresholds had not yet been issued. • Performance report – the Committees in Common received a summary of performance against constitutional standards including Referral to Treatment, Diagnostics, Cancer, Integrated Urgent Care, Stroke, NHS111, Advice and Guidance and ambulance standards. It was noted that in April MSE FT had recorded the highest number of Accident and Emergency attendances across its sites for the last 2 years and that the Trust was carrying out a deep dive to understand the reasons for this. NHS 111 activity had also increased in relation to queries around Covid-19 and Covid-19 vaccinations. • Finance Planning update – the committees received an update on the latest financial planning assumptions, including the headline 2021/22 System Budget. • Mental Health Transformation Plan – the Committees in Common received an overview of mental health planning priorities for 2021/22, Mental health investment, Mental Health workforce, Mental Health performance metrics and the proposed contracting and financial approach. Members noted the the risks around the ability to recruit additional staff to support the planned investment. • Financial Services - the Committees in Common received a proposal to move to a hybrid financial services model with Arden & GEM Commissioning Support Unit in 2021/22 and supported a 12 month extension of the contract in line with the previously approved F&P paper. • Patient Transport Services– the Committees in Common noted the recommencement of the Non-Emergency Patient Transport Services procurement process.

Recommendation The Board is asked to note the contents of the report.

ITEM 15 MINUTES FOR INFORMATION

NHS Castle Point & Rochford CCG & Southend CCG Joint Clinical Executive Committee Thursday 1st April, 2021, 1.00pm – 2.00pm Microsoft Teams

MINUTES

Members dialling in that sit across Southend CCG and Castle Point & Rochford CCG: Tricia D’Orsi (TD) NHS Alliance Director NHS CP&R & Southend CCGs Members dialling in from Castle Point & Rochford CCG Dr Sunil Gupta (SG) GP Governing Body Chair (Chair) NHS CP&R CCG Dr Riz Khan (RK) GP Governing Body Member NHS CP&R CCG Dr Mahesh Kamdar (MK) GP Governing Body Member NHS CP&R CCG Dr Biju Kuriakose (BK) GP Governing Body Member NHS CP&R CCG Dr Mark Metcalfe (MM) GP Governing Body Member NHS CP&R CCG Dr Lucy Saville (LS) GP Governing Body Member NHS CP&R CCG Dr Sami Ozturk (SO) GP Governing Body Member NHS CP&R CCG Members dialling in from Southend CCG Dr Taz Syed (TS) GP Governing Body Member NHS Southend CCG Dr Kelvin Ng (KN) GP Governing Body Member NHS Southend CCG Dr Brian Houston (BH) GP Governing Body Member NHS Southend CCG Dr Krishna Chaturvedi (KC) GP Governing Body Member NHS Southend CCG Dr Sharon Hadley (KB) GP Governing Body Member NHS Southend CCG People in attendance Caroline McCarron (CMC) Associate Director CYP NHS CP&R & Southend CCGs Becky Pollard (BP) Interim Public Health Consultant Southend Public Health Sharon Judge (SJ) Executive Assistant (Minutes) NHS CP&R & Southend CCGs Apologies received from: Simon Williams Director of Partnerships & Integration NHS CP&R & Southend CCGs Kate Barusya GP Governing Body Member NHS Southend CCG Dr Kashif Siddiqui GP Governing Body Member NHS CP&R CCG James Currell Associate Director Assurance NHS CP&R & Southend CCGs Hugh Johnston Associate Director Mental Health NHS CP&R & Southend CCGs

1 Welcome and Apologies 1.1 The Chair welcomed everyone to the Joint Clinical Executive Committee. 1.2 Apologies were noted as above. 2. Minutes & Actions from last meeting 2.1 The minutes from the meeting held on 18th March 2021 were approved as an accurate account of the discussion. 2.2 The Action Log was updated as attached. 3 Public Health – Sexual Health Services in Southend 3.1 BP gave an update on the newly commissioned sexual health services in Southend provided by Brook.

Page 1 of 3 3.2 The contract was commissioned as a two-part tender and both have been awarded to Brook. Brook, who have a good reputation for delivery are working with the digital provider SH24 to offer a 24-hour service covering face to face appointments, online advice, testing and sign posting together with outreach facilities. The service will cover HIV and Prevention and treatment and care. 3.3 The service is operating from Warrior House as an appointment service only at the moment but additional sites are being explored. 3.4 Southend Borough Council are having regular meetings with Brook whilst they establish the service and are closely monitoring KPIs. 3.5 As there is a significant backlog from Provide Southend Borough Council are working with Brook to help clear the backlog as quickly as possible. 3.6 The current GP and pharmacy contract has been extended for a further 12 months to allow the service to integrate across Mid and South East Essex. 3.7 BP reported that invites have been sent to all local pharmacies and CCGs so they can meet Brook to find out what services they provide. 4. Children & Young People Update 4.1 CMC shared a presentation on a number of new schemes for CYP. 4.2 CMC went through the slides covering the following services:

• Counselling Service – dedicated counselling service commissioned during CMC to Covid to work with anxious children. circulate • My Spira – interactive app for children aged 5-13 suffering with asthma slides • Oviva – this service has been extended for a further 12 months and has been after expanded across Mid and South Essex meeting • QB Test – this is a digital test for ADHD that should reduce waiting list significantly. Licences have been purchased for all community providers for one year. If successful the expectation is that providers will commission tests themselves. • ASD/Mental Health – offers parental support focusing on very anxious parents but only available for 48 families. This service is available across South East Essex only. • ASD Backlog – Funding has provided 1000 assessments across Mid and South Essex. Assessments will be done in chronological order and it is expected to be a six-month programme of work. • Paediatric Pumps – there are currently 12 children waiting for pumps. The hospital and local providers are going to purchase additional pumps to meet the expected demand for this financial year. • eRed books – current paper red books will be replaced with digital books which will allow all clinicians to see the data. Parents will also be able to add information. The only concern is that all partners must sign up to the scheme. CMC confirmed that GPs would be able to access the red books through Systm1.

4.3 TD reported that the national team are working hard to identify the priorities for CYP and went on to say that there are currently 38 patients waiting for Tier 4 beds. As an interim solution approval has been given for a local crash pad in collaboration with EPUT to be set up.

Weekly meetings are currently in place for Long View and Poplar Ward to discuss patients and to improve collaborative working.

BP was pleased to hear that child obesity was being prioritised and hoped it would dovetail into systems already in place. CMC felt it would be a good idea if BP linked in with Margaret Allen who is involved in the Programme Board for Obesity which covers children and adults. 5. Any Other Business 5.1 DoctorLink – MM raised a recent safeguarding issue involving suspected child sexual abuse and his

Page 2 of 3 concern that DoctorLink appear to hold no responsibility once a referral has been made. TS stressed that the safety of a child must always come first and advised that this should be escalated to DoctorLink and Rob Hunt as project lead to ensure that it never happens again. 5.2 Covid vaccinations – BK raised a query about a patient who had the Pfizer vaccination but since having the TD to first dose has now become housebound and asked for guidance on how the vaccine could speak to be given taking into consideration the strict rules for the storage of this vaccine. MM SW for suggested looking at the Green Book, Chapter 14a for guidance and also reported that guidance the AstraZeneca could be given as a second dose in certain circumstances. 5.3 As there were no other items for discussion the Chair closed the meeting at 1:50pm

Date of Next Meeting: Thursday 15 April 2021, 1pm – 2.30pm

via Microsoft Teams

Page 3 of 3

NHS Castle Point & Rochford CCG & Southend CCG Joint Clinical Executive Committee Thursday 15th April, 2021, 1.00pm – 2.30pm Microsoft Teams

MINUTES

Members dialling in that sit across Southend CCG and Castle Point & Rochford CCG: Tricia D’Orsi (TD) NHS Alliance Director NHS CP&R & Southend CCGs Simon Williams (SW) Director of Partnerships & Integration NHS CP&R & Southend CCGs James Currell (JC) Associate Director Assurance NHS CP&R & Southend CCGs Members dialling in from Castle Point & Rochford CCG Dr Sunil Gupta (SG) GP Governing Body Chair (Chair) NHS CP&R CCG Dr Riz Khan (RK) GP Governing Body Member NHS CP&R CCG Dr Mahesh Kamdar (MK) GP Governing Body Member NHS CP&R CCG Dr Biju Kuriakose (BK) GP Governing Body Member NHS CP&R CCG Dr Mark Metcalfe (MM) GP Governing Body Member NHS CP&R CCG Dr Lucy Saville (LS) GP Governing Body Member NHS CP&R CCG Dr Sami Ozturk (SO) GP Governing Body Member NHS CP&R CCG Dr Kashif Siddiqui (KS) GP Governing Body Member NHS CP&R CCG Members dialling in from Southend CCG Dr Taz Syed (TS) GP Governing Body Member NHS Southend CCG Dr Kelvin Ng (KN) GP Governing Body Member NHS Southend CCG Dr Brian Houston (BH) GP Governing Body Member NHS Southend CCG Dr Krishna Chaturvedi (KC) GP Governing Body Member NHS Southend CCG Dr Sharon Hadley (SH) GP Governing Body Member NHS Southend CCG Dr Kate Barusya (KB) GP Governing Body Member NHS Southend CCG Dr Alex Shaw (AS) GP NHS Southend CCG People in attendance Associate Director Children & Young NHS Southend CCG Caroline McCarron (CMC) People Dr Syed Aum Muhammad (SAM) F2 Doctor Southend Public Health Becky Pollard (BP) Interim Public Health Consultant Southend Public Health Sharon Judge (SJ) Executive Assistant (Minutes) NHS CP&R & Southend CCGs Apologies received from: Dr Mark Metcalfe GP Governing Body Member NHS CP&R CCG

3.6 - The current GP and pharmacy contract has been extended for a further 12 months

Page 1 of 5 to allow the service to integrate across Mid and South East Essex. 2.2 The Action Log was updated as attached. 3 ICE Update 3.1 JC reported that the planned upgrade to ICE had been delayed and no information had been provided on when it would take place. Once done this will give equity of access to all clinicians. JC is progressing this and will provide an update when available. 4. Clinical Interface Meeting – Agenda Setting 4.1 The Clinical Interface Group (CIG) is a long-established group and community colleagues are now attending. Stuart Harris, Chair of this meeting is keen for the agenda to focus on the interface between primary care and the hospital and pathway development. A question was put to members on how to influence the discussion at these meetings.

TD said that stroke services, the restoration of outpatient services, RTT and Lighthouse are all big issues at the moment. 4.2 There have been a number of conversations at CEC regarding strengthening communication across all services and a number of professional forums are in place. However, they do not appear to deliver what is needed to enhance services to our local population. 4.3 TD suggested that a forward planner for CIG should be done for the coming year and JC to work on JC recommended digital and radiology as the first two specialties for discussion. forward planner/invite Stuart Harris to be invited to the next meeting. Stuart Harris 4.4 TD asked for suggestions on how to strengthen CIG to improve the relationship between primary care and the hospital and asked colleagues who would be happy to attend and feedback.

BH said that he attends CIG and his suggestion would be to focus on 3-4 specialities per year in order to dedicate enough time to see them through to a satisfactory conclusion for both primary and secondary care. He added that discussions be honest and the hospital must tell GPs when they need to do things differently and referrals into the hospital should be screened before appointments are arranged. It was agreed that this approach could help identify and improve issues for both sides.

SW agreed that it needed to be a two-way process and said that the new Trust structure covering the three sites seems to be reasonably represented at meetings and added that clinical leads for specialities being discussed should attend their respective meetings. 4.5 SO reported difficulties in making referrals into radiology as it is not possible to do this SO to email electronically or by fax. details to TD 4.6 AS brought up Advice and Guidance and the fact that practices do not routinely receive JC to look notifications when a request has been actioned which means secretaries have to go into into this each individual request daily to check, this creates extra work and highlights that this problem should be addressed. 4.7 JC said that he has been attending CIG for some time now and finds the meetings very helpful but agreed the structure could be improved. 4.8 BK felt it was important for practices to know what GPs are representing them so that they can contact them directly regarding issues. It is also important for GPs to know what each department is doing, whether face-to-face appointments are being offered along with the length of the waiting list. He went on to say that dissemination of information is the biggest problem so whoever represents CIG takes on the responsibility of sharing all information and feeding back to colleagues. 4.9 TD highlighted that after the last spike in Covid cases a request came from CEC JC to speak members for an overview of waiting times and referral numbers for each discipline and to EH this can be repeated if they wish. 4.10 CIG minutes to be shared with CEC members and be a regular agenda item. SJ

Page 2 of 5 KB felt that CEC members should influence agendas in addition to the minutes as a standing item on CEC agenda. We need to decide what our priorities are for the CIG agenda and the clinical lead should attend their respective sessions. 4.11 ASI groups have been established and a GP has been aligned to each group to focus JC to look at on the reset in identified areas. membership with EH 4.12 AS said that Telederm had commenced this week and lots of other digital things are in the pipeline but we should be looking at what is coming out of the hospital and how we support them. 4.13 AS felt it was important to be clear on our Digital Strategy for the next 2-5 years as practices will certainly carry on with virtual appointments. PK to be invited to AS went on to say that there had been positive feedback on AccuRx which has been future CEC to funded for the next year. TS reported that as digital lead across the five CCGs he is give update involved in writing the Digital Strategy and it is clear the system is going to be under on digital pressure to make big savings in the future. 4.14 TS said that one procurement that involved all five CCGs is DoctorLink. A big concern is whether practices will engage but we lots of hard work is taking place to improve primary care engagement. 4.15 TD asked GP colleagues to submit an Expression of Interest if they would like to be involved in the professional forum. The invite will be extended to PCN Clinical Directors and whoever commits will have accountability to feed discussion back to colleagues. 4.16 TD went on to say that a paper had been brought to the committee in relation to establishing a professional forum. After further discussion it was agreed that it would be good for optometrists and dentists to be involved in this. Membership already includes primary care, acute, mental health, providers and social care practitioners. The paper has since been shared with partners and has been widely supported. A meeting will be going in the diaries within the next few weeks. TD asked who would like to represent this group at the forum. 5. Population Health Management 5.1 JS referred to slides presented at TTL on Population Health Management. South East Essex will lead on this programme of work that aims to build on current successes. It is therefore really important that successes are shared will all colleagues. 5.2 The current preparedness and stakeholder stage will move on to delivery at the end of June. JS said that there will be lots of support available for the next six months and it would be good to make the most of this opportunity. 5.3 Sign up from practices has been very good and JS advised GP colleagues that they could be called into the process depending on the specialities being discussed. 5.4 KB said that she thought the presentation was very informative and was pleased to hear about the progress that has already been made. PCNs will be able to look at their own data and sessions will be arranged for them where they will be able to invite other colleagues should they wish to do so. 5.5 BP would like to be involved with the PCN sessions and went on to say how important it is that Mid and South East Essex share learning experiences as things progress. BP has spoken to Tandra Forster who is keen on local authority engagement with the process and stakeholder events. 5.6 TD emphasised that stroke, AF, lung cancer, mental health, employment, heart disease all need to be looked at across MSE and asked that any concerns about progress are escalated at CEC. 5.7 The key to success will be good communication and AB has been speaking to all practices in relation to signing an agreement to share data with AGEM. This piece of work is expected to be completed soon. 5.8 TD suggested developing a newsletter for all practices but as we are nearly in a position to share information across the whole of the MSE it would make sense to wait.

LS kindly agreed to assist with the message that will be published in the newsletter. 5.9 AS said that if we look back three years ago we were having face-to-face meetings and

Page 3 of 5 then Covid hit and now primary care have WhatsApp group and practice managers are meeting via MS Teams. We are working as one team and are helping each other out and this has had a positive impact on PCNs. We have been forced to make changes and everyone has embraced it well. TD to look The challenge now is to get to the same point with all professionals and AS asked into NHS whether there was a tool that could make it possible to link with different services. TD Futures and referred to NHS Futures and wondered if this could be explored. feedback 5.10 JS highlighted that the next step was for the Stakeholder Plan to go to the Alliance. 6. Respiratory Hubs 6.1 SW gave a brief overview of two respiratory hubs that were commissioned in Hawkwell and Thorpe Dean. Both hubs were well utilised until August 2020 when numbers started to reduce. At this point, the decision was taken to close the Hawkwell site but keep the Thorpe Dean site open. 6.2 Following feedback a Service Specification was written so that all sites across Mid and South East Essex followed the same process. 6.3 The data shared applied to Southend only and was by practice outlining that face to face appointments have increased. The latest data shows that infection number appear to be mainly people aged under 40. 6.4 The cost of running the hubs is very high and Covid funding does not exist anymore. Capacity Expansion Fund is available and could be used but SW felt that it would be more sensible to spend it on something that gives more benefit to the local population. 6.5 CP&R are not using the service but practices that show high referrals will be asked what support they need once the hub has closed. 6.6 SW recommended that the service be decommissioned as quickly as possible and confirmed that Commisceo have reduced the number of appointments available and are able to close within a couple of weeks. 6.7 The Joint Clinical Executive Committee APPROVED the recommendation to decommission the hubs as quickly as possible. 7. TTL Feedback 7.1 TD reported that TTL agendas and speakers have been arranged last minute with minimum clinical support. TTL is a very important session as it allows practices to SO/TS to give engage with other colleagues. clinical support to After discussion, it has been agreed that there will be ten sessions per year; five CCG TTL run sessions and five in house sessions. It is important that the five CCG sessions are as informative as possible and provide practices with updated on pathway changes and any other updates to services. 7.2 Although there is a consistent model across MSE we still need local responsibility for TTL. 7.3 TD thanked SO and TS for offering to help with TTL and said that the agenda should be an agenda item at CEC so that we can influence topics discussed at TTL. 7.4 LS shared her concern that with only five CCG sessions it gave few opportunities to get messages across to practices and stressed that these sessions must be well planned and meaningful. 8. Any Other Business 8.1 JC stated that MSE are experiencing high cardiology demand and asked if anyone had similar experiences. KB reported increased demand and long waits for Advice and Guidance and BH added that mental health is experiencing very high demand.

JC informed committee members that MSE has made the decision to close Physio JC to Direct and replace it with a dedicated hospital line. They hope that this will make the feedback process quicker for patients, more details to follow. concerns to hospital. It was widely agreed that this appeared to be a backward step and JGL wanted know why they had made this decision without discussing it with primary care. BK felt this decision would add to the workload in primary care.

Page 4 of 5

TD asked if colleagues were confident that patients in the system in trauma and orthopaedics had access to physio.

8.2 KB highlighted that referrals for Fibromyalgia are being rejected by rheumatology which highlighted the need to have regular updates on changes that are made.

KB also reported that opticians and dentists are telling patients to visit their GP for the medication that can be brought over the counter and asked if a communication could be sent out asking them to advise patients to buy medications over the counter. SW suggested contacting local committees for the opportunity to discuss further.

8.3 As there were no other items for discussion the Chair closed the meeting at 2:40pm

Date of Next Meeting: Thursday 6th May, 2021, 1pm – 2.30pm

via Microsoft Teams

Page 5 of 5

NHS Castle Point & Rochford CCG & Southend CCG Joint Clinical Executive Committee Thursday 6th May 2021, 1.00pm – 2.30pm Microsoft Teams

MINUTES

Members dialling in that sit across Southend CCG and Castle Point & Rochford CCG: Simon Williams (SW) Director of Partnerships & Integration NHS CP&R & Southend CCGs James Currell (JC) Associate Director Assurance NHS CP&R & Southend CCGs Members dialling in from Castle Point & Rochford CCG Dr Sunil Gupta (SG) GP Governing Body Chair (Chair) NHS CP&R CCG Dr Riz Khan (RK) GP Governing Body Member NHS CP&R CCG Dr Mahesh Kamdar (MK) GP Governing Body Member NHS CP&R CCG Dr Biju Kuriakose (BK) GP Governing Body Member NHS CP&R CCG Dr Mark Metcalfe (MM) GP Governing Body Member NHS CP&R CCG Dr Lucy Saville (LS) GP Governing Body Member NHS CP&R CCG Dr Sami Ozturk (SO) GP Governing Body Member NHS CP&R CCG Members dialling in from Southend CCG Dr Kelvin Ng (KN) GP Governing Body Member NHS Southend CCG Dr Brian Houston (BH) GP Governing Body Member NHS Southend CCG Dr Krishna Chaturvedi (KC) GP Governing Body Member NHS Southend CCG Dr Sharon Hadley (SH) GP Governing Body Member NHS Southend CCG Dr Mark Metcalfe (KB) GP Governing Body Member NHS Southend CCG Dr Taz Syed (TS) GP Governing Body Member NHS Southend CCG People in attendance Stuart Harris (SHA) Medical Director SUHFT Charlotte Dillaway (CD) Director of Operations SUHFT Suzie Burt (SB) Healthy Workplace Co-Ordinator Everyone Health Amy Young (AY) Service Manager and Nutritionist Everyone Health Becky Pollard (BP) Interim Public Health Consultant Southend Public Health Sharon Judge (SJ) Executive Assistant (Minutes) NHS CP&R & Southend CCGs Apologies received from: Dr Brian Houston GP Governing Body Member NHS Southend CCG

1 Welcome and Apologies 1.1 The Chair welcomed everyone to the Joint Clinical Executive Committee. 1.2 Apologies were noted as above. 2. Update from SUHFT 2.1 SHA shared a presentation on the Future Operating Model Transition highlighting key points. 2.2 Three hospital sites merged into four key groups on 1st April: Group 1 - Basildon Hospital Group 2 - Broomfield Hospital

Page 1 of 3 Group 3 - Southend Hospital Group 4 - Pathology, Radiology and other therapies

The groups are operating as one single clinically led organisation to deliver standardised services across all sites and is cost neutral. 2.3 Structure charts for each group were shared and showed that each site would have a director and clinical lead for each specialty. 2.4 JC suggested linking commissioning managers at place and system level with their counterparts at the hospital so that they could have introductory conversations. 2.5 KC asked how primary care would escalate any issues and SHA replied that primary care is a local issue and therefore would need to go through local leads but if this could not resolve the issue it could be escalated to SH. SHA stressed that the essence of success will be communication and good relationships. 2.6 SHA reported that strategy meetings take place monthly and are looking at clinical strategy and input from primary care and patients is essential to this. It was widely agreed that it was important to include primary care at the planning stage of protocols 2.7 SHA agreed to come back to CEC in two months’ time with update SJ 3 Think NHS 111 Update 3.1 EH provided feedback following the Think NHS 111 Initial Evaluation Report. The paper was taken as read and EH highlighted key points. 3.2 The MSE Think 111 Programme Board was established last summer to oversee the delivery of the local programme. The reporting structure and key objectives of the Board were presented. 3.3 Two workstreams were put in place to look at the pathways into acute and primary care. A key factor of the requirements was to increase NHS 111 capacity so that it was able to cope with the activity coming in from other channels including the ability to make direct referrals into primary, community and mental health services. 3.5 EH reported that there had been a 10% increase in the number of calls being validated by clinicians and a 2% reduction in people having to attend A&E for treatment as a result of this. Both the staff and patient surveys received positive feedback. 3.6 EH continues to be involved in the National Evaluation Programme and will provide further updates when available. 3.7 SG asked if there had been any problems directing appointments to GP practices and EH replied that performance varies across practices, but Nicola Goodey is in regular contact with practices. 3.8 JC pointed out that there has been a big increase in activity, but conversations are taking place and it is hoped that additional communications can go out to reaffirm the appropriate usage of A&E and accessing services properly. 4. Orthotics Services – Change of Location 4.1 CH shared a presentation on proposed changes at the hospital and taking the paper as read highlighted key points. 4.2 CH confirmed that the first floor of Cherry Tree Building is now open to patients and it is hoped that the first and second floors will open in June; Phase 2 plans are in progress. And is looking at improving respiratory facilities and moving the CT scan to the first floor

Proposed changes include: • Orthotics relocating to Valkyrie Road Primary Care Centre – Kerry Harding and the primary care team are involved in discussions • Phlebotomy moved from Fair Havens back to the hospital in April – Fair Havens may be used for other services • Victoria Circus is being explored as it offers improved access for patients • Discussions are taking place for Audiology to move to Thamesgate House

4.7 SG asked if there were any capital investments and CD said that money is available for front door expansion only. However, plans are in place in preparation for capital that may become available later in the year. 5. PH – New Health Check delivery model

Page 2 of 3 5.1 Suzie Burt and Amy Young from Everyone Health were present for the update on the new health check delivery model. 5.2 Health checks were suspended in February and a new approach is now proposed to focus on health inequalities. All practices will be required to sign up to Health Options and those with higher deprivation scores will have higher targets. 5.4 Everyone Health have access to the system that allows them to identify patients with the highest risk of heart disease. Health Check Co-ordinators will support practices with outreach health checks on patients that would not normally take up the invitation to have a health check. 5.5 Public Health are currently reviewing the service specification with the assistance by BH and TS and the purpose of bringing the proposal today was to start the programme as soon as possible. 5.7 KNg asked if Everyone Health would be doing the health checks and SB replied that they would help identify patients but would not be doing any of the checks. 5.8 AM said that software allows Everyone Health to send out invites to lighten the admin burden at the practices. First and second invitations would be sent by letter and text message. Everyone Health will not be making telephone invitations. 5.9 DS added that Provide run health checks system for Essex County Council and can arrange for health checks to be undertaken by pharmacies and outreach. They can also manage the call and recall process. 5.10 Kelvin asked if other patients can be invited by practices when their health checks are due, and SB confirmed that Everyone Health will only focus on high risk groups. 5.11 BP confirmed that if practices carried out health checks for low risk patients, they would still receive payment. 5.12 DS agreed to look at data to see if he can identify patients that were invited but chose not to attend. 6. Minutes & Actions from last meeting 6.1 The minutes from the meeting held on 15th April were approved as an accurate account of the discussion. 6.2 The Action Log was updated as attached. 7. Any Other Business 7.1 MM asked for an update on Doctorlink. SW to pick up with Rob Hunt after meeting. To be added to action log. 7.2 MM asked whether the long Covid clinics could arrange blood tests themselves. They SH to are prescribing unlicensed medication and tests that are not appropriate. circulate BMJ guidance on prescribing inhalers 7.3 SH suggested looking at the current HR system as it appears to be inefficient. SW SW/SH to advised that there have been many changes in HR, but he was concerned to hear that discuss doctors are having problems with payments. outside of meeting 7.4 JC said that he would circulate the summary physio direct presentation after the meeting and would give an update at the next meeting. 7.5 Kelvin raised concerns that Covid vaccination sites are recording incorrect data into patient notes and asked if anything could be done to address this. MM added that they are also entering incorrectly which jab a patient has had which could be a safety issue. 7.6 JC recognised the complicated hospital structure presented by SHA and offered to support in any way he could. 7.7 As there were no other items for discussion the Chair closed the meeting at 2:35pm

Date of Next Meeting: Thursday 20th May 2021, 1pm – 2.30pm

via Microsoft Teams

Page 3 of 3

Patient and Community Reference Group Minutes

Date: 19 January 2021

Time: 10.30am 11.30pm

Venue: MS Teams

List of attendees Ann-Marie Fordham (AMF), Chair (in alphabetical order): Susan Baillie – Patient Representative Castle Point James Currell (JC), Director of Operations Brian Dawburn (BD) Patient Representation Rayleigh/Rochford Kath Daly (KD), Patient Representative Castle Point Janis Gibson (JG), Lay Member for Patient Participation John Hall (JH), Patient Representative Castle Point Cheryl Kirby (CK), Patient Representative Castle Point Barbara Oliver (BO), Patient Representative Rayleigh Claire Routh (CR) Head of Communications and Engagement Amanda Shears (AS), Patient Engagement Officer / Minutes Julia Skelton (JS), Patient Representative, Rayleigh/Rochford

Apologies (in alphabetical order): Sam Glover (SG), Public Health/Healthwatch Essex Lorraine Holditch (LH), Patient Representative Rayleigh Kathleen Leech (KL), Patient Representative Rayleigh and Rochford Victoria Marzouki (VM), RRAVS Colleen Mortensen (CM), Health Engagement Officer, Carers First

Item Subject Action

1. Welcome and Apologies

The Chair welcomed attendees to the meeting and apologies were noted above.

2. Draft minutes dated 17 November 2020 and matters arising

The draft Minutes dated 17 November 2020 were reviewed. AS to make the following amendment:

Page 2, agenda item 4 correct misspelling relating to James Paget Hospital.

Once this amendment had been made it was agreed the minutes provided an accurate reflection of discussions.

JS requested an update regarding the Hockley Phlebotomy Clinic. ACTION: AS to invite a representative from Pathology First to a AS future meeting to give a local update regarding phlebotomy services.

3. Action log

Due to the focus of today’s meeting review of the action log was deferred.

4. Systemwide Update

Following the Mid and South Essex Health Partnership’s declaration of a major incident on 29 December 2020 today’s meeting would focus on the current system pressures and the local response.

James Currell, Director of Operations attended the meeting to give an update on the systems response to the Major Incident as detailed in a presentation which was shared after the meeting.

The following key points were noted:

• Increase in demand in the acute with reduction in workforce which remains a significant challenge.

• Additional ‘step down’ community beds in Rochford, Braintree and Thurrock to support discharge.

• Significant increase in Covid 19 infections in care homes across Mid and South Essex.

• Primary Care colleagues are supporting with pathways out of the acute to minimize patients staying in hospital any longer than they need to.

• Cancer screening on hold.

• ‘Out Patients’ closed to free up staff and restrict patients going onto site.

• National key messages need to be maintained to prevent the spread of the coronavirus - ‘Hands, Face, Space’ and ‘Stay at Home’.

KD referred to the increase in Covid in carehomes and asked whether they had received the Covid vaccination. JC confirmed that colleagues are following national guidance and reassured KD that the CCG are in

contact with care home staff on a daily basis to understand how they can offer the appropriate support.

KD asked whether there were plans to vaccinate wardens supporting those residents living in sheltered accommodation. JC confirmed there had been a number of similar requests about how we vaccine people who are supporting the system. JC explained that vaccines are rationed to an extent and the programme is following the national priority lists. However to ensure there was no vaccine wastage discussions were taking place to identify specific cohorts of people who would benefit from having the vaccination.

KD gave praise to the Canvey Island Covid vaccination clinic and asked when the next batch of vaccines would be delivered JC confirmed that there was no specific date but patients would be contacted when supply was available.

JS thanked James and all colleagues cross the system for their fabulous work supporting the pandemic. JS paid tribute to all the people that had sadly passed away in the course of duty and suggested that the Government should consider paying tribute by holding a day of remembrance.

SB referred to the National prioritisation groups and questioned which cohort the Police fall into. CR confirmed a meeting had been arranged that afternoon to discuss a Single Point of Access for staff, frontline workers and volunteers and information would be shared once the process had been approved. JG and BO fully supported these discussions.

CR referred to the Key Messages outlined in the presentation and asked that members of the group help share these messages within their local groups and communities.

SB gave her personal experience of the pandemic and highlighted some of the issues her and her family had experienced whilst shielding/self isolating. This led to a suggestion that it would be helpful to be able to share information of what to do in case of emergency as an alternative to calling 999 for those people who were self isolating/shielding. JG will liaise with CR outside the meeting regarding the support CAVS are able to offer. ACTION: AS to share information relating to Ways to Wellness 01268 214000 [email protected] and other support services offered by CAVS .

With regard to selfcare JS added that the conditions associations also provide helpful information for specific conditions.

AMF had also heard reports that people were turning up for a vaccination without being invited. CR confirmed that on the very rare occasion that there is spare vaccination GPs can to vaccinate staff members/volunteers to avoid wastage.

SB requested a copy of a directory of acronyms and details of how the vaccination is cascaded. ACTION: AS to provide

BD gave praise to the Rayleigh PCN Covid Vaccination programme which is currently being coordinated from the Audley Mills Surgery.

SB raised her concerns regarding the use of the Benfleet Clinic as a Covid Vaccination clinic due to its restrictions. CR confirmed that every venue undergoes a stringent approval criteria set by NHS England. BO suggested information could be shared as to why a specific venue is chosen.

CR confirmed that a video would shortly be available to share via social media with a GP answering questions raised by local residents regarding the Covid Vaccination Programme.

KD thanked CR for an informative meeting and asked for a copy of the papers to be posted to her. KD also asked for further information regarding Oximeters and where these could be purchased. ACTION: AS to action.

Date of next meeting venue and time: 16 March 2021, 10.30am – 11.30am MS Teams Click here to join the meeting Or call in (audio only) +44 20 3321 5208, 546076973# United Kingdom, London Phone Conference ID: 546 076 973#

Patient and Community Reference Group Minutes

Date: 16 March 2021

Time: 10.30am 11.30am

Venue: MS Teams

List of attendees Ann-Marie Fordham (AMF), Chair (in alphabetical order): James Currell (JC), Director of Operations Brian Dawburn (BD) Patient Representation Rayleigh/Rochford Kath Daly (KD), Patient Representative Castle Point (by telephone) John Hall (JH), Patient Representative Castle Point Larrisa Kerridge, Healthwatch Essex Cheryl Kirby (CK), Patient Representative Castle Point Barbara Oliver (BO), Patient Representative Rayleigh Claire Routh (CR) Head of Communications and Engagement Amanda Shears (AS), Patient Engagement Officer / Minutes Simon Williams (SW), Director of Partnerships and Integration

Apologies (in alphabetical order): Janis Gibson, Chief Executive Officer (JG), CAVS Victoria Marzouki, Chief Executive Officer (VM), RRAVS

Item Subject Action

1. Welcome and Apologies

The Chair welcomed attendees to the meeting and apologies were noted above.

It was noted that due to technical issues Janis Gibson was unable to join the meeting.

2. Draft minutes dated 19 January 2021 and matters arising

The draft Minutes dated 19 January 2021 were reviewed and it was a

greed represented an accurate account of discussions.

There were no matters arising.

3. Action log

The action log was reviewed and current status noted.

4. Systemwide / Covid Vaccination Update

James Currell, Association Director of Operations (JC) and Simon Williams Director of Partnerships and Integration/Executive Lead for the local Covid 19 Vaccination programme (SW) had been invited to attend the meeting to provide an update to the Covid 19 incident response and the local vaccination programme. The presentation accompanying discussions had been circulated prior to the meeting.

JC referred to the presentation and advised that the current number number of confirmed Covid 19 cases across all Mid and South Essex hospitals had seen a further reduction from 373 to 106.

Sickness absence across the system had also seen a reduction. However, it was noted that staff had been reminded to take their annual leave by the end of March 2021 and this could potentially impact on workforce capacity over the next four weeks.

JC thanked members for their support in reinforcing messages regarding how to use services during the pandemic which had seen significant benefits.

BD suggested that the system should consider extending outstanding annual leave in order to minimize the impact on workforce capacity.

JH asked when services could expect to return to normal. JC acknowledged that the pandemic had a significant impact on 18 week wait targets and confirmed that work is currently underway to look at waiting lists. Plans were in place to prioritise patients appropriately depending on clinical need although processes were yet to be agreed.

Although Cancer remains a challenge recent Harm Reviews indicated that there had been very little potential harm caused to patients who had been awaiting cancer treatment during the pandemic.

Simon Williams made reference to the information contained within the presentation regarding ‘getting you second dose of the Covid 19 vaccine” and explained the importance of people having their second vaccination at the same site as their first dose.

CR provided an update regarding the Covid 19 hesitancy campaign as outlined in the presentation which included exploring opportunities to introduce small grants to empower the community to identify their own solutions to encourage uptake of the Covid 19 vaccination.

CR advised that recent local data suggests that over 90% of people over 70 years of age have accessed the first dose of the Covid 19 vaccination. Anyone from the top four priority cohorts who had not had their Covid 19 were urged to contact their GP.

CK referred to earlier discussions regarding where to obtain your second dose. It had come to her attention that people were accessing their second dose via the Covid 19 vaccination online booking system and booking their appointment at the community pharmacy as they hadn’t heard from their GP.

SW confirmed that surgeries are being encouraged to send messages reassuring patients that they will be contacted shortly and should wait. SW explained that unfortunately, the online system is not sophisticated enough to stop people booking their second dose at a different site and emphasized the importance of encouraging patients to have the same vaccination for both doses.

KD advised that despite the recent news pertaining to the temporarily suspension of the Atra Zeneca Covid 19 vaccine she was still actively encouraging people not to be concerned and to go ahead and have their vaccination when it was their turn.

In response to AM’s question SW confirmed that the first and second dose of the Covid 19 vaccination are the same.

In response to JH’s question SW confirmed that the National team only allow us to share certain information. Decisions have yet to be made with regard to whether we continue using Primary Care Network sites or mass vaccination sites going forward. It was acknowledged that it was important that GPs were able to return to looking after patients on a day to day basis. The same could be said for the Mass vaccination sites which will also need to return to business as normal over the coming months therefore the system needs to find a longer term solution.

SW explained that decisions had yet been made with regard to the future frequency of having the Covid 19 vaccination.

BD asked whether we were able to pinpoint the areas of low uptake referring particularly to female carers. CR confirmed that local data suggests lower uptake in Southend. Data also suggested that both Nationally and locally there had been lower uptake in cohort six. Issues regarding the impact on fertility was also a concern and CR shared the following link during the discussion in order to help dispel any myths. https://www.gov.uk/government/publications/covid-19- vaccination-women-of-childbearing-age-currently-pregnant-planning-a- pregnancy-or-breastfeeding/covid-19-vaccination-a-guide-for-women- of-childbearing-age-pregnant-planning-a-pregnancy-or-breastfeeding.

PS directed a question to SW regarding the eligibility for people with asthma. CR provided the following National guidance

An individual with a more severe case of asthma may have been included in the Clinically Extremely Vulnerable group, in which case they will be vaccinated in group 4.

People with asthma which requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, will be vaccinated in priority group 6.

This will include:

• anyone who has ever had an emergency asthma admission or; • those who have an asthma diagnosis and have had 3 prescriptions for oral steroids over a 3-month period (each prescription must fall within separate individual month windows), as an indication of repeated or continuous oral steroids."

PS asked for this guidance to be reiterated to GPs. ACTION: AS to ensure guidance is included in the GP bulletin.

Round robin

AM had been contacted by Kirsty O’Callaghan Head of Changing for Communities at Essex County Council to help coordinate NHS volunteers across Essex to help with both the Covid 19 testing and vaccination sites. Two thousand five hundred volunteers came forward across Essex.

JH shared his thoughts with regard to possible patient online booking systems for consideration as part of the wider Primary Care Digital Strategy. CR confirmed that insight from Healthwatch Essex following research into patient experience pertaining to digital exclusion would feed into the Strategy. ACTION: CR will share the draft strategy with JH for his thoughts.

CK highlighted her concerns that there was not a National screening programme for Postrate Cancer despite it affecting so many men. CR suggested CK raise this with her local MP on behalf of the group as this was a National decision and out of the CCG’s control.

CR referred to the upcoming National Day of Reflection that would take place on 23 March 2021 to pay tribute to those we have lost during the pandemic. In Essex this amounts to approximately 5000 Covid 19 related deaths. CR asked members of the group to promote a Facebook frame with their networks which would be shared shortly ACTION: Members of the group to help promote the National Day of Reflection by sharing Facebook frame on social media

Date of next meeting venue and time: 18 May 2021, 10.30am – 11.30am

Southend CCG Patient and Community Reference Group 16 February 2021 at 10.30am – 11.30am MS Teams

MINUTES

In attendance: Chris Gasper CG Deputy Chair/PPG Central Surgery Loretta Andrews LA Patient Participation Group Member Thorpe Bay Surgery Dawnette Fessey DF Chief Executive Southend Carers Patient and Public Involvement Lay Janis Gibson JS Southend CCG Member Breatheasy/Care Cars/St Lukes May Hamilton MH Patient Participation Group Member PPG Sally Carr SC Patient Participation Group Member Thorpe Bay Surgery Head of Communications and Castle Point, Rochford and Claire Routh CR Engagement, CCG Southend CCGs Castle Point, Rochford and Amanda Shears AS Patient Engagement Officer/Minutes Southend CCGs Apologies: Kristina Jackson Chair Tricia Cowdray PPG Representative, Shoebury Medical Centre Marija Seager PPG Representative, Valkyrie Surgery

1.0 WELCOME AND APOLOGIES 1.1 CG welcomed everyone to the meeting noting that today’s meeting would focus on the local Covid 19 response and vaccination programme. 1.2 Apologies were noted as above. 2.0 APPROVAL OF DRAFT MINUTES DATED 17 DECEMBER 2020 2.1 The draft minutes dated 17 December 2020 were reviewed. MH noted discussions pertaining to Covid 19 death rates by age group as highlighted in Dr Pankhania’s presentation. ACTION: AS to include the following information to the draft Minutes:

The death rate from catching flu is 0.1%.

Covid is more harmful to those over the age of 50. The rate of deaths for those catching Covid aged 50 - 59 is 1.3% The rate of deaths for those catching Covid aged 60 - 69 is 6% The rate of deaths for those catching Covid aged 70 - 79 is 8% The rate of deaths for those catching Covid aged 80+ is 15%

The minutes would be agreed as an accurate reflection of discussions Page 1 of 4

following the above amendment. 3.0 MATTERS ARISING 3.1 There were no matters arising 4.0 ACTION LOG 4.1 Outstanding actions on hold due to focus on pandemic.

Action 29 : LA advised that the Rotarians had raised £16,000 towards additional defibrillators for Southend seafront. 5.0 COVID 19 UPDATE James Currell, Associate Director of Operations and Jenni Speller, Director of Primary Care had been invited to the meeting to provide an update to the Covid 19 incident response and the local vaccination programme as outlined in Southend CCG - the attached presentation which was shared with members following the Covid 19 System update_CR (002).pptx meeting.

JC confirmed that the number of Covid patients across all three Mid and South Essex hospital sites equated to 373 (Southend – 113 /22% of bed base) compared to 900 at the beginning of January 2021.

JG enquired as to the level of support offered to Covid patients once they had been discharged from hospital. JC confirmed that there were discharge pathways in place for the frail and elderly by way of step-down facilities (Priory House, Cumberlege Intermediate Care Centre, Brentwood Hospital and Braintree Hospital).

CR noted that Oximetry meters were also being used to enable people to self- manage their oxygen levels at home upon discharge from hospital.

JS provided an overview of the local Covid vaccination programme which included information regarding the PCN and mass vaccination sites and the current progress with regard to four priority groups and care homes. JS advised that the vaccination programme remained the priority focus for primary care and the CCG. Acknowledgement was given to local partners (Southend Borough Council (SBC) and Southend Association of Voluntary Services (SAVS) along with Clinical Commissioning Group, Primary Care Network staff and volunteers who had been deployed to support the roll out of the vaccination programme

JS advised that the programme was now focusing on the second phase of the vaccination programme - those under the age of 70 and those who were identified as being ‘high risk’ which included learning disabilities. There were also plans to start offering people their second dose however this would be determined by the vaccine supply. It was noted that all local vaccination sites remained open and ready to administer the vaccination however this was determined by the current supply of vaccinations.

MH raised concerns on behalf of those people who were unable to travel to the vaccination sites offered to them and asked why they couldn’t attend a site which was closer. JS advised that the PCN hubs were offered to all patients belonging to that PCN. However due to strict clinical governance and the quality assurance guidelines PCNs were unable to extend the offer outside of their PCN. JS confirmed that another appointment would be offered if the initial appointment was not convenient.

Similar to the concern already raised regarding patient transport MH also raised concerns for those people who had difficulty attending out of area hospital appointments. JC confirmed that the Patient Advice Liaison team at the hospital would be able to investigate individual cases to ensure transport Page 2 of 4

options have been discussed.

SC felt that the vaccination programme had on the whole been very successful however she was concerned that some people may fall through the net echoing MH’s concerns raised regarding logistics of attending some of the venues offered.

CR reflected on the current situation and agreed that the programme does have its challenges however it was important to note that over the last 10 weeks 15,000,000 vaccinations had been delivered across the UK and credit should be given to all those who are involved. It was also noted that there had been a lot of positive community engagement which had involved Southend residents regarding the vaccination and local response.

CG reinforced the positive message regarding the local vaccination programme and the amount of hard work afforded by all those involved. A question was raised regarding whether you would be invited to the same venue for your second dose.

There were discussions in connection to mixing Covid vaccinations. JS advised that every effort would be given to provide a person with the same vaccine. However, guidance from the Green Book advises that it is better to have the second dose in the timeframe stated therefore this would depend on supply.

6.0 ANY OTHER BUSINESS 6.1 Following discussions regarding Patient Participation Group (PPG) engagement MH advised that the St Lukes PPG had not met since 3 June 2019.

LA acknowledged the tremendous effort involved in the rollout of the Covid vaccination programme. LA was keen to explore opportunities for PPGs and primary care staff to work together to promote the benefits of PPGs.

CG noted the appetite for PPGs to work in partnership with the PCNs and confirmed that he would raise this when the pressures of the current focus on the vaccination programme are reduced.

SC echoed these discussions and welcomed opportunities for the PPG to be more actively involved with her surgery.

JS suggested that PPG representatives consider how they could support/contribute to their respective PCN development.

CR gave a brief update regarding the White Paper which was published on 11th February 2021 and sets out legislative proposals for a health and care bill. These proposals are designed to support our health and care system to work together to provide high-quality health and care, so that we live longer, healthier, active and more independent lives. Many of the proposals build on the NHS’s recommendations in its Long Term Plan. It was anticipated that the application for Mid and South Essex’s to become an Integrated Care System (ICS) would take effect from Spring 2022.

Following this publication, the previous proposals for a merged CCG is now likely to be replaced by new proposals to become an ICS NHS organisation. Feedback from previous public engagement workshops pertaining to the CCG merger will also be taken into consideration as part of the application process.

Date of next meeting: 20 April 2021 at 10.30am –11.30am Page 3 of 4

Page 4 of 4