Wednesday 05 July 2017 Time: 13:45 – 16:00Hrs Venue: Kingston House Room: Boardroom

Sandwell and West Birmingham Clinical Commissioning Group PUBLIC Meeting of the Governing Body

Date: Wednesday 05 July 2017 Time: 13:45 – 16:00hrs Venue: Kingston House Room: Boardroom

AGENDA

Non-Confidential – Please ensure your phone is on silent throughout the meeting.

This meeting will be held in public and will be recorded purely as an aide memoir for the minute taker to ensure an accurate transcript of the meeting, decisions and actions. Once the minutes have been approved the recording will be destroyed. All care is taken to maintain your privacy; however, as a visitor in the public gallery, your presence may be recorded. Should you contribute to the meeting during questions from the public, you agree to being recorded.

No Subject Lead Time

INTRODUCTION

1. Apologies for Absence: Mr A Williams, Dr Ian Verbal Professor N Harding 13:45 Sykes, 2. Declarations of Interest Verbal Professor N Harding 13:50 To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item.

3. Minutes of Previous Meeting held on Wednesday 1 Professor N Harding 13:55 03 May 2017 4. Action Register 2 Professor N Harding 14:00 5. Questions from the Public Verbal Professor N Harding 14:05 6. Chairman’s Report Verbal Professor N Harding 14:06

7. Performance 7.1 Quality and Safety Committee Report 3 Dr S Mukherjee / Mrs C Parker 14:10 7.2 Finance Report 4 Dr V Bathla / Mr J Green 7.3 Performance Report 5 Mr J Green 14:20 • Urgent Care Report 7.4 Strategic Commissioning & Redesign Committee 6 Mr Richard Nugent 14:40 Report and NHS England Right Care 7.5 Audit and Governance Committee Report 7 Mrs Julie Jasper 15:00 7.6 Organisational Development Committee Report 8 Professor N Harding 7.7 Primary Co-Commissioning Committee Report 9 Mr R Sondhi 15:10

8. Governance and Business

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8.1 Evaluation of the PCCF 2016/17 10 Mr Andrew Harkness 15:20 8.2 Board Assurance Framework 11 Ms Michelle Carolan 15:25 8.3 Corporate Objectives 12 Ms Michelle Carolan 15:30 8.4 Minutes from the Black Country and West 13 Prof Nick Harding 15:40 Birmingham Joint Committee April & May 8.5 Integration of “placed based” health and care 14 Mrs Sharon Liggins 15:45 8.6 Single Commissioner Proposal for BSOL 15 Mrs Claire Parker 15:50

9. Minutes of Committees for Information (All minutes available on CCG Website) 9.1 Finance and Performance Committee Minutes 16 All 15:55 9.2 Quality and Safety Committee Minutes 17 9.3 Strategic Commissioning & Redesign Minutes 18 9.4 Audit and Governance Committee Minutes 19 9.5 Organisational Development Committee Minutes 20 9.6 Primary Care Commissioning Minutes 21 9.7 PPAG 22 9.8 Healthwatch Birmingham 2016/17 Annual Report 23

10. Minutes of Locality Commissioning Groups for Information 10.1 ICOF LCG Minutes 15:57 10.2 Black Country LCG Minutes 10.3 Pioneers for Health LCG Minutes 10.4 Sandwell Health Alliance LCG Minutes 10.5 HealthWorks LCG Minutes

11. ANY OTHER BUSINESS 11.1 Items to share with staff Verbal Professor N Harding 15:59

12. DATE AND TIME OF NEXT MEETING Wednesday 02 August 2017, Boardroom, Kingston House, 13:45hrs CLOSE OF MEETING 16:00

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Resolution adopted from the Public Bodies (Admission to Meetings) Act 1960: That those representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.

Guidance on Declarations of Interest

Definition of Interests A Governing Body/Committee member has a personal interest if the issue being discussed at a meeting affects the well-being or finances of the member, the member’s family, or a close associate more than most other people who live in the area affected by the issue. Personal interest are also things related to an interest the member must register such as outside bodies to which the member has been appointed by the CCG or membership of certain public bodies.

A personal interest is also a prejudicial interest if it affects the finances of the member, the member’s family or a close associate and which a reasonable member of the public with knowledge of the facts would believe it likely to harm or impair the member’s ability to judge the public interest.

Declaring interest If a member has an interest, they must normally declare it at the start of the meeting or as soon as they realise they have the interest. If a member has a personal and a prejudicial interest, they must not debate or vote on the matter and must leave the room.

Quoracy No business shall be transacted at a meeting unless there is at least one-third of the whole number of the Chair and member’s (including at least one member who is also an elected GP, one member who is a Chief Officer and one member who is considered independent (from the lay members, secondary care doctor, or registered nurse) is present.

Legend Accountable Officer – AO Chief Finance Officer –CFO Chief Officer, Operations – COO Chief Officer, Quality – COQ Chief Officer, Partnerships - COP

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Minutes of the Governing Body Meeting held in PUBLIC on Wednesday 07 June 2017, 14:07 – 16:07hrs, Boardroom, Kingston House

Professor Nick Harding Chair, Sandwell & West Birmingham CCG Chair Healthworks LCG Ranjit Sondhi Vice Chair

Mrs Joyti Atri Public Health Representative, SMBC Dr Ayaz Ahmed Vice Chair, Sandwell Health Alliance Dr Basil Andreou Chair, Sandwell Health Alliance Dr Sirjit Bath Vice Chair, Pioneers LCG Dr Sam Mukherjee Chair, ICOF LCG Dr Inderjit Marok Vice Chair, ICOF LCG Dr Ian Sykes Chair, Black Country LCG

Mr Jon Dicken Chief Officer, Operations Mrs Rachael Ellis Chief Officer, Emergency Mr James Green Chief Finance Officer Mrs Claire Parker Chief Officer, Quality Mr Andy Williams Accountable Officer

Mrs Julie Jasper Lay Member Mr Richard Nugent Lay Member Mrs Janette Rawlinson Lay Member

In Attendance: Ms Michelle Carolan Deputy Chief Officer, Quality Ms Helen Levitt Minute Taker Kiri Harbottle Arden & GEM CSU

Members of the Public: Ms Donna Mighty SWBH Mr Michael James IPSEN Dr Manir Aslam SWBCCG

Apologies Mr Jon Dicken Chief Officer, Operations Dr Ram Sugavanam Vice-Chair Healthworks LCG Dr Vijay Bathla Chair, Pioneers LCG Ms Therese McMahon Non-Executive Board Nurse

Absent without apologies

* part meeting

300/17 Declarations of Interest

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301/17 Members noted that prior to the meeting-taking place; a review of the conflicts of Interest checklist in compliance with the Conflicts of Interest guidance took place.

302/17 Mrs Jasper declared her role as a Board member and Audit Chair of Dudley CCG. No agenda items were identified as a conflict, therefore no mitigation was required.

303/17 A conflict of interest was declared regarding agenda item 7.4 SCR report. Regarding (i) Modality X-ray and (ii) prescribing for rheumatology. Prof Harding, Dr Sugavanam, Dr S Mukherjee and Dr I Marok, remained in attendance, but were excluded from discussions relating to this item.

304/17 Mr Williams declared a new interest regarding his role as Chair of the STP relating to agenda item 8.1 The Black country STP Partnership Memorandum of Understanding . Mr Williams confirmed an updated declaration of interest form will be submitted in order for the register of interests to reflect his new role. The STP has no formal decision making powers and is made up of 18 partner organisations; reflecting the collective view of the group. Therefore, Mr Williams was permitted to remain and present the paper regarding the proposed MOU.

305/17 Declarations declared by members of the Governing Body are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the governing body or the CCG website at the following link: https://sandwellandwestbhamccg.nhs.uk.

306/17 Minutes of the public meeting held on Wednesday 03 May 2017

307/17 The minutes of the public meeting held on Wednesday 03 May were accepted and ratified with the following amendments.

308/17 • The apologies of Mrs S Liggins to be noted. • 184/17 The CCG has achieved all 8 matrices of financial performance for the end of the year.

309/17 Action Register/ Matters Arising

310/17 The action register was discussed, completed actions were closed, uncompleted actions were deferred to the July meeting.

311/17 Dr Sykes updated members on action 1138/17, the action was closed.

312/17 Mr Green fed-back on action 221/17 and the action was closed.

313/17 Questions from the Public

314/17 No questions were presented for members.

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315/17 Chairs Report

316/17 Professor Harding spoke to this item and began by thanking NHS colleagues for their valuable support to the families of those that lost their lives during the terrorist incidents. The NHS remains a one of the key topics of the General Election with parties promising different ways to improve our health and care services.

317/17 Sandwell and West Birmingham Hospitals Trust have announced that the build of the Midland Metropolitan Hospital will be delayed for up to 6 months due to construction issues.

318/17 The Collaborative Commissioning Committee are working to compliment the STP agenda, the committee continue to meet monthly as the statutory mechanism by which the four CCGs make collaborative decisions on commissioning services across the Black Country.

319/17 In the news, experts have warned that the cost of treating Type 2 diabetes has risen to £10billion a year. Sandwell and West Birmingham CCG are working with practices to promote a new Diabetes Prevention programme launched by NHS England.

320/17 Prof Harding attended the HSJ Value in Healthcare Awards in June, the CCG were shortlisted in four catergories: Improving the Value of Primary Care Services, Pharmacy and Medicine Optimisation, Training and Development and Internal Communications. The CCG weren’t lucky enough to receive any awards, however Prof Harding congratulated the teams nominated for all their hard work and dedication.

321/17 Finally Prof Harding reported that the WWII bomb uncovered in Aston was safely detonated and thanked Church Road surgery who were part of the 500 meter cordon and had to move premises. The surgery did an amazing job redirecting patients to see them in an alternative location.

322/17 Mrs Jasper asked that members are briefed on the preparedness of the CCG in the event of a terror attack. Mrs Ellis offered to bring an interim report to next month’s meeting, however a report is already scheduled for September. 323/17 • Resolution: The Governing Body received the report for information. • Action: Mrs Ellis to present a report at the September meeting regarding EPRR

324/17 Quality Report

325/17 Dr Mukherjee presented the report, which highlighted data until the end of April 2017.

326/17 Primary Care 327/17 The incident-reporting rate at CCG member practices has fallen since October 2106; no new trends have been identified. There were four contract-monitoring visits in April 2017. Dr Mukherjee reported that all visits are done on a random basis. No significant concerns were identified.

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328/17 Sandwell & West Birmingham Hospitals 329/17 Safety Thermometer data currently stands at 94%. Dr Mukherjee reported on the planned introduction of clinical software to make recording of VTE mandatory to ensure the Safety Thermometer remains at 95%. Members noted that patient falls and pressure ulcers continue to be monitored and discussed at every CQRM meeting. No concerns were raised regarding mortality data. The CCG are working retrospectively with the Trust to track deaths following discharge. There were 4 mixed sex accommodation breaches in March 2017, from which learning points have been taken.

330/17 Emergency care performance rates remain a concern at the trust. Dr Mukherjee reported on the recruitments of Consultants to the ED. Data showed a slight improvement on referral to treatment times. Infection control rates remain below the trajectory.

A table top review is being undertaken following Mrs Parker reported on a ‘never event’ from a 331/17 provider; the findings will be shared and documented in a future report. Mrs Parker reported on the improvements made at the trust in relation to falls data, following a review visit by the Quality team. Work continues with Mrs Ellis’s team in relation to urgent and emergency care.

332/17 Members noted the improvement made by Black Country Partnerships Mental Health Foundation Trust in handling unexpected deaths of those in receipt of Community Services.

Mrs Parker reported on the Serious Incident Reporting, Root Cause Analysis review, undertaken 333/17 by Dudley CCG. This has resulted in far more consistency of RCA’s for Dudley incidents. Finally Mrs Parker reported a ’never event’ at Sandwell and West Birmingham Hospitals Trust, full details are to be recorded in the July report.

334/17 SWB CCG’s Quality team have commissioned training using the same company in order to achieve improve outcomes for serious incidents for Sandwell and West Birmingham Patients.

335/17 Mrs Rawlinson highlighted grammatical errors within the report.

336/17 Mrs Rawlinson fed-back concerns regarding mixed sex breaches, and queried whether breaches are affecting patient’s recovery.

337/17 Mrs Rawlinson enquired about the 56 serious incidents reported within the ICOF locality. Mrs Parker agreed to investigate and report directly to Mrs Rawlinson.

Ms Rawlinson enquired whether there were any themes around the communications and physical 338/17 health and unprofessional behaviourhighlighted at some of our providers. Mrs Parker agreed to pick up the finer detail of this and investigate Mrs Rawlinson’s concerns.

339/17 Mrs Rawlinson enquired about action plans in relation to the complaints around Care Homes. Ms Carolan responded explaining that in addition to the completion of quality indictor forms, every nurse carries out comprehensive quality assurances.

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340/17 Mrs Parker explained that despite there being no contractual line with nursing homes, Mrs Parker welcomed the reports as good practice for the nursing homes to report. Mrs Rawlinson recommended that the Quality report reflects who monitors activity and how this is undertaken.

341/17 • Resolution: The Governing Body received the report for information.

342/17 Finance Report:

343/17 Mr Green stated that finance reporting commences at month 2, therefore no report is presented

until the July meeting.

Mr Green reported that the contract with SWBH remains unsigned. Members noted that services 344/17 could be affected if QIPP challenges are not met.

• Resolution: The Governing Body received the report for information. 345/17

346/17 Performance Report

347/17 Mr Green presented the report.

348/17 IAPT: data for the final quarter of the year (16/17) is expected shortly. Waiting time trajectories were not met.

349/17 MRSA: breaches remained static for SWBH. The CCG reported 4 MRSA breaches for the whole year.

350/17 CDifficile: - The trust and the CCG met their year -end target.

351/17 Referral to Treatment Times (RTT): The CCG met their 18 week wait target. The trust met the national target, but missed the STP target.

352/17 Diagnostic Waiting Times: The CCG and the trust failed to meet their targets.

353/17 A&E performance: April data shows activity is below 85%. Mr Green reported that activity from 12 months ago match current data. Mr Green reported that 3 new A&E Consultants will be in post by June 2017 to address flow issues in the new hospital.

354/17 Cancer waiting times: Both the CCG and the trust have met the 2 week wait and the31 day waiting times. 62 day waiting targets were also achieved by the trust.

355/17 WAMS Performance: remains under pressure, targets set are not being achieved.

356/17 Mrs Rawlinson congratulated the trust on achieving their cancer waiting times targets. Mrs

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Rawlinson explained the national issues surrounding the 62 day waiting times, and reported on a new measure being introduced to determine cancer earlier.

357/17 Mrs Rawlinson highlighted missing data within the report relating to UHB and on pages 92 and 93 of the pdf. Mr Green agreed to review the report for future meetings.

358/17 Mr Nugent enquired about the recruitment of the A&E Consultants and the impact they will have to improve performance. Mr Williams responded explaining the changes the trust are making to improve performance. 359/17 • Resolution: The Governing Body discussed and approved the contents of the report.

360/17 Strategic Commissioning and Redesign Report : Thursday 11 May 2017

361/17 Dr Ian Sykes spoke to this item, updating members on the business of the Strategic Commissioning and Redesign (SCR) Committee held on Thursday 11 May 2017.

362/17 The Committee agreed to the continuation of funding for the Bethel Doula at the existing level and work with the project to increase some of their capacity infrastructure. The Committee gave full support to a change in pathways for patients with suspected colorectal cancer.

363/17 Dr Bath enquired whether GP’s had been informed of the new process. Dr Sykes confirmed GP’s were being notified.

363/17 The committee reviewed the risk register and approved the closure of one risk.

364/17 Finally, Dr Sykes fed-back the concerns of the Health and Wellbeing Board in relation to the Prescribing Consultation being undertaken by the CCG. Members noted that the consultation is currently on hold.

365/17 • Resolution: The Governing Body received the report for assurance.

366/17 Strategic Commissioning and Redesign Report : Thursday 25 May 2017

367/17 Dr Ian Sykes spoke to this item updating members on the business of the Strategic Commissioning and Redesign (SCR) Committee held on Thursday 25 May 2017.

368/17 A conflict of interest was declared in relation to agenda item 7.4, 3.1(i) Modality X-ray and (ii) prescribing for rheumatology.

369/17 Prof Harding, Dr Sugavanam, Dr S Mukherjee and Dr I Marok, remained in attendance and excluded from discussions relating to this item.

370/17 The committee agreed to amend the KPI for the x-ray service from 3 days to 5 days. The

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committee motioned to amend the pricing model for x-rays from £30 per patient to £25 per body part, which brings the CCG in line with other providers, however it is unclear whether this would create a cost pressure in future years.

371/17 The committee were presented with a concern relating to FP10s. The committee agreed with the recommendations of the report to contract directly with Modality and advise associated CCGs to hold their own contracts. Members noted that a pecuniary conflict of interest was declared at the committee meeting in relation to theFP10s. As the SCR Committee agreed with the recommendations of the report, it was deemed that as the Committee dealt with all reciprocal comments at their meeting on Thursday 25 May 2017, the item was presented to members for information, and therefore no mitigation was required.

372/17 The committee has approved funding for the Excess Treatment Costs (ETC) REACT Study.

373/17 Sickle Cell and Thalassemia services across Sandwell and West Birmingham are to be evaluated following the approval to re-commission the contract in April 2017.

374/17 Implementation of the proposed pathway for Non-Weight Bearing Beds was agreed along with the commissioning of the block of beds providing that there is a block in Sandwell and a block in Birmingham.

375/17 The Committee acknowledged and supported the plan for patients to receive the influenza vaccine in hospital. Members noted that a pecuniary conflict of interest was declared at the committee meeting in relation to the Influenza Vaccination. As the SCR Committee agreed with the recommendations of the report relating to the proposals, it was deemed that as the Committee dealt with all reciprocal comments at their meeting on Thursday 25 May 2017, the item was presented to members for information, and therefore no mitigation was required.

376/17 Right Care Update The Committee were reminded of the Right Care priorities which for 2017/8 are diabetes, respiratory and cancers. Dr Sykes reported that on the submission of a late report to the committee. The report requested additional invested for extra Mental Health in-patient beds across Birmingham, to cover the CCGs share of patients. The committee did not approve the recommendations and has been shared with finance colleagues and will be presented at the next SCR meeting for consideration.

377/17 • Resolution: The Governing Body approved the contents of the report.

378/17 Audit & Governance Committee Report:

379/17 Mrs Jasper introduced the report that provided members with an update on the items of business discussed at the meeting held on Thursday 18 May 2017.

380/17 The committee accepted and agreed under delegated authority the annual accounts. The annual

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report was also agreed, with the statutory requirements of the report being fulfilled and approved by external audit. However some minor amendments were identified, and will be completed before publishing. 381/17 Members noted that the committee also agreed the Local Security Management Plan for 2017/18.

Mrs Jasper fed-back the compliments from the external auditors to Mr Green and the team for 382/17 the timely manner in which the annual accounts were presented.

• Resolution: The Committee received the report for assurance.

383/17 Organisational Development Committee Report

384/17 The committee did not meet during the month of May, no report was submitted.

385/17 Primary Care Co Commissioning Committee Report

386/17 Mrs Liggins presented the report, that updated members of the actions and outcomes from the public meeting held on Wednesday 04 May 2017.

387/17 The committee approved the recommendation that Finch Road should be transferred to Birmingham South Central CCG.

388/17 SWB NHS Trust and Sandwell Council Public Health are working together to develop a renewed Public Health Plan which includes administering flu vaccinations in hospital for eligible groups, the committee approved the plan subject to the issues of GP targets being added to the risk register.

389/17 A 12 month extension of the GP Choice services with existing providers was agreed by the committee.

390/17 • Resolution: The Governing Body received the report for assurance.

391/17 Black Country Sustainability Partnership (STP) Memorandum of Understanding (MoU)

392/17 Mr Williams, as chair of the Black Country and West Birmingham STP, declared an interest regarding this item. . The MoU has been prepared by all 18 partners of the Black Country STP, and sets out how the STP will work towards leadership and decision making. Members noted that the STP has no formal governance in place; the MoU is a voluntary agreement holding each of the

18 partners to account for adherence to the MoU. Therefore, Mr Williams was able to continue to present the MOU. Member s noted that the MoU represents a commitment for partners to collaborate and work together. Mr Williams presented a draft MoU for members to review and approve the methodology of the STP, and asked that members note that the MoU is in place, and to support Mr Williams

393/17 Mr Nugent asked about resource capacity for the CCG to enable Mr Williams to discharge his STP

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duties. Mr Williams explained the current arrangements and future funding from NHSE that might be used to back fill his substantive post. Mr Williams stated that the Governing Body would be kept fully updated on matters.

394/17 Mrs Rawlinson referenced page 20 of the MoU, and highlighted that there was no mention of Lay representation in the Terms of Reference. Mr Williams responded by advising of the on-going discussions to incorporate Non-Executive representation.

395/17 • Resolution: The Governing Body accepted the Memorandum of Understanding for the Black Country Sustainability Partnership.

396/17 Minutes of the Constitutional Committees for information:

397/17 • Resolution: The Governing Body accepted the minutes for information and assurance.

398/17 Minutes of the Locality Commissioning Groups for Information:

399/17 • Resolution: The Governing Body accepted the minutes for information and assurance.

400/17 Share with Staff

• HSJ Value in Healthcare AwardsEPRR • 2 week wait and 31 day cancer target hit by the SWBH • Trends in DATIX • MOU for Black Country and West Birmingham STP • 3 A&E Consultants appointed at SWBH • Andy Williams appointed as Chair of the Black Country and West Birmingham STP

401/17 AOB:

On behalf of the organisation Prof Harding thanked Jon Dicken for his outstanding contribution to the organisation, and wished him a happy retirement.

Mrs Rawlinson highlighted errors within the Glossary of Terms.

• No mention of Right Care

• No mention of Primary Care Co-Commissioning

• 5-year forward view to be includes.

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402/17 Close of Meeting

The PUBLIC meeting of the Governing Body closed at 15:38hrs.

403/17 Date and Time of the Next Meeting:

The next meeting will be held on Wednesday 05 July 2017, Kingston House Boardroom, 13:45hrs

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Open Action Register : Wednesday 05 July 2017

Ref Action By Whom Deadline / Comment / Response Date update Completed

48/17 Quality & Safety Report: Mrs Parker/ Dr September 2017 Patient Falls and Pressure Ulcers are being Outcomes from CNO Scrutiny report Sam subjected to a CNO scrutiny report. Once relating to Patient Falls and Pressure Mukherjee plans are available, these will be shared at Ulcers to be shared with the Governing the SWBH Clinical Quality Review Meeting Body. (CQRM) and with members.

62/17 Quality & Safety Report: Mrs Parker August 2017 Governing Body members to receive for The dashboard relation to the CQRM information the dashboard relating to reports to be presented at the June CQRM reports. meeting.

178/17 Quality & Safety Report: Mrs Parker/ Dr September 2017 Outcomes from the CQC visit at SWBH to Outcome of the CQC visit at SWBH. Sam be shared with members of the Governing Mukherjee Body.

Sandwell & West Birmingham CCG Page 1 PUBLIC Meeting of the Governing Body Enc 2 – Action Register Wednesday 05 July 2017

Ref Action By Whom Deadline / Comment / Response Date update Completed 323/17 EPRR Report: Rachael Ellis September 2017

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GOVERNING BODY Report Title: Report author and Title: Quality Report Tom Richards

Date of Governing Body: Contact Details: Wednesday Agenda No: 7.1 Enclosure no: 3 Sign off from Chief Officers: (Before the report is presented to the Governing Body any implications relating to Finance, Quality and Commissioning must be agreed and signed by the Chief Officer. (see guidance note) Without this information the report will not be taken to the Governing Body)

Chief Finance Officer: Yes

Chief Officer for Quality: Yes

Chief Officer for Operations: Yes

Chief Officer for Partnership: Yes

Supporting Documents/further Reading: (Highlight any documents or further reading for members which supports this report)

Previous Decision (Inform the Governing Body/Committee if the paper has been reviewed or monitored by another committee and their recommendation or decision)

Summary of purpose and scope of the report: (Highlight key points you wish to bring to the attention of members)

Recommendations: To review the data contained in this report, which includes all data up to and including May 2017.

The Governing Body are requested to: Action Approve Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:

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Strategic Priorities related to the report: Quality & Safety Finance & Performance Partnership Strategic Commissioning and Redesign Organisational Development Primary Care Co-Commissioning Collaborative Commissioning Implications: Financial Assurance Framework Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated Consultation: X Patients Staff Committees Public Partners Sponsored By: (Chief Officer Date Report received for Governing Body

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Executive Summary Data contained in this report is up-to-date and includes all data up to and including May 2017.

Primary Care

Incident Reporting The incident reporting rate at CCG member practices has fallen since October 2016, with 117 incidents reported in May 2017. The percentage of more serious incidents continues to fall, with zero moderate to high grade incidents reported since February 2017.

Trends There are five existing trends: (1) Delays in receipt of Medical Records since service provider changed to Capita, (2) E-Referrals - A lack of provision of appointments by SWBH. (3) Acute Providers inappropriately delegating work to GPs (which arose as a result of a Freedom of Information Request). (4) Walk-In Centres failing to record patient consent status for sharing their consultation record with the patient’s GP. (5) Violence and Aggressive Patients in GP Surgeries

A new minor trend is being monitored regarding delays in the process of referring GP patients into the Kaleidoscope IAPT service.

Contract Monitoring Visits During May 2017 the following practices received a scheduled contract and quality monitoring visit: • Enki Medical Practice (Modality) • Rotton Park Medical Centre • Bloomsbury Health Centre

No significant concerns identified and visit teams are currently finalising reports.

Sandwell and West Birmingham Hospitals

1) Safety Thermometer: 93.7% reported for April against NHS Safety Thermometer against the target 95%; Consistent marginal under-performance.

2) Patient Falls - x69 [x74] falls reported in April with x0 [x2] falls resulting in serious injury. 23 falls within community and 46 in acute setting. Falls remain subject to ongoing CNO scrutiny.

3) Pressure Ulcers: x13 [x6] avoidable, hospital acquired pressure sores reported in April of which 6x grade 3; 7x grade 2; x6 [x6] separate cases reported within the DN caseload. Year on year comparison indicates elevated level, which merits CNO scrutiny.

4) Mortality: The Trust overall RAMI for most recent 12-mth cumulative period is 106 (latest available data is as at January) RAMI for weekday and weekend each at 104 and 112 respectively. Reassurance is required from MD on the levels reported. SHMI measure which includes deaths 30-days after hospital discharge is at 104 for the month of December (latest available data).

5) Mixed Sex Accommodation: There were x21 MSA breaches in April.

6) Emergency Care – - The Trust's performance against the 4-hour ED wait target in April was 84.95% [85.22%] against the 95% national target - 2,814 breaches were incurred in April; (2,875 Mar, 3,046 Feb, 2,821 Jan, 3,324 Dec, 3,237 Nov, 2,676 Oct, 2,051 Sept, 1,884 Aug) . - ED quarterly performance trend for 16/17 : Q1 at 91.9%, Q2 at 89.2%, Q3 at 83.64% and Q4 at 84.0% ; - Full Year 16/17 performance at 87.22%;

7) RTT Pathway - - RTT incomplete pathway for April is at 92.76% [93.08%]; continuing to perform closely to trajectory - April forecast was for the Trust to deliver 93.08% again as per previous month but this was not achieved mainly across surgical specialities - The backlog for April is at 2,350 patients (April forecast was set at 2,237) - The backlog for April is now largely inpatient driven (55% of backlog); 23% is follow ups and the remaining element is OP indicating a significant IP pressure - The total waiting list has remained fairly static for the last three months stabilising at 32,000-33,000 patients (Sept16 high at 37,380) - This is a significant and credible achievement for the Trust which needs to now be sustainably Friends & Family reporting requires a review to understand the consistent under- managed across all services

8) Infection Control: 1x C. Diff case reported during the month of April ; An annual trajectory of 30 has been agreed with the CCG for 17/18. Nil cases of MRSA Bacteraemia were reported in April; Annual target set at zero .

9) Workforce: a) PDR overall compliance as at the end of April is at 87.9% against the 95% target. Medical Appraisal at 81.8% worsening this month to previous periods (performance indicates appraisals 'validated' not 'carried out'). In-month sickness for April is at 4.40% against the 2.5% target ; the number of short term sickness 414 cases (785) has sharply reduced to last months and long term 214 (213) cases remainly static to the recently observed reduced levels. The cumulative sickness rate is at 4.45%. RTW is at 79.4% in month b) Mandatory Training at the end of April is at 87.6% overall against target of 95%; Health & Safety related training is above the 95% target at 96.4% in April. Safeguarding training recovery plan failing, with a further exception report extending delivery further out. A significant proportion of all training is below the 85% delivery at present.

Workforce:

Sep Oct Nov Dec Jan Feb Mar Apr Sickness 4.21% 4.53% 4.77% 4.9% 4.83% 4.5% 4.48% 3.15% - Short Term 727 837 922 911 956 808 785 414 - Long Term 253 245 247 246 253 205 213 214 Bank (Nursing - Qualified) 35.83% 46.77% 36.30% 41.77% 40.30% 27.10% 43.5% 42.1% Agency (Nursing - Qualified) 29.95% 18.76% 28.36% 20.17% 22.55% 18.70% 16.8% 16.3% Turnover - Nursing 11.9% 12.4% 11.7% 11.4% 11.6% 11.2% 11.7% 11.7% Mandatory Training (95%) 87.6% 87.3% 87.2% 87.1% 87.1% 87.5% 87.2% 95% PDR Compliance (95%) 88.9% 88.7% 88.5% 88.2% 88.1% - 87.9% 95%

Black Country Partnerships Divisional Quality Report (CAMHS)

Incident Reporting: • Incident reports average around 30 per month. Numbers have been consistent for past 18 months. Trends include Violence and Aggression, to which the trust are responding with several schemes to promote staff awareness and safety procedures. Patient Feedback: • Low numbers of patient feedback via FFT, but Trust are developing a new feedback mechanism (CHI) which is appropriate for users of the service. Trust will feed this into report once this has been developed. Audit: • Clinical Audit and Quality Improvement Plan programme for 2017/2018 is currently rated as green for all

Workforce: • The Division reported a vacancy rate of 14.98% (59.84 WTE) in April 2017, which sees an increase on figures reported in March 2017 (14.03%). Sickness absence has seen a 0.19% increase overall. [Note the Bank vs Agency trends have been moving in the right direction since Nov 2016, with overall lower spending on both since May 2016] • The turnover rate for Division is reported at 11.74% for April 2017, a small decrease on figures reported in February 2017 (11.84%). • Bank costs saw a decrease in April 2017 totalling £15,691 compared to March costs of £125,442 for the Division. Agency costs for April 2017 were reported as £48,987, a decrease on the previous months spend of £100,691.

Information Governance Report: • Reduction of IG Breaches since introduction of IG Structure • IG officer – Data Flow mapping exercise (570 Info Assets) • IG Toolkit Rating of 91% - 34 level 3’s out of 45 indicators. • Trust scored highly in terms of information security • IG steering group meet monthly.

Health and Safety Report: • Positive performance by Trust over the past 12 months, with notable good performance in regard to reporting methods, which have resulted in faster turnaround times for claims.

Exit Interviews Follow-up Report: There were a total of 72 leavers during Quarter 4. The primary reason for leaving identified on documentation was retirement age (19.48 of leavers).

The next highest reason for leaving was promotion (15.3% of leavers), closely followed by voluntary resignation due to work life balance (11.1% of leavers). There were a total of 12 leaver questionnaires received for leavers during the period, a reduction from Q3. The most common reasons for leaving identified were relocation, lack of opportunities and promotion. Lack of opportunities was cited on 3 occasions.

CQUIN

• BCP passed all CQUIN schemes for the Q4 milestone.

West Midlands Ambulance Service Serious Incidents There have been 10 Serious Incidents reported by WMAS since April 2017, 7 of these were reported in May.

Complaints and Concerns: There have been 0 Complaints reported against WMAS since April 2017, 0 of these were reported in April. There have been no trends identified thus far, although issues regarding the training and competency of staff have featured were suggested to contributory factors.

CQRM: The WMAS CQRM for May was cancelled due to forthcoming merging of the CQRM for West Midlands Ambulance Service and NHS111. Future Quality reports will feature a summary of this new meeting.

CQUIN WMAS has passed all milestone requirements for Q4. Primary Care Data contained in this report is up-to-date and includes all data up to and including May 2017.

Executive Summary

Primary Care Never Events There have been Zero Never Events reported by GP Practices since June 2016. Serious Incident Trends There have been 2 Serious Incidents reported by SWB CCG since June 2016, 0 of these were reported in May. Incident Reporting Rate and The incident reporting rate at CCG member practices has fallen since October 2016, Severity with 117 incidents reported in May 2017. The percentage of moderate-to-serious incidents continues to fall. Trends and Resolutions There are five existing trends: (1) Delays in receipt of Medical Records since service provider changed to Capita, (2) E-Referrals - A lack of provision of appointments by SWBH. (3) Acute Providers inappropriately delegating work to GPs (which arose as a result of a Freedom of Information Request). (4) Walk-In Centres failing to record patient consent status for sharing their consultation record with the patient’s GP. (5) Violence and Aggressive Patients in GP Surgeries

A new minor trend is being monitored regarding delays in the process of referring GP patients into the Kaleidoscope IAPT service. Contract Visits During May 2017 the following practices received a scheduled contract and quality monitoring visit:

• Enki Medical Practice (Modality) • Rotton Park Medical Centre • Bloomsbury Health Centre

No significant concerns identified and visit teams are currently finalising reports.

Incidents

Never Events There have been Zero Never Events reported by GP Practices since May 2016.

Serious Incidents Trends There have been 2 Serious Incidents reported by SWB CCG since June 2016, 0 of these were reported in May. The chart below highlights SI trends.

Month # Month # Jun 1 Dec 1 Jul 0 Jan 0 Aug 0 Feb 0 Sep 0 Mar 0 Oct 0 Apr 0 Nov 0 May 0

Incident Reporting and Severity

The incident reporting rate at CCG member practices has fallen since October 2016, with 117 incidents reported in May 2017. The percentage of serious incidents continues to fall.

GP Incident Reporting Rate

Incident Severity

The chart below shows the percentage of incidents reported by GPs by level of severity.

GP Reporting by LCG

The following table shows a breakdown of incident reporting per LCG, for the past four months.

Black Pioneers Sandwell Health Month Healthworks ICOF Total Country 4Health Alliance Jan 24 25 18 1 34 102 Feb 22 67 12 1 34 136 Mar 25 20 9 4 43 101 Apr 23 16 5 7 25 76 May 27 25 24 7 32 115

Trends and Resolutions

Summary:

Description (Policies) Actions/Feedback CAPITA First incident was reported in May 2016, with 73 subsequent incidents Capita has provided Primary Care Support Services recorded as of March 2017. Trend was formally recognised at August for the NHS since 1st September 2015, on a seven 016 Q&S Committee meeting. NHS E own this incident as they year contract. Services provided include patient commission Primary Care Support Services from Capita. records management. GPs have reported long delays in processing patient registrations and 13/09/2016 - CCG met with NHS E in September 2016, where an delivering patient records. action plan to address Capita issues was presented.

27/10/2016 - Further/Ongoing issues to be reported to NHS E on a monthly basis.

09/11/2017 - Issue debated in Parliament. Nicola Blackwood, minister for public health and innovation at the Department of Health: "NHS England has demanded and received rectification plans from Capita for the six most affected service lines, and has embedded a team of seven experts within Capita to support it as it resolves these issues. Capita has informed me that it is adding around 500 more full-time equivalent staff to the service, at its cost, and that it is improving the training provided to ensure that new staff understand the importance of the service to both patients and practitioners."

20/03/2017 - Alison Braham contacted Anna Nichols to provide an update on this issue, as she is now acting as point of contact for NHS E for this.

28/3/2017 - Update from NHS E: NHS E continue to recoginise that the issue persists but is now being addressed by the National Team. Practices are advised to report each and every new issue that occurs via the local Datix Incident Reporting system. CHOOSE AND BOOK/E-REFERRALS This issue was identified as a trend in May 2016. Although incidents GPs are reporting that appointments booked via the of this type have been recorded since 2014, they were largely E-Referral system (formerly known as Choose and sporadic and low in number, which didn't suggest a trend. During the Book) are not available to patients once the patient summer of 2016 however, the numbers of incidents of this type that calls the hospital to confirm their booking. E- were being reported increased significantly and the issue was formally Referrals can be directly or indirectly booked. Direct raised with the Quality and Safety Committee, who advised pursuing a booking involves the GP booking the appointment resolution to this problem via the SWBH Clinical Quality Review during the consultation, with the patient leaving the Meeting, so that the issue could be addressed at Director level. GP surgery with a confirmed attendance date. Indirect booking involves the GP printing off a list of The issue was then raised at the SWBH CQRM, where a decision to appointment options for the patient, who then leaves investigate was undertaken. In addition, a Task and Finish group was the surgery and calls the hospital at a later time to appointed to oversee this process, which included Dr Marok, the CCG confirm which appointment they would like to take. ICT Lead. MLSCU ICT Team were also tasked by the CCG to The issue affects only indirectly booked E-Referrals. investigate the issue from a Primary Care perspective. Their initial The issue is also affecting patient registered at findings confirmed that the problem was more widespread than initially member practices practces of neighbouring CCGs. thought, with patients at other CCG member practices affected. Brimingham Cross City CCG opted to lead on the collation of incidents reported by all local CCGs, with submissions of incident data being provided on a monthly basis.

The SWBH investigation revealed that appointment slots were being booked by SWBH to ensure patients met the RTT 18 week target. Often, this meant that in the time between the patient leaving the surgery and calling the hospital, the original appointment slot option that appeared on the E-Referral system was no longer available. This discovery ruled out any techinical issue that might have accounted for the anomaly, but allowed for a resolution to be reached via change of process.

At a subsequent Contract Review Meeting, SWBH confirmed that more slots would be made available and continued efforts would be taken to address the issue of backfilling. Updates on the reslution of this issue will be provided at future CQRM and CRM meetings, as there is the potential for further impact of this problem in regards to the 17-19 contract, where a significant value is attached to a CQUIN related to E-Referral performance.

The issue has persisted to date, with Feburary 2017 seeing the highest number of reported incidents in a single month (17).

DELEGATION OF WORK Trend initially identified in October 2016 and raised at the Quality and Issue pertaining to Acute Services provided by Safety committee for that month. Thus far, 8 incidents have been SWBH whereby work usually carried out by SWBH reported since October 2016. was being delegated back to Primary Care. This causes an unecessary burden of work in Primary Incident levels remain very low, therefore issue will be addressed on a Care and may increase the costs of, and duration of case-by-case basis until sufficient amount of data has been gathered waiting time for patients. to address specific issues related to partiuclar wards and departments. Reporting spike followed receipt of Freedom of Information request, which made reference to this problem being reported in the media. VIOLENCE AND AGGRESSION Options available to Practices: There has been a recent trend of violence and aggression incidents in GP Practices, where patients 1) Attempt to calm the situation: or patient relatives are the instigators and practice staff are the victims. Dealing with an aggressive patient takes care, judgement and self- control.

(i) Remain calm, listen to what they are saying, ask open-ended questions

(ii) Reassure them and acknowledge their grievances

(iii) Maintain eye contact, but not prolonged

(iv) Keep an adequate distance from the patient, but keep away from corners

(v) If the patient has a weapon, ask them to put it down (not to hand it over)

(vi) Use the panic button or call for help

(vii) Leave the room and call security or the police

(viii) If possible, move the patient to an area away from public view

2) Report the issue as an incident on Datix - this helps the CCG to monitor trends and collate useful advice to help other practices in future.

3) Issue patient with a Zero Tolerance warning letter

3) If patient is violent and aggressive in future, consider removal from practice list under the Excluded Patient Scheme

Further Information:

Patients, and sometimes their carers, become challenging, difficult, uncooperative or aggressive for a number of reasons:

• Unwell or in pain

• Drink/substance misuse

• Fear, anxiety or distress

• Communication or language difficulties

• Unrealistic expectations

• Previous poor experience

• Frustration

• Guilt that they didn't bring a sick relative in earlier.

Their challenging behaviour may take the form of:

• Being demanding or controlling

• Unwillingness to listen/uncooperative

• Verbal abuse or threats

• Physical violence against people or property.

Identifying the problem

Is it the patient?

Always consider first whether the patient’s behaviour is caused by a medical condition. If so, treat the patient as far as possible without putting yourself or others at risk.

Is it lack of resources?

Long waiting times, lack of available appointments or beds, locums unfamiliar with the department, poor communication by staff, etc may all contribute to a patient’s deteriorating mood or behaviour.

Is it the doctor?

Competing pressures on the doctor (time, resources, personal) may affect their communication style and potentially exacerbate the situation.

Assessing the risk Even if you are not in a position to determine the security policy at the trust or practice, you can seek ways to protect yourself, colleagues and other patients.

Identify high-risk situations – for example, Saturday night in the Emergency Department, or when you have to deliver bad news, or when patients are kept waiting for a very long time. Consider which staff may be vulnerable if a patient becomes violent. Reception area staff or doctors working alone in a clinic may be at greater risk.

Patients must not be denied necessary treatment even though they may be aggressive or violent. Treatment must be based on clinical need, however demanding the patient. Nevertheless you should assess and minimise the risks to yourself, the patient and others. In some cases it may be reasonable and necessary to consider alternative arrangements for providing treatment.

If systems, policies or availability of resources are compromising patient care, you must raise your concerns.

Training staff in conflict resolution and dealing with aggressive behaviour is advisable. NHS Protect offers online and in-house courses.

Consider your security requirements. Your Local Security Management Specialist (LSMS) - contactable via Michelle Carolan (Deputy Chief Officer - Quality) is responsible for security in your practice area and can advise you. If you have concerns about the safety of your environment, raise them with your Security Management Director or the LSMS.

For telephone advice and guidance, call T2T on 0121 612 4110.

WALK IN CENTRE First incidents reported in December 2016 and trend raised at the Issue reported by GP practices, whose patients are Quality and Safety Committee that month. 8 incidents in total reported reporting that despite giving consent for their records between December 2016 and Feb 2017. to be shared electronically with their GP Practice, this wasn't being carried out by the Walk-In Centre. 03/01/2017 - Quality Manager to inform Urgent Care commissioner of issue. Quality contract to raise issue formally at the next contract Review Meeting on 21st March 2017. Incident Team informed on new trend and will collate new incidents as evidence prior to the CRM.

06/04/2017 - Contract Meeting on 21st March was cancelled, so issue was rasied directly with provider. Provider confirmed with reception staff that all patients are being asked for consent, and that no further issues have been raised. CCG will continue to monitor incident reports to ascertain if trend persists.

Primary Care Updates

May 2017

Contract and During May 2017 the following practices received a scheduled contract and quality quality monitoring visit: monitoring • Enki Medical Practice (Modality) visits • Rotton Park Medical Centre • Bloomsbury Health Centre

No significant concerns identified and visit teams are currently finalising reports.

PCSE/Capita NHS England previously stated that they were seeing positive progress in terms medical record of stabilising the earlier reported PCSE/Capita medical records delays issue. delays

However, SWB CCG member practices have continued to experience problems with this service and have reported concerns via the Datix incident reporting system.

As a result of these issues, this matter will now be escalated to the national contract lead for PCSE at NHS England.

Practice A practice manager’s PLT session was held on 16th May 2017 and the following topics manager were covered: Protected • Learning Time CQC updates (including promotion of support available from the CCG) (PLT) event • Primary Care quality dashboard updates • Effective Telephony Training • Primary Care Commissioning Framework updates • Changes to GMS Contract • Prescriptions and Medicines Consultation • Cancer Research support to practices • Connected Palliative Care End of Life Hub • SWBH Bowel and Breast Screening programme

Primary care th commissioning On 24 May 2017 an extraordinary meeting of the Primary care commissioning framework committee was held in private.

The sole purpose of this meeting was for the Committee to approve a number of recommendations in relation to the Primary Care Commissioning Framework for 2016/17.

Sandwell & West Birmingham Hospitals Data contained in this report is up-to-date and includes all data up to and including May 2017.

Summary

Sandwell and West Birmingham Hospitals Never Events There has been one Never Event reported by this Trust since April 2017: Wrong Site Surgery - The anaesthetic block was applied to the wrong side, the left, when surgery was required on the right side. Serious Incidents Trends There have been 8 Serious Incidents reported by SWBH since April 2017, 4 of these were reported in April. There has been a good reduction in Pressure Ulcer Serious Incidents since April 2013, but an upward trend in patient falls since Jan 2017. GP Reported Incidents Since April 2017, the most prevalent type of incident reported by GPs in regard to (Trends) SWBH has been issues with Records, Communication and Information. Complaints and Concerns 1) There have been 2 Complaints reported against SWBH since April 2017, 1 of these was reported in May. Quality Assurance Visits There were no Quality Assurance visits in May 2017. CQRM Summary 1) Safety Thermometer: 93.7% reported for April against NHS Safety Thermometer against the target 95%; Consistent marginal under-performance.

2) Patient Falls - x69 [x74] falls reported in April with x0 [x2] falls resulting in serious injury. 23 falls within community and 46 in acute setting. Falls remain subject to ongoing CNO scrutiny.

5) Mixed Sex Accommodation: There were x21 MSA breaches in April.

Incidents

Never Events There has been one Never Event reported by this Trust since April 2017: Wrong Site Surgery - The anaesthetic block was applied to the wrong side, the left, when surgery was required on the right side.

Serious Incidents Trends There have been 8 Serious Incidents reported by SWBH since April 2017, 4 of these were reported in April. There has been a good reduction in Pressure Ulcer Serious Incidents since April 2013, but an upward trend in patient falls since Jan 2017.

The chart below highlights SI trends.

Top Trends Count Month # Month # (CF) DELAY in Care/Treatment 3 Apr 4 Oct

(INF) Outbreak - MRSA 1 May 4 Nov (PF) Fall/Trip/Slip while Mobilising Alone 1 Jun Dec (PF) Patient Fall resulting in FRACTURE 1 Jul Jan (TH) Anaesthetic incidents 1 Aug Feb (TH) Death in theatre 1 - - Sep Mar

Pressure Ulcers and Patient Falls Trends The charts below show long term trends of Pressure Ulcers and Patients Falls that fall under the Serious Incident Reporting Criteria. Pressure Ulcers are falling (with no new cases since Nov 2016), but Patient Falls have seen a recent upward trend over the last three months.

GP Reported Incident Trends (Top Five) Since April 2017, the most prevalent type of incident reported by GPs in regard to SWBH has been issues with Records, Communication and Information. A brief breakdown of appointment issues is shown beneath this chart.

Month/Type Count 2017 Records, Communication & Information 20 Diagnosis & Tests 18 Appointments, Discharge & Transfers 9 Clinical Care (Assessment/Monitoring) 8 Medication 4 Safeguarding 1 Grand Total 60

Complaints

Complaints Types There have been 2 Complaints reported against SWBH since April 2017, 1 of these was reported in May. Please note that in the table below a single complaint may contain more than one complaint ‘type’, depending on the nature of the issue raised.

Month/Type Count (P) Sandwell and West Birmingham (Community Services) 1 (SWBH Community) - District nursing 1 Lack of Accessibility (i.e. Access to Appointments) 1 (P) Sandwell and West Birmingham Hospitals (Acute) 1 (SWBH Acute) - Unspecified/Unknown 1 Poor Communication 1 Grand Total 2

Complaints Trends

There are no current trends pertaining to complaints.

Quality Assurance Visits

Date Location Reason Outcome

Summary

Further Actions

No Quality Assurance visits were carried out in this month.

Quality Data Review

Local Quality Requirements (Exceptions):

Indicator Target M1 Response Zero tolerance RTT waits over 52 weeks for incomplete 0 3 Breaches pathways All handovers between ambulance and A & E must take place 110 0 within 15 minutes with none waiting more than 30 minutes Breaches Percentage of Service Users on incomplete RTT pathways (yet 263 92% to start treatment) waiting no more than 18 weeks from Breaches Referral Percentage of Service Users waiting less than 6 weeks from 58 99% Referral for a diagnostic test (DM01) Breaches Percentage of A & E attendances where the Service User was 1870 95% admitted, transferred or discharged within 4 hours of their Breaches arrival at an A&E department All Service Users who have operations cancelled, on or after the day of admission (including the day of surgery), for non- clinical reasons to be offered another binding date within 28 0 1 Breach days, or the Service User’s treatment to be funded at the time and hospital of the Service User’s choice Maternity: RAP Trajectory. BMI recorded by 12+6 weeks of pregnancy; Reporting will be 85% 77.75% based on deliveries in month Urgent Care At least 35% of all patients should be discharged in the 35% 15.66% morning. Urgent Care A&E coding should include diagnosis coding in line with the 90% 85.53% A&E data set Safeguarding: RAP Trajectory. 79% 77.71% Safeguarding Children Level 2 Training Safeguarding: RAP Trajectory. 82% 80.98% Safeguarding Adults Advanced Training

CQRM Summary

Item Detail Integrated 10) Safety Thermometer: 93.7% reported for April against NHS Safety Thermometer against Performance the target 95%; Consistent marginal under-performance. Report 11) Patient Falls - x69 [x74] falls reported in April with x0 [x2] falls resulting in serious injury. 23 falls within community and 46 in acute setting. Falls remain subject to ongoing CNO scrutiny.

12) Pressure Ulcers: x13 [x6] avoidable, hospital acquired pressure sores reported in April of which 6x grade 3; 7x grade 2; x6 [x6] separate cases reported within the DN caseload. Year on year comparison indicates elevated level, which merits CNO scrutiny.

13) Mortality: The Trust overall RAMI for most recent 12-mth cumulative period is 106 (latest available data is as at January) RAMI for weekday and weekend each at 104 and 112 respectively. Reassurance is required from MD on the levels reported. SHMI measure which includes deaths 30-days after hospital discharge is at 104 for the month of December (latest available data).

14) Mixed Sex Accommodation: There were x21 MSA breaches in April.

15) Emergency Care – - The Trust's performance against the 4-hour ED wait target in April was 84.95% [85.22%] against the 95% national target - 2,814 breaches were incurred in April; (2,875 Mar, 3,046 Feb, 2,821 Jan, 3,324 Dec, 3,237 Nov, 2,676 Oct, 2,051 Sept, 1,884 Aug) . - ED quarterly performance trend for 16/17 : Q1 at 91.9%, Q2 at 89.2%, Q3 at 83.64% and Q4 at 84.0% ; - Full Year 16/17 performance at 87.22%;

16) RTT Pathway - - RTT incomplete pathway for April is at 92.76% [93.08%]; continuing to perform closely to trajectory - April forecast was for the Trust to deliver 93.08% again as per previous month but this was not achieved mainly across surgical specialities - The backlog for April is at 2,350 patients (April forecast was set at 2,237) - The backlog for April is now largely inpatient driven (55% of backlog); 23% is follow ups and the remaining element is OP indicating a significant IP pressure - The total waiting list has remained fairly static for the last three months stabilising at 32,000-33,000 patients (Sept16 high at 37,380) - This is a significant and credible achievement for the Trust which needs to now be sustainably Friends & Family reporting requires a review to understand the consistent under- managed across all services

17) Infection Control: 1x C. Diff case reported during the month of April ; An annual trajectory of 30 has been agreed with the CCG for 17/18. Nil cases of MRSA Bacteraemia were reported in April; Annual target set at zero .

18) Workforce: c) PDR overall compliance as at the end of April is at 87.9% against the 95% target. Medical Appraisal at 81.8% worsening this month to previous periods (performance indicates appraisals 'validated' not 'carried out'). In-month sickness for April is at 4.40% against the 2.5% target ; the number of short term sickness 414 cases (785) has sharply reduced to last months and long term 214 (213) cases remainly static to the recently observed reduced levels. The cumulative sickness rate is at 4.45%. RTW is at 79.4% in month d) Mandatory Training at the end of April is at 87.6% overall against target of 95%; Health & Safety related training is above the 95% target at 96.4% in April. Safeguarding training recovery plan failing, with a further exception report extending delivery further out. A significant proportion of all training is below the 85% delivery at present.

Focus on Staffing

Commissioning for Quality and Innovation (CQUIN) Update

The Commissioning for Quality and Innovation (CQUINs) payments framework encourages care providers to share and continually improve how care is delivered and to achieve transparency and overall improvement in healthcare.

SWBH CQUINs:

Scheme Q1 Q2 Q3 Q4 Comments Health and Well Being (A) – Staff Initiatives The 5 percentage point improvement should be achieved over a period of 2 years, with the baseline survey being the 2015 staff survey. Health and Well Being (B) – Healthy Food Providers will be expected to build on the four changes required in the 2016/17 CQUIN Health and Well Being (C) – Influenza Vaccinations Achieving an uptake of flu vaccinations by frontline clinical staff of 75% Sepsis (A) Timely identification of sepsis in emergency departments and acute inpatient settings Sepsis (B) Timely treatment for sepsis in emergency departments and acute inpatient settings Sepsis (C) Antibiotic review Sepsis (D) Reduction in antibiotic consumption per 1,000 admissions Mental Health – A&E Improving services for people with mental health needs who present at A&E Advice and Guidance A&G services for non-urgent GP referrals. E-Referrals Improving availability of services and appointments on the NHS e-Referral SupportingSi Safe and Proactive Discharge Improving experience and outcomes for young people as they transition out of Children and Young People’s Mental Health Services (CYPMHS). Preventing Risk Behaviours Percentage of unique adult patients who are screened for smoking status AND whose results are recorded. Wound Care Improving wound care assessment.

Personalised Care

Personalised care and support planning for people with long-term conditions.

Summary: The milestone report for the first quarter performance will be presented at the August Q&S. Black Country Partnerships Mental Health Foundation Trust The data for this report is up to date and includes all data up to and including May 2017.

Executive Summary

Black Country Partnerships Never Events There have been zero Never Events reported by this Trust since April 2017. Serious Incident Trends There have been 6 Serious Incidents reported by BCP since April 2017, 3 of these were reported in May. Other Trends There have been no concerns or incidents reported by GPs since April 2017. Complaints There have been no concerns or complaints raised by patients since April 2017. Quality Assurance Visits There have been zero Quality Assurance Visits to BCP this month. CQRM Divisional Quality Report (CAMHS) Incident Reporting: • Incident reports average around 30 per month. Numbers have been consistent for past 18 months. Trends include Violence and Aggression, to which the trust are responding with several schemes to promote staff awareness and safety procedures. Patient Feedback: • Low numbers of patient feedback via FFT, but Trust are developing a new feedback mechanism (CHI) which is appropriate for users of the service. Trust will feed this into report once this has been developed. Audit: • Clinical Audit and Quality Improvement Plan programme for 2017/2018 is currently rated as green for all

Exit Interviews Follow-up Report: There were a total of 72 leavers during Quarter 4. The primary reason for leaving identified on documentation was retirement age (19.48 of leavers).

The next highest reason for leaving was promotion (15.3% of leavers), closely followed by voluntary resignation due to work life balance (11.1% of leavers).

There were a total of 12 leaver questionnaires received for leavers during the period, a reduction from Q3. The most common reasons for leaving identified were relocation, lack of opportunities and promotion. Lack of opportunities was cited on 3 occasions.

Local Quality LQR Ref KPI Description Exception Details Requirements LQGE01b Percentage of inpatients with a 33/35, with 95% target. Crisis Management plan on Query regarding data supplied. discharge from secondary care. Trust to review and re-send (NB: exclusions apply to patients exception to CCG within 5 working who discharge themselves against days. clinical advice or who are AWOL)

LQGE12b % of Crisis assessments carried 95/101 with 95% target. out within 4 hours. Exception Accepted, but CCG will monitor and apply sanctions if performance does not recover over the next two months.

LQGE14a % of Routine assessments carried 112/136 with 85% target. out within 8 weeks. Exception Rejected – CPN issued.

CQUIN Schemes BCP passed all CQUIN schemes for the Q4 milestone.

Incidents

Never Events There have been zero Never Events reported by this Trust since April 2017.

Serious Incidents Trends There have been 6 Serious Incidents reported by BCP since April 2017, 3 of these were reported in May. Current SI trends include unexpected/potentially avoidable deaths and suicides.

Top Trends Count Month # Month # (CD) Unexpected Death - Unknown 1 Apr 3 Oct (REC) Confidentiality Breach 2 May 3 Nov Jun Dec Attempted Suicide 2 Jul Jan Self Harming Behaviour 1 Aug Feb Sep Mar

Other Incidents

The majority of incidents reported by GPs relate to issues around correspondence being sent to the wrong practice. Black Country Partnerships have recently provided confirmation that GP incidents raised via Quality Matters will be responded to within 21 working days.

Month/Type Count 2017

Records, Communication & Information 1 Appointments, Discharge & Transfers 1 Grand Total 2

Complaints

Complaints Trends There have been 0 Complaints raised against BCP since April 2017, 0 of these were reported in May. There have been no trends identified this year thus far.

Incident date Concern Summary Status/Resolution

Quality Assurance Visits

Date Location Reason Outcome

Summary There have been zero Quality Assurance Visits to BCP this month.

Quality Data Review

Local Quality Requirements (Exceptions): There were two indicators that failed this month’s targets – EIS (Percentage of all routine EIS referrals, receive initial assessment within 10 working days), and Infection Prevention and Control Training (Percentage of staff who have up-to-date IPC training ).

LQR Ref KPI Description Exception Details LQGE01b Percentage of inpatients with a Crisis 33/35, with 95% target. Management plan on discharge from Query regarding data supplied. Trust to review and re- secondary care. (NB: exclusions apply to send exception to CCG within 5 working days. patients who discharge themselves against clinical advice or who are AWOL)

LQGE12b % of Crisis assessments carried out within 4 95/101 with 95% target. hours. Exception Accepted, but CCG will monitor and apply sanctions if performance does not recover over the next two months.

LQGE14a % of Routine assessments carried out within 112/136 with 85% target. 8 weeks. Exception Rejected – CPN issued.

LQGE17 Provide commissioners with Level 1 (concise) 4/5, with 100% target. and Level 2 (comprehensive) RCA reports Applies to Wolves CCG only. within 60 working days and Level 3 (independent investigation) 6 months from the date the investigation is commissioned as per Serious Incident Framework 2015 page 41. All internal investigations should be supported by a clear investigation management plan.

CQRM Summary – 6th June 2017 (CAMHS)

Item Detail Divisional Divisional Quality Report (CAMHS) Quality Incident Reporting: Report • Incident reports average around 30 per month. Numbers have been consistent for past (Mental 18 months. Trends include Violence and Aggression, to which the trust are responding with Health) several schemes to promote staff awareness and safety procedures. Patient Feedback: • Low numbers of patient feedback via FFT, but Trust are developing a new feedback mechanism which is appropriate for users of the service.

Audit: • Clinical Audit and Quality Improvement Plan programme for 2017/2018 is currently rated as green for all

Workforce: • The Division reported a vacancy rate of 14.98% (59.84 WTE) in April 2017, which sees an increase on figures reported in March 2017 (14.03%). Sickness absence has seen a 0.19% increase overall. [Note the Bank vs Agency trends have been moving in the right direction since Nov 2016, with overall lower spending on both since May 2016] • The turnover rate for Division is reported at 11.74% for April 2017, a small decrease on figures reported in February 2017 (11.84%). • • Bank costs saw a decrease in April 2017 totalling £15,691 compared to March costs of £125,442 for the Division. Agency costs for April 2017 were reported as £48,987, a decrease on the previous months spend of £100,691.

Exit Interviews Follow-up Report: There were a total of 72 leavers during Quarter 4. The primary reason for leaving identified on documentation was retirement age (19.48 of leavers).

The next highest reason for leaving was promotion (15.3% of leavers), closely followed by voluntary resignation due to work life balance (11.1% of leavers).

Commissioning for Quality and Innovation (CQUIN) Update

Black Country Partnerships Foundation Trust CQUINs

Scheme Q1 Q2 Q3 Q4 Health and Well Being (A) – Staff Initiatives The 5 percentage point improvement should be achieved over a period of 2 years, with the baseline survey being the 2015 staff survey. Health and Well Being (B) – Healthy Food Providers will be expected to build on the four changes required in the 2016/17 CQUIN Health and Well Being (C) – Influenza Vaccinations Achieving an uptake of flu vaccinations by frontline clinical staff of 75% Physical Health Improving physical healthcare to reduce premature mortality in people with SMI. Cardio Metabolic assessment and treatment for patients with psychoses. Mental Health – A&E Improving services for people with mental health needs who present at A&E. Transitions out of CYP Services This CQUIN aims to incentivise improvements to the experience and outcomes for young people as they transition out of Children and Young People’s Mental Health Services (CYPMHS). Preventing Risk Behaviours Percentage of unique adult patients who are screened for smoking status AND whose results are recorded.

Summary The first milestone submission for the CQUIN scheme is July 2017, so Q1 performance summary will appear in July Q&S report.

Urgent Care Data contained in this report is up-to-date and includes all data up to and including May 2017. It does not include information pertaining to West Midlands Ambulance Service and Accident and Emergency as this information is outlined in a separate section of this report.

Urgent Care Summary Never Events There have been Zero Never Events reported by Urgent Care Services since April 2016. Serious Incident Trends There has been 1 Serious Incident reported in Urgent Care Services since April 2016. Intermediate Care There have been 34 incidents reported by Intermediate Care Centres since April 2016, with the main identified trend being issues with incorrect or incomplete correspondence being received from Acute Trusts. SWBH are addressing this issue via formulation of a new discharge summary template, which is being supported by a CQUIN scheme. There have been zero complaints or concerns. NHS111 There have been six incidents reported about NHS111 since April 2016; however there have been nine complaints and concerns, with the primary trend being communication issues between the service and service users. NHS111 has recently been re-procured by the CCG. Out of Hours GPs There have been three incidents and zero complaints and concerns reported about Out of Hours GPs since April 2016

Incidents and Issues

Never Events There have been Zero Never Events reported by Urgent Care Services since April 2017.

Serious Incidents Trends There have been 0 Serious Incidents reported in Urgent Care Services since April 2017.

Intermediate Care There has been 1 incident reported by Intermediate Care Centres since April 2017, with the main identified trend being issues with incorrect or incomplete correspondence being received from Acute Trusts. SWBH are addressing this issue via formulation of a new discharge summary template, which is being supported by a CQUIN scheme. There have been zero complaints or concerns.

Month/Type Count 2017 Apr 1 (ICC) (Sandwell) - Waterside Nursing Home (BUPA), 60 Dudley Road, Tipton DY4 8EG Medication 1 May 7 None Grand Total 32

NHS 111 There have been zero incidents reported about NHS111 since April 2017; however there have been nine complaints and concerns, with the primary trend being communication issues between the service and service users. NHS111 has recently been re-procured by the CCG.

Incidents Month/Type Count 2017 Apr 1 Diagnosis & Tests 1 Grand Total 1

Complaints Month/Type Count (P) NHS 111 Service 0 None Grand Total 0

Out of Hours GPs There have been three incidents and zero complaints reported about Out of Hours GPs since April 2016. Poor communication has been identified as trend.

Incidents Month/Type Count Apr None 0 May None 0 Grand Total 0

Complaints There have been no recorded complaints or concerns about Out of Hours GP services. Other NHS Contracts

Data contained in this report is up-to-date and includes all data up to and including April 2017. Please note there was no meeting for The Dudley Group. This section summarises the key points tabled at the most recent Clinical Quality Review Group for NHS services for whom Sandwell and West Birmingham CCG hold a significant budget.

Other NHS Contract CQRM Summaries The Dudley Group Serious Patient Safety Incident Report May The Trust has reported zero Never Events for the month of April 2017. A total of 20 serious incidents have been reported in April 2017 (6 General SI’s and 14 pressure ulcer SI’s).

Reporting of Serious Incidents

The Trust’s highest category of SI’s for April is “stage 3 and 4 pressure ulcers”, this equates to 70% of the reported SI’s in the month. This is similar to the percentage of pressure ulcer SI’s in preceding month March 2017 (72%). It can be seen that there has been a significant reduction in the number of SI’s reported in April 2017 (43% decrease). This decrease is primarily due to the reduction in the number of pressure ulcers being reported now that verification is undertaken by a member of the Tissue Viability Team.

Reported SI (highest category) - Stage 3 and 4 Pressure Ulcers

Pressure ulcers are reported to the Patient Safety Team by a member of the Tissue Viability team once verified as a stage 3 or 4 pressure ulcer. The lead investigator completes the RCA and then presents this in the pressure ulcer meeting. There has been a significant reduction in the number of hospital acquired pressure ulcers in April 2017, the Tissue Viability Team undertook a road show and visited wards in March 2017. This focused on the promoting the importance of preventing pressure ulcers.

Serious incidents reported within other categories

It can be seen that the second highest reporting category is patient falls (15%). RCA investigations have been commissioned and will identify if the fall was unavoidable or avoidable.

Request for Deletion from STEIS

If an incident is reported externally on STEIS and subsequent evidence, information or the investigation identifies this was not externally reportable the Lead Clinician/Director will instruct the Corporate Governance team to request deletion from the CCG.

There were 11 requests for deletion from STEIS in April 2017. A request has been submitted to the CCG for the deletion of 102 pressure ulcer serious incidents that were identified as unavoidable and that have been closed by the commissioners. Complaints Complaints for year ending 31 March 2017 and claims report for the *figures in [ ] refer to year ending 31/3/2016 year ending 31 March • 100% [100%] of complaints received during were acknowledged within 3 2017 working days

• 87% [38%] The revised timescale for a reply (within 40 working days) has shown a big improvement in response times during year.

• 49% [59%] of complaints received and closed were upheld/partially upheld.

• 26 [11] complainants expressed dissatisfaction with their response (received and investigated).

• In quarters 1,2 & 3 all further correspondence from complainants was incorrectly categorised as ‘dissatisfied’ when many were actually seeking additional information and were not therefore dissatisfied with their response. This was remedied in Q4 hence a reported reduction in actual dissatisfied complainants in that quarter.

• 115 [101] local resolution meetings held with complainants.

• 23 [12] Inquests held and closed.

• 1 [1] rule 28 - reports on ‘Action to Prevent Future Deaths’ received from Senior Coroner.

• 5 [4] Complaints accepted for investigation by the PHSO in year ending 31/3/17. Birmingham Community Healthcare Commissioner There were 1745 incidents reported within this period. It should be noted that due Quarterly to the report being produced so close after the end of the quarter that not all Summary incidents have been through the management process and coding and data could Report change. 2016/2017 – Quarter 4 Reported Incidents by Incident Type

The top three incident types for Quarter 4 are Patient Incident (1027, 59%) Staff, Visitor, Contractor Incident (326, 19%) and Medication, Medical Gas, Medication Delivery System Incidents (139, 8%).

This compares with 1844 incidents being reported for the same period in 2015/16, when the top three incidents reported were: Patient Incident (1053, 57%) Staff, Visitor, Contractor Incident (342, 19%) and Medication, Medical Gas, Medication Delivery System Incidents (159, 9%) and Infrastructure Incidents (159, 9%).

Never Event

There has been 1 Never Event reported: Retained foreign object post-procedure (Dental Division). Patient The report provides information about feedback received from patients and the Experience public, the lessons learned, action taken and themes and trends identified. This Report report provides assurance of listening in this way and supports the strategies and For Quarter 4, frameworks for engagement and involvement. 2016/17 Customer Services / Patient Advice and Liaison Service (PALS)

During quarter 4 there were 887 entries logged by the Customer Service Team onto the Trust Datix system. The following enquiry issues / themes were identified from the enquiries received:

• Calls not answered / not returned • Waiting time at appointment is too long • Waiting time for appointment and for equipment • Car parking • lack of • costs • pay on exit required (Bham Dental Hospital) • Community staff member did not attend when / as expected

Overall Friends and Family Test (recommendation) and rating report

The Trust-wide Friends and Family Test (FFT) score for the quarter was 92. This confirms 92% of respondents indicated they were extremely likely or likely to recommend the service to another. 91% of respondents also said they considered the service to be excellent or very good. This is from a total of 4326 patients who responded to the FFT question and 4255 who responded to questions about how they would rate the service.

Complaints received

The Trust received 49 formal complaints within this reporting period, with the majority of complaints once again relating to the coordination of care, particularly, poor standards or quality of care. Further detail in this regard is provided within the report.

For this period 100% of complaints were acknowledged within 3 working days and 100% were responded to within the 6 months statutory timescale or as agreed with the complainant. In addition, all complainants were offered meetings throughout the complaint investigation process. University Hospitals Birmingham Service RTT Waits Quality Performance At Trust level, the unfinished 18 week referral to treatment target was achieved in Exception April at 92.5%. The CCG-commissioned treatment functions that did not achieve the Report – May unfinished target were Neurosurgery (82.5%), Ophthalmology (79.5%) and General 2017 Surgery (83.8%).

Neurosurgery performance improved slightly and is expected to continue to show the improvements seen throughout the year. Ophthalmology performance improved slightly also at 79.5% which is the highest it has been since November.

A&E Clinical Quality – Total time spent in A&E - % waiting 4 hours or less

Performance for the A&E 4 hour wait target in April was 82.7% which was slightly below the March performance of 84.6%. There were 9,427 attendances in the month, an average of 314 per day.

Cancer targets – 62 Day GP, 31 subsequent drugs and 62 consultant upgrade

Performance for the Cancer 62 day standard was 76.1% in March compared to 67.1% in February which is the highest it has been since December.

The 98% 31 day subsequent chemotherapy standard was missed again in March with a performance of 94.1%. The breach tolerance is very small for this standard at just 4 patients. A temporary capacity issue was the main problem and the standard is expected to be met again from April.

The 62 day consultant upgrade standard was narrowly missed in March with a performance of 87.6% against a target of 90%, however the standard was achieved overall for the 2016/17 year.

Cancelled operations – 28 day guarantee

There were 2 breaches of the 28 day guarantee in April. This is a reduction from March breaches of 5 and also the lowest amount of breaches since November. A&E 4 hour Over the last 6 months the Unscheduled Care Steering Group has delivered a wait programme of service improvements with the overall objective of increasing performance against the A&E 4-hour wait target.

Reducing demand in A&E

At the beginning of January 2017, the Surgical Assessment Unit (SAU) was moved ward so that its capacity could be increased by 12 trolley spaces. This allowed new specialities to see patients in SAU, thereby reducing the number of specialty expected patients presenting in A&E.

Increasing Capacity in A&E

5 additional cubicle spaces have been created for seeing patients in the Minors part of A&E. This has helped reduce delays in and contributed to an improvement in non-admitted performance in February and March 2017.

Improving flow through the hospital

From the beginning of January 2017, ward 517 has been open to create 24 additional medical beds. This is being operated as a medicine multi-speciality ward with 7-day consultant ward rounds. However there is still an overall gap in medical beds. Since the beginning of January, 43% (3,236) of the Trust’s A&E 4-hour wait breaches were admitted to CDU. Cancer 62 day Performance for the Cancer 62 day standard was reported externally as 76.1% in GP Referral March.

As outlined last month, the 31 day subsequent chemotherapy target was again missed in March. There is a small breach tolerance for this indicator (4 breaches). This was due to a temporary capacity issue and is now resolved. April performance is expected to be within target.

Nursing and Care Homes Data contained in this report is up-to-date and includes all data up to and including May 2017.

Incidents

Incident Reporting and Trends:

Month/Type Count 2017 Apr 2 Medication 1 Pressure Sore 1 Grand Total 2

Complaints Trends:

Themes/Trends 2016 Apr No complaint May No complaints

Summary: There have been 2 incidents reported against Nursing and Care homes since April 2017, with no significant trends identified thus far. Private and 3rd Sector Contracts Data contained in this report is up-to-date and includes all data up to and including May 2017.

Summary:

Private and 3rd Sector Providers Never Events There have been zero Never Events reported by Private and 3rd Sector service providers since April 2017. Serious Incidents There has been 1 Serious Incident reported by Private and 3rd Sector service providers since April 2017, 0 of these were reported in May. The have been no trends identified thus far. Other Incidents There have been 80 incidents reported by Private and 3rd Sector service providers since April 2016. The most prominent trends to emerge are issues with the Quality of Scans and communication with GPs by Health Harmonie (Community Ultrasound Service). These issues have been addressed directly with the provider and the CCG is seeing good evidence of improvement in these areas. Health Harmonie now also provide full root Cause Analyses documents for all incidents reported by GPs. Complaints and Concerns There have been 10 Complaints and Concerns reported about Private and 3rd Sector service providers since May 2016. 0 of these were reported in April. Trends reflect the trends identified via the incident reporting route.

Incidents

Never Events There have been zero Never Events reported by Private and 3rd Sector service providers since April 2017.

Serious Incidents Trends There has been 1 Serious Incidents reported by Private and 3rd Sector service providers since April 2017, 0 of these were reported in May. The have been no serious incident trends identified thus far.

Year/Month/Type Count 2017 Apr 0 None 0 May 1 Health Harmonie – Minor Ops 1 Grand Total 1

Other Incidents There have been 15 incidents reported against Private and 3rd Sector service providers since April 2017.

Month/Type Count 2017 Apr 7 (CCG) (Private) Health Harmonie (Minor Surgery) 1 Clinical Care (Assessment/Monitoring) 1 (CCG) (Private) Health Harmonie (Ultra Sound) 4 Appointments, Discharge & Transfers 1 Diagnosis & Tests 1 Records, Communication & Information 2 (CCG) (3rd Sector) Forward Thinking Birmingham (LD) 1 Records, Communication & Information 1 (CCG) (Private) West Bourne Centre - Surgery 1 Clinical Care (Assessment/Monitoring) 1 May 8 (CCG) (Private) Health Harmonie (Minor Surgery) 3 Diagnosis & Tests 1 Records, Communication & Information 2 (CCG) (Private) Health Harmonie (Ultra Sound) 3 Clinical Care (Assessment/Monitoring) 1 Records, Communication & Information 2 (CCG) (3rd Sector) Forward Thinking Birmingham (LD) 1 Appointments, Discharge & Transfers 1 (CCG) (3rd Sector) Kaleidoscope Plus - Community Wellbeing 1 Appointments, Discharge & Transfers 1 Grand Total 15

Complaints There has been 1 Complaints reported about Private and 3rd Sector service providers since April 2017. Trends reflect the trends identified via the incident reporting route.

Month/Type Count (P) Private Sector Contracts 1 (CCG) (Private) Out of Hours GP Service - Primecare 1 Poor Management of Physical Health 1 Grand Total 1

GOVERNING BODY/FINANCE & PERFORMANCE COMMITTEE Report Title: Report author and Title: Financial & Activity Report James Green, CFO (as at 31st May 2017) David Hughes, Deputy CFO

Date of Governing Body Meeting Contact Details: Wednesday 5th July 2017 [email protected] [email protected] Agenda No: 7.2a Enclosure no: 4a Sign off from Chief Officers: (Before the report is presented to the Governing Body any implications relating to Finance, Quality and Commissioning must be agreed and signed by the Chief Officer. (see guidance note) Without this information the report will not be taken to the Governing Body)

Chief Finance Officer: Agreed Chief Officer for Quality: N.A Chief Officer for Operations: N.A Chief Officer for Partnership: N.A

Supporting Documents/further Reading: (Highlight any documents or further reading for members which supports this report) None Previous Decision (Inform the Governing Body/Committee if the paper has been reviewed or monitored by another committee and their recommendation or decision)

Summary of purpose and scope of the report:

The purpose of this report is to provide an update to the Finance & Performance Committee and Governing Body in respect of the CCG’s financial position for April to May 2017. The key points are:-

• Sandwell and West Birmingham CCG’s overall Revenue Resource Limit (annual budget) is £798m. • The CCG has a planned surplus for the year of £19m. This is the maintenance of the cumulative surplus of £21.5m delivered for the financial year 2016/17, less the NHS mandated draw down funding planned for 2017/18 of £2.5m. • The CCG’s QIPP target for 2017/18 is £25.1m. • The CCG is currently operating within its Running Cost Allowance of £11.5m. • The funding allocation transfer in relation to practice moves is yet to be agreed and remains within the financial position within reserves.

Recommendations:

Members of the Finance and Performance Committee are asked to:

Sandwell & West Birmingham CCG PUBLIC meeting of the Governing Body Page 1 Agenda Item 7.2 Finance and Performance Wednesday 05 July 2017 Report – Enc 4a

• Discuss the content of the report; • Approve the content of the report.

The Governing Body/Committee are requested to: Action Approve X Assurance Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified X Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision: Strategic Priorities related to the report: Quality & Safety Finance & Performance X Partnership Strategic Commissioning and Redesign Organisational Development Primary Care Co-Commissioning Collaborative Commissioning Implications: Financial Assurance Framework Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated Consultation: X Patients Staff Committees Public Partners Sponsored By: (Chief Officer or Committee James Green, CFO Chair) Date Report received for Governing Body/Committee

Sandwell & West Birmingham CCG PUBLIC meeting of the Governing Body Page 2 Agenda Item 7.2 Finance and Performance Wednesday 05 July 2017 Report – Enc 4a

Finance and Performance Committee

Report Topic: Finance and Activity Report as at 31st May 2017 (Month 2 – 2017/18)

Report From: James Green – Chief Finance Officer

Date: Monday 26th June 2017

To provide information to the committee on the financial performance of the CCG for the period of April to Purpose of the Report May 2017.

• Sandwell and West Birmingham CCG’s overall Revenue Resource Limit (annual budget) is £798m. • The CCG has a planned surplus for the year of £19m. This is the maintenance of the cumulative surplus of £21.5m delivered for the financial year 2016/17, less the NHS mandated draw down funding planned for 2017/18 of £2.5m. Key Issues Summary • The CCG’s QIPP target for 2017/18 is £25.1m. • The CCG is currently operating within its Running Cost Allowance of £11.5m. • The funding allocation transfer in relation to practice moves is yet to be agreed and remains within the financial position within reserves.

Members of the Finance and Performance Committee are asked to:

Recommendations - Discuss the content of the report and approve the content. - Approve the content of the report

Sandwell & West Birmingham CCG PUBLIC meeting of the Governing Body

Agenda Item 7.2 Finance and Performance Report – Enc 4a Wednesday 05 July 2017

Executive Summary – CCG Assurance

Commentary Financial Performance • The table opposite is similar to the CCG assurance framework used by NHS England to assess the financial performance of CCGs. The overall Self No. Indicator Assessment performance is rated as green (as less than three indicators are amber).

• The underlying surplus is calculated by taking the forecast financial

1 Underlying Recurrent Surplus 1.9% position, adjusting for the full year effect of expenditure

commitments/savings and removing non-recurrent items. The

Surplus - Year to Date Performance - underlying surplus is 1.9% of total expenditure. This attracts a green 2 0.0% Variance rating.

• The year to date position shows £12k ahead of the planned surplus. 3 Surplus - Full Year Forecast - Variance 0.0%

• The CCG has a planned surplus for the year of £19m. This is the

Management of 2% NR Funds Within Agreed maintenance of the cumulative surplus of £21.5m delivered for the 4 Yes Processes financial year 2016/17, less the draw down funding planned for 2017/18 of £2.5m. 5 QIPP - Year to Date Delivery 100% • The CCG’s running costs allowance expenditure is forecast at £11.4m for 2017/18, producing an under spend of £93k. 6 QIPP - Full Year Forecast 100%

• The CCG is holding £3.4m (0.50% of funds and additional NHS England 7 Running Costs 100% funds) non-recurrently as directed by NHS England per STP guidelines.

These funds are budgeted in month 12. Clear Identification of Risks Against Financial Indicator Met In 8 Delivery & Mitigations Full • The funding allocation transfer in relation to practice moves is yet to be agreed and remains within the financial position within reserves. Overall: All Primary Indicators Are Green Green

1. Financial Position

Commentary Surplus Analysis (£000s) • The CCG’s Revenue Resource Limit for 2017/18 is £798m. £20,000

£18,000 • The year to date position shows £12k ahead of the planned surplus. £16,000

£14,000 £12,000 • The CCG has a planned surplus for the year of £19m. This is the £10,000

maintenance of the cumulative surplus of £21.5m delivered for the financial £8,000 £6,000 year 2016/17, less the NHS mandated draw down funding planned for £4,000 2017/18 of £2.5m. £2,000 £0

• A more detailed breakdown of the financial position can be found in

Appendix 1 of this document, together with details of budget movements Revised Plan Actual between2. Contractareas in Appendix Finance 2.

2. Revenue Resource Limit

The CCG’s Revenue Resource Limit (income) for 2017/18 is £798m. This represents an initial baseline allocation of £771m with further in- year adjustments of £27m. An overview of the allocation adjustments for M2 can be seen below:-

3. Practice Moves

From the 1st April 2017 the following GP practices have moved CCG constituency:

Work is currently still being undertaken with Birmingham South Central CCG to agree the value of allocation to transfer. It is has been difficult to determine the basis for the funding transfer and to obtain the historic information on allocations from existing PCT organisations prior to the CCG’s existence.

Monthly updates on progress with practice moves will be shared within this report. 3. Contract Finance

The table below details the CCG’s higher value contracts. The main contracts to note are Sandwell & West Birmingham Hospitals and Dudley Group Hospitals.

YTD Forecast Forecast Annual Plan YTD Budget YTD Actual Acute Surplus/(Deficit) Outturn Surplus/(Deficit) £000 £000 £000 £000 £000 £000 Sandwell and West Birmingham NHS Trust 234,466 39,078 39,078 (0) 234,466 0 University Hospitals Birmingham NHS FT 24,686 4,114 4,114 0 24,686 0 Dudley Group of Hospitals NHS FT 35,315 5,886 5,886 (0) 35,315 0 Walsall Hospitals NHS Trust 8,263 1,377 1,377 (0) 8,263 (0) Heart of England NHS FT 9,070 1,512 1,512 (0) 9,070 (0) Birmingham Women's and Children's Hospital NHS FT 13,961 2,327 2,327 0 13,961 0 Royal Orthopaedic Hospital NHS FT 5,451 908 908 0 5,451 0 Royal Wolverhampton Hospital NHS Trust 2,265 377 377 (0) 2,265 0 West Midlands Ambulance Services NHS Trust 17,295 2,882 2,894 (11) 17,306 (11) Worcester Acute Hospitals NHS Trust 376 63 65 (2) 378 (2) University Hospitals of North Midlands NFT 311 52 52 0 311 0 Shrewsbury and Telford Hospital NHS Trust 171 28 28 (0) 171 (0) Extended Choice 3,596 599 599 0 3,596 (0)

YTD Forecast Forecast Annual Plan YTD Budget YTD Actual Community Surplus/(Deficit) Outturn Surplus/(Deficit) £000 £000 £000 £000 £000 £000 Sandwell & West Birmingham Hospitals 27,171 4,528 4,528 0 27,171 0 Birmingham Community Healthcare Trust 17,903 2,984 2,984 (0) 17,903 (0) Walsall Hospitals NHS Trust 321 53 53 0 321 (0) Royal Wolverhampton Hospital NHS Trust 97 16 16 (0) 97 (0) Dudley Group of Hospitals NHS FT 371 62 62 0 371 0

YTD Forecast Forecast Annual Plan YTD Budget YTD Actual Mental Health Surplus/(Deficit) Outturn Surplus/(Deficit) £000 £000 £000 £000 £000 £000 Black Country Partnership 35,705 5,951 5,952 (1) 35,711 (6) Dudley & Walsall Mental Health 1,887 315 315 (0) 1,887 (0) Birmingham & Solihull Mental Health 999 166 167 (0) 999 0

Forward Thinking Birmingham (BW&C) 5,430 905 905 0 5,430 0

4. Prescribing Performance

Commentary Prescribing - Outturn • The prescribing budget for 2017/18 is £86.8m,

with expenditure currently forecast of £87.2m. This over spend is due to the level of prescribing rebates expected for the year to be much lower

Actual £000 compared to previous years. Budget £000 • Information has yet to be received from the Prescription Pricing Authority for activity relating to 2017/18.

86,600 86,700 86,800 86,900 87,000 87,100 87,200

• The graph below shows a comparison of prescribing expenditure over the financial years. 2013/14 to 2016/17.

Prescribing - Expenditure

£7,400,000

£7,200,000 2014/15

£7,000,000 2015/16 2016/17 £6,800,000 £6,600,000

£6,400,000

£6,200,000

£6,000,000

5. Primary Care

The CCG primary care expenditure is currently forecast to breakeven with total expenditure against its delegated resource of £78.9m.

The CCG also has the following further plans in relation to the GP resilience programme, enhanced services and collaborative fees:

6. Quality Innovation Price Productivity (QIPP)

Commentary • The CCG’s overall QIPP target for the year is £25.1m. • Details of the schemes can be found in the table below.

Annual Year to Date Forecast Outturn QIPP Schemes Plan Plan Actual Variance Plan Actual Variance £000 £000 £000 £000 £000 £000 £000 Transactional Acute services 7,585 790 790 0 7,585 7,417 (168) Mental Health Services 562 92 92 0 562 562 0 Community Health Services 2,529 422 318 (104) 2,529 1,906 (623) Continuing Care Services 795 132 137 5 795 1,504 709 Primary Care services 2,270 378 378 0 2,270 2,270 0 Other Programme Services 4,181 0 0 0 4,181 4,181 0 Primary Care Co-Commissioning 700 116 116 0 700 700 0

Total Transactional Schemes 18,622 1,930 1,831 (99) 18,622 18,540 (82) Transformational Acute services 3,773 633 634 1 3,773 3,773 (0) Mental Health Services 1,004 168 168 0 1,004 1,004 0 Community Health Services 628 104 104 0 628 628 0 Continuing Care Services 218 36 36 0 218 218 0 Primary Care services 680 116 191 75 680 722 42 Other Programme Services 150 0 0 0 150 150 0

Total Transformational Schemes 6,453 1,057 1,132 75 6,453 6,495 42 Other Other Gains & Benefits 0 0 26 26 0 40 40

Total Other Schemes 0 0 26 26 0 40 40

Total QIPP Schemes 25,075 2,987 2,989 2 25,075 25,075 (0)

7. Statement of Financial Position

31 May 2017 £'000 Comments: Non-Current Assets 0 Total Non-Current Assets 0 The CCGs Statement of Financial Position Current Assets (SOFP), or Balance Sheet, provides a Inventory 0 Trade and Other Receivables 1,967 snapshot of the CCG’s financial position Accrued Income and Prepayments 3,174 on the 31st May 2017. The SOFP is made VAT 529 Bad Debt Provision (51) up of two parts which must always equal Cash and Cash Equivalents 16 each other. The top part (total assets Total Current Assets 5,635 employed) shows the CCG’s assets and Total Assets 5,635 liabilities (what the CCG owns and is Current Liabilities owed) and the bottom part (total Trade and Other Payables (14,224) Accrued Expenditure and Deferred Income (16,551) taxpayers’ equity) which shows how the Prescribing (14,522) Provisions (5,575) CCG has been financed. The SOFP Tax and Social Security (225) statement is set out in the table to the left. Total Current Liabilities (51,097)

Non-Current Assets plus/less Net Current The balance sheet cash book balance was Assets/Liabilities (45,462) £16k at the end of May 2017. This differs Non-Current Liabilities from the bank balance shown in section 8 Trade and Other Payables 0 Provisions 0 due to transaction timing differences of Total Non-Current Liabilities 0 £312k. Assets Less liabilities (45,462)

Financed by Taxpayers' Equity General Fund (45,462) Revaluation Reserve 0 Charitable Reserves 0 Total Taxpayers' Equity (45,462)

8. Cash Efficiency

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's ACTUAL BANK BALANCE 10 417 0 0 0 0 0 0 0 0 0 Funding from DH 54,613 55,200 0 0 0 0 0 0 0 0 0 Adjustments to main funding 0 2,400 0 0 0 0 0 0 0 0 0 Total cash available 54,623 58,017 0 0 0 0 0 0 0 0 0

Less net payments via Government Banking Service 54,206 57,689 0 0 0 0 0 0 0 0 0 0 0 0 0 Total net payments 54,206 57,689 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Closing BANK BALANCE 417 328 0 0 0 0 0 0 0 0 0 Actual % of closing balance (compared to opening balance 0.76% 0.60% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% plus drawdown)

Commentary

The CCG has a bank balance of £328k at the end of May 2017. This balance was within the 1.25% of in month funding ceiling set by NHS England.

9. Better Payment Practice Code

2016-17 (April to March 2017-18 (April to May 2017) Commentary 2017) 31-May-17 31-May-17 31-Mar-16 31-Mar-16 Number £000 Number £000 The CCG is required to pay 95% of all valid invoices Non-NHS Payables: CCG within 30 days. Total Non-NHS trade invoices paid in the year 2,509 30,023 16,449 192,827 Total Non-NHS trade invoices paid within target 2,491 29,922 16,068 186,980 In Month Percentage of CCG Non-NHS Trade Invoices Paid 99.28% 99.66% 97.68% 96.97% Within Target NHS Payables: CCG During May 2017, 1,785 invoices were registered with a Total NHS trade invoices paid in the year 564 83,575 4,025 491,580 combined value of £58.6m. However, 1,764 invoices Total NHS trade invoices paid within target 544 81,826 3,959 488,595 (99%) were processed within 30 days. Percentage of CCG NHS Trade Invoices Paid Within 96.45% 97.91% 98.36% 99.39% Target

Year-to-date

Better Payment Practice Code performance for the period

ended May 2017 showed that 99% of Non NHS invoices were paid within 30 days (with 100% in value terms) paid Invoices Paid on time. 101.00% 100.00% Better Payment Practice Code performance for the period 99.00% % Passed ended May 2017 showed that 96% of NHS invoices were 98.00% paid within 30 days (with 98% in value terms) paid on 97.00% time. % Amount 96.00% Passed 95.00% Overall Performance 94.00% % Target 93.00% The cumulative year-to-date performance is significantly 92.00% above the required target of 95%.

10. Conclusion

In conclusion, the key points to note from this report are:-

• Sandwell and West Birmingham CCG’s overall Revenue Resource Limit (annual budget) is £798m.

• The CCG has a planned surplus for the year of £19m. This is the maintenance of the cumulative surplus of £21.5m delivered for the financial year 2016/17, less the draw down funding planned for 2017/18 of £2.5m.

• The CCG’s QIPP target for 2017/18 is £25.1m.

• The CCG is currently operating within its Running Cost Allowance of £11.5m.

11. Recommendations

Members of the Finance and Performance Committee are asked to:

• Discuss the content of the report; • Approve the content of the report.

Contact Officers

James Green – Chief Finance Officer – [email protected] - Tel: 0121 612 1568

David Hughes - Deputy Chief Finance Officer – [email protected] – Tel: 07872055022

Laura Mainwaring – Head of Financial Management – [email protected] – Tel: 07872055060 Appendix One YTD Forecast Annual Budget YTD Budget YTD Actual Forecast Outturn Surplus/(Deficit) Surplus/(Deficit) £000 £000 £000 £000 £000 £000

SOURCES OF FUNDING

Confirmed Allocations - Commissioning (700,050) (111,316) (111,316) 0 (700,050) 0 Confirmed Allocations - Primary Care Co-Commissioning (78,998) (13,166) (13,166) 0 (78,998) 0 In Year Allocations (19,038) (3,173) 0 0 (19,038) 0 Potential Allocations 0 0 0 0 0 0

Total Revenue Resource Limit (798,086) (127,655) (124,482) 0 (798,086) 0

APPLICATIONS - PROGRAMME

Acute Services

NHS Acute Services Sandwell and West Birmingham NHS Trust 234,466 39,078 39,078 (0) 234,466 0 University Hospitals Birmingham NHS FT 24,686 4,114 4,114 0 24,686 0 Dudley Group of Hospitals NHS FT 35,315 5,886 5,886 (0) 35,315 0 Walsall Hospitals NHS Trust 8,263 1,377 1,377 (0) 8,263 (0) Heart of England NHS FT 9,070 1,512 1,512 (0) 9,070 (0) Birmingham Women's and Children's Hospital NHS FT 13,961 2,327 2,327 0 13,961 0 Royal Orthopaedic Hospital NHS FT 5,451 908 908 0 5,451 0 Royal Wolverhampton Hospital NHS Trust 2,265 377 377 (0) 2,265 0 West Midlands Ambulance Services NHS Trust 17,295 2,882 2,894 (11) 17,306 (11) Worcester Acute Hospitals NHS Trust 376 63 65 (2) 378 (2) University Hospitals of North Midlands NFT 311 52 52 0 311 0 Shrewsbury and Telford Hospital NHS Trust 171 28 28 (0) 171 (0)

Total NHS Acute Services 351,629 58,605 58,618 (13) 351,642 (13)

Acute Services Other Non Contracted Activity & Out of Area 4,907 934 941 (7) 4,907 0 Individual Funding Requests 50 8 0 8 42 8 Extended Choice Contracts 3,596 599 599 0 3,596 (0) Other Acute Services 1,132 85 85 (0) 1,137 (5)

Total Acute Services Other 9,685 1,627 1,625 2 9,682 3

Total Acute Services 361,313 60,232 60,243 (12) 361,324 (10)

Commissioned Community Services

NHS Community Services Sandwell & West Birmingham Hospitals 27,171 4,528 4,528 0 27,171 0 Birmingham Community Healthcare Trust 17,903 2,984 2,984 (0) 17,903 (0) Walsall Hospitals NHS Trust 321 53 53 0 321 (0) Royal Wolverhampton Hospital NHS Trust 97 16 16 (0) 97 (0) Dudley Group of Hospitals NHS FT 371 62 62 0 371 0 Birmingham Community Health Care Trust - Non Contracted 1,557 0 0 0 1,557 0

Total NHS Community Services 47,420 7,644 7,644 (0) 47,420 (0)

Community Assessment NHS 111 1,719 287 287 0 1,719 0 Clinical Assessment & Urgent Care Centres 2,875 476 434 41 2,826 48 Total Community Assessment 4,594 762 721 41 4,546 48 Continuing Healthcare Continuing Healthcare - Physical Disabilities 12,003 2,000 2,001 (1) 11,327 676 Continuing Healthcare - Children 637 106 105 1 656 (19) Continuing Healthcare - Staffing 1,599 266 238 28 1,599 1 Continuing Healthcare - Joint Funded 0 0 136 (136) 664 (664) Personal Health Budgets 774 129 137 (8) 852 (78) Funded Nursing Care 6,876 1,146 1,141 5 6,843 33 Looked After Children 794 132 (44) 177 749 46 Total Continuing Healthcare 22,683 3,780 3,714 67 22,689 (5) Other Community Services Interpreting Services 913 152 190 (38) 1,043 (131) Reablement 278 46 47 (0) 279 (0) Safeguarding (Programme) 1,138 190 163 26 1,098 40 Carers 527 88 84 4 501 26 Hospices 236 39 41 (2) 235 1 Palliative Care 3 1 1 (0) 3 0 Intermediate Care 1,489 248 213 35 1,476 13 Commissioning Schemes 0 0 (6) 6 (6) 6 Patient Transport 1,936 323 198 125 1,821 115 Non NHS Community Contracts 6,401 1,067 1,289 (223) 6,935 (534)

Total Other Community Services 12,921 2,153 2,219 (66) 13,385 (464)

Property Costs NHS Property Costs 3,810 635 630 5 3,811 (0)

Total Property Costs 3,810 635 630 5 3,811 (0) Total Community Services 91,429 14,975 14,928 47 91,850 (421) Mental Health & Learning Disabilities

NHS Trust Contracts Black Country Partnership 35,705 5,951 5,952 (1) 35,711 (6) Dudley & Walsall Mental Health 1,887 315 315 (0) 1,887 (0) Birmingham & Solihull Mental Health 999 166 167 (0) 999 0 Forward Thinking Birmingham 5,430 905 905 0 5,430 0

Total NHS Trust Contracts 44,021 7,337 7,338 (1) 44,027 (6)

Mental Health Birmingham Joint Commissioning arrangements 21,369 3,562 3,613 (52) 21,678 (309) Assessments 0 0 2 (2) 8 (8) CAMHS 319 53 40 13 338 (19) IAPT 381 63 63 (0) 381 (0) Mental Health NCA 256 43 43 (1) 256 (0) Mental Health Non NHS 1,380 230 199 31 1,392 (11) Mental Health Placements 13,033 2,172 2,454 (282) 11,358 1,675 Mental Health Section 117 0 0 321 (321) 1,674 (1,674)

Total Mental Health 36,739 6,123 6,737 (614) 37,086 (347)

Learning Disabilities Learning Disability (Hosted) 9,681 1,614 1,313 300 9,236 446 Learning Disability Placements 6,121 1,020 1,040 (20) 6,239 (118) Learning Disability Section 117 0 0 67 (67) 187 (187)

Total Learning Disabilities 15,802 2,634 2,420 214 15,662 141

Total Mental Health & Learning Disabilities 96,562 16,094 16,495 (401) 96,774 (212)

Winter Pressures

Winter Pressure Schemes 1,430 141 144 (3) 1,433 (3)

Total Winter Pressures 1,430 141 144 (3) 1,433 (3)

Primary Care

GP Commissioning (Delegated) 78,998 12,759 12,339 419 78,998 (0) Local Incentive Schemes 90 15 15 0 90 0 Out of Hours 3,113 519 443 76 3,071 42 GP IT 1,567 261 227 34 1,565 2 Collaborative Commissioning 286 48 48 (0) 288 (2) Primary Care Non Recurrent 853 0 6 (6) 859 (6)

Total Primary Care 84,907 13,601 13,079 522 84,871 36

Prescribing

Prescribing Practice Budgets 80,772 13,776 13,715 60 80,735 37 Prescribing Other 4,310 718 751 (32) 4,744 (434) Home Oxygen 921 153 151 2 921 0 Medicines Management Clinical 806 134 103 31 762 44

Total Prescribing 86,808 14,782 14,720 61 87,161 (353)

Better Care Fund

Better Care Fund 18,746 3,124 3,124 0 18,746 0

Total Better Care Fund 18,746 3,124 3,124 0 18,746 0

Reserves, Contingency & QIPP

Reserves, Contingency & QIPP 5,047 (268) 0 (268) 4,178 870 Non Recurrent Reserve 3,415 0 0 0 3,415 0 Practice Moves Reserve 17,904 0 0 0 17,904 0

Total Reserves 26,366 (268) 0 (268) 25,497 870

TOTAL PROGRAMME EXPENDITURE 767,562 122,681 122,734 (53) 767,655 (93)

APPLICATIONS - RUNNING COSTS

CCG Running Costs 10,936 1,710 1,651 59 10,843 93 CCG Running Costs - CSU 464 77 72 6 463 1 CCG Running Costs - NHS 111 86 14 14 (0) 86 0

TOTAL RUNNING COSTS 11,486 1,801 1,737 64 11,393 93

TOTAL EXPENDITURE 779,048 124,482 124,471 12 779,048 0

Required Surplus

Planned Surplus 19,038 3,173 0 3,173 0 19,038 Planned Required Surplus 19,038 3,173 0 3,173 0 19,038

Report Topic: Key Indicators Performance Report – data up to April 2017

Report From: James Green – Chief Finance Officer Date 26th June 2017

To provide information to the Board on the performance of the CCG against key indicators for the financial years up Aim of Report to 2017/18.

- A & E Discussion Points - Cancer waits

Members of the Committee are asked to: RECOMMENDATIONS 1. Discuss the contents of the report 2. Approve the contents of the report Contents

Section Page

Key Messages 2

Outcomes Domain 3 3 Outcomes Domain 5 4 The Forward View into action - Annex B Measures 5 IAF Better Health 14 IAF Better Care 15 Legend 16

1 Key Messages

Summary: Our lead roles and responsibilities:

Sandwell and West Birmingham Clinical Commissioning Group (SWB CCG) is the lead commissioner on; Accident & Emergency (A&E) NHS 111 across the West Midlands. A&E performance (84.95%) continues to be below both the 95% national target and the local STF trajectory. Further to the plan WMAS across the West Midlands presented at the April A&E delivery board meeting, only one action was due for completion in May. This was an increase of 20% Home Oxygen across the West Midlands. capacity in Sandwell ED through using the space differently. SWBHT state that this action is on track however ED capacity breaches Urgent care for the Black Country are not showing a corresponding decrease.

The number of people that attended A&E in May was 19 253, an increase from April but below the level of activity seen in May 2016 (20,366). The main reasons for ED breaches continue to be due to delays in clinical decision making, ED cubicles full, awaiting Sandwell and West Birmingham CCG is leading the reconfiguration of Stroke services across Birmingham and the Black Country on a bed on AMU and “other ED delays”. (The definition of Other ED delays is Not Referred within 180mins AND does not meet any behalf of all commissioners. other ED reason). Commissioners have noted a continued increase in reliance on the use of bank and agency staff in May. Stroke Cancer Waits

The CCG failed to meet the 31 day subsequent treatment for surgery and the 62 day 1st treatment in April. The CCG Cancer Our significant CCG redesign projects are; Steering Group is establishing a process for following up the breaches. Community Nursing Diabetes Right care right here – As part of the partnership programme an on-going process of redesigning services with a stronger Community focus.

2 Outcomes Domain 3. Helping people to recover from episodes of ill health or following injury

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Overarching Indicators Emergency readmissions within 30 days 8.46% 8.32% 7.92% 7.84% 8.05% 7.21% 7.47% 7.66% 8.68% 8.43% 9.00% 8.07% 7.71% C3.2 Reduce % CCG Apr-17 7.71% 7.71% of discharge from hospital             

Updated

Emergency readmissions has improved in April falling to 7.71% Bringing it back in line with the middle part of last year. Data for this indicator is taken from SUS and due to access privileges we can only do comparisons to the other local CCGs, SWBCCG has the second highest rate locally with Solihull CCG the highest with 7.77%, Dudley CCG had the lowest rate on the patch with 5.33%.

Improving recovery from mental health conditions 4.78% 4.00% 4.72% E.A.3 IAPT - People entering treatment 3.75% < 3.75% % CCG Q3 16-17 4.72% 13.50% G   

54.55% 55.51% 56.23% E.A.S.2 IAPT - Moving to recovery 50% < 50% % CCG Q3 16-17 56.23% 55.54% G   

50.84% 53.88% 55.61% E.A.S.2 IAPT - Moving to recovery 50% < 50% % BCPFT Q3 16-17 55.61% 53.56% G   

Waiting times The proportion of people that wait 6 weeks or less from referral to entering a 59.60% 71.19% 78.62% E.H.1_A1 course of IAPT treatment against the 75% < 75% % CCG Q3 16-17 78.62% 69.80% R number of people who finish a course of    treatment in the reporting period.

The proportion of people that wait 18 weeks or less from referral to entering a 84.34% 91.53% 90.94% E.H.2_A2 course of IAPT treatment against the 95% < 95% % CCG Q3 16-17 90.94% 88.94% R number of people who finish a course of    treatment in the reporting period

Updated

Entering Treatment CCG – Q3 was above plan . Monthly data for January was also above plan but there was a dip in February, particularly at BCPFT, which is being followed up with the provider. YTD to February we are at 13.50% against the 15% annual target. Local March data suggests both March and Q4 will be above the target.

Moving to recovery Both the CCG and BCPFT are above plan in Q3. January and February national data was also above plan. An early look at the local data for March suggests Q4 will be achieved.

Waiting Times Performance against the 6 week target improved in Q3 and the CCG met the target achieving 78.65%, however the 18 week target is still below the 95% with 90.94%. There are still some discrepancies between national and local data for this indicator and this is being addressed though the commissioning and contract routes. Both the 6 and 18 week waiting times for the CCG were achieved in January and February. Some local data for March is still outstanding but it is hoped that both March and quarter 4 will also be achieved.

3 Outcomes Domain 5. Treating and caring for people in a safe environment and protecting them from avoidable harm

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Improvement Areas Reducing the incidence of avoidable harm 0 1 1 2 2 3 3 4 4 4 4 4 1 1 CCG YTD May-17 0 1 R               E.A.S.4 MRSA Zero 0 Number 0 0 0 0 0 0 0 1 2 2 2 2 0 0 SWBHT YTD May-17 0 0 G              

14 20 34 40 47 58 73 83 94 102 107 109 9 9 <= 109 Number CCG YTD May-17 0 9 G               E.A.S.5 Cdiff Reduce 2 3 5 8 11 14 16 19 20 20 21 21 1 1 <= 30 Number SWBHT YTD May-17 0 1 G              

Updated

MRSA CCG - There were 0 breaches in May. SWBHT - There were 0 breaches in May.

Cdiff CCG - There were 0 breaches in May. SWBHT - There were 0 breaches in May.

4 The Forward View into action - Annex B Measures

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Incomplete Referral to Treatment pathways 92.59% 92.75% 92.98% 92.43% 92.25% 91.41% 90.70% 91.31% 89.79% 91.15% 92.30% 93.04% 92.84% CCG Apr-17 92.84% 92.84% R              E.B.3/ % of incomplete pathways within 18 92% < 92% % 129a weeks 92.35% 92.50% 92.72% 92.06% 92.03% 91.20% 90.04% 90.58% 88.93% 90.33% 92.13% 93.09% 92.77% SWBHT Apr-17 92.77% 92.77% R             

4 6 8 5 3 3 9 7 9 7 11 9 14 CCG Apr-17 14 14              Number of 52 week Referral to E.B.S.4 0 > 0 Number Treatment Pathways - Incomplete 0 2 2 0 0 1 2 2 2 1 3 2 3 SWBHT Apr-17 3 3 R             

Updated RTT - Incomplete - CCG RTT - Incomplete > 52 wks - CCG 95% 15 Incompletes

90% 10 CCG - Overall the CCG met the target in April with 92.84%. 2362 out of 33008 patients waited over 18 weeks. 85% Neurosurgery, General Medicine, Dermatology, Cardiology, Plastic Surgery & T&O failed the speciality targets. 5 80%

75% 0 SWBHT - Overall the Trust met the national target in April with 92.77%. 2327 patients out of 32187 waited over 18 weeks, 526 waited over 26 weeks. Dermatology, Plastic Surgery, Cardiology, Oral Surgery & T&O failed the speciality targets.

% < 18 wks National Target Number > 52 wks National Target 52 week waits

CCG - 14 patients waited over 52 weeks - 3 at SWBHT, 2 in Urology and 1 in Dermatology. 11 at ROH. A member of the CCG contracting team will be attending the next ROH contract review meeting to RTT Incomplete - SWBH RTT- Incomplete >52 wks - SWBH investigate the increasing number of long waiters there. 95% 3.5 3 SWBHT - 3 patients waited over 52 weeks - 2 in Urology and 1 in Dermatology. Exception reports are still outstanding. The breaches are all down to administraion erros and further checking has 90% 2.5 confirmed that no harm has come to the patients. A training packages is being implemented which will ensure that all staff (from admin to consultants) are compliant with clock rules around RTT. 2 85% 1.5 80% 1 0.5 75% 0

% < 18 wks National Target Number > 52 wks National Target

5 The Forward View into action - Annex B Measures Cont.…

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Diagnostic test waiting times 0.43% 0.25% 0.39% 0.43% 1.07% 1.43% 0.95% 0.98% 1.85% 1.62% 0.65% 1.06% 1.97% CCG Apr-17 1.97% 1.97% G              % waiting 6 weeks or more for a E.B.4 0.99% > 0.99% % diagnostic test 0.32% 0.11% 0.16% 0.29% 0.85% 1.37% 0.96% 0.83% 1.41% 0.96% 0.26% 1.29% 1.77% SWBHT Apr-17 1.77% 1.77% G             

Updated Diagnostic Test Waiting Times - CCG Diagnostic Test Waiting Times - SWBH 2.5% 2.0% 1.8% CCG 2.0% 1.6% The Trust failed to meet the target in April with 1.97%. There were 151 over 6 week breaches of which 9 waited over 13 weeks. Of the 13+ week breaches - 7 in MRI and 2 in Cystoscopy. MRI, CT, 1.4% 1.5% 1.2% Ultrasound, Echocardiography, Electrophysiology, Urodynamics, Flexisigmoidoscopy, Gastroscopy and Cystoscopy failed as individual specialties. 1.0% 1.0% 0.8% 0.6% 0.5% 0.4% 0.2% SWBHT 0.0% 0.0% The Trust failed to meet the national target in April with 1.77%. There were 132 over 6 week breaches of which 2 waited over 13 weeks. Of the over 13 weeks breaches both were in Cystoscopy. CT, Echocardiography, Flexisigmoidoscopy, Cystoscopy and Gastroscopy all failed as individual specialties.

Monthly Actual National Target Monthly Actual National Target

A & E Waiting Times < 4 hours % of patients who spend 4 hours or less 91.40% 92.88% 91.31% 88.81% 89.67% 89.14% 86.05% 82.84% 81.94% 84.19% 82.27% 85.32% 84.95% 81.57% E.B.5 93.54% < 93.54% % SWBHT May-17 81.57% 83.23% R in A & E              

Total number of patients who have 0 0 0 0 0 0 1 0 0 0 0 0 0 0 E.B.S.5 waited over 12 hours in A&E from 0 > 0 Number SWBHT May-17 0 0 R decision to admit to admission              

Updated % < 4hrs in A&E - SWBH 100% AA&E performance (84.95%) continues to be below both the 95% national target and the local STF trajectory. Further to the plan presented at the April A&E delivery board meeting, only one action was due for completion in May. This was an increase of 20% capacity in Sandwell ED through using the space differently. SWBH state that this action is on track however ED capacity breaches are not showing a corresponding decrease. 95%

The number of people that attended A&E in May was 19 253, an increase from April but below the level of activity seen in May 2016 (20,366). The main reasons for ED breaches continue to be due to 90% delays in clinical decision making, ED cubicles full, awaiting a bed on AMU and “other ED delays”. (The definition of Other ED delays is Not Referred within 180mins AND does not meet any other ED reason). Commissioners have noted a continued increase in reliance on the use of bank and agency staff in May.

85% The trust continue to report that additional bed capacity is open, an average of 63 per week in May (up from 55 per week in April) however existing staffing resource is being utilised to cover the expanded bed base. The proportion of medically fit patients within the bed base in April has remained fairly static; on average there were 59 medically fit patients per day in the acute bed based 80% compared to 65 in April. In May there were 464 days delays resulting from delayed transfers of care, a small reduction from April . Of these, 163 (35%) were attributable to the NHS and 201 (65%) to social care.

75% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 There were zero 12 hour decision to admit breaches and we were only notified of four cases breaching the 8 hour period in April, three were at the City site and one at Sandwell Monthly Actual National Target

6 The Forward View into action - Annex B Measures Cont.…

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Cancer - 2 week wait 94.73% 95.85% 96.10% 94.15% 95.18% 93.70% 94.75% 94.09% 95.75% 95.75% 94.40% 94.65% 95.18% CCG Apr-17 95.18% 95.18% G              E.B.6 All cancer two week wait 93% < 93% % 95.90% 95.41% 95.87% 94.59% 94.91% 93.01% 93.82% 93.49% 94.51% 95.34% 94.42% 93.96% 94.81% SWBHT Apr-17 94.81% 94.81% G             

96.71% 96.14% 98.01% 96.82% 92.86% 93.84% 93.98% 97.25% 95.76% 95.43% 96.65% 94.32% 95.93% CCG Apr-17 95.93% 95.93% G              E.B.7 Two week wait for breast symptoms 93% < 93% % 98.11% 96.75% 97.06% 97.58% 94.19% 93.43% 93.24% 96.41% 94.01% 96.02% 96.17% 93.62% 95.19% SWBHT Apr-17 95.19% 95.19% G             

Updated All cancer 2 week waits - CCG 100% CCG

95% All cancer two week wait - Overall the CCG met the target in April with 95.18%. 60 out of 1246 patients waited over two weeks. 49 of these were at SWBHT - 28 Patient Choice, 16 'Other', 3 Capacity and 2 Medical. 5 at DGFT - 4 Patient Choice, 1 'Other'. 5 at UHB - 4 due to Patient Choice and 1 due to Capacity. 1 at The Shrewsbury and Telford Hospitals Trust - due to 'Other'. 90% Monthly Actual Breast - The CCG met the target in April with 93.93%. 7 patients out of 172 waited over two weeks. 6 at SWBHT - 5 due to Patient Choice and 1 'Other'. 1 at HEFT - due to Capacity. 85% National Target

80% We urgently need to establish a means to follow up breach reasons with providers; this was raised at the recent Cancer Steering Group meeting and it was agreed that SWBHT would attend the next Cancer Performance Sub Group to try and establish how we monitor and attempt to reduce the number of breaches with inadequate reasons. With regard to other local providers, we are re-instating 75% attendance at contract review meetings. Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 SWBHT

All Cancer 2 week waits - SWBH Both categories were within target in April.

100%

95%

90% Monthly Actual 85% National Target

80%

75% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

7 The Forward View into action - Annex B Measures cont.…

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Cancer - 31 day waits 99.12% 96.58% 94.16% 98.00% 98.73% 96.99% 97.12% 97.32% 100.00% 98.33% 96.35% 97.95% 98.33% CCG Apr-17 98.33% 98.33% G              % receiving first definitive treatment E.B.8 96% < 96% % within one month 99.19% 97.83% 96.43% 99.34% 98.68% 98.39% 97.54% 97.93% 98.28% 98.44% 96.95% 97.42% 99.15% SWBHT Apr-17 99.15% 99.15% G             

100.00% 100.00% 95.45% 96.00% 93.55% 96.43% 100.00% 96.30% 92.31% 100.00% 100.00% 100.00% 91.30% CCG Apr-17 91.30% 91.30% G              31-day standard for subsequent cancer E.B.9 94% < 94% % treatments-surgery 100.00% 100.00% 94.44% 95.00% 100.00% 100.00% 100.00% 100.00% 94.12% 100.00% 100.00% 100.00% 100.00% SWBHT Apr-17 100.00% 100.00% G             

100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% CCG Apr-17 100.00% 100.00% G              31-day standard for subsequent cancer E.B.10 98% < 98% % treatments-anti cancer drug 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% SWBHT Apr-17 100.00% 100.00% G             

97.73% 100.00% 96.49% 100.00% 96.49% 100.00% 100.00% 100.00% 100.00% 96.67% 100.00% 100.00% 100.00% CCG Apr-17 100.00% 100.00% G 31-day standard for subsequent cancer              E.B.11 94% < 94% % treatments-radiotherapy

SWBHT This service is not provided at SWBHT

Updated Cancer 31 day waits - CCG 100% CCG

95% 31 day first treatment - Overall the CCG met the target in April with 98.33%. 2 patients out of 120 waited over 31 days. 1 at Dudley - the reason given was capacity and 1 at UHB - through Patient Choice.

90% 31 day subsequent surgery - The CCG failed to meet the target with 91.3%. 2 patients out of 23 waited over 31 days. Both were at RWH, the reason given for both were ‘unable to schedule within Monthly Actual standard’. RWH failed as a total Trust in April with 73.08%. A member of the contracting team will attend the next contract review meeting. 85% National Target 31 day sub anti-cancer drug - The CCG met the target achieving 100%. 27 patients were seen within target. 80%

75% 31 day sub radiotherapy - The CCG met the target achieving 100%. 44 patients were seen within target. Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

SWBHT Cancer 31 Day Waits - SWBH

100% The Trust were meeting all 31 day targets in April.

95%

90% Monthly Actual 85% National Target

80%

75% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

8 The Forward View into action - Annex B Measures cont.…

Target Previous Year Current Monitoring Year Data Actual FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Cancer - 62 day waits 87.10% 78.67% 83.58% 88.57% 79.49% 81.67% 87.67% 87.18% 76.92% 80.70% 74.39% 88.64% 81.97% CCG Apr-17 81.97% 81.97% G              All cancer two month urgent referral to E.B.12 85% < 85% % first treatment wait 87.50% 84.29% 89.92% 89.78% 84.14% 86.09% 87.07% 85.31% 81.98% 85.19% 80.77% 91.57% 85.59% SWBHT Apr-17 85.59% 85.59% G             

100.00% 90.00% 88.89% 100.00% 100.00% 93.33% 100.00% 88.24% 100.00% 77.78% 87.50% 75.00% 100.00% CCG Apr-17 100.00% 100.00% G 62-day wait for first treatment following              E.B.13 referral from an NHS cancer screening 90% < 90% % service 100.00% 97.87% 95.56% 96.61% 98.18% 93.75% 95.45% 92.16% 100.00% 93.75% 93.75% 90.48% 100.00% SWBHT Apr-17 100.00% 100.00% G             

94.74% 95.83% 92.00% 90.91% 94.74% 100.00% 96.15% 91.30% 100.00% 85.19% 68.75% 88.89% 100.00% CCG Apr-17 100.00% 100.00% 62-day wait for first treatment for cancer No              E.B.14 following a consultants decision to Operational % upgrade the patient's priority Standard 93.10% 93.10% 93.33% 90.00% 95.65% 96.30% 100.00% 95.45% 94.12% 96.43% 90.48% 93.33% 100.00% SWBHT Apr-17 100.00% 100.00%             

Updated Cancer 62 day waits - CCG

100% CCG

95% 62 day first treatment - The CCG failed to meet the target with 81.97%. 11 patients out of 61 waited over 62 days. 5 at SWBHT, 2 due to delays in diagnostics and 3 for medical reasons. 3 were at UHB, 2 for medical reasons and one no capacity (tertiary from SWBHT day 41). Two waited at DGFT, one for medical reasons and one through patient choice. The remaining one was at RWH and was due to a 90% Monthly Actual late tertiary received on day 69 from DGFT. 85% National Target 62 day screening - The CCG achieved 100%. 12 patients were seen within target. 80% 62 day consultant upgrade – The CCG achieved 100%. 20 patients were seen within target. 75% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

SWBHT Cancer 62 day waits - SWBH 100% SWBHT met all 62 day targets in April. The national average for the 62 day 1st failed to meet the operational standard with 82.91%, the other two 62 day targets were met.

95%

90% Monthly Actual 85% National Target

80%

75% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

9 The Forward View into action - Annex B Measures cont.…

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Response Times 87.01% 87.11% 71.47% 71.95% 69.96% 69.50% 67.64% 72.13% 71.81% 73.28% 71.62% 70.34% 73.11% 71.30% CCG Apr-17 73.11% 72.13% R               Category A red 1 incidents within 8 E.B.15i 75% < 75% % minutes. 76.77% 75.56% 69.10% 67.28% 68.49% 67.13% 64.58% 65.55% 65.61% 67.22% 65.63% 65.91% 69.65% 66.46% WMAS Apr-17 69.65% 68.00% R              

Updated Ambulance Red 1 Response Time - SWBHT

100% 90% Due to Purdah, the final evaluation of the Ambulance Response Programme remains delayed until July, therefore no performance commentary is available at this time. 80% 70% Unfortunately, preparation for new indicators had an impact on the reporting of historic metrics. Work is underway to rectify the situation and historic data will be 60% available next month. 50% Monthly Actual 40% Target (%) 30% 20% 10% 0% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Ambulance Red 1 Response Time - WMAS

90% 80% 70% 60% 50% Actual 40% National Target 30% 20% 10% 0% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

10 The Forward View into action - Annex B Supporting Measures cont.…

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Handover Times 81 65 78 156 131 158 135 188 227 189 129 107 SWBHT Mar-17 107 1644 R             E.B.S.7a Handovers of over 30 minutes 0 > 0 Number 2295 2335 2559 2793 2533 2720 3287 3653 4755 4943 3420 3059 WMAS Mar-17 3059 38352 R            

2 1 1 8 6 9 15 21 19 11 13 5 SWBHT Mar-17 5 111 R             E.B.S.7b Handovers of over 1 hour 0 > 0 Number 153 138 190 123 232 189 368 424 671 750 478 202 WMAS Mar-17 202 3918 R            

Ambulance Handover Delays - SWBH Ambulance Handover Delays - WMAS 250 6000

200 5000 4000 150 3000 100 2000 50 1000 0 0 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Monthly Actual > 30 mins Monthly Actual > 1 hour National Target Monthly Actual > 30 mins Monthly Actual > 1 hour National Target

Crew Clear Times - Local measure 6 10 7 5 7 3 5 8 32 42 24 21 SWBHT Mar-17 21 170 R             E.B.S.8a Crew clear delays of over 30 minutes 0 > 0 Number 53 49 60 62 47 41 74 89 309 374 256 184 WMAS Mar-17 184 1598 R            

0 0 1 0 0 0 1 0 0 1 0 3 SWBHT Mar-17 3 6 R             E.B.S.8b Crew clear delays of over 1 hour 0 > 0 Number 0 4 8 2 4 2 4 4 4 6 2 11 WMAS Mar-17 11 51 R            

Ambulance Crew Clear Delays - SWBH Ambulance Crew Clear Delays - WMAS

50 400

40 300 30 200 20 100 10

0 0 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Monthly Actual > 30 mins Monthly Actual > 1 hour National Target Monthly Actual > 30 mins Monthly Actual > 1 hour National Target

11 The Forward View into action - Annex B Supporting Measures cont.…

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Mixed Sex Accommodation Breaches 0 1 2 0 0 0 4 7 32 9 8 4 22 CCG Apr-17 22 22 R              Number of mixed sex accommodation E.B.S.1 0 > 0 Number (MSA) Breaches 0 0 0 0 0 0 2 6 38 5 4 4 21 SWBHT Apr-17 21 21 R             

Updated MSA Breaches - CCG MSA Breaches - SWBH CCG 35 40 There were 22 breaches in April - 17 at SWBHT, 3 at Walsall and 2 at HEFT. 30 Walsall - Bed capacity pressures continue to impact on the timely step down of patients from the critical care unit. Work is currently underway within the Trust to improve patient flow by reducing 25 30 20 inpatient bed occupancy and length of stay by implementing the 'SAFER' patient flow bundle should create the extra capacity required to minimise breaches going forward. 20 15 We are still waiting for a response by Birmingham Cross City CCG, who are the co-ordinating commissioner, regarding the breaches at HEFT. 10 10 5 SWBHT 0 0 There were 21 breaches in April - 11 at City Hospital and 10 at Sandwell General. At City hospital it was as a result of two incidents on AMU 1, the first on 8th April, a male admitted with 4 females. The second on 24th April, 3 females and 3 males. Both of these due to capacity issues. At Sandwell General it was also two incidents on AMU A. Both on 12th April, the first one female with two males. The second 1 female with 6 males. Both due to long wait DTA. All were approved by the COO. Monthly Actual National Target Monthly Actual National Target

Cancelled Operations % of cancelled operations offered Reduce from previous 0.00% 0.00% 2.61% 3.55% E.B.S.2 % SWBHT Q4 16-17 3.55% 1.81% R another binding date within 28 days year    

No new data Cancelled Operations offered another binding date within 28 days - SWBH 4.00% Cancelled Operations - The Trust failed to meet the target with 3.55%. 6 patients out of 169 waited over 28 days after a cancelled elective operation in Q4 16/17. Early unconfirmed data for April shows 3.50% 1 patient not seen within 28 days. This was a dermatology patient whose clinical picture changed which caused the delay. The patient remains under care and has received an appropriate treatment 3.00% plan. 2.50% 2.00% Monthly Actual 1.50% 1.00% National Target 0.50% 0.00% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 16/17 16/17 16/17 16/17 17/18 17/18 17/18 17/18

Urgent operations cancelled for a second time Reduce from previous E.B.S.6 operations cancelled for a second time Number SWBHT 0 0 0 0 0 0 0 0 0 0 0 0 0 Apr-17 0 0 year

Updated Urgent operations cancelled for second time 15 SWBHT had zero urgent operations cancelled for the second time in April. 10 5 0

SWBHT

12 The Forward View into action - Annex B Supporting Measures cont.…

Target Previous Year Current Monitoring Year Actual Data FOT Ref Indicator Basis Mth/Qtr/ Green Red Statistic A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Care Programme Approach (CPA) 95.36% 97.06% 96.65% 95.95% CCG Q4 16-17 95.95% 1.81% G    

98.23% 98.04% 97.85% 96.59% E.B.S.3 Follow-up within 7 days 95% < 95% % BCPFT Q4 16-17 96.59% 1.81% G    

Sandwell 98.23% 98.04% 97.85% 98.32% Q4 16-17 98.32% 1.81% G BCPFT    

No new data Care Programme Approach (CPA) - CCG 100.00% CPA - The CCG & BCPFT were both within target for Q4 16/17. 90.00% 80.00% 70.00% 60.00% 50.00% Monthly Actual 40.00% National Target 30.00% 20.00% 10.00% 0.00% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 16/17 16/17 16/17 16/17 17/18 17/18 17/18 17/18

13 IAF - Better Health

Previous Year Current Year Actual Data FOT Ref Indicator Target Statistic Basis Mth/Qtr/ A M J J A S O N D J F M A M J J A S O N D J F M Period YTD RAG Annual

Anti-microbial resistance

Anti-microbial resistance: appropriate 1.086 1.088 1.085 1.087 1.093 1.089 1.087 1.094 1.095 1.105 1.100 107a Reduce Number CCG Feb-17 1.100 12.009 prescribing of antibiotics in primary care           

Anti-microbial resistance: Appropriate 6.7 6.6 6.5 6.4 6.4 6.4 6.4 6.3 6.3 6.2 6.2 107b prescribing of broad spectrum antibiotics Reduce Number CCG Feb-17 6.2 70.4 in primary care           

Updated

107a The rate has remained fairly consistent although there has been a marginal increase over the last few months. The England average in February was 1.071 so now slightly lower than SWBCCG. In relation to CCGs with similar demographics Waltham Forest CCG had the lowest rate with 0.922 and North Manchester CCG the highest with 1.287.

107b The rate has continued to reduce and is now 0.6 lower than the same time last year and lower than the England average of 8.9. SWBCCG is the third lowest in relation to our comparator CCGs with Bradford Districts CCG and Wolverhampton CCG having the lowest rate with 5.7 and Redbridge CCG the highest with 12.9.

The CCG will be rolling out some education for GPs to raise awareness, and are encouraging them to do an audit around antibiotic prescribing as part of their PCCF meds management standard. There is also an additional element that we will be focusing on this year which should bring antibiotic prescribing to the forefront again. The new element is around reducing the prescribing of trimethoprim as a ratio of nitrofurantion. Having analysed the data for our surrounding CCGs, the general trend that we are seeing in SWBCCG is not dissimilar to those around us, but we are still improving performance in terms of numbers of practices over the target within our CCG have been reduced.

14 IAF - Better Care

Dementia Estimated diagnosis rate of people with 65.73% 65.00% 64.76% 65.47% 65.91% 65.68% 65.42% 65.66% 65.52% 65.26% 64.79% 64.83% 126a Increase 67% CCG Mar-17 64.83% R dementia            

Updated

126a - There was little change in the diagnosis rate in March, and there has been a one percentage point reduction since the beginning of the year. The CCG failed to meet the national target of 66.7%. The England average score was just above the national target with 67.61%. In relation to our comparators SWBCCG was the third lowest with Redbridge and Birmingham Cross City being lower with 61.68% and 64.08% respectively. North Manchester had the highest score with 98.44%.

15 Legend

NHSE Six Clinical Priority Areas Basis CCG Sandwell & West Birmingham CCG SWBHT Sandwell & West Birmingham Hospital Foundation Trust BCPFT Black Country Partnership Foundation Trust WMAS West Midlands Ambulance Service

Statistic DSR Direct Standardised Rate ISR Indirect Standardised Rate

FOT RAG G Green - forecast to achieve target A Amber - some uncertainty but may achieve target R Red - unlikely to achieve target

Directional Arrows  Improvement in data since last data point  Decline in data since last data point  No change in data since last data point or first publication of data

16 Report Topic: Urgent Care Report From: Performance Team and Debra Howls

Report For: Governing Body Date Jun-17 Aim of Report To provide information to the Board on the performance of the CCG against key indicators. IUC - NHS 111 referral rates to ED are now below the level seen in the same period last year however ambulance dispatches appear to be holding steady. There is limited evidence of seasonal trends within this data. A & E - Performance in May (81.57%) continues to be below both the national and STF targets, the trust implemented some planned changes at BMEC in May which had a predicited impact of a 3% deterioration in ED performance. Therefore, 2017/18 performance continues to be below the rate achieved for the same period in 2016/17. At a site level performance at City hospital continues to be the worst performing site although Sandwell is also showing a worsening position. NEL Activity - Non-elective admissions (NEL) are lower YTD in 2016/17 than the same period in 2015/16 and this trend is seen at a trust level and at city hospital. The position at Sandwell has been slightly different with a slight increase in NELs for the first half of the year and then a reduced level of activity, below 2015/16 levels seen from October onwards. NEL LoS - NEL length of stay (LoS) has seen some small movements YTD at a trust and indivual site level but overall there has been little change. From July onwards LoS are above the durations seen in 2015/16, so whilst the number of NELs in 2016/17 has fallen from 2015/16, those admitted are staying slightly longer. LoS at Sandwell tends to be above the levels seen at City and this is reflective of the demographic Key Messages differences. Readmissions - The readmission rates in Q1 and 2 were below the 15/16 activity however this position has worsened in Q3 with readmission rates now much more closely aligned with 2015/16 activity. This is reflected at a trust and individual site level. April saw a slight decrease in readmission rates compared to previous months Bed availability - The trust is moving forwards with its bed closure plans to ensure it mirrors MMH capacity and therefore we have seen further decreases in beds open. Discharges - The weekly medical discharge rate YTD has been below the levels seen in 2016/17 with the average being 399 compared to 483 in the same period last year. There has been some improvement in recent weeks. DTOCs - Sandwell MBC continue to have zero reportable DTOCs due to investment in a community health and social care ward that accomodates patients awaiting placement or a package of care. YTD, we see an average of 458 delayed days per month, compared to 419 in the same period last year. Of those, 39% are health delays and 61% are social care; there is a slight increase in health delays this month (April was 35%). NHS 111 T:\Strategy\Urgent Care\IUC\Contract Management\[NHS 111 disposal routes.xlsx] Key Message - NHS 111 referral rates to ED are now below the level seen in the same period last year however ambulance dispatches appear to be holding steady. There is limited evidence of seasonal trends within this data.

ED April May June July August September October November December January February March Number of calls triaged 8485 8131 7364 7824 6935 6922 7917 7877 9465 7529 7079 8444 2016/17 Number recommended to attend A&E 674 720 642 671 598 635 642 690 722 564 643 713 % referral rate 7.94% 8.85% 8.72% 8.58% 8.62% 9.17% 8.11% 8.76% 7.63% 7.49% 9.08% 8.44% Number of calls triaged 9015 8968 Number recommended to attend A&E 666 696 2017/18 % referral rate 7.39% 7.76%

NHS 111 Referral to ED rate

10.00%

8.00% 6.00% 2016/17 4.00% 2017/18

Referral(%)rate 2.00% 0.00% April May June July August September October November December January February March

Ambulance April May June July August September October November December January February March Number of calls triaged 8485 8131 7364 7824 6935 6922 7917 7877 9465 7529 7079 8444 Number of ambulance dispatches 857 852 941 862 715 787 846 1029 1261 935 871 1020 % Dispatch rate 10.10% 10.48% 12.78% 11.02% 10.31% 11.37% 10.69% 13.06% 13.32% 12.42% 12.30% 12.08% 2016/17 Red 1 6 14 5 14 9 2 5 Red 2 401 384 453 385 331 344 354 Green 402 413 428 422 335 394 436 Other 48 41 55 41 40 47 49 Number of calls triaged 9015 8968 2017/18 Number of ambulance dispatches 1094 1048 % Dispatch rate 12.14% 11.69%

NHS 111 Ambulance Dispatch rate 14.00%

12.00% 10.00% 8.00% 2016/17 6.00% 2017/18

4.00% Dispatchrate (%) 2.00% 0.00% April May June July August September October November December January February March Accident + Emergency T:\Performance\A&E\16-17\Daily EC 4 hour wait summary Key Message - A&E performance in May (81.57%) continues to be below both the national and STF targets, the trust implemented some planned changes at BMEC in May which had a predicited impact of a 3% deterioration in ED performance. Therefore, 2017/18 performance continues to be below the rate achieved for the same period in 2016/17. At a site level performance at City hospital continues to be the worst performing site although Sandwell is also showing a worsening position.

SWBHT National Target 95% April May June July August September October November December January February March < 4 Hours 17,091 18,915 17,077 17,201 16,362 16,843 16,509 15,625 15,085 15,694 14,158 16,668 2016/17 Total Attendances 18,699 20,366 18,702 19,369 18,246 18,894 19,185 18,862 18,409 18,640 17,184 19,535 Performance 91.40% 92.88% 91.31% 88.81% 89.67% 89.14% 86.05% 82.84% 81.94% 84.20% 82.39% 85.32% < 4 Hours 15,881 15,704 2017/18 Total Attendances 18,695 19,253 Performance 84.95% 81.57% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

A&E Attendances - All Sites A&E Performance - All Sites

21,000 100.00% 20,000 95.00% 19,000 18,000 90.00% 17,000 85.00%

16,000 A&E A&E Attendances 15,000 A&E Attendances 80.00%

2016/17 2017/18 2016/17 2017/18 Target

City Hospital National Target 95% April May June July August September October November December January February March < 4 Hours 7,955 8,956 8,257 8,514 7,659 7,935 7,734 7,205 7,252 7,663 6,821 8,019 2016/17 Total Attendances 8,620 9,531 8,855 9,158 8,487 9,043 9,065 8,838 8,809 8,867 8,186 9,283 Performance 92.29% 93.97% 93.25% 92.97% 90.24% 87.75% 85.32% 81.52% 82.32% 86.42% 83.33% 86.38% < 4 Hours 6,241 6,731 2017/18 Total Attendances 7,774 8,552 Performance 80.28% 78.71% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

A&E Attendances - City Hospital A&E Performance - City Hospital

12,000 100.00% 10,000 95.00% 8,000 6,000 90.00% 4,000 85.00%

2,000 A&E A&E Attendances - A&E Attendances 80.00%

2016/17 2017/18 2016/17 2017/18 Target Sandwell General Hospital National Target 95% April May June July August September October November December January February March < 4 Hours 6,831 7,663 6,842 6,710 6,606 6,793 6,642 6,302 5,893 6,055 5,616 6,601 2016/17 Total Attendances 7,735 8,489 7,832 8,194 7,631 7,705 7,974 7,893 7,655 7,783 7,285 8,165 Performance 88.31% 90.27% 87.36% 81.89% 86.57% 88.16% 83.30% 79.84% 76.98% 77.80% 77.09% 80.85% < 4 Hours 7,605 7,777 2017/18 Total Attendances 8,837 9,466 Performance 86.06% 82.16% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

A&E Attendances - Sandwell General Hospital A&E Performance - Sandwell General Hospital

10,000 100.00% 8,000 95.00% 6,000 90.00% 85.00% 4,000 80.00%

2,000 75.00% A&E A&E Attendances - A&E Attendances 70.00%

2016/17 2017/18 2016/17 2017/18 Target

City Eye A+E (BMEC)

National Target 95% April May June July August September October November December January February March < 4 Hours 2,305 2,296 1,978 1,977 2,097 2,115 2,133 2,118 1,940 1,976 1,701 2,048 6 2016/17 Total Attendances 2,344 2,346 2,015 2,017 2,128 2,146 2,146 2,131 1,945 1,990 1,713 2,087 Performance 98.34% 97.87% 98.16% 98.02% 98.54% 98.56% 99.39% 99.39% 99.74% 99.30% 99.30% 98.13% < 4 Hours 2,035 1,196 39 2017/18 Total Attendances 2,084 1,235 Performance 97.65% 96.84% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

A&E Attendances - City Eye A+E A&E Performance - City Eye A+E

2,500 100.00% 2,000 98.00% 1,500 96.00% 1,000 94.00%

500 92.00% A&E A&E Attendances - A&E Attendances 90.00%

2016/17 2017/18 2016/17 2017/18 Target Non-Electives - Admissions Non-Electives - Average LOS T:\Performance\Urgent Care\16-17\Report data\NEL LOS Key Message - Non-elective admissions (NEL) are lower YTD in 2016/17 than the same period in 2015/16 and this trend is seen at a trust level and Key Message - NEL length of stay (LoS) has seen some small movements YTD at a trust and indivual site level but overall there has been little at city hospital. The position at Sandwell has been slightly different with a slight increase in NELs for the first half of the year and then a reduced change. From July onwards LoS are above the durations seen in 2015/16, so whilst the number of NELs in 2016/17 has fallen from 2015/16, those level of activity, below 2015/16 levels seen from October onwards. admitted are staying slightly longer. LoS at Sandwell tends to be above the levels seen at City and this is reflective of the demographic differences.

SWBHT SWBHT April May June July August September October November December January February March April May June July August September October November December January February March 2016/17 3,620 3,728 3,522 3,539 3,357 3,353 2,563 3,602 3,621 3,486 3,311 3,492 2016/17 4.2 3.6 3.4 3.6 3.9 3.6 4.0 4.1 4.1 4.4 4.4 4.2 2017/18 3,191 2017/18 4.3

SWBHT - NEL Admissions, All sites SWBHT - NEL LOS, All sites

4,000 5.0

3,000 4.0 3.0 2,000 2016/17 2016/17 2.0

1,000 2017/18 2017/18 NEL Avg NEL Avg Days

NEL Avg NEL Avg Days 1.0

City Hospital City Hospital April May June July August September October November December January February March April May June July August September October November December January February March 2016/17 1,563 1,620 1,554 1,603 1,520 1,534 1,233 1,573 1,571 1,574 1,460 1,521 2016/17 3.6 3.1 3.1 2.8 3.3 3.1 3.3 3.8 3.7 3.7 3.5 3.5 2017/18 1,411 2017/18 3.6

City Hospital - NEL Admissions City Hospital - NEL LOS

2,000 5.0

1,500 4.0 3.0 1,000 2016/17 2016/17 2.0

500 2017/18 2017/18 NEL Avg NEL Avg Days

NEL Avg NEL Avg Days 1.0

NELNEL admissionsadmissions - - April May June July August September October November December January February March April May June July August September October November December January February March Sandwell General Hospital Sandwell General Hospital April May June July August September October November December January February March April May June July August September October November December January February March 2016/17 2,046 2,099 1,963 1,928 1,831 1,815 1,328 2,024 2,040 1,906 1,845 1,961 2016/17 4.6 4.0 3.6 4.3 4.4 4.1 4.7 4.3 4.5 5.0 5.0 4.7 2017/18 1,769 2017/18 4.8

Sandwell General Hospital - NEL Admissions Sandwell General Hospital - NEL LOS

2,500 6.0

2,000 4.0 1,500 2016/17 2016/17 1,000

2017/18 2.0 2017/18 NEL Avg NEL Avg Days

500 NEL Avg Days

City Eye A+E (BMEC) City Eye A+E (BMEC) April May June July August September October November December January February March April May June July August September October November December January February March 2016/17 11 9 4 8 5 4 2 4 8 6 6 10 2016/17 3.2 2.9 0.3 3.0 11.8 3.3 4.0 1.0 3.4 0.5 3.2 2.7 2017/18 9 2017/18 2.7

City Eye A+E - NEL Admissions City Eye A+E - NEL LOS

15 15.0

10 10.0 2016/17 2016/17

5 2017/18 5.0 2017/18

NEL Avg NEL NEL Avg Avg Days Days

Other Sites Other Sites April May June July August September October November December January February March April May June July August September October November December January February March 2016/17 - - 1 - 1 - - 1 2 - - - 2016/17 - - 19.0 - 10.0 - - - 33.0 - - - 2017/18 2 2017/18 7.0

Other Sites - NEL Admissions Other Sites - NEL LOS

3 40.0

2 30.0 2 2016/17 20.0 2016/17 1

2017/18 10.0 2017/18 NEL Avg Days

1 NEL Avg Days

NELNEL admissionsadmissions - - April May June July August September October November December January February March April May June July August September October November December January February March Re-Admissions T:\Performance\Urgent Care\16-17\Report data\Readmissions Key Message - The readmission rates in Q1 and 2 were below the 15/16 activity however this position has worsened in Q3 with readmission rates now much more closely aligned with 2015/16 activity. This is reflected at a trust and individual site level. April saw a slight decrease in readmission rates compared to previous months

SWBHT April May June July August September October November December January February March Admissions 7,434 7,393 7,601 7,317 7,267 7,214 7,215 7,589 7,182 7,268 6,865 7,605 2016/17 Re-admission 622 637 593 581 553 520 588 580 617 589 579 631 % 8.37% 8.62% 7.80% 7.94% 7.61% 7.21% 8.15% 7.64% 8.59% 8.10% 8.43% 8.30% Admissions 6,539 2017/18 Re-admission 524 % 8.01%

SWBHT - Re-Admissions, All sites

10.00%9.00% 8.00% 5.00% 2016/17 7.00%

2017/18

admissionsadmissions -

- 6.00%0.00% Re Re AprilApril MayMay JuneJune JulyJuly AugustAugust SeptemberSeptember OctoberOctober NovemberNovember DecemberDecember JanuaryJanuary February March

City Hospital April May June July August September October November December January February March Admissions 2,886 2,965 3,038 2,962 2,920 2,877 2,893 2,912 2,916 2,961 2,720 2,999 2016/17 Re-admission 264 266 271 243 254 245 255 269 261 245 263 258 % 9.15% 8.97% 8.92% 8.20% 8.70% 8.52% 8.81% 9.24% 8.95% 8.27% 9.67% 8.60% Admissions 2,530 2017/18 Re-admission 213 % 8.42%

City Hospital - Re-Admissions

15.00%10.00% 10.00%9.00% 2016/17 5.00%8.00%

2017/18

admissionsadmissions -

- 0.00%7.00% Re Re April May June July August September October November December January February March Sandwell General Hospital April May June July August September October November December January February March Admissions 3,341 3,283 3,201 3,131 2,991 2,994 3,021 3,284 3,078 3,054 2,884 3,195 2016/17 Re-admission 355 361 315 331 295 273 326 310 350 341 311 371 % 10.63% 11.00% 9.84% 10.57% 9.86% 9.12% 10.79% 9.44% 11.37% 11.17% 10.78% 11.61% Admissions 2,799 2017/18 Re-admission 308 % 11.00%

Sandwell General Hospital - Re-Admissions

15.00% 10.00% 2016/17 5.00%

2017/18

admissionsadmissions

- - e

e 0.00% R R April May June July August September October November December January February March

City Eye A+E (BMEC) April May June July August September October November December January February March Admissions 498 467 523 459 512 526 472 536 436 457 466 510 2016/17 Re-admission 3 10 7 7 4 3 7 1 5 3 5 2 % 0.60% 2.14% 1.34% 1.53% 0.78% 0.57% 1.48% 0.19% 1.15% 0.66% 1.07% 0.39% Admissions 483 2017/18 Re-admission 3 % 0.62%

City Eye A+E - Re-Admissions

3.00% 2.00% 2016/17 1.00%

2017/18

admissionsadmissions -

- 0.00% Re Re April May June July August September October November December January February March

Birmingham Treatment Centre & Rowley Regis Hospital Other Sites April May June July August September October November December January February March Admissions 709 678 839 765 844 826 829 857 752 796 795 901 2016/17 Re-admission ------1 - - - % 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.13% 0.00% 0.00% 0.00% Admissions 727 2017/18 Re-admission - % 0.00%

Other Sites - Re-Admissions

0.15% 0.10% 2016/17 0.05%

2017/18

admissionsadmissions -

- 0.00% Re Re April May June July August September October November December January February March Bed Availability T:\Performance\Weekly Sitrep Report Key Message -The trust is moving forwards with its bed closure plans to ensure it mirrors MMH capacity and therefore we have seen further decreases in beds open.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 2014/15 06/04/2014 13/04/2014 20/04/2014 27/04/2014 04/05/2014 11/05/2014 18/05/2014 25/05/2014 01/06/2014 08/06/2014 15/06/2014 22/06/2014 29/06/2014 06/07/2014 13/07/2014 20/07/2014 27/07/2014 03/08/2014 10/08/2014 17/08/2014 24/08/2014 31/08/2014 Wk Ending 787 793 812 813 776 776 811 814 816 814 816 818 813 813 814 814 761 763 773 775 782 775

2015/16 05/04/2015 12/04/2015 19/04/2015 26/04/2015 03/05/2015 10/05/2015 17/05/2015 24/05/2015 31/05/2015 07/06/2015 14/06/2015 21/06/2015 28/06/2015 05/07/2015 12/07/2015 19/07/2015 26/07/2015 02/08/2015 09/08/2015 16/08/2015 23/08/2015 30/08/2015 Wk Ending 751 791 771 784 790 766 767 776 774 771 773 771 768 757 764 750 734 757 758 767 759 754

2016/17 03/04/2016 10/04/2016 17/04/2016 24/04/2016 01/05/2016 08/05/2016 15/05/2016 22/05/2016 29/05/2016 05/06/2016 12/06/2016 19/06/2016 26/06/2016 03/07/2016 10/07/2016 17/07/2016 24/07/2016 31/07/2016 07/08/2016 14/08/2016 21/08/2016 28/08/2016 Wk Ending 743 736 748 710 731 742 745 733 715 749 736 711 734 735 735 735 724 716 722 742 723 722

2017/18 02/04/2017 09/04/2017 16/04/2017 23/04/2017 30/04/2017 07/05/2017 14/05/2017 21/05/2017 28/05/2017 04/06/2017 11/06/2017 Wk Ending 676 595 675 678 681 684 667 668 682 686 668

Beds Breakdown by Ward 02/04/2017 09/04/2017 16/04/2017 23/04/2017 30/04/2017 07/05/2017 14/05/2017 21/05/2017 28/05/2017 04/06/2017 11/06/2017 Name Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Av. Beds Occ. Beds Occ. Beds Occ. Beds Occ. Beds Occ. Beds Av. Beds Occ. Beds CCS - Critical Care Services - City 12 12 7 6 7 6 8 6 7 5 12 10 8 6 10 9 10 9 11 11 8 6 D5 - Cardiology (Female) 12 11 12 11 12 10 12 11 12 11 12 10 12 10 12 11 12 10 12 11 12 10 D11 - Male Older Adult 20 20 20 19 20 20 20 20 21 21 21 21 21 21 21 21 20 20 20 20 20 16 D15 - Gastro/Resp/Haem (Male) 16 16 14 14 14 14 14 14 15 14 16 16 16 16 16 16 18 14 17 17 17 16 D16 - (Female) 16 16 19 17 19 16 19 18 19 19 19 19 19 19 19 19 15 15 15 15 15 14 D19 - Paediatric Medicine 8 5 8 5 8 5 8 7 11 7 11 7 8 8 8 4 8 7 8 7 8 5 D21 - Male Urology / ENT 21 21 18 18 17 7 17 15 18 14 18 17 16 15 17 17 17 17 18 9 17 17 D25 - Extra Capacity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 D26 - Female Older Adult 20 20 20 20 20 20 20 20 20 20 20 19 20 20 20 20 20 20 20 20 20 20 D27 - Oncology 18 16 18 18 18 18 18 18 18 15 18 17 18 12 18 17 18 15 18 16 18 16 AMU 2 & West Midlands Poisons Unit - City 19 15 19 19 19 16 19 15 19 19 19 19 19 19 19 15 19 16 19 16 19 16 D7 - Cardiology (Male) 20 19 20 12 20 18 20 18 20 17 20 20 20 18 20 19 20 18 20 18 20 18 Ophthmalic Unit - City 12 6 12 6 12 7 12 7 12 14 12 15 12 9 12 12 12 6 12 12 12 19 Female Surgical Ward - City 16 12 16 16 16 8 16 8 16 14 16 13 16 13 16 16 16 12 16 15 16 12 AMU 1 - City 32 31 32 30 32 23 32 27 32 25 32 27 32 32 32 32 32 27 32 26 32 22 Neonatal Unit - City 29 21 29 19 29 18 29 20 29 17 29 20 29 18 29 9 29 12 29 15 29 14 Critical Care - Sandwell 10 8 8 7 8 6 8 6 11 10 8 6 8 6 6 6 8 7 8 6 8 7 AMU A - Sandwell 32 29 32 22 32 32 32 22 32 27 32 28 32 27 32 24 42 35 42 41 42 32 Older Persons Assessment Unit (OPAU) - Sandwell 10 10 10 9 10 9 10 8 10 10 10 10 10 10 10 9 10 9 20 20 20 15 Lyndon 1 - Paediatrics 18 14 18 12 18 8 18 14 18 10 18 15 18 17 18 12 18 14 18 11 18 12 Lyndon 2 - Surgery 24 24 33 24 33 24 33 32 24 23 24 24 24 22 24 24 24 24 33 24 24 24 Lyndon 3 - T&O/Stepdown 31 27 31 20 31 19 31 29 31 26 31 28 31 24 31 24 32 27 31 23 31 24 Lyndon 4 34 34 34 31 34 31 34 33 34 31 34 33 34 33 34 34 34 33 34 34 34 33 Lyndon 5 - Acute Medicine 34 33 34 32 34 31 34 34 34 33 34 33 34 34 34 33 34 34 34 34 29 29 Lyndon Ground - PAU/Adolescents 14 6 14 13 14 10 14 9 14 8 14 7 14 11 14 11 14 10 14 7 14 5 AMU B - Sandwell 20 20 20 20 20 19 20 20 20 16 20 20 20 20 20 20 20 20 0 0 0 0 Newton 3 - T&O 33 30 33 26 33 31 33 31 33 30 33 30 33 31 33 30 33 30 33 27 33 30 Newton 4 - Stroke and Neurology Rehab 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 27 28 28 28 28 Newton 5 - Haematology 14 9 14 11 14 9 14 13 18 14 18 14 14 13 14 14 15 15 18 16 18 13 Priory 2 - Colorectal/General Surgery 24 24 29 24 24 24 24 24 24 23 24 24 24 24 24 24 24 21 24 24 24 24 Priory 4 - Stroke/Neurology 26 24 26 17 26 20 26 22 26 18 26 21 26 20 26 21 26 17 26 21 26 16 Priory 5 - Gastro/Resp 33 33 32 30 33 28 33 33 33 31 33 31 33 33 33 33 34 34 34 34 34 33 SAU - Sandwell 20 15 22 16 20 15 22 17 22 10 22 15 18 11 18 10 20 10 22 10 22 12 Total 676 609 682 572 675 550 678 599 681 580 684 617 667 600 668 594 682 585 686 588 668 558 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 07/09/2014 14/09/2014 21/09/2014 28/09/2014 05/10/2014 12/10/2014 19/10/2014 26/10/2014 02/11/2014 09/11/2014 16/11/2014 23/11/2014 30/11/2014 07/12/2014 14/12/2014 21/12/2014 28/12/2014 04/01/2015 11/01/2015 18/01/2015 25/01/2015 01/02/2015 08/02/2015 15/02/2015 22/02/2015 01/03/2015 08/03/2015 15/03/2015 22/03/2015 29/03/2015 804 753 753 781 763 810 781 814 804 785 772 762 778 769 786 808 751 800 817 779 782 778 774 787 780 790 783 779 771 781

06/09/2015 13/09/2015 20/09/2015 27/09/2015 04/10/2015 11/10/2015 18/10/2015 25/10/2015 01/11/2015 08/11/2015 15/11/2015 22/11/2015 29/11/2015 06/12/2015 13/12/2015 20/12/2015 27/12/2015 03/01/2016 10/01/2016 17/01/2016 24/01/2016 31/01/2016 07/02/2016 14/02/2016 21/02/2016 28/02/2016 06/03/2016 13/03/2016 20/03/2016 27/03/2016 732 733 730 703 733 708 731 732 692 724 728 709 693 680 720 726 695 701 722 702 747 710 713 694 736 752 764 698 754 723

04/09/2016 11/09/2016 18/09/2016 25/09/2016 02/10/2016 09/10/2016 16/10/2016 23/10/2016 30/10/2016 06/11/2016 13/11/2016 20/11/2016 27/11/2016 04/12/2016 11/12/2016 18/12/2016 25/12/2016 01/01/2017 08/01/2017 15/01/2017 22/01/2017 29/01/2017 05/02/2017 12/02/2017 19/02/2017 26/02/2017 05/03/2017 12/03/2017 19/03/2017 26/03/2017 720 741 702 733 687 709 698 703 715 708 698 735 728 701 734 724 671 666 686 697 684 706 720 705 679 676 685 698 672 668

Total Available Beds 900

850 800 750 2014/15 700 2015/16 650 2016/17 600 Number of open beds of openNumber 550 2017/18 500 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52

Week Discharges

Key Message - The weekly medical discharge rate YTD has been below the levels seen in 2016/17 with the average being 399 compared to 483 in the same period last year. There has been some improvement in recent weeks.

2016/17 2017/18 w/c 04/04/16 472 445 w/c 11/04/16 492 422 Weekly Discharges SWBH (Medical) w/c 18/04/16 468 351 600 w/c 25/04/16 498 491

w/c 02/05/16 480 307 500 w/c 09/05/16 489 286 400 w/c 16/05/16 532 337 w/c 23/05/16 501 458 300 w/c 30/05/16 488 400 w/c 06/06/16 448 484 200 2016/17

w/c 13/06/16 441 412 2017/18 NUmber of discharges discharges of NUmber w/c 20/06/16 458 100 w/c 27/06/16 451 0 w/c 04/07/16 396 w/c 11/07/16 462 w/c 18/07/16 464

w/c 25/07/16 402

W/C 7/11/16

w/c25/04/16 w/c02/05/16 w/c11/07/16 w/c18/07/16 w/c26/09/16 w/c03/10/16 w/c12/12/16 w/c27/02/17 w/c04/04/16 w/c11/04/16 w/c18/04/16 w/c09/05/16 w/c16/05/16 w/c23/05/16 w/c30/05/16 w/c06/06/16 w/c13/06/16 w/c20/06/16 w/c27/06/16 w/c04/07/16 w/c25/07/16 w/c01/08/16 w/c08/08/16 w/c15/08/16 w/c22/08/16 w/c29/08/16 w/c05/09/16 w/c12/09/16 w/c19/09/16 w/c10/10/16 w/c17/10/16 w/c24/10/16 w/c14/11/16 w/c21/11/16 w/c28/11/16 w/c05/12/16 w/c19/12/16 w/c26/12/16 w/c02/01/17 w/c09/01/17 w/c16/01/17 w/c23/01/17 w/c30/01/17 w/c06/02/17 w/c13/02/17 w/c20/02/17 w/c06/03/17 w/c13/03/17 w/c20/03/17 w/c27/03/17 w/c 01/08/16 419 31/10/16W/c w/c 08/08/16 394 w/c 15/08/16 479 w/c 22/08/16 440 w/c 29/08/16 447 w/c 05/09/16 460 w/c 12/09/16 468 w/c 19/09/16 516 w/c 26/09/16 453 w/c 03/10/16 495 w/c 10/10/16 469 w/c 17/10/16 531 w/c 24/10/16 379 W/c 31/10/16 438 W/C 7/11/16 406 w/c 14/11/16 456 w/c 21/11/16 429 w/c 28/11/16 513 w/c 05/12/16 456 w/c 12/12/16 519 w/c 19/12/16 492 w/c 26/12/16 407 w/c 02/01/17 431 w/c 09/01/17 441 w/c 16/01/17 434 w/c 23/01/17 412 w/c 30/01/17 404 w/c 06/02/17 491 w/c 13/02/17 431 w/c 20/02/17 402 w/c 27/02/17 484 w/c 06/03/17 524 w/c 13/03/17 446 w/c 20/03/17 448 w/c 27/03/17 402 Delayed Transfer of Care - at SWBHT by LA https://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/2016-17-data/ Key Message - Sandwell MBC continue to have zero reportable DTOCs due to investment in a community health and social care ward that accomodates patients awaiting placement or a package of care. YTD, we see an average of 458 delayed days per month, compared to 419 in the same period last year. Of those, 39% are health delays and 61% are social care; there is a slight increase in health delays this month (April was 35%). Unify returns are no longer collecting the patient snapshot detail.

Title: DTOC - Delayed Days by LA

Sandwell Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Sandwell Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 NHS 0 0 0 0 0 0 0 0 0 0 0 0 NHS 0 0 Social Care 0 0 0 0 0 0 0 0 0 0 0 0 Social Care 0 0 Both 0 0 0 0 0 0 0 0 0 0 0 0 Both 0 0 Total 0 0 0 0 0 0 0 0 0 0 0 0 Total 0 0

Birmingham Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Birmingham Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 NHS 183 193 229 196 176 188 201 153 161 112 142 135 NHS 171 163 Social Care 234 228 251 245 287 215 266 272 449 435 309 375 Social Care 324 258 Both 0 0 14 0 0 0 0 4 0 0 0 0 Both 0 0 Total 417 421 494 441 463 403 467 429 610 547 451 510 Total 495 421

700 600 600 500 500 400 400 300 300 200 200 100 100 0 0 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Sandwell Birmingham Sandwell Birmingham Title: DTOC - Patient Snapshot by LA

Sandwell Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Sandwell Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 NHS 0 0 0 0 0 0 0 0 0 0 0 0 NHS 0 Social Care 0 0 0 0 0 0 0 0 0 0 0 0 Social Care 0 Both 0 0 0 0 0 0 0 0 0 0 0 0 Both 0 Total 0 0 0 0 0 0 0 0 0 0 0 0 Total 0

Birmingham Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Birmingham Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 NHS 5 7 7 3 6 6 6 6 3 5 6 2 NHS 0 Social Care 3 9 3 6 8 3 7 7 10 9 13 13 Social Care 0 Both 0 0 0 0 0 0 0 0 0 0 0 0 Both 0 Total 8 16 10 9 14 9 13 13 13 14 19 15 Total 0

20 1 0.8 15 0.6 10 0.4 5 0.2

0 0 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Sandwell Birmingham Sandwell Birmingham

GOVERNING BODY/COMMITTEE Report Title: Report author and Title: Strategic Commissioning & Redesign Dr Ian Sykes & Committee Update to Governing Body Olivia Amartey Deputy Chief Officer 8 June 2017 (Operations)

Date of Governing Body/ Committee: Contact Details: 5 July 2017 [email protected] Agenda Item No: 0121 612 3471

Sign off from Chief Officers: Chief Finance Officer:

Chief Officer for Quality:

Chief Officer for Operations:

Chief Officer for Partnership:

Supporting Documents/further Reading: None Previous Decision: N/A

Summary of purpose and scope of the report: This report to Governing Body updates on - The business of the Strategic Commissioning & Redesign Committee held on Thursday 8 June 2017. - Right Care (update presented to SCR on 22 June 2017).

Recommendations:

• It is recommended that Governing Body members note the contents of the report

The Governing Body/Committee are requested to: Action Approve x Assurance Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified x Conflict noted, conflicted party can participate in clinical discussion but not decision

Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:

Strategic Priorities related to the report: Quality & Safety Finance & Performance Partnership Strategic Commissioning and Redesign x Organisational Development Primary Care Co-Commissioning Collaborative Commissioning Implications: Financial Assurance Framework Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated Consultation: X Patients Staff Committees Public Partners Sponsored By: (Chief Officer or Committee Sharon Liggins Chair) Date Report received for Governing 19 June 2017 Body/Committee

1. INTRODUCTION

This report provides details of the Strategic Commissioning & Redesign Committee which took place on 8 JUNE 2017. It covers:

2. MATTERS ARISING

2.1 Health Harmonie: communication of results.

3. ITEMS FOR DECISION MAKING

3.1 Forward Thinking Birmingham Contract 2016/17

3.2 Excess Treatment Costs for Cognitive Behaviour Treatment in Atrial Fibrillation

3.3 Stone Road Contract Extensions

4. ITEMS FOR INFORMATION

4.1 Update: Mental Health in-patient beds

4.2 Risk Register review and update

4.3 Corporate Update

4.4 Mental health Portfolio Update

5. ANY OTHER BUSINESS

5.1 CCG Public Health Memorandum of Understanding

1. INTRODUCTION

This report provides details of the Strategic Commissioning & Redesign Committee which took place on 8 JUNE 2017. It covers:

2. MATTERS ARISING

2.1 Health Harmonie: communication of results

Following a Heath Harmonie contract review meeting it was confirmed that it is the provider’s responsibility to communicate both normal and abnormal results to the GP and patients.

3. ITEMS FOR DECISION MAKING

3.1 Forward Thinking Birmingham Contract 2016/17

This paper was sent to SCR to agree retrospectively.

It details and requests the CCG to provide ‘top up’ funds of £187,000 . Prior to SCR, Olivia Amartey (Deputy Chief Officer, Operations) had discussed the request with David Hughes who confirmed that the £187,000 shortfall request has been secured and is now within the baseline.

Concerns were highlighted by SCR committee members regarding the discrepancy in the finances between the sum agreed with FTB at the initial tender stage and the significant sum that the CCG has had to transfer for the financial year 2016/17. SCR asks for the reasons behind this: ie is the requested funding due to increased demand and/or a change in the operating model?

This question is to be raised with Jo Carney, (Associate Director Mental Health, Joint Mental Health Team) during her meeting with the Chief Officers on Monday 12 June and feedback to SCR.

Decision: SCR approves the additional funding. However the contracting and finance teams must ensure the contract is accurate from the start as this will not repeated next year.

3.2 Excess Treatment Costs for Cognitive Behaviour Treatment (CBT) in Atrial Fibrillation (AF)

This request has been resubmitted as SCR did not approve the original request for CBT in AF trial patients. The initial sum requested was £97,000 and would cover all three Birmingham CCGs.

The resubmission request is for £11,000 to cover SWBCCG only patients.

Moving forward, it was agreed that guidance and a set of principles is needed regarding funding research, which includes a cap and rationale for approving / rejecting research requests.

Further the Committee has asked Andrew Harkness to clarify the CCGs statutory responsibility and to feedback at the next meeting.

SCR will therefore await further guidance before these excess treatment costs are approved

3.3 Stone Road Contract Extensions

Governing Body has made the decision to commission the initial health screening service at Stone Road until 31 March 2018. The contract for the wrap around services expires at the end of June 2017.

The request is for the committee to approve an extension to the contract for the midwifery service, the CPN service, the Doula services and the minor ailments service in alignment with the contract extension for the Stone Road Screening Service.

Decision: The committee agreed to approve funding to extend the contracts to continue for the midwifery service, the CPN service, the Doula services and the minor ailments service until 31 March 2018.

4. ITEMS FOR INFORMATION

4.1 Update: Mental Health in-patient beds

It was noted that request for funding was agreed in principle by SCR Committee. However, further assurances are sought and it is envisaged that following a meeting between the Chief Officers and the Associate Director of Mental Health, Joint Commissioning Team, to be held on Monday 12 June, that answers to the questions discussed at SCR will be clarified.

Final agreement will be the responsibility of the Governing Body.

4.2 Risk Register review and update

The risk register was reviewed and updated. The details are itemised in the SCR Committee minutes dated 8 June 2017.

4.3 Corporate Update

There were no corporate updates discussed.

4.4 Mental health Portfolio Update

Anet Baker, Senior Commissioning Manager updated the Committee on the current CCG portfolio for Adult and Older Peoples’ Mental health.

There were no decisions requested of the Committee.

The details highlighted in her presentation are itemised in the SCR Committee minutes dated 8 June 2017.

5. ANY OTHER BUSINESS

5.1 CCG Public Health Memorandum of Understanding (MOU)

It was confirmed that Nick Harding has sign the MoU, presented to SCR.

6. SCR MEETING, 22.6.17

There is no urgent business to be ratified by Governing Body from the SCR meeting of 22nd June. A report from this meeting will be shared with the August Governing Body.

Right care summary (22nd June 2017) – SCR

Andrew Harkness

Progress update (verbal):

• Remain on track for September 2017 to articulate plans for three priority programme areas (respiratory, diabetes and cancers); o In year developments and potential impact o Commissioning intentions for 2018/19 • NHS England have mandated a template return at the end of June, July and August. In June and July we are required to submit one programme area each month. August we are required to submit all three programme areas. We are submitting programmes as follows; o June – diabetes o July – cancers o August – respiratory, diabetes and cancers • Diabetes submission (June 2017) – a request has been made to share our CCG submission as an example of good practice, due to the range and focus of work we are undertaking. • Evaluation of the 2016/17 PCCF has shown a significant impact on areas that directly link to Right Care including diabetes, hypertension, AF and cancer. o Right Care have approached the CCG to ask to use the PCCF as a case study for them to publish through their national programme. • Elements of Right Care that may be delivered by primary care (via PCCF) for the six programme area priorities for 2017/18 and 2018/19 are being developed for consideration and will be finalised for end of August 2017.

GOVERNING BODY Report Title: Report Author and Title: Audit and Governance Committee Michelle Carolan, Date of Governing Body: Contact Details: 0121 612 Wednesday 05 July 2017 3830 [email protected] Agenda No: 7.5 Enclosure No: 6

Sign off from Chief Officers: (Before the report is presented to the Governing Body any implications relating to Finance, Quality and Commissioning must be agreed and signed by the Chief Officer. (see guidance note) Without this information the report will not be taken to the Governing Body)

Chief Finance Officer:

Chief Officer for Quality:

Chief Officer for Operations:

Chief Officer for Partnership:

Supporting Documents/further Reading: (Highlight any documents or further reading for members which supports this report) Previous Decision (Inform the Governing Body/Committee if the paper has been reviewed or monitored by another committee and their recommendation or decision)

Summary of purpose and scope of the report: (Highlight key points you wish to bring to the attention of members)

The aim of the report is to provide the Governing Body of the issues discussed at the Audit and Governance Committee held in June 2017 Recommendations:

• Note the report from the Audit and Governance Committee for assurance • Approve the risk closures relating to the Board Assurance framework

The Governing Body/Committee are requested to: Action Approve x Assurance x Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified x Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only)

Sandwell & West Birmingham CCG Audit & Governance Committee Report Page 1 Agenda Item 7.5 - Enc 7 Wednesday 05 July 2017

Please state rationale for above decision:

Strategic Priorities related to the report: Quality & Safety x Finance & Performance x Partnership x Strategic Commissioning and Redesign x Organisational Development x Primary Care Co-Commissioning x Collaborative Commissioning x Implications: Financial State any financial implications for the CCG Assurance Framework The Audit and Governance Committee have delegated responsibility to review the Assurance Framework and provide assurance to the Governing Body

Risks and Legal Obligations The Audit and Governance Committee Review the corporate risk register on behalf of the Governing Body.

Equality and Diversity Statutory and External Influences Further implications not stated Detail any further implications including resources and training Consultation: X Patients Staff Committees Public Partners Sponsored By: (Chief Officer or Committee Julie Jasper, Lay Member and Audit Chair Chair) Date Report received for Governing Body 26th June 2017

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SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP

Report to the Governing Body

Subject: Audit and Governance Committee

Date: 15 June 2017

Author: Michelle Carolan, Deputy Chief Officer, Quality

Remit of Subcommittee

The Audit and Governance Committee is a committee of the SWBCCG Governing Body. The Committee will inform the Governing Body of its deliberations formally by means of a report to the Governing Body meeting after the Committee has met, and informally by other means of communication.

The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the organisation's activities (both clinical and non-clinical), that supports the achievement of the organisation's objectives.

Progress last Month

The committee discussed :

• Internal Audit • Progress Report • Outstanding Recommendations Report • Partnership Audit Report • HR processes Internal Audit Report • Continuing Healthcare Internal Audit Report • Counter Fraud • Anti-Fraud Annual Report • Anti-Fraud Plan 2017/18 • Conflicts of Interest Action Plan • Audit & Governance Risk Register • BAF Risk Register • Risk Closures

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Internal Audit

• The Internal Audit Progress Report based on work undertaken for 2017/18 was presented. There have been no changes to the audit plan since it was approved by the Audit Committee. Reports are currently being drafted in relation to Primary Care Co-Commissioning • The recommendation tracker was reviewed; there are currently 44 recommendations sitting on the tracker. 29 are not yet due and 15 are in progress, none are outstanding. • Internal Audits for HR Processes and Continuing Healthcare were presented to the group. The audit for HR processes was approved; the continuing healthcare audit required further clarification and will be re-presented for consideration.

Counter Fraud

• The Anti-Fraud Annual Report provides a summary of the anti-fraud activities and details of any investigations undertaken during 2016/17. The Anti-Fraud service has worked with the CCG to embed an organizational culture of combating economic crime and respond to any new referrals received. During the year the Anti-Fraud service supported the committee in the interpretation of the Standards and has undertaken work to help ensure compliance, as well as maintaining an effective deterrence against economic crime. • Anti-Fraud Plan for 2017/18 were presented to the group; designed to meet the requirements of the Standards for Commissioners relating to fraud, bribery and corruption. The plan was approved by the committee.

Risk Registers & Conflicts of Interest

• The Conflicts of Interest Action Plan was presented to the group. Further guidance is due to be released in a couple of weeks, which will provide further information regarding case studies and training • The Audit and Governance Risk Register was reviewed by the group. • The committee reviewed the BAF and agreed in principle, subject to Governing Body approval, to close the following risks: PT01 FP05 SC17 These are included in the papers for reference.

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Escalation to the Governing Body

• Outstanding Recommendations • Anti-Fraud plan • Risk Register updates at committees

Sandwell & West Birmingham CCG Audit & Governance Committee Report Page 5 Agenda Item 7.5 - Enc 7 Wednesday 05 July 2017 Audit & Governance – BAF Risk Closures

PT01 Description Cuts to local authorities budgets will impact on health-related expenditure and patient flows through SWBH it could impact on CCG performance.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 140 4 5 20 Reduce the Health and Well Being Gap Opened Current Probability Current Impact Current Risk Grading 15/01/2014 4 5 20 Reviewed Controls Actions and Updates 27/03/2017 15/01/2014 - The Better Care Fund workstream is focused towards designing the health and 15/01/2014 - The BCF work stream is focused towards redesigning the Health and Social landscape to improve service social landscape to enable more resource to be released on early support/preventive and integration. It is expected to deliver a 3.5% reduction in NEL admissions Efficiencies against plan will be used to support Committee social care intervention therefore less resources for secondary care and crisis management. mutually agreed social care provision.

F&P 27/03/2017 - Agreements in place; regular senior level meetings. 12/08/2015 - Both Birmingham and Sandwell BCF programmes are not delivering the anticipated target. SMBC adult

services cuts for 2016/17 is anticipated to be £5.1m, we do not yet know the proposed areas they will cut but they Initial Risk Level report it will effect services for vulnerable people and have an impact on health provision. BCC have announced they will cut 3rd sector Prevention Budget from £7.6m to £4.2m from April 2016. This represents a reduction of approximately I - High (16+) 50%. By March 2016 total spend by Birmingham city Council across mental health, with all projects reducing by 50%. We do not yet have a full picture of BCC planned cuts. Current Risk Level 17/08/2016 - The BCF Policy Framework for 2016/17 has removed the payment for performance National Condition featured in the policy for 2015/16 in recognition of the overwhelming challenge faced by the NHS in reducing avoidable C- High (16+) hospital admission numbers. The CCG has maintained its commitment to support Sandwell adult social care services in Status 2016/17 and the Sandwell BCF continues to protect vital prevention services. DFG funding for 2016/17 is being used to recruit additional assessment capacity which is also expected to mitigate impacts of demand and LA budget reductions Open - On BAF on health services. However, planned cuts to some Day Opportunities for older people and the potential closure of the Closure Requested Gaps in Controls last remaining residential care home under the control of the Local Authority may impact on demand for local primary and secondary care services. 15/01/2014 - The arrangements in both Birmingham and Sandwell are yet to be clarified due 17/11/2016 - Comment from A&G: Red risks should be updated monthly. Closure Reason to the complexity of the terms of reference of the fund. 15/12/2016 – Reviewed and remains the same – update BCF continues to protect social care services. Duplication 16/01/2017 - Risk description changed from "Lack of financial resources within the local authorities and known expenditure reductions will impact on health-related budgets with respect to social care, which may result in poor Closure Approved Internal Assurances and/or reduced services to patients.", to "Cuts to local authorities budgets will impact on health-related expenditure and patient flows through SWBH it could impact on CCG performance." Recommended that the risk is moved to F&P. 15/01/2014 - The Partnerships and Collaboration Committee has changed its terms of 27/03/2017 - Risk reviewed and found to be incorporated in FP07 and additional funding has been allocated, therefore Closure Approved reference to ensure a programme board approach is taken internally to the progress of the risk recommended for closure due to duplication. Date implementation of the Better Care Fund. Board reports and minutes. 20/04/2017 27/03/2017 - Regular senior level meetings. Closure Rules External Assurances Approval Required 15/01/2014 - National process as determined by NHS England. from A&G Responsibility Sharon Liggins Gaps in Assurances ID 15/01/2014 - Since this is emerging piece of work on both a national and local level the 15 formation of a local robust strategy to manage the fund is yet to be developed that would

SC17 Description If the mobilisation of NHS 111 is compromised then this would result in an adverse impact across the region.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 4 16 Improving Care and Quality Opened Current Probability Current Impact Current Risk Grading 12/10/2016 1 1 1 Reviewed Controls Actions and Updates 27/04/2017 12/10/2016 - Well-resourced and defined programme and project management 29/07/2016 - Explore revised governance arrangements through the establishment of a committee in common Committee arrangement; Clear governance structure; Independent professional legal advice. Risk 26/10/2016 - Procurement is complete and we are now moving to mobilisation. SCR reduced to 12. 23/12/2016 - The mobilisation of NHS111 is progressing. 09/02/2017 - Risk reviewed, remains the same. 27/04/2017 - Reviewed at SCR. NHS111 mobilisation has happened. Risk reduced to 1. Recommend for closure. Initial Risk Level

I - High (16+)

Current Risk Level C - Very Low (1-3) Status pen - Removed from BA Closure Requested Gaps in Controls 12/10/2016 - 16 separate organisations involved in the procurement each of whom have to Closure Reason operate their own governance arrangement Time Limited Closure Approved Internal Assurances 12/10/2016 - Clear line of reporting through project to SCR and GB. Clear progress reports Closure Approved against a project plan. Date

Closure Rules External Assurances Approval Required 12/10/2016 - Clear line of reporting through project to SCR and GB. Clear progress reports from A&G against a project plan. Responsibility Debra Howls Gaps in Assurances ID None 76

FP05 Description If we fail to identify sufficient QIPP schemes for 16/17 and future years then the CCG will need to revise its investment plans and may need to look at existing levels of expenditure to ensure a balanced financial position.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 16 4 4 16 Deliver Financial Stability and Efficiency Opened Current Probability Current Impact Current Risk Grading 21/12/2015 2 2 4 Reviewed Controls Actions and Updates 24/04/2017 21/12/2015 - PMO in place. QIPP working group led by CFO with engagement from senior 21/12/2015 - Senior Officers involved producing robust PIDs to ensure delivery of required level savings. staff in other departments, utilising benchmarking information to identify potential schemes. 25/01/2016 - JG met with CSU to produce a piece of work to identify how to deliver the benchmarked opportunities Committee 21/03/2016 - Reviewed at Finance and Performance Committee. No change to risk. F&P 27/06/2016 - Reviewed, no change to risk. 25/07/2016 - Risk reviewed; risk increased to 20 due to higher impact, as a result of STP 1% non-recurrent funding. Initial Risk Level 26/09/2016 - Risk reviewed, no change. 24/10/2016 - Financial position improved and good progress has been made on the 17/18 plans. Risk reduced to 16. 28/11/2016 - Prescribing related QIPP schemes identified. I - High (16+) 23/01/2017 - Significant confidence in the delivery of 16/17 QIPP. Risk downgraded to 6. JG to meet with TR to create new risk for future years. Current Risk Level 27/03/2017 - Forecast to achieve by end of 2016/17. C - Low (4-7) 24/04/2017 - Risk reviewed, QIPP target delivered for 2016/17 as evidenced by year end position, therefore recommend closure. Status Open - On BAF Closure Requested Gaps in Controls

21/12/2015 - Lack of sufficient QIPP schemes to deliver required level of savings. Closure Reason Time Limited Closure Approved Internal Assurances 21/12/2015 - Regular reporting to audit and F&P committee. Closure Approved 27/06/2016 - A new QIPP sustainability team are in place and are presenting at the next F&P Date Meeting. 25/07/2016 - QIPP sustainability team will report back in October 2016. Closure Rules External Assurances Approval Required 21/12/2015Completion of financial plan submissions to NHS E. from GB Responsibility James Green Gaps in Assurances ID None 7

GOVERNING BODY Report Title: Organisational Development Report author and Title: Alice McGee, Head Committee of HR and OD Date of Governing Body/ Committee: 5th July Contact Details: 2017 Agenda enclosure no: Sign off from Chief Officers: (Before the report is presented to the Governing Body any implications relating to Finance, Quality and Commissioning must be agreed and signed by the Chief Officer. (see guidance note) Without this information the report will not be taken to the Governing Body)

Chief Finance Officer:

Chief Officer for Quality: Claire Parker

Chief Officer for Operations:

Chief Officer for Partnership:

Supporting Documents/further Reading: (Highlight any documents or further reading for members which supports this report) Organisational Development Committee Minutes

Previous Decision (Inform the Governing Body/Committee if the paper has been reviewed or monitored by another committee and their recommendation or decision)

Summary of purpose and scope of the report: (Highlight key points you wish to bring to the attention of members)

The aim of the report is to provide the Governing Body of the issues discussed at the Organisational Development Committee on 13th June 2017 Recommendations:

The Governing Body are asked to note the content of the report.

The Governing Body/Committee are requested to: Action Approve Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified X Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:

Strategic Priorities related to the report: Quality & Safety Finance & Performance Partnership Strategic Commissioning and Redesign Organisational Development X Primary Care Co-Commissioning Collaborative Commissioning Implications: Financial Assurance Framework Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated Consultation: X Patients Staff X Committees Public Partners Sponsored By: (Chief Officer or Committee Prof Nick Harding Chair) Date Report received for Governing 26th June 2017 Body/Committee

Report

Staff Council Update

The Staff Council met on 12th June 2017 and welcomed the new Staff Council Chair, Alison Braham following the voting process by staff. The new membership of the Staff Council will commence from July 2017 and we will be thanking those members across the CCG who have not been voted on for a 2nd term of office.

Workforce Dashboard

The committee received a dashboard and a discussion was had in relation to the workforce indicators. It was noted that the figures for mandatory training compliance had significantly increased over the last few months however it was important to continuously improve and maintain the figure. The current compliance rate is 85% across all staff however this increases to 95% for those staff within the business i.e. excluding all maternity leave, long term sickness and secondments.

OD Committee noted the slight increase in PDR compliance but were given assurance that some of the low compliance rates are due to managers not recording the necessary information on ESR. Monthly managers reports were now being sent to Chief Officers and business support to ensure that recording increased.

Primary Care OD Plan

The OD Committee received a verbal update on the progress against the GP Five Year Forward View and that this was being managed through a programme management approach. The Committee agreed to work with clinical leads and GP Directors at the July Clinical Leads meeting to further develop opportunities for OD to meet the needs of the future including exploring a CCG led Clinical Employment Bank.

Emergency Resilience The OD Committee were provided with a verbal debrief of a desktop review undertaken following the Cyber Attack and agreed to consider the operationalisation of the EPRR plan at future committee meetings.

Black Country and West Birmingham Joint Commissioning Board OD Update

The OD Committee had a verbal update and assurance on the HR and OD agenda for the joint commissioning board and agreed to continue to have this as a standing item each committee meeting.

CSU Scores

The OD Committee were provided with the customer scores for Midlands and Lancashire CSU and Arden and GEM CSUI. The majority of service scores are rated as satisfactory or good with the exception of the Quality score. The committee were provided assurance that a plan was in place to recover the scores and deliver the service

Risks

The committee also reviewed all associated risks and updated the register.

GOVERNING BODY

Report Title: Primary Care Commissioning Report author and Title: Committee Public Session Update – June 2017 Carla Evans Head of Primary Care

Date of Governing Body: 5 July 2017 Contact Details: Agenda No: 7.7 [email protected] Enclosure No: 9

Chief Finance Officer:

Chief Officer for Quality:

Chief Officer for Operations:

Chief Officer for Partnership:

Supporting Documents/further Reading: N/A

Previous Decision N/A

Summary of purpose and scope of the report: To update the Governing Body on the outcomes of the public session of the June 2017 Primary Care Commissioning Committee.

Recommendations: To note the contents of the report and decisions taken by the Primary Care Commissioning Committee.

The Governing Body/Committee are requested to: Action Approve Assurance x Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified x Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances

Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Body Agenda Item 7.7 Primary Care Co-Commissioning Page 1 Wednesday 05 July 2017 Report – Enc 9 only) Please state rationale for above decision:

Assurance Framework x

Risks and Legal Obligations x

Equality and Diversity x

Statutory and External Influences Further implications not stated Consultation: X Patients Staff Committees x Public Partners Sponsored By: (Chief Officer or Committee Chair) Sharon Liggins Date Report received for Governing Body 21/06/2017

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Public Primary Care Co-Commissioning Update to Governing Body

1.0 INTRODUCTION

1.1 This paper is to update the Governing Body of the actions and outcomes from the previous meeting of the Primary Care Co-Commissioning Committee Public session which took place on 1June 2017.

1.2 The items updates presented at the Committee for information included: • Contracting Update • Finance Update • Risk and Issues Register Report • GPFV

1.3 The following items were presented to the Committee for decision: • Update to PCCF 17/18

2.0 DETAIL OF THE REPORT

2.1 Contracting Update

2.1.1 There were no contract variations during May 2017.

2.1.2 During May three practices had contract and quality monitoring visits and in June a further six practices will be visited. All practices will be visited over a 2 year period; practices where concerns (by CQC or otherwise) have been raised will be prioritised.

2.1.3 There are some GMS contract changes and an overview of these was presented at the Practice Managers PLT on 16 May 2017. Also presented was this year’s DES together with an update on the contract and quality monitoring visits.

2.1.4 The importance of communicating with the public that the CCG is working with and supporting practices to resolve issues was agreed. JSS suggested this is reported in conjunction with GPFV (not just about CQC) to give the public a balanced view.

2.1.5 Great Bridge Partnerships for Health (GBPH) held a PMS Contract. In April 2015 GBPH exercised their right to return to a GMS Contract, the GMS Contract was entered into with Dr R Gatge, Joanne Davidson and Yvette Townsend acting in partnership. It is the Partnerships’ view that the contracting party is an error and the partnership now wish for the contract to be novated to Great Bridge Partnerships for Health Ltd. This was approved by the committee.

2.2 Finance Update

2.2.1 The primary care delegated resource for 2017/18 is £79.0m (an increase of £1.7m on 2016/17) with additional allocations of an estimated £4.8m as per GPFV planned

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expenditure. The global sum has been increased from £80.59 to £85.35 per weighted capitation.

2.2.2 PMS Premium is phased out over a maximum of 7 years and 2017/18 is year 3. In 2017/18 £3.2m PMS premium funding is planned to be released. All PMS Premium released will be reinvested into primary care services.

2.2.3 Audited and approved actual spend for 2016/17 was £79.9m. Planned spend for 2017/18 is £82.4m. This equates to a planned investment increase of £2.5m for SWB CCG member practices to access in 2017/18.

2.2.4 Recurrent monies with the addition of GPFV provides a real term increase of £13.2m over 5 years.

2.2.5 Risks included (i) national contract changes for premises rates, (ii) support for asylum seekers and (iii) practice moves (these have been approved by NHSE and will be adjusted by month 3 June 2017).

2.2.6 Details of the increased spend will be released to the public via the next stakeholder bulletin which will focus on primary care.

2.3 Risk and Issue Register Report

2.3.1 Risk PC11 was reduced to 12 – this related to the transfer of practices to Birmingham South Central which has now been confirmed by NHSE.

2.3.2 Four new risks were added:

• “If GP practices are not promptly informed in of the patients that have received a flu vaccine at Sandwell and West Birmingham Hospitals NHS Trust there is a risk to the practice achievement of their flu targets for over 65s.”

• “There is a risk to GP practices ability to achieve the requirements of the PCCF if the necessary IT templates, searches and prompts are not in place and functioning effectively.”

• “11 GP practices will be affected by the termination of their BT telephone contracts which could result in them having no telephone system in place from 1st November 2017 if a suitable alternative is not put in place before that date.”

• “If practice groups or the 7 practices fail to implement improved access (6.30pm – 8pm Monday to Friday and opening at weekends) by 1st September 2017, there is a risk to us receiving the funding (£6 per head) and coming under scrutiny from NHSE.”

2.4 GPFV

2.4.1 LM presented a spreadsheet summary of the deliverables that have a RAG status and explained that the areas in red are mostly out of SWB CCG control. They relate to finances, Public Health Education and workforce (in collaboration with NHSE). SWB CCG is on track

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with new models of care schemes and LM will provide more details on schemes at next month’s PCCC. There will be a monthly performance meeting going forward and LM will update PCCC monthly.

2.4.2 AW will pick up issues around GPFV workforce at STP level and will feedback to PCCC.

2.5 Update to PCCF 2017/18

2.5.1 LM presented a PCCF document highlighting a number of proposed updates to provide clarification for practices. Committee was also informed that the colour of PCCF will be changed for 2017/18 and date/version details will be added so the practices can identify this as 2017/18 version.

2.5.2 There has been no discussion with members due to the tight timescale but each area of PCCF has both an officer and a clinical lead who have checked and signed off the changes. They are mostly changes to clarify/give more detail or a better explanation of what is required in order to strengthen the document. It is hoped this can be implemented by quarter 2.

2.5.3 Committee approved the recommended changes subject to a covering letter being sent with the revised PCCF document, that PCCF is included on LCG agendas so that discussion can take place regarding the changes and that a substantive process to include a consultation is put in place going forward. Meetings are already underway to work on the 2018/19 PCCF.

3. RECOMMENDATIONS

3.1 Members of the Governing Body are asked to: • To note the contents of the report and decisions taken by the Primary Care Commissioning Committee

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GOVERNING BODY Report Title: Summary of Outcomes – Primary Report author and Title: Arun Ahluwalia, Care Commissioning Framework 2016/17 Specialty Registrar in Public Health. Supervised by Andrew Harkness, Consultant in Public Health. Date of Governing Body: Contact Details: Wednesday [email protected], 07872 055084. Agenda No: 8.1 [email protected], 07736 286671. Enclosure no: 10 Sign off from Chief Officers: (Before the report is presented to the Governing Body any implications relating to Finance, Quality and Commissioning must be agreed and signed by the Chief Officer. (see guidance note) Without this information the report will not be taken to the Governing Body)

Chief Finance Officer: Yes

Chief Officer for Quality: Yes

Chief Officer for Strategic Commissioning: Yes

Supporting Documents/further Reading: Primary Care Commissioning Framework 2016/17.

Previous Decision N/A

Summary of purpose and scope of the report: This report demonstrates some of the performance and possible health outcome benefits that may be attributed to the introduction of the Primary Care Commissioning Framework in 2016/17.

The report does not seek to measure performance of practice individually, but that of the participating practices as a whole, and how this may drive improvements in both quality of health care and health outcomes for people registered with these practices.

Recommendations: The governing body is asked to note the contents of the report, and that the PCCF can demonstrate impact on both the delivery and quality of health care provided

The Governing Body are requested to: Action Approve Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified X Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion

Sandwell & West Birmingham CCG PUBLIC Meeting of the Governing Meeting Enc - Page 1

Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:

Strategic Priorities related to the report: Quality & Safety X Finance & Performance X Partnership Strategic Commissioning and Redesign X Organisational Development Primary Care Co-Commissioning X Collaborative Commissioning Implications: Financial Assurance Framework Risks and Legal Obligations Equality and Diversity Statutory and External Influences Further implications not stated Consultation: X Patients Staff Committees Public Partners Sponsored By: (Chief Officer Sharon Liggins Date Report received for Governing Body 28/06/2017

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SUMMARY OF OUTCOMES – PRIMARY CARE COMMISSIONING FRAMEWORK 2016/17

1. INTRODUCTION This report sets out a selection of indicators and potential improvements in health care delivery that the Primary Care Commissioning Framework (PCCF) of 2016/17 have achieved. Standards 2, 3, 9 have not been included in this document, although they have been measured as part of the framework.

2. DETAIL OF REPORT 2.1 Standard 1: Primary Care Service Provision Practices were required to provide primary care services between 08:00 and 18:30, Monday to Friday, and ensure that a minimum of 87 clinical contacts were provided per 1,000 registered population. Other delivery requirements were also set out in the PCCF documentation.

There was a significant increase in the number of contacts per week, for participating practices (see Table below)

2016/17 2015/16 (End PCCF Change (Baseline) Year 1) Contacts per week across all practices 50,260 55,063 + 4,803

Contacts per 1,000 patients per week 95.8 106.2 + 10.4

Contacts per year (all practices, calculated) 2,613,520 2,863,285 + 249,765

A total of 68/86 practices met the target of 87 contacts per 1,000 registered patients per week. The practices that were offering the fewest contacts per week in 2015/16 were, in general, the ones that improved the most during the course of the PCCF in 2016/17. This reduction in variation suggests a more consistent or equitable provision of services across the CCG.

The significant increase in contacts should be a demonstration of improved access and therefore higher patient satisfaction.

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2.2 Standard 4: Carers given priority Practices were required to create a carer’s register, end ensure carers were offered flu vaccination, a health check, and support as required. Other delivery requirements were also set out in the PCCF documentation.

This was the first year of a carer’s register being available. The numbers noted (7,097 carers identified) is a good start, but still likely underestimates the number of carers across the CCG. The figure below shows the number of carers that received a health check (red), compared to the number of carers in each practice (blue). This shows there is still scope to improve the health offer to registered carers. Flu immunisation uptake was 52%.

It is anticipated that further improvements will be found when PCCF 2017/08 is evaluated.

Total number of carers and proportion who completed health check, by practice 250 Number of carers

200 Carers register completed health check last 12m 150

Carers 100

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2.3 Standard 5: Demand Management – Falls Falls are a source of significant poor health outcomes, and expenditure, within the CCG. Practices were required to identify

• The number of people at risk of a fall (using a validated tool) • Those that had fallen in the previous 12 months • The number of those that had been reviewed by MDT and/or referred to a falls service The graph below shows that 2,887 people were identified as being at risk of falling, with 29% of those being assessed by an MDT. This provides good quality baseline data that can be built upon within Standard 3 of PCCF 2017/18.

3500 Patients at risk of fall 3000 2887 2500 Patients At risk of falling since 1st Oct 16 2000

1500 Out of which were discussed at MDT 1000 Out of which had an 832 500 onward referral 505 0

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2.4 Standard 6: Long Term Conditions 2.4.1 Hypertension Hypertension is a significant risk factor for poor cardiovascular health and outcomes, yet estimates before the commencement of PCCF suggested 48,000 people were undiagnosed with the condition. Practices were required to increase the observed to expected prevalence by 10%, or if already at 80%, to maintain the baseline level.

A total of 48/86 practices met the target. The figure below shows that across participating practices, every practice improved their observed / expected figure. The overall average increased by 4.4%. There is evidence that suggests the identification of those with hypertension in 2016/17 may lead to an extra 318 to 530 years of life within the population (costing the CCG £94 to £157 per extra

Proportion of people on Hypertension register compared to expected number, 2016/17 by

Obs / Exp 16/17 Obs / Exp Baseline Average 16/17 Average Baseline 100%

90%

80%

70%

60%

50%

diagnosed 40%

30%

20%

10%

Proportion of 'expected' patients with hypertension hypertension with patients 'expected' of Proportion 0% Practice year of life)

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2.4.2 Stroke Atrial Fibrillation (AF) is a significant risk factor for stroke. Estimates for the CCG prior to PCCF suggested there were 5,592 people with AF that remained undiagnosed. Practices were required to increase the observed to expected prevalence by 10%, or if already at 80%, to maintain the baseline level.

A total of 78/86 practices me the target. The figure below shows that across participating practices, nearly every practice improved their observed / expected figure. The overall average increased by 12.6%. There is evidence that suggests the identification of those with AF in 2016/17 may lead to 16 fewer strokes within the population (costing the CCG £3,122 per averted stroke, but saving £110,050 in health and social costs overall)

Proportion of people on AF register compared to expected number, 2016/17 by practice Obs / Exp 16/17 Obs / Exp Baseline Average 16/17 Average Baseline

120%

100%

80%

60%

40%

20%

Proportion of 'expected' patients with AF AF diagnosed with patients 'expected' of Proportion 0% Practice

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2.4.3 Diabetes Diabetes is known to be an increasingly important risk factor for both morbidity and mortality across the UK. National guidelines suggest that GPs should be providing 8 key care processes to those with diabetes, in order to minimise the risk of poor health outcomes. Practices were required to increase the proportion of those with diabetes receiving all 8 processes by 10%, or meet the CCG 75th centile.

A total of 71/86 practices met the target. The table below shows that the improvement in this regard appears to be substantial across participating practices. The number of new diagnoses in 2016/17 makes the improvement even more impressive.

2015/16 2016/17 (End PCCF Year Change (Baseline) 1) Total received all 8 8,856 18,203 + 9,347 processes % received all 8 care 23.3% 42.6% + 19.3% processes

Of the newly diagnosed cohort of 2,914 patients within 2016/17, assuming that one sixth would not have been diagnosed for another 3 years, there is some evidence that the early identification may have prevented 10 deaths in the CCG over a 5 year period. This equates to approximately £5,000 per averted death.

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2.5 Standard 7: Mental Health People with Serious Mental Illness (SMI) have a higher risk of cardiovascular and respiratory disease. Practices were therefore required to provide an annual mental and physical health check for patients on any SMI register. Other delivery requirements were also set out in the PCCF documentation.

80/86 practices achieved 40% or higher performance for the annual check, of which 75 achieved at least 50% and 62 achieved at least 60% (see graph below). It is anticipated that as this standard matures, achievement will increase further, with reductions in variation across practices.

2.6 Standard 8: Cancer Cancer is a significant burden of disease locally and nationally. In SWB CCG, there is evidence to suggest that despite having a similar standardised incidence rate of all cancers, the one year survival for all cancers is significantly below the England average. Practices were expected to actively follow up patients that did not attend their cancer screening when invited (bowel, breast, cervical). Other delivery requirements were also set out in the PCCF documentation.

Of the 11,065 that did not return a bowel screening sample, 8,231 (74.4%) were actively followed up. Of the 4,844 that did not attend breast screening, 4,053 (83.7%) were actively followed up. Of the 4,427 that did not attend their cervical screening, 3,799 (85.8% were actively followed up.

The majority of practices have followed up their patients that missed their opportunity to be screened. It is anticipated that these figures will improve further in PCCF 2017/18.

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3. RECOMMENDATIONS The governing body is asked to note the contents of the report, and that the PCCF can demonstrate impact on both the delivery and quality of health care provided.

Arun Ahluwalia, Specialty Registrar in Public Health

Supervised by Andrew Harkness, Consultant in Public Health

Strategic Commissioning and Redesign

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GOVERNING BODY

Report Title: Report author and Title: Mrs Assurance Framework 2017/18 Michelle Carolan, Deputy Chief Officer, Quality, Julie Jasper, Chair Audit and Governance Committee Date of Governing Body: Contact Details: Wednesday 05 July 2017 0121 612 3830 Agenda No: 8.2a [email protected] Enclosure no: 11a

Chief Finance Officer: Yes

Chief Officer for Quality:

Chief Officer for SCR:

Chief Officer for Transformation:

Supporting Documents/further Reading: (Highlight any documents or further reading for members which supports this report)

Previous Decision the Governing Body has received progress reports on the Assurance Framework throughout the year.

Summary of purpose and scope of the report:

To inform the Governing Body on the development of the Assurance Framework 2017/18. The Governing Body needs to be confident that the Assurance Framework; • Focuses on key risks and is driving the delivery of the corporate objectives • Controls listed are relevant to manage the risk to an acceptable level • Assurance are relevant and provide a suitable level of reassurance • Gaps in controls and updates to the assurances are a true evaluation of the situation and allocated an appropriate individual for addressing. • Approve risks that have been requested for closure •

Sandwell & West Birmingham CCG Governing Body Board Meeting Agenda Item 8.2a - Assurance Framework – Page 1 05 July 2017 Enc 11a

Recommendations: Approve the content of the report Review and discuss the 201/18 Assurance Framework updates highlighted in Red The Governing Body/Committee are requested to: Action Approve X Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:

Strategic Priorities related to the report: Quality & Safety X Finance & Performance X Partnership X Strategic Commissioning and Redesign X Organisational Development X Primary Care Co-Commissioning X Collaborative Commissioning X Implications: Financial State any financial implications for the CCG Assurance Framework Detail any links to the Assurance Framework Risks and Legal Obligations State any risks or legal implications related to this document. Ensure the risk is entered on the CCG risk register Equality and Diversity Statutory and External Influences Further implications not stated Detail any further implications including resources and training Consultation: X Patients Staff Committees Public Partners

Sandwell & West Birmingham CCG Governing Body Board Meeting Agenda Item 8.2a - Assurance Framework – Page 2 05 July 2017 Enc 11a

Sponsored By: (Chief Officer or Committee Andy Williams Chair) Date Report received for Governing 27th June 2017 Body/Committee

Sandwell & West Birmingham CCG Governing Body Board Meeting Agenda Item 8.2a - Assurance Framework – Page 3 05 July 2017 Enc 11a

Board Assurance Framework – July 2017

SC06 Description If the CCG are unable to work effectively with partners to deliver the required conditions, then the new Midland Met Hospital may not be successfully commissioned.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 152 3 4 12 Deliver Financial Stability and Efficiency Opened Current Probability Current Impact Current Risk Grading 08/08/2014 4 4 16 Reviewed Controls Actions and Updates 08/06/2017 08/08/2014 - Right Care Right Here Partnership Board involving all the key partners. Board 08/08/2014 - To implement the actions agreed at partnership board and programme. Committee has agreed a specific programme of work linked to the commissioning of Midland Met Hospital 26/11/2015 - Formalising the relationship between SCR and RCRH. and is supported by a joint project team. 20/07/2015 - Query raised as to whether this should be responsibility of SCR. SCR 20/04/2017 - Monthly meeting initiated with the Trust since December 2016. Risk score 26/07/2016 - "Evolution plan – •IZ System level integration & sustainability transfers to STP process (June 2016) IZ•

reduced to 8. RCRH Executive becomes Sandwell & West Birmingham Strategic System Resilience committee (July 2016)•IZ Establish Initial Risk Level task force to implement the Midland Met model of care, led by SWBH with RCRH partner representation (July 2016), with key focal areas: I - Moderate (8-15) and paediatric community support, regardless of their own or their GPs postcode across west Birmingham and Sandwell Current Risk Level review to confirm whether the right mix of acute/community beds and non-bedded community services will be available for when MMH opens (report by June 2017)•IZ Evolution communications & engagement plan – migrate to C- High (16+) STP (Sept 2016) & ensure task force reporting to include HWBs Status 12/10/2016 - Risk end dated by introduction of STP. Our CCG is part of the Black Country STP and we are working in partnership to deliver system wide transformation which includes MMH. Closed. Open - On BAF 17/11/2016 - Comment from A&G: Risk definition needs to be improved, particularly in relation to MMH. Closure Requested Gaps in Controls 20/04/2017 - Reviewed by A&G Committee: Changes need to be updated before risk can be submitted to A&G for closure approval. 08/08/2014 - Process is currently being established but is not fully established. 20/04/2017 - Monthly meeting initiated with the Trust since December 2016, where key issues affecting MMH Closure Reason transformation plan are reviewed to ensure services are appropriately commissioned and that primary care and OP activity is aligned. 08/06/2017 - Risk reviewed. Meeting arrangements with Trust are currently proving ineffective, therefore risk increased Closure Approved Internal Assurances to 16. 08/08/2014 - Documentation around the Partnership Board. Closure Approved 20/04/2017 - Monthly meeting initiated with the Trust since December 2016. Date

Closure Rules External Assurances Approval Required 08/08/2014 - Right Care Right Here Board Plan. Approval letter and conditions from from GB Department of Halth. Responsibility Andy Williams Gaps in Assurances ID 08/08/2014 - No definite plan signed off by Partnership Board. 69

PC12 Description If the relationship between partnership agencies breaks down, then this may result in gaps in service provision, which may lead to a reduction in the health and well-being of asylum seekers currently in initial accommodation (hotels).

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 4 16 Reduce the Health and Well Being Gap Opened Current Probability Current Impact Current Risk Grading 20/05/2015 4 4 16 Reviewed Controls Actions and Updates 19/05/2017 20/05/2016 - 1) Unannounced visits undertaken to initial accommodation sites and 20/05/2016 - Recommendations for urgent request for meeting with Home Office. Committee safeguarding referrals made; 2) Escalation of issues to Home Office; 3) Continued to work with 17/06/2016 - CCG will continue to work with partners to address the needs of Asylum seekers in initial accommodate partners around pathway development and relationship management; 4) Migrant Health hotels PCCC Workshop undertaken with partners and has improved relationships. 29/07/2016 - Migrant Health Workshop undertaken with partners and has improved relationships. (Risk reduced to 9

20/01/2017 - We anticipate a response from the new letter to NHS E advising them that we 19/08/2016 - Risk Reviewed, no change. Awaiting outcome of teleconference call between AO and NHS E on 23rd Initial Risk Level intend to hand the contract back to NHS E as from 1st April 2017 and terminate the wrap August 2016 around services. 23/09/2016- NHS E did not dial into the teleconference and CCG continues to receive lack of response from NHS E I - High (16+) 17/02/2017 - The CCG has agreed to extend the stone road service until 30th June 2017. despite number telephone calls and emails. Risk increased to 16. 18/11/2016 - SWB CCG Governing body made decision for AO to write formally to NHSE to request that adequate Current Risk Level funding needed to be received for the service provision and if not received we will be returning contract back from 1st April 2017 – awaiting response from NHSE. C- High (16+) 16/12/2016 - Risk reviewed no change to risk. Still no response from NHS E. Status 20/01/2017 - Risk reviewed no change to risk. A new letter has been sent to NHS E following governing body on 11th January 2017, we are awaiting a response. Open - On BAF 17/02/2017 - NHS England has now responded to the CCG and they are exploring finances with the national team. Closure Requested Gaps in Controls 17/03/2017 - Risk reviewed no change. 21/04/2017 - The CCG are working with NHS England and the Home Office to attempt to rectify the situation. 21/04/2017 - The home office has agreed to make the Kensington Hotel an 80 bed initial 19/05/2017 – Risk reviewed no change to risk. Closure Reason accommodation centre, without any consultation or agreement. The CCG will be expected to provide a health screening service.

Closure Approved Internal Assurances 17/03/2017 - The CCG's Partnerships Development Manager is now regularly liaising with Closure Approved partner agencies. Date

Closure Rules External Assurances Approval Required 17/02/2017 - Commitment from NHS E to try and resolve Stone Road issues. from GB Responsibility Lisa Maxfield Gaps in Assurances ID 32

PT02 Description If the SMBC Better Care Fund does not release sufficient funds to compensate for the level of adult social care cuts in 2016, there will be a significant impact on patient flows from SWBH.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 220 4 5 20 Deliver Financial Stability and Efficiency Opened Current Probability Current Impact Current Risk Grading 01/07/2015 1 1 1 Reviewed Controls Actions and Updates 08/06/2017 01/07/2015 - Agreed BCF Plan. Governance Structure is established to monitor delivery. 01/07/2015 - SMBC to identify where the predicted cuts will occur. Evaluate the impact of proposed cuts. Develop Committee SMBC Fit for future programme. business case for consideration and or contingency plan. 15/12/2016 – SMBC BCF has stabilised essential core social care services and they are 12/08/2015 - The trajectory for reducing non elective activity will not be achieved therefore the investment SMBC SCR managed within budget. Risk rating reduced from 20 to 9. were depending upon will not be available.

09/02/2017 - Risk reviewed at SCR committee meeting. Impact re-reviewed and risk 28/07/2016 - Viability of LA is addressed within the STP the financial and stability work stream and therefore there is Initial Risk Level downgraded from 9 to 6. little prospect of the Better Care Fund or the wider health and social care system reversing the trend in non-elective admissions in the short term to a level that will facilitate a further transfer of funds sufficient to compensate for SMBC I - High (16+) [Need Controls to explain reduction in Risk] funding cuts in 2016/17.CLOSED 17/11/2016 - Comment from A&G: Closure not approved. A&G - Have Partnerships raised a further risk in relation to Current Risk Level Local Authority pressures, which have an impact on health? If PT01 is to be kept open, what has changed? 15/12/2016 – SMBC BCF has stabilised essential core social care services and they are managed within budget. Risk C - Very Low (1-3) rating reduced from 20 to 9. Status 16/01/2017 - (SL) Risk description reviewed and changed from "Lack of financial resources within the local authorities and known expenditure reductions will impact on health-related budgets with respect to social care, which may result in Open - On BAF poor and/or reduced services to patients.", to "If cuts to the local authorities budget impact on health related Closure Requested Gaps in Controls expenditure and pt flows through SWBH, it could impact CCG performance." Due to nature of risk, risk transferred to F&P committee.

16/01/2017 - Risk description changed from "The SMBC Better Care Fund does not release sufficient funds to Closure Reason compensate for the level of adult social care cuts in 2016." to "If the SMBC Better Care Fund does not release sufficient funds to compensate for the level of adult social care cuts in 2016, there will be a significant impact on patient flows from SMBC." Risk Reviewed - SMBC have sustained care services with additional support from the CCG. They will Closure Approved Internal Assurances receive additional funds in 2017 from DOH. This remains a minor risk until the level of cuts is known to SCR. Risk transferred to SCR committee. 01/07/2015 - Minutes from partnership Committee. Minutes of Governing Body. 09/02/2017 - Risk reviewed at SCR committee meeting. Impact re-reviewed and risk downgraded from 9 to 6. Closure Approved 20/04/2017 - The Sandwell Better Care Fund continued to fully protect vulnerable Adult Social Care prevention services Date throughout 2016/17. Significant additional investment of £48 million into the Sandwell Better Care Fund over the three years from 2017 to 2020 is committed through the Local Government settlement and Spring Budget. This additional Closure Rules External Assurances funding is mandated for investment in Adult Social Care services. A government green paper anticipated for Autumn 2017 is expected to offer more sustainable future funding arrangements for Adult Social Care post BCF. Further, BCF Approval Required 01/07/2015 - HWB board Minutes. Health & Social Care Integration Board Minutes. Policy for 2017-19 requires areas to implement the High Impact Change Model which is expected to deliver significant from GB improvement in patient flow across the health and social care system. Accordingly it is considered that this risk has been fully mitigated (at least for the next three years) and should be considered for removal. Risk Score reduced to 1. Responsibility 18/05/2017 - A&G rejected closure - more detail required in terms of why risk score reduced to 1. Sharon Liggins Gaps in Assurances 08/06/2017 - Controls need to be added to explain the reduction in risk score. ID 01/07/2015 - Areas under threat from cuts have not yet been identified therefore potential 16 impact is unknown.

PT03 Description If the Sandwell BCF does not deliver the agreed trajectories, it will affect negatively on the CCG's performance.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 219 4 4 16 Reduce the Health and Well Being Gap Opened Current Probability Current Impact Current Risk Grading 01/07/2015 1 1 1 Reviewed Controls Actions and Updates 08/06/2017 01/07/2015 - Agreed BCF Plan. Governance Structure is established to monitor delivery. 01/07/2015 - Monitoring performance. Evaluating the delivery of the programme. Develop mitigation plans. Committee 12/08/2015 - Currently it appears the national metrics are not being met. This is a picture which is replicated across [Need controls to explain how the risk has been reduced] the country. SCR 28/07/2016 - The national non elective metric has not been met. New policy guidance has been issued and the new

plans will be submitted. Initial Risk Level 17/08/2016 - National metrics are not being met in common with the predominant picture nationally. Across Sandwell & West Birmingham CCG NEL admissions are increasing by around 4.5% annually, admission rates to care I - High (16+) homes are increasing and with only around 65% of patients discharged from acute into re-ablement or intermediate care still at home 91 days after discharge against a target of 80% there is still a significant amount of improvement Current Risk Level required. Neither the Community Offer nor the Push Site pilots have been able to evidence impact on the national metrics. C - Very Low (1-3) CLOSE Status 17/11/2016 - Comment from A&G: Closure not approved. A&G - Have Partnerships raised a further risk in relation to Local Authoritiy pressures, which have an impact on health? If PT01 is to be kept open, what has changed? Open - On BAF 15/12/2016 – The BCF is no longer accountable for reductions in NEL admissions as prescribed by national policy. Closure Requested Gaps in Controls Accordingly this is no longer a risk. Risk grading reduced to 1. Recommend closure. 21/12/2016 - A&G committee requested update from planning guidance and audit report to be added to the risk [Needs to be filled in] before it can be approved for closure. Risk grading also needs to be adjusted to reflect impact of mitigations. Closure Reason 16/01/2017 - Risk reviewed and description changed from "The BCF may not deliver the agreed trajectories.", to "If the BCF does not deliver the agreed trajectories, it will affect negatively on the CCG's performance." Risk grading downgraded to reflect mitigations. Ready for approval to close. Closure Approved Internal Assurances 20/04/17 – Reviewed by A&G Committee: Risk Transferred to SCR. Not approved for closure. Consider reviewing Corporate Objectives. 01/07/2015 - Minutes from partnership Committee. Minutes of Governing Body. Closure Approved 20/04/2017 - Reviewed by OA. Corporate Objective updated as requested. 18/05/2017 - Referred back to committee by A&G to justify drop in risk grade from 16 to 1, and clarity required for the Date closure request. Also, a new risk will be required for 2017/18

08/06/2017 - Controls to be added to explain reduction in Risk score. Closure Rules External Assurances Approval Required 01/07/2015 - HWB board minutes. BCF Board minutes. CW Audit audit of Governance of BCF. from GB Responsibility Olivia Amartey Gaps in Assurances ID 01/07/2015 - Some schemes are proving their concept but until evaluation will not be sure of 17 effectiveness.

SC14 Description If the CCG doesn't sufficiently develop Primary and Community services in line with the MMH timescales, the patient flow through the system will be compromised.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 244 3 4 12 Deliver Financial Stability and Efficiency Opened Current Probability Current Impact Current Risk Grading 26/11/2015 4 4 16 Reviewed Controls Actions and Updates 08/06/2017 20/04/2017 - Since December 2016, the CCG has a formalised meeting with SWBH to discuss 26/11/2015 - CCG to formalise the relationship between SCR and RCRH. Committee and align MMH transformation plans with the CCG's primary care community transformation plan. Risk reduced to 8. 26/07/2016 - There is no requirement to formalise the relationship between RCRH and SCR as the programme has SCR ceased and is being delivered via the successor mechanisms. The MMH taskforce membership includes a CCG exec level

representative, and in order to remain sighted on the remaining transformation work underway in readiness for the Initial Risk Level new hospital SCR may need to agree how it wants to do this.

I - Moderate (8-15) 28/07/2016 - Risk to be superseded by more specific risks.

Current Risk Level 23/12/2016 - This is to be re-worded to: “If the CCG are unable to work collaboratively with SWBH Trust to successfully deliver MMH then this could adversely impact primary/community based commissioned services." [Original Wording: If C- High (16+) CCG are unable to work effectively with partners to deliver the required conditions to successfully commission the Status community based services around the new Midland Metropolitan Hospital as part of RCHC.] Actions update: The Operations and partnerships directorate have merged to become the new Strategic Commissioning and Redesign Open - On BAF Directorate under the leadership of Chief Officer Sharon Liggins. The new directorate’s commissioning delivery has Closure Requested Gaps in Controls been refreshed to focus on two workstreams: Primary and Community Transformation (Lisa Maxfield) and Acute, STP/Strategic Collaborative Commissioning (Olivia Amartey). A comprehensive workplan inclusive of these two

26/07/2016 - There is no requirement to formalise the relationship between RCRH and SCR workstreams will go some way towards mitigating the risk. The progress of the workplan will be monitored through Closure Reason as the programme has ceased and is being delivered via the successor mechanisms. The MMH PMO and reported to SCR Committee. taskforce membership includes a CCG exec level representative, and in order to remain sighted

on the remaining transformation work underway in readiness for the new hospital SCR may 09/02/2017 - SCR Committee - this risk to be re-worded from "If the CCG are unable to work collaboratively with SWBH Closure Approved Internal Assurances Trust to successfully deliver MMH then this could adversely impact primary/community based commissioned services.", to: “If the CCG doesn't sufficiently develop Primary and Community services in line with the MMH timescales, the 20/04/2017 - The SCR directorate has been refocused so that the two DCO are focused on patient flow through the system will be compromised." Closure Approved ensuring that acute, primary and community services are directly aligned to MMH Date transformation plan and timescales. 20/04/2017 - Since December 2016, the CCG has a formalised meeting with SWBH to discuss and align MMH transformation plans with the CCG's primary care community transformation plan. Closure Rules External Assurances 08/06/2017 - Partnership arrangements between CCG and provider organisation have not progressed enough to Approval Required provide additional confidence around this risk, therefore risk score increased to 16. from GB Responsibility Olivia Amartey Gaps in Assurances ID 79

PC08 Description If reimbursement for Stone Road scheme is not received from Home Office, there will be financial implications for the CCG.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives 255 3 3 9 Deliver Financial Stability and Efficiency Opened Current Probability Current Impact Current Risk Grading 18/03/2016 2 3 6 Reviewed Controls Actions and Updates 15/06/2017 18/03/2016 - Financial contingencies exist within the Primary Care budget. 18/03/2016 - CCG to submit bid to Home Office and face-to-face meeting arranged. Accountable Officer discussed Committee 17/02/2017 - The CCG has agreed to extend the Stone Road service until 30th June 2017. with CCGs the potential to contribute if Home Office reject bid. 22/04/2016 - No change. The bid has been submitted (14/4) and a face to face meeting has been arranged for 27/4 PCCC 20/05/2016 - Delay from Home Office regarding meeting to discuss issues. Risk grading has been increased to 1

17/06/2016 - Following meeting with Home Office on 9th June, the CCG was informed that a national review was Initial Risk Level being undertaken in regard to the initial accommodation centres. CCG advised Home Office that the CCG is at financial risk. No timeline has been set by the Home Office to respond to the issues. PCCC to escalate this issue to the CCG I - Moderate (8-15) Accountable Officer and Governing Body. Risk grading increased to 16. Paper will be raised at committee meeting on 7th July 2016. Current Risk Level 29/07/2016 - Continue to work with Home Office and NHS E. Further reports have been submitted to Home Office and NHS E. The Financial Sustainability Meeting identified that the CCG will need to make a decision whether services should C - Low (4-7) be may be reduced. Decision to be made in September 2016. Status 19/08/2016 - Teleconference has been organised for 23rd August with CCG Accountable Officer and Ruth Passman from NHS E in order to discuss the financial risk and determine a solution. Following this teleconference, the Governing Open - On BAF Body will be asked to make a decision as to whether the CCG continues to commission all services for stone Road Closure Requested Gaps in Controls Residents or potentially decommission service to reduce the financial risk. 23/09/2016 - Deputy Chief Officer (Partnerships) Lisa Maxfield attended the Finance and sustainability group this

21/04/2017 - The home office has agreed to make the Kensington Hotel an 80 bed initial week. At the request of CCG accountable officer a paper will be submitted to the October 2016 Governing body with a Closure Reason accommodation centre. Risk score increased as without any consultation and agreement CCG number of options. will be expected to provide a health screening service with the potential of no additional 18/11/2016 - GIZ overning body supported that SWB CCG’s Accountable Officer would write formally to NHS E to request funding. immediate additional funding and if this not received to advise NHSE that SWB CCG would be returning the Asylum Closure Approved Internal Assurances seeker contract back to NHS E from 1st April 2017. Awaiting outcome from NHS E. 16/12/2016 - CCG still had no response from NHS E. This is being chased by the CCG Accountable Officer. 20/01/2017 - Meeting being held with current provider to discuss the future of SLA. 20/01/2017 - The CCG has still received no formal response from NHS E following the letter dated the 7th November Closure Approved 2016. Following governing body on 11th January 2017 the governing body agreed to write formally to NHS E outlining Date they would be handing the SLA contract for health screening back to NHS E on 1ST April 2017 and agreed to decommission the wrap around services with immediate effect from 1st March. Legal advice was sought and the Closure Rules External Assurances governing body decision was made on the basis on the legal advice. 17/02/2017 - NHS E has now responded to the CCG and they are exploring Finances with the National Team. Approval Required 17/02/2017 - Commitment from NHS E to try and resolve Stone Road issues. 17/03/2017 - To date there does not appear to have been any reputational damage to the CCG as a consequence of this from GB risk, therefore score reviewed and reduced to 6. 19/05/2017 – Risk reviewed, no change to risk. Responsibility Lisa Maxfield Gaps in Assurances ID 29

NCM04_16a Description Lack of capability within system providers will result in CCG not be able to commission new care models.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 4 16 Opened Current Probability Current Impact Current Risk Grading 01/04/2016 4 4 16 Reviewed Controls Actions and Updates 14/03/2017 03/03/2017 - Regular dialogue with Chief Officer - SCR. Primary care development plan (to be 01/04/2016 - PCCF established – v3 for 2017/18. developed) 01/02/2017 - Connected Care Partnership Vanguard capability in west Birmingham. Committee 03/02/2017 - Clinical leads appointed. Learning from Dudley vanguard re provider engagement and co-production NCM event.

16/02/2017 - GP engagement & development learning from Dudley vanguard. Initial Risk Level 23/02/2017 - Plan & resources for provider development discussed with Chief Officer - SCR. 16/03/2017 - GP engagement event. I - High (16+) 14/03/2017 - Risk description changed from "Lack of capability within primary care will result in CCG not being able to commission new care models", to "Lack of capability within system providers will result in CCG not be able to Current Risk Level commission new care models." C- High (16+) Status Open - On BAF Closure Requested Gaps in Controls

Closure Reason

Closure Approved Internal Assurances 03/03/2017 - NCM Programme Board will monitor primary care market development & Closure Approved implementation of the engagement plan. Date

Closure Rules External Assurances Approval Required 03/03/2017 - Integrated Support & Assurance Process. from GB Responsibility Angela Poulton Gaps in Assurances ID 255

FP07 Description Non achievement of financial balance

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 5 20 Deliver Financial Stability and Efficiency Opened Current Probability Current Impact Current Risk Grading 29/07/2016 2 3 6 Reviewed Controls Actions and Updates 15/06/2017 29/07/2016 - Regular financial reporting to GB. Specific QIPP work stream established to 29/07/2016 - Team established, early work has begun reviewing expenditure and contracts. Committee identify £7M savings. 26/09/2016 - Risk reviewed; no change 24/10/2016 - Financial position showing marginal improvement. Risk reduced to 16. F&P 28/11/2016 - Year to date improvement in position gives confidence for delivery of year- end target surplus. Risk

reduced to 12. Initial Risk Level 23/01/2017 - Further confidence based on year-to-date position - Risk reduced to 6. 27/03/2017 - High level of confidence to achieve financial balance. Risk recommended for closure due to end date. I - High (16+) 22/05/2017 - F&P reviewed; still awaiting confirmation of closure. 15/06/2017 - No gaps in assurance; accounts audited and signed off. A&G agreed to close. Current Risk Level C - Low (4-7) Status Open - On BAF Closure Requested Gaps in Controls 29/07/2016 - Absence of plan to deliver £7m savings Closure Reason Time Limited Closure Approved Internal Assurances 29/07/2016 - Programme management board will oversee operational progress. Reported Closure Approved through F&P Committee. Regular updates to Audit committee & GB Date 15/06/2017 Closure Rules External Assurances Approval Required 15/06/2017 - No External assurance. from GB Responsibility James Green Gaps in Assurances ID 15/06/2017 - No gaps in assurance. 9

NCM07_16b Description Potential reputational damage to the CCG if Vanguard does not deliver value for money following the investment made by NHSE nationally.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives QS19 4 4 16 Improving Care and Quality Opened Current Probability Current Impact Current Risk Grading 29/07/2016 4 4 16 Reviewed Controls Actions and Updates 15/06/2017 29/07/2016 - Quarterly national assurance visits; Partnership Vanguard Boar 29/07/2016 - Gain detailed financial information through Partnership Board Committee 15/11/2016 - The CCG have a new care models programme board. Within this workstream is 15/11/2016 - Further updates due in December 2016. a gateway assurance process. 17/11/2016 - Comment from A&G: Should this risk be moved to the Partnerships risk register? What is the NCM mechanism for testing value for money, especially as the Vanguard had Prime Minister's challenge funding twice - how

would this be accounted for separately from CCG investment. Initial Risk Level 20/12/2016 - Risk reviewed, remains the same. 20/02/2017 - Value for money managed through quarterly assurance visits between NHS E/Care Connected I - High (16+) Partnership. CCG has oversight however still need to consider reputational risks. Risk to be transferred to NCM Risk Register when committee has been established formally. Current Risk Level 14/03/2017 - Risk closed - Transferred to NHS E, as is not owned by SWB CCG. 20/04/2017 - Reviewed by A&G Committee: Closure request rejected. Committee should re-consider what C- High (16+) residual remains for the CCG, even if controls lie with other organisation. Status 25/05/2017 - NCM advised there are no residual risks, therefore risk Transferred and closed. 15/06/2017 - A&G advised that the risk still exists. If it has been transferred, please state to whom. Open - On BAF Closure Requested Gaps in Controls 29/07/2016 - Lack of financial detail submitted to board- high level lines only Closure Reason Transferred Closure Approved Internal Assurances 29/07/2016 - CCG membership of Partnership vanguard Boar. Closure Approved 15/11/2016 - NCM Programme Board. Date 20/12/2016 - NCM Working group.

Closure Rules External Assurances Approval Required 29/07/2016 - NHSE assurance quarterly vanguard meetings from GB Responsibility Angela Poulton Gaps in Assurances ID 29/07/2016 - No detailed financial breakdown report 52

NCM07_16a Description If the members do not agree with the proposed models of care, an alternative approach may be required.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives PT08 4 4 16 Deliver Financial Stability and Efficiency Opened Current Probability Current Impact Current Risk Grading 29/07/2016 3 3 9 Reviewed Controls Actions and Updates 14/03/2017 29/07/2016 - Initial engagement through LC. Some emerging GP groups supportive of NCM 29/07/2016 - Work being undertaken by CCG and NHSE to understand the scope and viability of the model. Committee approach. 15/12/2016 – This is to be transferred to the New Models of Care risk register. Recommend closure. 20/12/2016 - A&G committee reviewed risk, and added the following comments: (i) Risk Description changed from 'The NCM membership do not agree with the proposed model of care' to 'The members do not agree with the proposed models of

care'; (ii) As NMC Risk Register does not yet exist, the risk cannot be transferred and closed until the executive proposal Initial Risk Level is sent to and approved by the Governing Body. 16/01/2017 - Risk reviewed and description changed from "The members do not agree with the proposed models of I - High (16+) care.", to "If the members do not agree with the proposed models of care, an alternative approach may be required.". Risk grading downgraded to reflect current situation and risk transferred to SCR. Mitigation includes member Current Risk Level engagement plan. 09/02/2017 - Transfer to NCM committee Risk register. C - Moderate (8-15) 14/03/2017 - Reviewed and felt that this is not a current risk but a future risk, therefore request to close as entered in Status error. Open - On BAF Closure Requested Gaps in Controls 29/07/2016 - Regular stakeholder engagement is not being undertaken. Closure Reason Entered in Error Closure Approved Internal Assurances 29/07/2016 - Reports to GB and GP directors Closure Approved Date 20/04/2017 Closure Rules External Assurances Approval Required 29/07/2016 - Work underway with NHSE national team on a number of work streams in from GB relation to the commercial viability. Responsibility Angela Poulton Gaps in Assurances ID 29/07/216 - Low level of engagement and understanding of the NCM. 22

PC14 Description If the IT solution for PCCF is not effectively implemented, then this will have an impact of the CCG’s ability to monitor performance and also result in member dissatisfaction

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 4 16 Deliver Financial Stability and Efficiency Opened Current Probability Current Impact Current Risk Grading 19/08/2016 2 4 8 Reviewed Controls Actions and Updates 18/05/2017 29/07/2016 - Working with practices to resolve issues. 29/07/2016 - Trial demonstration on 2nd August to view IT system, make amendments and sign off business rule 23/09/2016 - CCG and CSU collaboration in developing the template has been successful. 19/08/2016 - CCG working with CSU to develop a plan B solution which involves the administration of template Committee Practices have now received the IT templates, searches and practices are starting to use this. searches in the ports for Practices to use instead of the ICT solution. All practices will have the new template installed PCCC 17/02/2017 - Information has gone out to practices to ensure they are using exception codes. by the end of August 2016. The CCG continues to work with the ICT supplier to address the long term solution.

17/03/2017 - The CCG now has an alternative solution in place to monitor performance, 23/09/2016 - CCG and CSU collaboration in developing the template has been successful. Practices have now received Initial Risk Level therefore risk score reviewed and reduced to 8. the IT templates, searches and practices are starting to use this. View to reduce risk at next PCCC, following assessment of impact of controls. I - High (16+) 18/11/2016 - New templates reissued to practices w/c 14th November, there has been a GP practice event to provide updates on the PCCF and the IT element of the PCCF. Responses to the self-declaration will be received from practices Current Risk Level by 25th November. 16/12/2016 - Member dissatisfaction remains high despite all of the intervention by the CCG to remedy this risk there C - Moderate (8-15) are still flaws and gaps in the ability to monitor the performance. As a result the risk grading is increased to 16. Status 20/01/2017 - We are now able to extract data and we are starting to review the performance. We will be working with practices around coding appropriately to ensure accuracy. Risk reduced to 12. Open - On BAF 17/02/2017 - We are waiting for the new data extraction which we expect to have received by the end of February Closure Requested Gaps in Controls 2017. 21/04/2017 - The data extraction has now been received and utilised as a consequence closure requested. 18/05/2017 - A&G - risk requires external assurances to be filled in. Closure Reason 19/05/2017 – The current risk relates to 2016/17 PCCF. A new risk will be opened to reflect 2017/18 PCCF, closure requested. Closure Approved Internal Assurances 19/08/2016 - Project manager working with ICT, daily conference calls. Closure Approved 20/01/2017 - Actively working with CSU to enable data extraction. Date

Closure Rules External Assurances Approval Required 19/05/2017 - No external assurances apply to this risk. from GB Responsibility Lisa Maxfield Gaps in Assurances ID 35

QS25 Description If the CCG only has one GP trained in the Individual Funding Request (IFR) process, then this means there will be no clinical representation on the appeals panel.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 4 16 Improving Care and Quality Opened Current Probability Current Impact Current Risk Grading 19/09/2016 1 1 1 Reviewed Controls Actions and Updates 13/06/2017 20/12/2016 - Another GP has now completed the necessary training, therefore risk mitigated 17/10/2016 - CCG actively looking to recruit. Committee (Grade reduced to 1) and closed. 15/11/2016 - At Nov 2016 GB Private meeting, CO for Quality asked for GP volunteers, to receive training to become part of IFR panels. Q&S 20/04/2017 – Reviewed by A&G Committee: Internal and external assurances need to be added before risk can be

closed. Initial Risk Level 18/05/2017 - A&G reviewed - still awaiting internal and external assurances. 13/06/2017 - Update from Meds Quality required for complete External and Internal assurances. I - High (16+)

Current Risk Level C - Very Low (1-3) Status Open - On BAF Closure Requested Gaps in Controls None. Closure Reason

Closure Approved Internal Assurances 25/05/2017 - Appeals process finalised and GP included in representation. Closure Approved Date

Closure Rules External Assurances Approval Required from GB Responsibility Claire Parker Gaps in Assurances ID 62

FP10 Description If the CCG does not achieve its constitutional targets, there will be an impact on patient care and quality. Also, this will have a detrimental effect on the assurance rating of the CCG and potentially a financial consequence to the quality premium.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 4 16 Deliver Financial Stability and Efficiency Opened Current Probability Current Impact Current Risk Grading 26/09/2016 4 4 16 Reviewed Controls Actions and Updates 22/05/2017 11/10/2016 - – CCG-wide system resilience group, which includes providers, including the A&E 11/10/2016 - A governance structure exists within the organisation (see Internal Assurances). Committee delivery board. Regular contract via regular meetings, including CQRMs. Regular meetings 28/11/2016 - Monthly cancer steering group added to controls. Monthly performance reports scrutinised at F&P with NHS E regarding assurance of IA and reported to GB. Isues of concerns escalated to GB as appropriate. F&P 28/11/2016 - Monthly Cancer Steering Group; Monthly performance reports scrutinised at 23/01/2017 - Risk reviewed and, given the current system wide pressures, remains the same.

F&P and reported to GB. 27/03/2017 - Risk Reviewed, remains the same. Initial Risk Level 24/04/2017 - Risk reviewed, remains the same. 22/05/2017 - Risk reviewed, remains the same. I - High (16+)

Current Risk Level C- High (16+) Status Open - On BAF Closure Requested Gaps in Controls 03/05/2017 - Achievement of Quality Premium is dependent on the performance of providers Closure Reason and this can only be influenced by the CCG. Actual performance for constitutional targets is the responsibility of individual providers.

Closure Approved Internal Assurances 11/10/2016 - A governance structure exists within the organisation in order to continually Closure Approved monitor against constitutional targets and identify where performance is not satisfactory and, Date where this is found to be the case this is picked up via the Quality and Safety committee.

Closure Rules External Assurances Approval Required 11/10/2016 - Regular meetings with NHS E. from GB Responsibility James Green Gaps in Assurances ID 03/05/2017 - Despite actions taken so far some constitutional targets are still not be achieved 11 (particularly A&E 4hr wait).

NCM11_16c Description If public opinion regarding new care models is not known, then this may result in poor public perception and may delay the commissioning on NCMs.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 5 4 20 Opened Current Probability Current Impact Current Risk Grading 01/11/2016 3 4 12 Reviewed Controls Actions and Updates 26/05/2017 03/03/2017 - 1) Healthwatch Birmingham and Healthwatch Sandwell non-voting NCM 01/11/2016 - CCG Head of Engagement assigned as work stream lead and to sit on NCM Programme Board/Working Committee Programme Board members. Patient representative non-voting NCM Programme Board Group. Non-executive chair appointed to NCM Programme Board. member; 2) Bespoke NCM communications & engagement plan to include pre-procurement 28/02/2017 - NCM patient engagement event (pre-consultation); CC apprentices developing approach to engaging NCM dialogue and consultation. young people; Dedicated engagement event for community pharmacists; Early dialogue with head teacher of Q3

Academy. Initial Risk Level 14/03/2017 - Risk description changed from "Unknown public opinion regarding new care models resulting in delay in decision to progress to commissioning new models", to "Unknown public opinion regarding new care models resulting I - High (16+) in poor public perceptions which will delay commissioning NCMs". 14/03/2017 - Engagement plan is being developed. Risk scored reviewed and raised to 12. Current Risk Level 26/05/2017 - Risk description changed to: "If public opinion regarding new care models is no known, then this may result in poor public perception and may delay the commissioning on NCMs.", to clarify wording. C - Moderate (8-15) Status Open - On BAF Closure Requested Gaps in Controls

Closure Reason

Closure Approved Internal Assurances 03/03/2017 - NCM Programme Board will monitor implementation of the engagement plan. Closure Approved Date

Closure Rules External Assurances Approval Required from GB Responsibility Angela Poulton Gaps in Assurances ID 259

NCM11_16a Description Lack of Capability within SWB CCG and its support provision will impact upon programme workstreams resulting in delay in determining NCM and their procurement.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 3 12 Opened Current Probability Current Impact Current Risk Grading 01/11/2016 4 4 16 Reviewed Controls Actions and Updates 26/05/2017 03/03/2017 - Work stream exception performance reports & slippage remedial plans (in 01/11/2016 - Senior managers assigned to lead work streams. Working group established. Committee development; Escalation from NMC Working Group to Programme Board. 01/01/2017 - Monthly finance & contracting meetings established. Standing agenda item on commissioning managers monthly meeting. NCM 01/02/2017 - Clinical leads appointed. Band 8B post approved (recruitment March 2017), 0.33 wte business support

commenced 6 February 2017. Initial Risk Level 14/03/2017 - Risk description changed from "Financial and workforce constraints impacting upon Programme work streams resulting in delay in determining new care models and their procurement." to "Lack of Capability within SWB I - Moderate (8-15) CCG and its support provision will impact upon programme workstreams resulting in delay in determining NCM and their procurement." Current Risk Level 26/05/2017 - Risk reviewed and regraded to 16, to reflect the true level of risk. C- High (16+) Status Open - On BAF Closure Requested Gaps in Controls 03/03/2017 - NCM work programme not embedded within wider CCG team operational work Closure Reason plans.

Closure Approved Internal Assurances 03/03/2017 - NCM Programme Board will monitor delivery of Programme Plan. Closure Approved Date

Closure Rules External Assurances Approval Required from GB Responsibility Angela Poulton Gaps in Assurances ID 256

PC11_16c Description There is a risk in the way that funding is allocated from NHSE for elements of the GP forward view that the spend will not materialise during the financial year that it is committed in, resulting in a potential loss of opportunity.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 4 16 Opened Current Probability Current Impact Current Risk Grading 18/11/2016 4 3 12 Reviewed Controls Actions and Updates 18/05/2017 18/11/2016 - Continue to seek clarification from NHSE. 18/11/2016 - NHSE continue to feed down different communication around funding which imposes challenging Committee 21/04/2017 - There was an under-spend on 31st March. Our finance team are working with timescales on the CCG resulting in a potential loss off opportunity to put these things in place by the end of the financial NHS E in relation to this. year. PCCC 16/12/2016 - We have not received clarification from NHS E regarding the allocations coming to the CCG which have to

be spent by the end of the financial year. Initial Risk Level 20/01/2017 - We have now received final allocation of TF monies and a process has been put in place for practices to bid for monies, therefore risk reduced to 9. I - High (16+) 17/02/2017 - Practices have submitted bids for the transformational funding and we anticipate that the transformational monies will be spent by the 31st March 2017. Current Risk Level 17/03/2017 - The CCG expects to spend the majority of funding but anticipates an underspend of transformation monies. Risk score reviewed and increased to 12. C - Low (4-7) 18/05/2017 - A&G noted risk score has not been updated. This has now been done. Status Open - On BAF Closure Requested Gaps in Controls

Closure Reason

Closure Approved Internal Assurances 18/11/2016 - Primary care operations matrix team working diligently to develop plans to Closure Approved allocate the expenditure. Date 20/01/2017 - A panel has been set up for February 8th 2017 to review the practice bids.

21/04/2017 - NHS E can distribute the financial allocations at any point. Closure Rules External Assurances Approval Required from GB Responsibility Lisa Maxfield Gaps in Assurances ID 18/11/2016 - Inability to assure the committee. 41 16/12/2016 - Conflicting information from NHS E identifies that the gap in assurance has

FP11_2016a Description If the CCG are unable to agree a two year contract with SWBH there is a higher likelihood of intervention by NHS E and NHS I.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 4 16 Deliver Financial Stability and Efficiency Opened Current Probability Current Impact Current Risk Grading 28/11/2016 4 4 16 Reviewed Controls Actions and Updates 22/05/2017 28/11/2016 - Initial offer issued on 4th November as per the national deadline. CCG 28/11/2016 - Discussion with Acute Trust on 25th November 2016 in order to attempt to convene a meeting w/c 28th Committee continues to attempt to establish contract meetings with SWBH November 2016. 23/01/2017 - Reviewed. Still awaiting outcome of the contract mediation process. F&P 27/03/2017 - Still unable to agree contracts despite mediation. Efforts continue to work with the Trust to gain

signatures. Risk reviewed, remains the same. Initial Risk Level 24/04/2017 - Independent review being commissioned by NHS E. Regularly reviewed and outcome will be reviewed. 18/05/2017 - A&G reviewed; risk remains the same. I - High (16+) 22/05/2017 - FP reviewed, risk remains the same.

Current Risk Level C- High (16+) Status Open - On BAF Closure Requested Gaps in Controls 28/11/2016 - Provider has refused to engage in contract negotiations to date. Closure Reason 03/05/2017 - Negotiations have failed to secure an agreed contract positin with SWBH. 03/05/2017 - Various levels of arbitration have been undertaken by NHS E/I however, this has

also failed to secure contract agreement. Closure Approved Internal Assurances 28/11/2016 - Robust calculation of contract value, underpinned by detailed forecasting data. Closure Approved Regular rpeorts on position to GP directors and F&P committee. Date 03/05/2017 - The CCG has abided by the outcome of the national arbitration process and is content with the resultant contract offer. Closure Rules External Assurances Approval Required 28/11/2016 - Contract tracker completed on a weekly basis. from GB 03/05/2017 - The CCG is in regular dialogue with NHSE/I. 03/05/2017 - It is now proposed to undertaken an independent financial review of the SWBH Responsibility health economy in order to ascertain the financial stability of both the provider and CCG. This James Green Gaps in Assurances ID 03/05/2017 - Contract still remains unsigned and we are already a month into the contract 12 period.

OD01_17a Description If SWB CCG fail to recruit a secondary care doctor, then there will be no external clinical challenge at committees, which could lead to potential challenge regarding conflicts of interest.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 3 12 Opened Current Probability Current Impact Current Risk Grading 30/01/2017 4 2 8 Reviewed Controls Actions and Updates 18/05/2017 30/01/2017 - External challenge provided by Lay Members and Board Nurse. 30/01/2017 - Superseded from OD03. 1) Vacancies put to advert in February 2016, August 2016, and November 2016. Committee 2) Liaised with other CCGs regarding possibility of role sharing arrangement. OD 18/05/2017 - A&G request for external and internal assurances to be added.

Initial Risk Level

I - Moderate (8-15)

Current Risk Level C - Moderate (8-15) Status Open - On BAF Closure Requested Gaps in Controls

Closure Reason

Closure Approved Internal Assurances

Closure Approved Date

Closure Rules External Assurances Approval Required from A&G Responsibility Alice McGee Gaps in Assurances ID 251

NCM02_17a Description If the CCG is too cautious in the scope of commissioning New Care Models(s) which have minimal/limited/no impact and will not achieve desired outcome for our population.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 5 4 20 Opened Current Probability Current Impact Current Risk Grading 03/02/2017 4 4 16 Reviewed Controls Actions and Updates 26/05/2017 03/03/2017 - 03/02/2017 - NHSE policy development & considerations via participation in national events/teleconferences. Committee •IZSTP & CCG strategy alignment Discussions with Dudley CCG regarding their outcomes, scope and model design, and underpinning rationale. First •IZRobust business case demonstrating how new care models will deliver outcomes public engagement event to be held on 28th February 2017 to help shape scope. NCM •IZStakeholder engagement and co-production 01/03/2017 - GP engagement event to identify gaps and aspirations.

•IZDialogue at Directors meetings 01/04/2017 - Provider co-production & engagement event. Initial Risk Level •IZF & P Committee, Audit & Remuneration Committee and Governing Body scrutiny and 14/03/2017 - Risk description changed from "If the CCG is too caious in the scope of commissioning New Care approval Models(s) which have minimal/limited/no impact" to "If the CCG is too catious in the scope of commissioning New I - High (16+) •IZIndependent clinical leadership Care Models(s) which have minimal/limited/no impact and will not achiev desired outcome fro our population." •IZCCG core values 26/05/2017 - Risk reviwed. Risk that not identifying correct outcomes from outset will impact on successful delivery of Current Risk Level part or all of NCM. The committee offered no comments and it was agreed it should be included. C- High (16+) Status Open - On BAF Closure Requested Gaps in Controls

Closure Reason

Closure Approved Internal Assurances 03/03/2017 - CCG corporate governance committees – regular updates & decision making; Closure Approved NCM Programme Board will monitor development of new care model business case. Date

Closure Rules External Assurances Approval Required 03/03/2017 - ISAP process; NHSE STP performance monitoring. from GB Responsibility Angela Poulton Gaps in Assurances ID 260

NCM03_17b Description If the correct clinical, quality, patient experience, or financial outcomes, etc. are not identified from the outset, this will have a significant impact on the successful delivery of part or all of the NCM.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 4 4 16 Opened Current Probability Current Impact Current Risk Grading 14/03/2017 4 4 16 Reviewed Controls Actions and Updates 14/03/2017 14/03/2017 - CCG in discussions with CSU to establish what level of support can be provided in terms of establishing outcomes. CCG also contacting NHS E regarding the outcome that were identified by all of the vanguard areas to use as Committee a baseline for shaping our outcomes. CCG has also discussed processes undertaken by Dudley CCG to achieve the NCM outcomes that they have listed.

Initial Risk Level

I - High (16+)

Current Risk Level C- High (16+) Status Open - On BAF Closure Requested Gaps in Controls

Closure Reason

Closure Approved Internal Assurances

Closure Approved Date

Closure Rules External Assurances Approval Required from GB Responsibility Angela Poulton Gaps in Assurances ID 262

NCM03_17a Description If the issues regarding VAT and Pensions are not resolved by the Government, then there could be an impact on CCG finances and quality of services.

Initial Risk Level

I - High (16+)

Current Risk Level C- High (16+) Status Open - On BAF Closure Requested Gaps in Controls 14/03/2017 - Resolution ultimately lies with Government. Closure Reason

Closure Approved Internal Assurances 14/03/2017 - Issue being monitored by NCM programme board. Finance Team aware of issue. Closure Approved Date

Closure Rules External Assurances Approval Required from GB Responsibility Angela Poulton Gaps in Assurances ID 14/03/2017 - Resolution ultimately lies with Government. 261

PC03_17c Description If individual or groups of practices do not take full advantage in the advances in digital technology they will miss the opportunity to adopt new ways of workings, i.e. online consultations.

Old Reference Initial Probablity (1-5) Initial Impact (1-5) Initial Risk Grading Corporate Objectives N/A 3 3 9 Opened Current Probability Current Impact Current Risk Grading 17/03/2017 5 3 15 Reviewed Controls Actions and Updates 19/05/2017 18/05/2017 - Reviewed by A&G. Committee to complete blank fields. 19/05/2017 – There is a new CCG IT group that has been established which will focus on the IT strategy and an Committee implementation plan for the CCG. The Head of Primary Care is involved in the group to ensure practices are taking full PCCC advantage of the opportunities available.

Initial Risk Level

I - Moderate (8-15)

Current Risk Level C- High (16+) Status Open - On BAF Closure Requested Gaps in Controls

Closure Reason

Closure Approved Internal Assurances 17/03/2017 - The delivery of the digital programme form part of the CCG primary and Closure Approved community transformation plan, which reports to PMO monthly and is formerly reported via Date the CCG governance structure (SCR, PCCC).

Closure Rules External Assurances Approval Required from GB Responsibility Lisa Maxfield Gaps in Assurances ID 266

FP04_17a Description If we fail to identify sufficient QIPP schemes for 2017/18, or fail to deliver the total value of QIPP required, the CCG will need to reduce expenditure and investment plans in order to achieve its financial target.

Right Care opportunities underway. Initial Risk Level

I - High (16+)

Current Risk Level C- High (16+) Status Open - On BAF Closure Requested Gaps in Controls 03/04/2017 - Some QIPP schemes are dependent on successfully challenging charges through Closure Reason the contract.

Closure Approved Internal Assurances 03/04/2017 - Regular specific QIPP report to be provided to F&P committee to ensure in year Closure Approved progress is monitored. Date 22/05/2017 - Presentation to FP committee on QIPP progress to date.

Closure Rules External Assurances Approval Required 03/04/2017 - Financial plan submitted to NHS E and confirmation of assurance received. from GB Responsibility James Green Gaps in Assurances ID 03/04/2017 - Scale of QIPP challenge is substantial and requires back-up schemes to be 267 identified as contingencies.

GOVERNING BODY

Report Title: Report author and Title: Mrs Corporate Objectives 2017/18 Update Michelle Carolan, Deputy Chief Officer, Quality Date of Governing Body/ Committee: Contact Details: Wednesday 05 July 2017 0121 612 3830 Agenda No: 8.3a [email protected] Enclosure no: 12a Sign off from Chief Officers: (Before the report is presented to the Governing Body any implications relating to Finance, Quality and Commissioning must be agreed and signed by the Chief Officer. (see guidance note) Without this information the report will not be taken to the Governing Body)

Chief Finance Officer: Yes

Chief Officer for Quality: Yes

Chief Officer for SCR: Yes

Chief Officer for Transformation: Yes

Supporting Documents/further Reading: (Highlight any documents or further reading for members which supports this report)

Previous Decision the Governing Body have been provided with updates on progress of the objectives for 2016/17 throughout the previous year.

Summary of purpose and scope of the report: (Highlight key points you wish to bring to the attention of members)

The corporate objectives for 2017/18 have been reviewed and updated by officers of the CCG. The 2016/17 objectives have all now been achieved or continued as part of the 2017/19 objectives. All updates are in red text.

Recommendations: • To approve the updates

The Governing Body/Committee are requested to: Action Approve X Assurance X Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified x Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion

Sandwell & West Birmingham CCG Governing Body Board Meeting Agenda Item 8.3a - Corporate Objectives – Page 1 05 July 2017 Enc 12a

Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:

Sandwell & West Birmingham CCG Governing Body Board Meeting Agenda Item 8.3a - Corporate Objectives – Page 2 05 July 2017 Enc 12a

STP Strategic Aim SWB Transformation Plan Goals Responsible Committee Owner Date By Action/Update Impact on completion Links RAG Deliver Financial Develop "one commissioner" approach Deliver commissioning system efficiencies SCR Sharon Liggins Jun-17 collaborative commissioning scoping workshop held on the Increased collaborative commissioning in key areas. Transforming Care green Stability and for: mental health, learning disabilities, (reduce duplication, better utilisation of 16th June Demonstrable efficiencies within the system. Partnership Efficiency within the maternal health (others tbc) commissioning workforce, Recommendations from the workshop approved by JCCC on Mental Health Forward Health Economy commissioning/procurement efficiencies, the 22nd June View improved contract management) thorough JCCC have confirmed the approach in the short term is collaborative commissioning arrangements collaborative working by mutual consent, no formal team across the Black Country STP and Birmingham changes will happen at least in the short term STP Commissioners to identify the common commissioning intentions, SDIP proposals

Ensure contracts and service To manage the transition between the current SCR Sharon Liggins Mar-19 Provider agree programme of transformation to deliver Delivery of strategic plan Delivering the Five Year green developments are aligned with the status quo and the formal commissioning of efficiencies Consolidation of patient pathways for identified Forward View -Planning outputs from the STP provider system new models of care/pathways new care pathways to be agreed with commissioners and conditions. Guidance 2016 to 2021 efficiencies workstream, the new acute included in contracts Reduced cost to the system Carter Report 2016 provider model and the development of commence work with providers to transform models in line planned transition from old models to new models new models of care with the ambitions for new models of care and new acute deliver efficiency across the black country care models (particularly MMH) (specifics to be added when detail is known) no up date

Formally procure new models of care To incentivise a step change to transform Governing Body Claire Parker Mar-19 To specify the new model of care new care model delivering integrated primary and 5YFV amber community and primary care services based on to determine the financial envelope and required risk share community care (potentially social care) close to home a population health approach, delivering assess risks and implications integrated, standardised, place-based services to procure and award contracts built around the registered list. To delivery a An Alliance model is emerging for West Birmingham sustainable health and social care system. regarding place based models. A Sandwell place based model is being scoped

System Leadership To deliver financial stability and efficiency Governing Body Andy Williams Mar-19 SWB CCG AO has been appointed Chair of the Black Country Consistency of services across the locality, with the aim green through partnership working and West Birmingham STP. 18 partner organisations of reducing variation and inefficiencies and reflecting collaborating. The Black Country and West Birmingham the madate of national policies CCG's have a joint commissioning board to implement a single approach to commissioning across the locality.

Effectively commission the new Midland A commissioning focus and oversight of the Governing Body Sharon Liggins Mar-18 the detail of the new model of care proposed for MMH is the relationship with the Trust remains challenging. The Amber Metropolitan Hospital new acute provision emergent. likelihood of developing the specification(s) for MMH in Dialogue has commenced regarding transformation of out partnership is low. The impact may be limited patient activity but the trust have not yet shared the detail because the Trust haven't signed the 2017/18 contract of the plan. but they continue to care for our patients. The opening of MMH has been delayed by 6 months Deliver the local QIPP plan Deliver £25m savings programme for 17/18 F&P James Green Mar-19 QIPP savings to be delivered across the majority of areas Balanced financial position Delivery of Statutory duties amber Deliver £24m savings in 18/19 within the CCG’s commissioning portfolio. In particular, there will be an increased emphasis upon the Right Care initiatives over the next two-three years. For example: pathway improvements in diabetes, respiratory, cardiovascular, maternity and cancer. In addition, the CCG will rely upon robust contract monitoring and improvements in quality/demand management. Improving Care and Deliver operating plan, constitutional Delivery of key constitutional targets: SCR Sharon Liggins Mar-19 Targets achieved. Deliver CCG Assurance Framework. NHS Constitution amber Quality targets and improve performance against 95% A&E target the 6 national clinical priorities RTT Maternity - Contribution to delivering "better births" Cancer Mental Health the Sandwell and Birmingham BCF's are focusing on LD reducing DTOC and improving out of hospital services Maternity to support the improvement of A & E performance/patient flows.

Deliver improvements in maternal and Delivery service improvements in maternity SCR Claire Parker Mar-19 In addition, the CCG will rely upon robust contract Targets achieved. Deliver CCG Assurance Framework. NHS Constitution amber infant health services, in line with "better births" monitoring and improvements in quality/demand improve infant mortality - through effective management. Maternity - Contribution to delivering "better births" children services commissioning work in partnership across the STP

SWB CCG Walk-In-Centres To support a decision on the future provision of SCR Nighat Hussain/Deb Mar-19 Mids and Lanc CSU activity modelling commissioned high quality safe service Bruce Keogh urgent and amber (Summerfield/Parsonage Street) WIC activity currently being provided at the Howls Governance of decision to be agree via SCR improved patient experience emergency care reviews two WIC. Communication and engagement plan to be developed reduced demand unplanned care services Links with the Sandwell UCC and system wider Urgent & Emergency care are being considered as part of this work.

Integrated urgent care ensure effective commissioning of integrated Governing Body Rachael Ellis Mar-19 high quality safe service Bruce Keogh urgent and green urgent care service (111, OOH) and urgent and improved patient experience emergency care reviews emergency ambulance (999) across the West reduced demand unplanned care services National urgent care policy Midlands

Governance of decision to be agree via SCR Transform primary care (General Practice) Primary care is sustainable and members are SCR Sharon Liggins Mar-19 continuity of care Five year forward view amber in readiness to the deliver of new models prepared to deliver new models of care by April sustainability of primary care GPFV of care in partnership 2019 planned development (deliver of GPFV, technology plan, pathway developments)

Communication and engagement plan to be developed commission effective primary care Deliver the CCG General Practice Strategy PCCC Lisa Maxfield Mar-19 Systematically delivery the General Practice Strategy – sustainable primary care Five year Forward green services strategy in place and embedded in all work streams. GPFV quality primary care services View/General Practice covers all of our strategy. Strategic alignment of priorities (primary care Forward View commission primary care services in line with the CCG and commissioning and CCG) national strategic direction – in place manage the primary care commissioning budget, including the PCCF Successful year end outturn 15/16, PCCF has been evaluated, changed and recommissioned for 2017/2018. delivery quality improvements – working with PC Q & S team, PC dashboard in place, contracting and quality visits in place and support . Support primary care with organisational development and workforce planning to ensure services are able to deliver against New Models of Care and meet the requirements of the GPFV – 7 GP provider networks coming together to deliver the new improving access as set out in the GPFV. In place a monitoring group for the GPFV with assurance of delivery at PCCC. PC OD now embedded into the OD committee and an OD strategy is being written for PC by Alice McGee

Better Care Commission high quality cancer services To improve the quality of experience for those SCR Sharon Liggins Mar-18 1. Increase early diagnosis by: 2017/18 planning guidance green affected by cancer and to improve health • implementing the use of ERS for 2 week wait and outcomes for those living with and beyond appointments cancer • Working with Cancer Research Facilitator to support practices to increase their screening rates • Working with Public Health colleagues around access to screening • Undertaking a range of education and communication with a range of stakeholders.

2. Support and improve survivorship

3. Work with Contracting and Trust colleagues to identify and address breaches including monitoring RCA’s and RAPs

4. Implement the 5 service specifications for: - Breast - Bowel - Cervical - Prostate - Lung

5. Develop and implement a communications and engagement plan work on going

Reduce the Health Implement the Right Care approach across understand potential opportunities (spend and SCR Andrew Harkness Mar-18 Deliver service development/improvements in the three Potential improvements in opportunities (spend and 5YFV green and Wellbeing gap SWBCCG. outcomes) and implement subsequent programme areas ; endocrine, respiratory, and cancer. outcomes). NMC commissioning priorities. Diabetes delivery plan has been submitted to NHSE - end Reduction in variation, particularly at GP practice level. June. Plan to submit cancer delivery plan end July. All three Improved health and wellbeing of population. final delivery plans to be submitted end August. Reduced health inequalities.

Delivery plans include outcome and spend opportunities, with anticipated timescales for delivery and impact.

Long term condition identification and Target key long-term conditions to reduce SCR Andrew Harkness Mar-19 Hypertension, AF and diabetes prevalence included in PCCF Greater proportion of the population accurately PCCF green management variation in prevalence and management (i.e. for 2017/18. diagnosed. 5FYV Diabetes, CHD) GP practices signed up to PCCF have been set improvement Better patient management and outcome. challenges to reach. Evaluation from 2016/17 has Reduced longer term healthcare costs, particularly if demonstrated positive impact on new diagnosis of diabetes, reduce secondary care usage. AF and hypertension.

LTC management and prioritisation of focus across patient pathways is being further developed.

Deliver the equality priority (TBC) Equality and Diversity Group, Saba Rai Mar-18 2017-18 priority infant mortality and learning disabilities. tbc green Reducing Infant mortality commissioning opportunities identified and low cost options agreed for implementation by SCR / Governing Body in April 2017. Learning disabilities will be the focus of the CCG Equality awards taking place in November 2017.

Review the stakeholder engagement and Patient and Partnership Advisory Group Jayne Salter Scott Mar-18 The PPE Model and work plan around engagement will be CCG assurance framework amber involvement activity/model to ensure our tabled for discussion and review at the Patient and activity reflects the diverse groups Partnership Advisory Group, with an appropriate action plan being developed to ensure that our activity targets appropriate our diverse communities. A conversation about our approach to engagement has begun with our Patient and Partnership Advisory Group. The discussion commenced with a conversation with Andy Williams and members of PPAG. This will be a main feature of the work programme for 17/18 ensuring that our work reflects our diverse communities.

Work in partnership to develop placed Support the development and delivery of the Primary Care Commissioining Committee Andrew Harkness Mar-19 PCCF has been evaluated and shown to positively impact on Improved access and user experience green based prevention/wellbeing interventions Joint Health and Wellbeing Strategy improving overall health and well-being of our population connecting voluntary, community and ensure interventions adopted are evidence and impacted on reducing inequality in some areas. primary care provision. based and targeted to addressing the health and wellbeing gap Various information and evidence sources have and connect voluntary, community and primary continue to be used to prevent disease, improve health and care provision through the PCCF and BCF. wellbeing and reduce inequality.

Work is ongoing to explore how we effectively utilise local health and care providers.

Plan the integration of health and social Deliver the BCF plans BCF Governance structure and Sharon Liggins Mar-18 Implement the development plan and commissioning Movement towards integration of health and social Five year forward view, green care provision in line with the emerging engage the Health and Wellbeing Board in a Partnership Committee services to support health and social care. care as outlined in the 5YFV General Practice Forward new models of care and the general move discussion about the development of 2017/18 BCF plans for 2017-19 are in development. GB has View, implementation of towards integration (for non new model of integration plans based on the new models of approved the highlevel scope of services suitable for the health and social care care areas) care principles integration of health and social care for Sandwell. Work act now needs to commence on the development of the integrated care model. STP Strategic Aim SWB Transformation Plan Goals Responsible Committee Deliver Financial Work with STP partners to Deliver commissioning system efficiencies STP, SCR Stability and Efficiency establish "commissioning at (reduce duplication, better utilisation of within the Health scale" work streams commissioning workforce, Economy commissioning/procurement efficiencies, improved contract management) thorough collaborative commissioning arrangements across the Black Country STP and Birmingham Work with STP partners to Deliver provider system efficiencies work STP, SCR deliver provider system streams(improved procurement, reduce efficiencies duplication, better utilisation of workforce, system planning service configuration, network development across the Black Country STP. Develop and deliver the local Deliver of £7m savings programme for 16/17 F&P QIPP plan and identification of QIPP plan for 17/18

Close down the local RCRH Transition the RCRH arrangements into the STP GB governance structure and harmonise into the STP governance

Deliver constitutional targets and Delivery of key constitutional targets: SCR/F&P operating plan: 95% A&E target RTT Cancer Mental Health LD Maternity

Improving Care and Integration of urgent care Deliver key elements of urgent care network SCR Quality system redesign such as: integrated urgent care implementation of Summary Care Records/Your Care Connect delivery of the Sandwell Urgent Care Centre delivery of the urgent and emergency care programme (9 work streams)

Complete the procurement and mobilisation of SCR integrated urgent care for the West Midlands (NHS 111 and out of hours) Transformation Area Plan

Plan the integration of health Deliver the 2016/17 BCF plans BCF Governance structure and and social care provision in line engage the Health and Wellbeing Board in a Partnership Committee with the emerging new models discussion about the development of 2017/18 of care and the general move integration plans based on the new models of towards integration (for non new care principles model of care areas)

Deliver service transformation Develop the specification and develop the SCR and integration through the market in readiness for the adoption of the development and new models of care: implementation of New Model of Define the local model(s) Care Define the local funding Assess financial and service delivery risks Agree the contractual framework Implement and spread across the CCG footprint

Build resilience in General Establish a delivery plan for the CCG General PCCC Practice Practice Strategy

Reduce the Health and Implement the Right Care Identify and prioritise programme areas, SCR/Quality and Safety Wellbeing gap approach across SWBCCG. understand potential opportunities (spend and outcomes) and implement subsequent commissioning priorities. understand variation linked to infant mortality

Work in partnership to develop Support the development and delivery of place Partnership Committee placed based based programmes and services. Ensure prevention/wellbeing interventions adopted are evidence based and interventions connectiing targeted to addressing the health and voluntary, community and wellbeing gap. Connect voluntary, community primary care provision. and primary care provision through the PCCF and BCF.

Long term condition Target key long-term conditions to reduce SCR identification and management variation in prevalence and management (i.e.diabetes, CHD)

Design interventions to reach Latent TB infection screening programme PCCC and target high risk and diverse groups

Improve access to primary and community care PCCC for migrants and asylum seekers

Deliver the equality priority. 2016/17 priorities Equality and Diversity Group, are infant mortality and learning disability

Review the stakeholder engagement and Partnership Committee involvement activity/model to ensure our activity reflects the diverse groups

Work in partnership to develop Support the development and delivery of the Partnership Committee placed based Joint Health and Wellbeing Strategy prevention/wellbeing ensure interventions adopted are evidence interventions connectiing based and targeted to addressing the health voluntary, community and and wellbeing gap primary care provision. connect voluntary, community and primary care provision through the PCCF and BCF. Owner Date By Action/Update Mar-17 Develop STP proposals for consideration by partners. Local approval via SCR. Joint commissioning Jon Dicken, Sharon board set up across the Black Country and Liggins West Birmingham

Jon Dicken Mar-17 To be picked up as part of the joint commissioning board and Black Country and West Birminghsm STP, which includes 18 partner organisations

James Green Mar-17 Challenges have been made to contract charges for 16/17 at SWBH this has resulted in agreed reductions to contract value. There have also been further reviews of the CCG's budgets and additional reductions have been made to contribute to the financial gap. Current forecast is that the CCG will hit it's financial target and will consequently deliver against the £7m unidentified QUIPP challenge.

Andy Williams Sep-16 Transition plan under development and discussion. RCRH project director actively working on these arrangements. Completed and closed Sharon Liggins/Claire Mar-17 Weekly SRG calls by escalation. Parker Identified task and finish groups to address poor performance. Maternity - listening exercise commenced for community midwifery service for Sandwell and West Birmingham. Walsall Maternity deliveries are capped, so new births being diverted to City MLU. LSM board set up across locality. Maternity Strategy Group in place. Work Stream included in STP, action closed.

Nighat Hussain Mar-17 Work stream developed as part of urgent care programme integrated urgent care procurement is on track ready to go live Nov 16 Work stream developed as part of urgent care programme, commissioned a new piece of analysis (March 2017)to support the decision on the current WIC (parsonage Street and Summerfield hse) integrated urgent care service has gone live November 2016. Included in 2017/19 objectives

Jon Dicken Oct-16 Procurement commenced. Completed. Sharon Liggins Dec-16 Implement the development plan and commissioning services to support health and social care. BCF included in 2017.19 objectives

Claire Parker Mar-17 Accelerate the programme as part of the Transformation Area plan. Initial engagement with members and partners has been delivered . Paper prepared for November Governing Body for sign off of proposed model. Programme delivery plan to be put in place. Included in objectives for 2017/19

Lisa Maxfield Oct-17 Patient engagement and co design of the strategy has been completed and going to GB Nov for ratification. Completed work force analysis and no understand where the pressures are across member practices. Actively working with practices to introduce new roles such as aprenticeships etc. Funding for GP forward view starteing to come through, for care navigator role. Working with practices to ask them to put themselves forwrad for vulnerable practices funding and resilience funding. GPFV and Primary care plan included in objectives for 2017/19

Andrew Mar-17 We are part of wave two for the National Right Harkness/Sharon Care programme, joining the scheme in Liggins November 2016. We have agreed three priority areas to be monitored by NHS England for 2017/18 - diabetes, respiratory and cancers. As a CCG we are also adopting RC methodology to review; mental health, dementia, maternity, CVD and LD. A number of areas identified as opportunities for the CCG have been incorporated in to the PCCF for 2017/18 Progress is monitored via PMO in conjunction with the QIPP programme. Plan and timescales have been articulated. Five programme areas have been prioritised; cardiovascular, endocrine, respiratory, maternity and cancer. Opportunities for each of the five programmes have been undertaken. Work shops with relevant stakeholders for each programme have taken place in Sept. Outputs from Right Care workshops have been incorporated into Commissioning intentions. The detail is now being worked up, in line with the commissioing cycle Andrew Harkness Mar-17 Links have been established between the NMC programme lead and RC lead to ensure that learning and developments are shared and aligned. Closer partnership working is ongoing and developing with the PH teams to ensure prevention is embedded and services are more closely aligned from a patient perspective. Maternity and Infant Mortality work at STP level is progressing with a drive for progression commencing March 2017. This will be encompassed within the NCM objective for 2017/18. Right care programme is being linked to NMC work in SWBCCG, healthy LE work in SMBC and STP priorities. Infant mortality / maternity work is progressing on a SWBCCG footprint in coordination with BCC and SMBC PH teams, SWBHT and third sector involvement. Included in 2017/19 objectives

Andrew Harkness Mar-17 The PCCF has been reviewed and revised to include separate standards for respiratory, CVD and diabetes for 2017/18. There is now a greater focus across the patient pathway, directly linked to opportunities for the CCG identified in RC. In the 2017/18 objectives this will be on-going via the Right care programme. Hypertension, AF and diabetes prevalence included in PCCF. GP pratices signed up to PCCF have been set improvement challenges to reach over 2016/17. Some technical issues have been reported and are being picked up by the PCCF operational team

Mo Khalil Mar-17 There has been positive progress through the year with this programme. The numbers screened have been steadily rising through the year with an anticipated total number screened for 2016/17 being in the region of 1,000 patients. We have also been successful in recruiting further GP practices to sign up, and they are due to commence in April 2017. NHSE have confirmed funding for 2017/18 based on our anticipated forecast of patients to be screened in 2017/18. This is a nationally funded programme via NHSE and is scheduled to last until 2020. The Local Improvement Scheme (LIS) was approved by PCCC at 7th April meeting and the commissioning arrangements were sign-off by SCR on 27th April. The LIS criteria includes retrospective screening of eligible patients registered in the last 5 years and prospective screening for new patients. The LIS was launched on the 1st May for CCG practices to participate, to date 55 practices have signed-up to the LIS. Saba Rai Mar-17 A Peer Training programme has been co- roduced with the oluntary sector and health professionals. 6 training sessions have been delivered to date and 37 organisations have participated in the programme so far. Further training is planned as not all sessions planned for 2016-17 were delivered. Performance based interactive training was co-produced with front line staff and relevant patient groups. 126 people attended the training between Nov 16 - January 2017. Participant evaluation of the training was positive, but numbers of front line staff accessing the training was lower than the 300 expected. Work with partners to improve the care pathways for this group of vulnerable patients. Commissioined peer training through the voluntary sector to reach newcomers on access to primary care. This has been rolled out this year. Commissioned performance based training for frontline GP practice staff on understanding the needs of vulnerable patients. Stone Road facility in place. Closed

Saba Rai Mar-17 Proposal presented to SCR in November and Governing body in December 2016. Recommendations made by governing body neccessitated requirement to review the outcomes and investment sought. A revised proposal will be presented to SCR on 23rd March 2017. Infant Mortality - Undertaken stakeholder engagement and co design workshops with partners. Learning Disability : no progress to date. A proposal has been developed and is scheduled to be shared with SCR in November. Learning disabilities - scoping with commissioners where the CCG can have the greatest impact on ontcomes. Included in 2017/19 objectives Jayne Salter Scott Mar-17 The PPE Model and work plan around engagement will be tabled for discussion and review at the Patient and Partnership Advisory Group, with an appropriate action plan being developed to ensure that our activity targets appropriate our diverse communities Our Engagement model is regularly reviewed by our Patient and Partnership Advisory Group, together with regular reviews undertaken by members of the engagement team in relation to specific pieces of work e.g. consultation exercises. The Equality and Diversity Group is currently reviewing our ED Strategy and will as part of the work review will touch upon our engagement and involvement activity and how it reflects the needs of our diverse communities. New commissioning cycle in place, including stakeholder engagement. Closed

Andrew Harkness Mar-17 The Partnership committee has been discontinued as of January 2017. On going work regarding placed based prevention / wellbeing interventions is contnuing through RC work programme and linking in to NMC work etc. To align with BCF and PCCF models. Update to be provided from BCF. Rolled into 2017/19 objectives for place based care Impact on completion Links RAG Increased collaborative commissioning in key areas. Green Demonstrable efficiencies within the system.

Delivery of strategic plan Delivering the Five Year green Consolidation of patient pathways for identified Forward View -Planning conditions. Guidance 2016 to 2021 Reduced cost to the system Carter Report 2016 deliver efficiency across the black country Balanced financial position. QIPP plan included in Delivery of Statutory duties Amber 2017/18 objectives

Continuity of RCRH plans through the step work stream. Five year forward view Green

Target achieved. Deliver CCG Assurance Framework. NHS Constitution Amber

Maternity - Contribution to delivering "better births"

Bruce Keogh urgent and green emergency care reviews

New service mobilised from 1st October 2016 Keogh Review - Urgent and Green Emergency care Movement towards integration of health and social Five year forward view, green care as outlined in the 5YFV General Practice Forward View, implementation of the health and social care act

A new commissioning model and integrated service Five year forward view green delivery for Health

CCG has an overarching document guiding the Five year Forward Green development of General Practice which is going to GB View/General Practice in November Forward View

Potential improvements in opportunities (spend and STP / 5YFV / NMC Green outcomes). Reduction in variation, particularly at GP practice level. Improved health and wellbeing of population. Reduced health inequalities. Reduced duplication of work across organisations. PCCF / BCF / Right Care / green Improved coordination of services. Improved patient / STP service user centred and coordinated care.

Greater proportion of the population accurately PCCF / 5YFV Green diagnosed. Better patient management and outcome. Reduced longer term healthcare costs, particularly if reduce secondary care usage.

Increased detection and treatment Primary Care Framework Green Improved access and user experience None Green

Intelligence to inform the CCG commissioining green intentions re reducing infant mortality. CCG assurance framework Green

Improved access and user experience BCF Green Outstanding Objectives 2015/16

High level Responsible Impact on Goals Owner Date By Action/Update Links RAG Objective Committee completion NHS 111 NHS 111 Procurement Contract award for Staffordshire CCGs and mobilisation under way. Failure to Revised step in reward a arrangements to be contract for 16 implemented for the West Mids. To deliver the other 16 CCGs on 8th CCGs has procurement September 2015 and significantly of NHS 111 for re procurement to changed ourselves and commence the timetable for as GB Andy Williams Sep-15 Reports to GB. Amber beginning of completion coordinating September 2015. requiring new commissioner The target date for step for the West completing the re arrangements Midlands procurement is and October 2016. procurement Reviewed no further exercise to be update. undertaken.

See above Closed and Preferred Andy superseded by new provider GB Sept 15/16 See above Amber Williams corporate objective mobilised on NHS 111 procurement RCRH RCRH Programme Detailed proposals currently being considered by RCRH Re-establish exec. Programme for the RCRH RCRH has been programme reenergised and a and ensure refreshed vision the key agreed. Governance elements of arrangements are the GB Andy Williams Sep-15 signed off and None None Amber programme operational. are delivered The STP has offered in accordance an alternative way with the forward and partnership transition plan arrangements are being discussed by RCRH partners. Closure Urgent Care Review

Depending on the outcome of the co Time frames design. are linked to Currently taking legal national advice on how long directives such we can extend as NHS 111 contracts such as out and out of of hours and walk in hours and centre to allow time therefore it is to develop the new important we model of care. The GB can deliver Mobilise has agreed the within this National revised Urgent RCRH Jon Dicken Oct-16 extension of all 3 timescale. directive for Amber Care Partnership contract. Walk Centre There may be NHS111 arrangements and out of hour a risk to the contracts have been out of hours extended and no risks extension this or issues identified. will be Urgent care managed programme Board is closely by the developing a 5 year contracts urgent care strategy team in line to deliver urgent care with CCG risk access in the strategy. community.

Primary Care

Patient engagement and co design of the strategy planned for August and September. First draft ready September. Awaiting fro report from Patient Engagement Activity. CCG will have Initial draft strategy an overarching Develop a Primary Care 01/09/2015 complete, awaiting document Sharon Five year Primary Care Commissionin Feb 2016 / consultation. The guiding the Amber Liggins Forward View Strategy g committee June 2016 primary care development development group of primary clinical leads continue care to work on the strategy to ensure it reflects membership ethos. A re draft will take 6 weeks followed by consultation through LCG membership LCG clinical leads to engage their members in the at scale discussion. To support the development of collaborative working To maintain based on the views of Clinical Lead and its members. To and strengthen provide leadership membership membership and strategic own the Five Year involvement direction to agenda. LCG Partnership Sharon Forward View. and Mar-16 encourage to the development Amber Committee Liggins Primary Care engagement appropriate at scale plans. Strategy to deliver the collaboration. In Collaborative Primary Care progress with clear working that at scale evidence of the transforms priority emergence of Primary Care collaborative working. This will continue to be an area of development as relationships form and collaboration takes place.

Better Care Fund

Agreed plans in place. Programme of work established. Monitoring impact. Pilots have not yet to commence and the projected impact is Reduction in Deliver the un known. Some of none elective Partnership agreed the Birmingham activity. Committee/Joi BCF Plans. performance schemes have Keeping nt Partnership Operating trajectories for Sharon commenced. people at boards with Mar-16 Plan. HWB Red Birmingham Liggins Expected impact will home. both Local Boards and Sandwell be minimal. Updated Reducing Authorities/H priorities Better Care trajectories will be admissions to WBB Fund Plans submitted as part of residential the planning round. care Sandwell plans have be implemented overall within the system there is no evidence of impact on unplanned care. Transparency Develop SMBC to identify of the areas contingency where the predicted under threat plans with cuts will occur. To Partnership of cuts. Shared Sandwell MBC develop a business Committee/Joi understanding in the event case for consideration BCF Plans. nt Partnership of the that we are Sharon by the BCF board. SMBC Facing Boards with Mar-16 potential Red unable to Liggins SMBC to identify their the Future both Local impact on affect efficient contingency actions. Programme Authorities/H residents/pati transfer from No change. Currently WB Board ents. Shared urgent Care to not delivering the informed support adult national metrics. No decision social care. change making.

Equality and Engagement

Evaluate the current model of engagement Review the against the CCG model of anticipated changes Stakeholder Operating emerging from the re engagement Fit for purpose Plan. Five year Partnership Sharon 01/12/2015 focus. Propose and model of Forward View. Amber Committee Liggins June 2016 changes accordingly. involvement in engagement. Equality This is on-going till light of the Strategy. June 2016 in line with organisations possible refocus constitutional changes.

Quality

Play an To ensure appropriate Improvement Plans children in role in the Quality & are in place and need are Children’s Safety Claire Parker Sep-15 approved at LSCB for managed OFSTED Amber improvement Committee Sandwell and through the plans within Birmingham system Sandwell and effectively Birmingham

Parity of Esteem Strategy in One page highlight place and all strategy which has Develop a work streams been agreed and programme will align endorsed. for Mental Mental Health Jon 01/12/2015 Need to agree man Five Year Health Group and C Dicken/John October Amber power to complete forward View including a QRM Levy 2016 JSNA. Mental Health Fully strategy to be Strategy written and approved.

Organisational Development Outpatients Modernisation Comprehensive programme of redesign in place. Out patient Action plan for activity procurement/re provided in Progress out procurement in place. community patient Project plans have and primary modernisation been signed off by care locations RCRH business programme in SCR Jon Dicken Mar-16 SCR and PMO board. in accordance Amber Case accordance Only 2 areas of phase with RCRH with RCRH one of implantation plans which plans plan that have not support the been completed, trajectory for Cardiology and the Midland dermatology. Plans in Met Hospital place to take those forward.

Support to Vanguard

Increase patient access. The CCG to link in To establish Reduction in with the Vanguards at new care none elective operational and models as part care. strategic levels to Five Year of 5 year Improved O/D Claire Parker Oct-15 understand Forward View, Amber forward view patient commissioning and October 2014 and their experience contracting and impact on and quality. delivery of Vanguard commissioning Integration of models. Health and Social Care

Finance and Performance Identify QIPP Responsibility for Deification of None. This is savings for identification and sufficient to be closed as 2016/17 delivery of QIPP savings to superseded by savings transferred to enable new objective CFO effective from balance plan on QIPP 1st August. to be Formal process to be developed established and to 2016/17 work closely with commissioning colleagues. Two meetings held with CCG Officers, opportunities being scoped through November and detailed plans to be drawn up & approved Amber/Close F&P James Green Jan-16 at SCR. further meetings held d however opportunities identified have fallen substantially short of required level. A further programme has been initiated to develop a schemes which will focus on the national Right Care opportunities and this is being led by the consultant in Public Health. Initial report into MSK will be presented to the PMO Board 15/3/16. Develop the specification and develop the market in readiness for the adoption of the new models of care: Define the local model(s) Define the local funding Assess financial and service delivery risks Agree the contractual framework Implement and spread across the CCG Black Country and West Birmingham Joint Committee Minutes of Meeting dated 20 April 2017

In attendance: David Hegarty – Chairman, Dudley CCG - Chair Helen Hibbs – Accountable Officer, Wolverhampton CCG Paul Maubach – Accountable Officer, Walsall & Dudley CCG Andy Williams – Accountable Officer, Sandwell & West Birmingham CCG Jim Oatridge – Interim Chair, Wolverhampton CCG

Apologies: Nick Harding – Chairman, Sandwell & West Birmingham CCG Anand Rischie – Chairman, Walsall CCG

1. Minutes of the last meeting

Minutes of the meeting held 23 March 2017 were agreed.

2. Actions from the last meeting

See action log for updates.

3. Reports from the Task & finish group reports

3a. Comms and engagement Talent management process • All discussed the name of the group, needs to be consistent across all 4 CCGs • Timeframe isn't clear on the talent management process • 4 CCG staff events (3 AOs to be at all events) to take place before the talent management process starts • Equalitive analysis process to be included in the talent management process - HR leads to ensure this happens through HR task and finish group. Action: HR leads • All discussed purdah – Communications task and finish group to keep all updated • Talent management process to include introductory paper to include current management figures

3b. Finance task & finish group • Paper presented to the Joint Committee for information on the review of the financial sustainability - to be reviewed on 22 June 2017 • All agreed that the finance review should proceed as set out in the paper from the Finance task & finish group

3c. Systems re-design task & finish group • Paul Maubach explained that there are differences of opinion on what should be local and what should be place based for mental health. A specific discussion to take place at the next task and finish group on mental health to rectify significant issues – principals to be used in future discussions

• The task and finish group were asked to look at Dudley’s scope of services and amend as necessary ahead of the next task and finish group. Paul to update all at the next Joint Committee and then link through CRG

Black Country and West Birmingham Joint Committee Minutes of Meeting dated 20 April 2017

3d. Governance • All agreed that the Terms of Reference for the Joint Committee are to go to all Black Country CCG Governing Bodies for sign off and that the Clinical Reference Group TOR and task and finish group TORs are to go to the 4 Governing Bodies for information only as subsequent groups of the Joint Committee

Joint committee TOR • All agreed on the following new membership to the Joint Committee, two Chief Finance Officers and 2 lay members from across all 4 CCGs • Lay members chosen for the Committee should be involved in two different remits, one of those remits to include communications and public engagement - Dudley or Walsall CCG Chief Finance Officer – Matthew Hartland - Sandwell & West Birmingham CCG Chief Finance Officer – James Green - Lay member for Finance to be chosen from Wolverhampton CCG. Action: Jim Oatridge - Lay member for patient and public involvement to be chosen from either Dudley or Walsall CCG. Action: David Hegarty • The following changes were made to the Joint Committee TOR. Action: Paul Maubach - Section 2.5 - remove term 'clinical' chair - Anand Rischie - Vice Chair of the Joint Committee - Add to section 7, a lay member to manage the conflicts of interest as an extra paragraph in the TOR - action paul Maubach - add to section 7 - Quorum - 1 CFO or 1 lay member - Add to section 6.2 - to make binding decisions on those matters on behalf of the CCG • All happy to make recommendation to of the TOR to all Governing Bodies

Clinical Reference Group TOR • The following changes were made to the CRG TOR. Action: Paul Maubach - Provision of evidence to come from the work streams - addition - Section 6 – addition – to develop a clinical strategy - Section 4 - Quorum to be changed to: Chair or Vice Chair and at least 1 voting member from each of the 4 geographical areas - Section 3.1 - Chair of CRG not joint committee • CRG TOR is subject to sign off of CRG. Action: David Hegarty.

All task and finish group TOR • Agreed by all, to go to Governing Bodies for information

4. Programme manager outline of responsibilities

• The proposed outline of responsibilities for the Programme Manager role were presented to all. The applicant of any band 8 level will continue on their existing job description for a period of 12 months working to the outline of responsibilities

• All agreed for the job advert to go out as soon as possible. Action: Paul Maubach • One issue raised was how you differentiate amongst band 8s if you don't have a job description criteria and the need to effectively accommodate this – Action: Nick Harding for interview stages

Black Country and West Birmingham Joint Committee Minutes of Meeting dated 20 April 2017

5. Any Other Business

5a. Clinical Reference Group • David Hegarty circulated a paper (Appendix 1) • David Hegarty explained that the CRG are required to create a clinical strategy, an analysis of the data based on projected needs of populations to align with national ‘must do’s’ (data has to largely come from Rightcare) • The first iteration of the strategy should be completed by the end of May with then a projected 6 month period to complete. • Finance task & finish group – look at the methodology by which we share resources - Action: Andy Williams • Recommendation in paper regarding project manager for CRG - strategy unit cover in short term as previously agreed • All agreed on the proposed costs to the Strategy Unit

5b. Key communications from this meeting to HR • All agreed that as a decision making group, staff and the public should be updated on all decisions made and that the communications task and finish group are to do an interpretation of the minutes. Action: Helen Hibbs • Once meeting minutes are approved, they are to be sent out with the public Governing Body Board papers

th Date of next meeting: 25 May, 1 – 2.30pm Black Country and West Birmingham Joint Committee Minutes of Meeting dated 25 May 2017

In attendance: Nick Harding – Chairman, Sandwell & West Birmingham CCG – Chair Anand Rischie – Chairman, Walsall CCG David Hegarty – Chairman, Dudley CCG Helen Hibbs – Accountable Officer, Wolverhampton CCG Paul Maubach – Accountable Officer, Dudley CCG & Walsall CCG Andy Williams – Accountable Officer, Sandwell & West Birmingham CCG Jim Oatridge – Interim Chair, Wolverhampton CCG Matthew Hartland – Chief Operating & Finance Officer, Dudley CCG and Interim Strategic Finance Officer, Walsall CCG James Green – Chief Finance Officer, Sandwell & West Birmingham CCG Simon Collings – Assistant Director of Specialised Commissioning, NHS England Claire Finn – Head of Finance, NHS England – Midlands & East Clare Hamilton – Executive Assistant to David Hegarty & Paul Maubach, Dudley CCG – Note taker

Apologies: Peter Price – Lay member, Wolverhampton CCG

1. Minutes of the last meeting

Minutes of the meeting held 20 April 2017 were agreed.

2. Actions from the last meeting

See action log for updates.

3. STP Update

Andy Williams updated all on the Sustainability & Transformation Plan. Andy, Paul Maubach, David Hegarty, James Green & Helen Hibbs attended the Quarter 1 Stocktake Event with NHS England and NHS Improvement on 25 May 2017. Andy Williams has now been identified as the Black Country STP lead. Positive feedback was received from NHSI and NHSE regarding the Black Country & West Birmingham Joint Committee.

All agreed that a clinical lead and programme management lead will be required for each Black Country service area and each service area will include (but not be limited to) the six priority areas that NHS England have identified. These areas will complement the STP agenda, so some of these leads, as well as being the CCG lead representative, may also become the lead representative for the STP as a whole. Andy Williams to work with HR to standardise a process across all four CCGs to ensure a fair and consistent approach is reached if there is more than one applicant for each future post. Action: Andy Williams

Paul Maubach explained that Walsall CCG are currently consulting on moving their Stroke services, however, this is not happening on a Black Country basis. All agreed Black Country and West Birmingham Joint Committee Minutes of Meeting dated 25 May 2017 to adopt a model where there are three approaches to how services are commissioned in the future:

1. Commissioning on a Black Country level (across all four CCGs) 2. Commissioned on place based with Black Country wide pathways of care (each CCG commissions its own model locally, but to the same agreed standards / protocols across all four CCGs with the same contract) 3. Place based commissioning (each CCG has its own model and each has its own contract which may differ from the others)

4. Reports from the Task & Finish group reports

4a. Governance Task & Finish group

• Paul Maubach updated all on the above Task & Finish group • All Task & Finish groups are now taking place monthly • Joint Committee Terms of Reference has not yet been approved by all Governing Bodies • A discussion took place regarding Nurse representation on the Joint Committee, all agreed to look at future representation once the Joint Committee has received delegation from all four Governing Bodies • Each CCG to source a Non-Executive Director to represent on the Joint Committee Action: CCG Chairs

4b. Systems Re-design Task & Finish group

• Paul Maubach updated all on the above Task & Finish group • The group are currently debating their shared scope of services based on Dudley’s scope • All agreed on the proposed principles which will be used to determine which services, for the long-term are to be commissioned on a place based or Black Country level • All agreed that a shared piece of work is required to define what it means in practice to commission a place based model and for each CCG to share their intelligence around this

4c. Infrastructure Task & Finish group

• Helen Hibbs updated all on the above Task & Finish group • Discussions are taking place regarding an estates solution and how this can be determined alongside a Clinical Strategy being defined • Nick Harding to share details of the national IT lead at NHS England with Helen Hibbs • All agreed that cyber attack planning should be part of this Task & Finish group

4d. Communications & Engagement Task & Finish group

• Helen Hibbs updated all on the above Task & Finish group Black Country and West Birmingham Joint Committee Minutes of Meeting dated 25 May 2017

4e. CCG Collaboration Task & Finish Group

• Andy Williams updated all on the above Task & Finish group • Andy described an overlap between System Re-design and Collaborative Commissioning • All agreed that a workshop should take place with senior commissioners to work on the areas of comparison • All agreed that this group would concentrate mutually on the six key areas described above • Matt Hartland updated on progress on ‘back office functions’ element of the work programme

4f. Finance Task & Finish Group

• James Green updated all on the above Task & Finish group • A specification has been drafted for the Black Country wide provider analysis which will be provided soon • The potential conflict/duplication of MMH reviews was discussed and it was agreed that only one review was required, and Andy Williams to discuss with NHSE whether an extension to the scope is required

David Hegarty and Matthew Hartland left the meeting.

5. Specialised Commissioning

Simon Collings updated all on Specialised Commissioning and will be attending all future Joint Committee meetings as Assistant Director of Specialised Commissioning from NHS England.

Simon explained that Specialised Commissioning will have a ‘seat’ at all collaborative commissioning arrangement meetings that include place based commissioning by April 2018. Ernest and Young are providing Finance and Governance support.

Updates will be required from the Governance Task & Finish Group and Collaborative Commissioning Task & Finish Group from Specialised Commissioning.

Date of next meeting:

nd 22 June, 1 – 3pm

Public - GOVERNING BODY Report Title: Report author and Title: Integration of “placed based” health and care. Sharon Liggins Chief Officer (SCR) Date of Governing Body: Contact Details: 5th July 2017 [email protected] Agenda No: 8.5 0121612 2833 Enclosure no: 14 Sign off from Chief Officers: Andy Williams OA

Supporting Documents/further Reading: Better Care Fund guidance Five Year Forward View Next Step Five Year Forward View Options for Integrated Commissioning, beyond Baker – Kings Fund Previous Decision This is the first time this item has been discussed at Governing Body Summary of purpose and scope of the report:

This paper sets out the national and local aspiration to integrate health and social care in line with the 2020 target and the local plans to change the commissioning and provider landscape. To support the shift towards integrated health and social care in Sandwell the following proposition is presented for consideration and approval: 1 Design and deliver a new integrated model of care for Sandwell in partnership with Sandwell Metropolitan Borough Council and service providers 2 Build upon the Sandwell BCF structure to establish and manage the transformation programme 3 Direct iBCF investment towards delivering zero DTOC (delayed transfers of care) and establishing a programme of integration 4 Align the relevant commissioning portfolios towards this agenda The paper attempts to demonstrate that this proposition is congruent with national policy and would support the emerging landscape for commissioning and new health and care integrated provision. It offers three options ranging from sustain the status quo to fully align place based commissioning to work in partnership with Sandwell Council to deliver integrated health and care for Sandwell. The achievement of the outcomes and benefits described will directly correlate to the scale of integration.

Recommendations:

The recommendations are outlined in section 8.

Prior to the General Election the paper could not be discussed in the public section of Governing Body, it was however discussed in the private section where members approved option 2.

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The Governing Body are requested to: Action Approve X Assurance Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified Conflict noted, conflicted party can participate in clinical X discussion but not decision Clinical Directors and CCG Staff are potentially conflicted because: The proposition may conflict with future business interests of Clinical Directors. The proposition may impact on CCG workforce deployment. Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision: Members personal interests in developing MCP or PACS new care models may have an impact on their view of SMBC as an integration partner Strategic Priorities related to the report: Quality & Safety X Finance & Performance x Partnership x Strategic Commissioning and Redesign x Organisational Development Primary Care Co-Commissioning x Collaborative Commissioning x Implications: Financial x Assurance Framework Risks and Legal Obligations x Equality and Diversity Statutory and External Influences x Further implications not stated Consultation: X Patients Staff Committees Public Partners Sponsored By: (Chief Officer Date Report received for Governing Body

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Integrated Health and Care

1 Executive Summary

This paper sets out the national and local aspiration to integrate health and social care in line with the 2020 target and the local plans to change the commissioning and provider landscape. To support the shift towards integrated health and social care the following proposition is presented for consideration: 1 Design and deliver a new integrated model of care for Sandwell in partnership with Sandwell Metropolitan Borough Council and service providers 2 Build upon the Sandwell BCF structure to establish and manage the transformation programme 3 Direct iBCF investment towards delivering zero DTOC (delayed transfers of care) and establishing a programme of integration 4 Align the relevant commissioning portfolios towards this agenda The paper attempts to demonstrate that this proposition is congruent with national policy and would support the emerging landscape for commissioning and new health and care integrated provision. It offers three options ranging from sustain the status quo to fully integrate commissioning with Sandwell Council to deliver integrated health and care for Sandwell. 2 National Context

The government has made a range of commitments towards delivering health and social care integration, most notably by the creation of the Better Care Fund (BCF) in 2015-16. In 2014, NHS England published the Five Year Forward View (FYFV), setting out how the NHS should aim to achieve a financially sustainable health and care system by 2020. In the document it is suggested that Accountable Care Organisations (ACSs) could be one possible option, taking a number of different forms ranging from fully integrated systems to looser alliances and networks of hospitals, medical groups and other providers. The government reiterated its commitment to joining up health and social care in the Spending Review and Autumn Statement 2015. It stated that locally led transformation of health and social care delivery has the potential to improve services for patients and unlock efficiencies. The government committed £2bn new money for social care as part of the 2017 budget announced in March, it is to be spent through the BCF over the next two years. The BCF guidance has not yet been published but health and social care are expected to integrate by the year 2020. Local areas are required to produce a plan to deliver integration of health and social care by the autumn. Next Steps on the Five Year Forward View (March 2017) confirms the major move to achieving integrated care using new models. The document advocates the

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acceleration of an integrated way of working, through partnerships of care providers and commissioners in Sustainability and Transformation Partnerships (STP). A handful of the STPs will be designated ‘Accountable Care Systems (ACS), this means they will not have the restrictions of the internal market that has characterised the NHS since the 1990s. Rather than ‘commissioners’ arranging services by ‘buying’ them through a set of transactional contracts, the ACS will hold a single budget and work collaboratively with NHS bodies, local authorities and the third sector. The Commission on the Future of Health and Social Care in England (Barker Commission) has recommended that ‘England moves to a single, ring-fenced budget for health and social care, with a single commissioner, something which it sees as being fundamental to achieving a joined-up health and social care system. This is seen as a necessary step towards addressing the myriad of problems that face health and social care.

The House of Commons Health Committee’s inquiry (2012) on the future of social care also highlighted the problem of fragmented commissioning budgets. The inquiry concluded that attempts to address this problem by ‘building bridges’ between services had not worked, and that truly integrated services would not be achieved without the establishment of a single commissioner. Subsequent Health Committee reports have reiterated the problem of fragmented commissioning arrangements as an obstacle to truly integrated services

3 Local Context

The CCG is actively engaged in a dialogue with partners to co-design a new commissioning landscape that will support the delivery of new provider alliances and new integrated health and care models across the Black Country and West Birmingham STP (BCaWB STP) and the Birmingham and Solihull STP (BSOL STP).

The complexity and scale of the transformation agenda set out in the FYFV, Next steps for the FYFV and the GP Forward View (GPFV) is huge and influenced by the number of partners involved, but there are common themes which are emerging in both STPs.

In the BCaWB STP, commissioners have made the commitment to commission on three levels and work is underway to determine how commissioning functions will be organised in the future at:

1. At a placed based level (geographical based on CCG footprints) 2. At the Black Country level 3. At a regional level (e.g. integrated urgent care, specialised commissioning)

The BCaWB STP placed based work stream is currently considering the vision for local placed based models of care. Each CCG is considering the scope of NHS services described in the Dudley Multispecialty Community Provider model against their local aspirations. How each CCG develops and commissions future placed

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based models of care will inevitably vary; according to the local scale of aspiration and the maturity of local partnerships.

The BSOL STP are currently exploring the concept of an ACS for the whole of Birmingham and the full integration of health and social care. The STP has aligned the Better Care Fund plans towards delivering immediate strategic objectives:

1. Delivering two priority areas – urgent and emergency care and general practice/primary care development around prevention. 2. Stabilising Birmingham City Council (BCC) and the transformation of adult social care in preparation for health and care integration. 3. Reform CCG and BCC commissioning to develop opportunities for integrated commissioning.

West Birmingham is part of the Birmingham BCF and the west Birmingham vanguard (Your Care Connected) relies on the interface with the Birmingham providers and the city council. The CCG has therefore assured Birmingham that it will continue to actively influence the development of the ACS concept and the future integrated commissioning plans.

The conversations between the CCG and Adult Social Care in Sandwell Metropolitan Borough Council (SMBC) have focused on the local response to the concept of integrated placed based care. The CCG and SMBC recognise that integrating health and social care is vitally important for improving the efficiency of public services.

An integrated approach to commissioning would require the formation of new/refreshed and trusting relationships with key partners. Research suggests that examples of fully integrated commissioning are limited, and that this approach is typically confined to a small number of service areas. The evidence that is available suggests that the nature and success of integrated commissioning arrangements varies significantly between local areas and between services.

Our history or working collaboratively with SMBC is also variable. However, both parties are committed to addressing the historical barriers to design and deliver an integrated health and social care model for Sandwell.

The following proposition is congruent with the strategic direction of the Sandwell Health and Wellbeing Board, the BCaWB STP and the ambition of the new Black Country Collaborative Commissioning Committee (BCCCC). It is also congruent with the CCGs aspiration to deliver a new model of care that will help create a resilience of health and care system.

4 A Shared Strategic Intent

The shared strategic intent of both the CCG and SMBC is to deliver effective integrated health and care to the local population of Sandwell, in a way that meets their changing needs and reflects the reality of both the human and financial resources available.

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There is emerging evidence that the integration of health and care services can produce a range of benefits, particularly in the care of older people, vulnerable individuals who need effective care co-ordination and carers. Integrated care has also been shown to better support individuals to remain within their communities, to counter threats to their independence and improve clinical outcomes.

Integration of health and social care, if it includes deploying effective prevention strategies, is seen as a solution to managing the anticipated increase in future demand for services. Typically health and care systems in developed countries try to achieve this by managing demand through:

• Supporting public behaviour change to increase self-reliance and self-care and to promote independence. • Increasing the emphasis on prevention rather than treatment. • Recovering people as quickly as possible to independence following acute periods of illness or dependency. • Reducing access to services through rationing by time, location, price or eligibility. • Treating people as conservatively as is consistent with their presenting condition. • Reducing unwarranted variation in treatment practice. • Reducing duplication in service offering or delivery. • Reducing delays in the treatment or care process. • Reducing direct and indirect costs through control of pay, capital and consumables.

Building upon the Sandwell BCF, it is our aspiration to develop a joint programme of transformation that will align Adult Social Care, public health and CCG commissioning intentions with the co-design of a new integrated model of care for Sandwell. The BCF will fund additional programme and project management support to enable the transformational programme to gain momentum. The CCG and SMBC believe the resulting model of care will address the following STP challenges: If we fail to get serious about prevention then attempts to address healthy life expectancy will stall, health inequalities will widen, and our ability to fund beneficial new interventions will be crowded-out by the need to spend the limited finance available on wholly avoidable escalation of health and care needs - Widening the health and wellbeing gap Unless we reshape care delivery, harness technology, and drive down variations in quality and safety of care, then our populations’ changing needs will go unmet, people will be harmed who should have been safe, and unacceptable variations in outcomes will persist, and may even grow – Widening the care and quality gap

Sandwell & West Birmingham CCG Governing Body Board Meeting Agenda Item 8.5 - Enc 14 Page 6 05 July 2017

If we fail to match reasonable funding levels with system efficiencies, the result will be worse services, fewer staff, deficits, restricted access to care and new treatments - Widening the funding and efficiency gap The proposition of commissioning an integrated health and care model is not a new concept, it has been done in several parts of England with varying degrees of success and currently the national Vanguard Programme is testing a number of different approaches. The lessons learnt from these experiences will be considered. Other points to consider include: • securing support for the approach from all stakeholders, • the potential impact on the system, • the potential risk of stranded costs should the provider landscape change following procurement, • if appropriate the financial impact of VAT on the providers supply chain balanced against the benefits, • the future management of changing policy and central dictates, • sufficient time for mobilisation before benefits realisation, • the potential disruption to current service provision, • impacts on the recruitment and retention of the workforce • And the level of organisational development required by all partners to ensure a new shared culture is developed and embedded.

The CCG and SMBC recognise the significance of the above points and are committed to working them through to achieve the best outcomes for its population. 5 Integrated Health and Social Care Model

The CCG and SMBC want to ensure the sustainability of health and social care services for the future and will consider the alignment of commissioning activities, as a means to deliver a fundamental shift in the current health and social care model of care delivery in Sandwell. Building on the ethos of the BCF programme to:

• commission integrated service provision which strives to prevent ill health by keeping people well, • living as long as possible in their own homes by focusing on people empowerment, re-ablement and self-care, • harness the resources within the community • and provide evidence based quality care in the community that reduces the future dependence on traditional hospital based medical models.

This view is congruent with the long term ambition of the Right Care Right Here Programme and it is supported by national policy as described in the Five Year Forward View, the GP Forward View, the Better Care Fund Guidance and the Care Act (2014).

It is our shared vision to deliver a new integrated health and social care model covering the breadth of services required to deliver the STP placed based models of care, through:

• Redesigning the way prevention strategies are targeted and delivered,

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• Supporting the redesign of General Medical Services and enhanced primary care to meet the needs of defined communities (30,000 – 50,000 registered populations). • Redesigning community services to ensure they meet the needs of the local community and interface seamlessly with all the interdependent agencies to ensure the people of Sandwell receive timely, efficient and optimal care when they need it. • Working in partnership with interdependent agencies to ensure people who are the responsibility of the CCG and/or SMBC but are not currently residing in Sandwell receive equity of care and outcomes. • Working in partnership with acute services to ensure the interfaces between both tiers of provision work in harmony to improve care and system efficiency. • Moving to community-based multi-professional teams based around the registered lists of general practice, which would include generalists working alongside specialists. • Focusing on intermediate care, case management and support to home- based care. • Joint care planning and co-ordinated assessments of care needs • Personalised health care plans and programmes • Named care co-ordinators who act as navigators and who retain responsibility for peoples care and experiences throughout the health and care journey • Clinical records that are shared across the multi-professional team.

It is our shared aspiration to commission a safe, trusted, personalised health and care system delivered by a trusted and quality focused provider(s) who is committed to fundamentally changing the relationship between professionals, services and service users; by:

• ensuring individuals and their carers feel supported, assured and empowered to manage and prevent exacerbation of conditions and concerns; • achieving systematic and improved prevention, detection and early intervention at any point of access to care services; • enabling people with urgent but non-life-threatening needs easily available access to advice and care that respects people’s time; • providing better coordinated, proactive care for individuals with multiple co- morbidities, or who are frail or nearing the end of life, with services working together using shared health and care records in an integrated way closer to home; • growing the involvement and use of the voluntary community and social enterprise sectors in system care provision • supporting general practices to work with each other (at an optimum scale), as well as in partnership with all other health and care statutory and non- statutory agencies, to deliver consistent, optimal primary care services at scale • ensuring the interface between primary care, community service, social care and specialist services is effectively managed and enables a smooth transition for those following the local pathways. • recruiting and retaining a reliable, flexible and competent system workforce capable of working together and combining expertise appropriately to meet individual bio-psychosocial needs of the local population.

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• using technology to maximise education, empowerment and extend access to individuals, as well as care professionals.

In the above integrated health and care model the population of CCG and SMBC will be analysed and stratified to inform service redesign and reconfiguration, to ensure provision best supports the maintenance of health and independence. Services will be redesigned in line with known best practice and where national evidence is not available local research/evaluation will be a founding principle for service improvement.

The integrated model will be delivered across the whole of Sandwell but the majority of provision will be aligned to defined groups of practices (scale to be confirmed e.g. 30,000 to 50,000 or above) across the 6 towns. There are cohorts of people who will reside outside of the six towns but are still eligible for components of the care provided by the integrated health and social care model, because they are either under the care of a Sandwell GP or are the responsibility of the local authority.

6 Expected Outcomes

New placed based models aim to use an outcomes focused approach to drive new and innovative service solutions. In taking this approach the outcomes framework will need to take into account the national mandated metrics and outcomes that can be measured to demonstrate an improvement in the health and care experience of our population.

Population segmentation offers a method to identify the needs of the local geographies, either based on towns and/or groups of individuals with similar health status, health and care needs. This approach will ensure the service commissioned will be able to identify and address the different needs of our population.

Some outcomes will be defined by the National outcome metrics, such as those shown in Table 3 below, but these will be supplemented by locally derived outcome measures that reflect the needs of the people of Sandwell.

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Table 3 Integrated outcomes to be delivered through the placed based model NHS & Adult Social Care NHS & Public Health • NHSOF2 Health related quality of life for • NHSOF1.1 & PHOF4.4 Under 75 mortality people with long term conditions & ASCOF1A rate from cardiovascular disease Social-care related quality of life* • NHSOF1.2 & PHOF4.7 Under 75 mortality • NHSOF2.4 Health related quality of life for rate from respiratory disease carers & ASCOF1D Carer- reported quality of • NHSOF1.3 & PHOF4.6 Under 75 mortality life* rate from liver disease • NHSOF3.6i-ii & ASCOF 2B Proportion of older • NHSOF1.4 & PHOF4.5 Under 75 mortality people (65 and over) who were still at home 91 rate from cancer days after discharge from hospital • NHSOF1.5 & PHOF 4.9 Excess under 75 (reablement/rehabilitation) mortality rate in adults with serious mental • NHSOF 2.6ii & ASCOF 2F the effectiveness of illness post-diagnosis care in sustaining independence • NHSOF1.6i & PHOF4.1 Infant Mortality and improving quality of life (in development)* • NHSOF2.6i & PHOF4.16 Estimated diagnosis • NHSOF 4.9 People’s experience of integrated rate for people with dementia care & ASCOF 3E Effectiveness of integrated • NHSOF3b & PHOF4.11 emergency care (both in development)* readmissions within 30 days of discharge from • NHSOF? And ASCOF 2b delayed transfers of hospital care • Other dying with dignity NHS Outcomes • BCF reduction of unplanned care, reduction Framework of admissions to nursing homes

NHS, Public Health & Adult Social Care • NHSOF2.2 &PHOF1.8 Employment of people with long term conditions & ASCOF1E Proportion of adults with a learning disability in paid employment* Public Health Outcomes • NHSOF2.5 Employment of people with Adult Social Care mental illness & PHOF1.8 employment of Framework Outcomes Framework people with long term conditions & ASCOF 1F: Proportion of adults in contact with secondary mental health services in paid employment*

Public Health & Adult Social Care • PHOF1.6 & ASCOF 1G Proportion of adults with a learning disability who live in their own home or with their family • PHOF1.6 & ASCOF 1H Proportion of adults in contact with secondary mental health services living independently, with or without support • PHOF1.18 & ASCOF 1I Proportion of people who use services and their carers, who reported that they had as much social contact as they would like • PHOF1.19 Older people’s perception of community safety & ASCOF 4A The Proportion of people who use services who feel safe*

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7 High Level Benefits

People will benefit from • improved coordinated care without traditional organisational barriers • a clear point of contact enabling an improved access experience • telling their story once because everyone uses the same care record • short waits in the care process because access would be improved and services will be responsive • overall positive experience of keeping well and being engaged • supported independence and increase control over their care • feeling supported, assured and empowered to manage and prevent exacerbation of conditions and concerns • improved quality of health and care • increased confidence in the health & care system • a greater respect for people's time in the way we deliver care • a pervasive customer orientated culture throughout the care system

Commissioners will benefit from • a mechanism for delivering the placed based commissioning agenda for Sandwell • an integrated provision meeting both the health and care needs for the population of the CCG and SMBC • joined up focus on improving outcomes and the quality of care • joined up focus on managing the health and care market • efficient management of demand and finances • shifting emphasis to prevention • the removal of traditional organisational boundaries and the assurance that people will receive a seamless service • an integrated provider meeting shared priorities and policy targets i.e. DTOC • sharing back office functions

The integrated health and care model provider(s) will benefit from: • having influence and control over the entire community physical and mental health and social care pathways to reduce unwarranted variation and improve outcomes • having the autonomy to address unwarranted variation in order to maximising Right Care opportunities. • having control of resource allocation (human, financial and infrastructure) to shift the model of care and realise opportunities • having only one commissioner (and all it entails) • having a longer term contract in order to mobilise the model and deliver the broad range of outcomes • better use of estates on a place based footprint. • the formation of new partnerships • growing the involvement and use of the voluntary community and social enterprise sectors in system care provision • harnessing the expertise of primary care providers

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• facilitating a shift to services users being responsible drivers of their health and care, with providers encouraging and valuing them as full partners • co-ordinated system leadership to deliver the successful delivery of the model and achieve better outcomes

8 Options

Governing Body agreed option 2 on the 2nd June 2017

Option 1 The CCG can decline the proposition, choosing to continue with a more traditional health approach: primarily with health partners only and continue to have a traditional arm’s length relationship with the SMBC.

• This option will not deliver local integrated health and care by 2020. • It could deliver a health only model of integration. • It could give the CCG time to further explore other options but it could potentially damage the relationship with SMBC who may withdraw their support for future integration.

Option 2 The CCG can accept the proposition, choosing to align (not pool) and co-locate a select number of commissioning portfolios/staff. Those portfolios considered to directly rely on an effective interface between health and social care (see Appendix 1).

• This option would deliver partial integrated commissioning and it would deliver frontline integrated health and care for determined cohorts by 2020 (e.g. frail elderly, complex care, mental health, learning disabilities). • It would provide a starting point for the development of the integrated provider model. • It would require a clear remit and governance through an MOU/section 75. • The CCG could re-base the current BCF to cover the extended remit limiting the alignment of additional investment. • It would give the CCG and SMBC the space to prove aligned commissioning would work, thereby building trust and understanding. • It would provide space for the wider commissioning conversations to continue i.e. the BSOL STP and the Collaborative Commissioning development. • It may not be straightforward to divide the commissioning workforce between Sandwell, West Birmingham and Collaborative Commissioning • The iBCF would fund an OD programme to support commissioning integration and the co-design of the model with

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providers. Option 3 The CCG can choose to align (not pool) all of the placed based commissioning scope with SMBC (see Appendix 2). The CCG and SMBC have considered this option because of the synergy with the STP/Collaborative Commissioning view on the place based scope.

• This option would deliver full integrated health and care for Sandwell by 2020. • It would make a full commitment to commissioning for the place of Sandwell. • It would require a clear remit and governance through an MOU or a section 75. • It would be a decisive action towards changing the commissioning landscape. • It may not be straightforward to divide the commissioning and back office workforce between Sandwell, West Birmingham and Collaborative Commissioning. • The iBCF would fund an OD programme to support commissioning integration and the co-design of the model with providers. • It could be a natural progression from option 2, over time.

9 High Level Risks

The risk below are applicable to both options 2 and 3, the detail and scale of risk will depend upon the level of commitment made by the CCG and SMBC.

Financial 1. If the provider(s) of the future model of care fails to reduce unwarranted variation and improve outcomes that deliver financial efficiencies it will not successfully manage demand and achieve financial sustainability. 2. If financial plans are not open and transparent about NHS efficiency targets and the council’s budget reduction the trust in the new partnership will falter.

Organisational 3. If either the CCG, SMBC or individual providers adopt a “fortress mentality” towards preserving their individual organisational control, power, culture and resources the commissioning and mobilisation of integrated commissioning and the development of a new model may fail. 4. If the provider(s) of the new model of care do not create a culture that supports the successful integration of the health and care workforce, it will be unable to improve care pathways, reduce unwarranted variation, attract and retain the required workforce and ultimately the people of Sandwell will not receive a better care experience. 5. If one or any of the current providers challenge the approach of an alliance, the services that deliver the new care model may need to be tendered, leaving unsuccessful bidders with stranded costs and significant TUPE issues.

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6. If some or all of the required enablers to make the joint commissioning and the new model work are not in place, or are not likely to be in place the model it increases the risk of failure. 7. If data capturing systems are not aligned to the required reporting requirement to meet both the CCG and SMBCs statutory reporting requirements the commissioners will be unable to continue to support the model. 8. If SMBC and the CCG do not align resources (human, relevant commissioning expenditure) towards this common agenda the programme will structure to become established and deliver the required outcome.

Political 9. If local politicians and/or NHS regulators do not support the model it will not be commissioned and an alternative plan will be required.

Reputational 10. If the CCG and the Council do not effectively manage the commissioner provider relationship (the council is both), future procurement of a new model may be compromised and exposed to challenge.

10 Interdependencies with other services

The following interdependencies apply to both option 2 and 3 however, the significance of the interdependency will depend on the option chosen.

• The interface with local primary care, acute services, mental health and the third sector to ensure effective pathways • The interface with neighbouring providers and systems to meet the needs of people placed out of area. • The interface with neighbouring local authorities and CCGs for patients who are not a resident Sandwell or do not have a Sandwell GP. • The interface with system level urgent care services (integrated 111 and Out of Hours, West Midlands Ambulance Service) to ensure effective hospital avoidance and improved care in the community. • The interface with housing and other council provision • The interface with the Sandwell Children’s Trust

11 Governance

The CCG and SMBC have the opportunity to build upon the current Better Care Fund governance arrangements but key decisions need to be made, for example: • If option 2 is chosen, the BCF could be reprofiled to cover the services in scope. • If the value of option chosen exceeds the minimum value of the BCF, an MOU or scheme of delegation would be required to outline the operating prinicples.

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• If either option 2 or 3 is chosen, the relevant CCG and SMBC commissioning staff should be co-located. This would mean clearly identifying the staff who would work on the Sandwell integrated model. • It would be politically symbolic for SMBC and ultimately the Health and Wellbeing Board to host the commissioning arrangements but it would need to ensure it meets the governance and regulatory requirements of the CCG/NHSE. • Regardless of who hosts the commissioning process the commissioning team would need to represent the expertise of both health and care. • In order for a joint team to function effectively it would require strong shared leadership and a programme of organisational development to move to a shared culture and operating principles. • The current section 75 would be up dated to reflect the additional responsibilities. • The BCF governance would be strenghtend to ensure the CCGs governance needs are met.

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APPENDIX 1 Option 2 - Proposed Scope of Services

Sandwell Metropolitan Borough Council

Service line In Potential scope Adults Prevention and Enablement STAR (Short Term Assessment and Re-ablement)  Therapy (adults and children)  Sensory Services  Prevention/Equipment Stores (adults and children)  DFG (Disabled Facilities Grants)/Home Improvement Team –  adults and children Community Alarms  Floating Support  Enquiry (Advice and Information Centre)  Adult Direct Services LD Day Opportunities  Adult Social Care Commissioning Budget Placements for Care Homes and Nursing Homes  Early Supported Discharge  Carers  Public Health Prevention Obesity  GUM  Falls and Frail elderly  Prevention/Physical Health  Alcohol and Drugs  Smoking Cessation  Mental Health  Cancer Screening  Prevention of infection in care homes  Health Visiting  School Nursing  General Welfare Rights  Citizens Advice 

Sandwell and West Birmingham Clinical Commissioning Group

Service line In Potential scope Elderly Frail Community Contacts  Advanced Nurse Practitioners/Care Homes  Support to Nursing Homes 

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Domiciliary Fees  Stepdown  Dementia Home Support and Carer Awareness  Dementia Support Service  Alzheimer’s Service  Alzheimer’s Family Support  Community & Primary Urgent Care Community Rapid Response Team  Community Nursing Community contacts  District Nursing  Leg Ulcer  Children’s Nursing  Community Nursing  Free Nursing Care  Continuing Health Care  Hospital at Home Community Contacts  Excluded Drugs  Hospital Liaison Team Community Contacts  Intermediate Care Community Contacts  Care Homes  Stepdown  Local Authority Services  GP Respite Beds  A&E Diversion  Own Bed Instead (OBI)  Intermediate Care GP Support  Carers Carers Services  Equipment Services Tissue Viability  Childrens Equipment  Wheelchairs  Community Equipment Stores  Community Devices  Occupational Therapy Community Contacts  Learning Disabilities  Orthotics Orthotics  Physiotherapy and Orthopaedic Assessment Service Community Contacts  Learning Disabilities  Paediatric Physiotherapy  Orthopaedic Assessment Unit  Physiotherapy 

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Intermediate Care Physiotherapy  Group Physiotherapy  Direct Access  Rehabilitation Outpatients  Community Contacts  Rehabilitation (Moor Green Clinic)  Day Care Attenders  Stroke Medicine Outpatients  Community Contacts  Inpatient Rehabilitation  Stroke Clinics  Community Rehabilitation  Mental Health Mental Health - Older Adults  Mental Health - Community  Mental Health - Early Intervention  Mental Health Rehabilitation  Mental Health Community  Mental Health - Placements  Learning Disabilities (excludes forensic) Community Contacts  Children’s Learning Disability Nurses  Assessment and Treatment  Behavioural Psychological Services  Health Access  Dysphagia  Placements  Respite  Community Nursing  Free Nursing Care  Continuing Health Care 

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APPENDIX 2 Option 3 – Proposed Full Scope of Place Based d Services

Sandwell Metropolitan Borough Council

Service line In Out of scope scope Adult Social Work Teams Community Teams  Mental Health Crisis  CMHT  Safeguarding  DOLS  Hospital  Adults Prevention and Enablement STAR (Short Term Assessment and Re-ablement)  Therapy (adults and children)  Sensory Services  Prevention/Equipment Stores (adults and children)  DFG (Disabled Facilities Grants)/Home Improvement Team –  adults and children Community Alarms  Floating Support  Enquiry (Advice and Information Centre)  Adult Direct Services LD Day Opportunities  Extra Care  Shared Lives Schemes (Adult Fostering and Respite)  Meals on Wheels  Adult Social Care Commissioning Budget Placements for Care Homes and Nursing Homes  Domiciliary care  Direct Payments  Day Services  Supported Living  Extra Care  Voluntary Grants  Carers  Public Health Prevention Obesity  GUM  Falls and Frail elderly  Prevention/Physical Health  Alcohol and Drugs  Smoking Cessation  Mental Health  Cancer Screening 

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Prevention of infection in care homes  Health Visiting  School Nursing  Adult Social Care Safeguard Board  Appointeeship  General Welfare Rights  Citizens Advice  Planning  Housing (Council and Private)  Regeneration  Bin Collections  Education  Children’s Trust  Children’s Commissioning  MASH (Multi Agency Safeguarding Hub) 

Sandwell and West Birmingham Clinical Commissioning Group

Service line In Out of scope scope Ambulatory Care Conditions Stable Angina (excludes cardiac catheterisation)  Asthma  Cellulitis  Chronic Obstructive Pulmonary Disease  Congestive Heart Failure  Convulsions And Epilepsy  Dehydration And Gastroenteritis  Dental Conditions  Diabetes Complications  Ear, Nose And Throat Infections  Gangrene  Hypertension  Influenza And Pneumonia  Iron Deficiencies anaemia  Nutritional Deficiencies  Other Vaccine Preventable  Pelvic Inflammatory Disease  Perforated/Bleeding Ulcer  Urinary Tract Infections  Anticoagulation Outpatients  Community Contacts  Audiology Electives  Outpatients  Community Contacts 

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Hearing Aids  Hearing Aid Service  Digital Hearing Aids  Cardiology 24 hour blood pressure monitoring  Elective inpatients  Child Development Child Development  Children with Neuro Development Delays  Childrens Packages of Care/Placements Childrens Packages of Care/Placements  Child - Paediatrics Outpatients  Community Contacts  Enuresis  Elective inpatients  Childrens Physical Health Service Paediatric Eye Service  CYP&F - Physical Health  Childrens CAMHS Outpatients  Counselling  IAPT  Psychology  Eating Disorders  Child & Family Service  ASD  CAMHS Transformation Funding  CAMHS Services (BCPFT)  Tier 3+  Chiropody/Podiatry Outpatients  Community Contacts  Chiropody  AQP Podiatry  Podiatry  Clinical Immunology and Allergy Elective inpatients  Outpatients  Continence Community Contacts  Childrens Community Contacts  Continence Products  Dermatology Electives  Outpatients  Community Contacts  Laser  Dietetics Outpatients 

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Community Contacts  Enteral Feeds  Dietetics - Mental Health  Direct Access Diagnostics ECGs  Radiology  Biochemistry  Haematology  Microbiology  Immunology  Community Phlebotomy  Histology  Cytology  EEG  Echos  Exercise Tolerance Test  Vitamin D Screening  DEXA Scans (SWB)  Other  Direct Access  Audiology  Pathology  Respiratory  Endocrinology & Diabetic Medicine Outpatients  Community Contacts  Primary Care Glucose Tolerance Test  Elective inpatients  Insulin Pumps  ENT Elective inpatients  Community Contacts  Gastroenterology Elective inpatients  Outpatients  General Medicine Outpatients  Gynaecology Outpatients  Endometrial Biopsy  Elective inpatients  Community Contacts  Haematology CYP&F - Spec Nursing  Elective inpatients  Sickle Cell  Heart Failure Community Contacts  Heart Failure Monitoring  Advice Service for Heart Failure 

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Lymphodema Outpatients  Community Contacts  Nephrology Outpatients  Elective inpatients  Community Contacts  Neuro-Disability Outpatients  Parkinsons Specialist Nurse  Neurology Electives  Outpatients  Community Contacts  Epilepsy Service  Elective inpatients  Neurophysiology Tests  Occupational Therapy Outpatients  Community Contacts  Learning Disabilities  Ophthalmology, Optometry and Orthoptics Outpatients  Community Contacts  Eye Clinic Liaison Officer (ECLO) Service  Orthoptics  Orthotics Orthotics  Pain Management Outpatients  Physiotherapy and Orthopaedic Assessment Service Electives  Outpatients  Community Contacts  Learning Disabilities  Paediatric Physiotherapy  Orthopaedic Assessment Unit  Physiotherapy  Intermediate Care Physiotherapy  Group Physiotherapy  Direct Access  Rehabilitation Outpatients  Birmingham Wheelchair Service  Community Contacts  Rehabilitation (Moor Green Clinic)  Neuro Rehabilitation  FES Specialist Clinics  Inpatient Rehabilitation  Day Care Attenders 

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Respiratory Medicine Outpatients  Community Contacts  Rheumatology Elective inpatients  Outpatients  Stroke Medicine Outpatients  Community Contacts  Inpatient Rehabilitation  Stroke Clinics  Community Rehabilitation  Urology Outpatients  Community Vasectomy  Elective inpatients  Community Urogynaecology  Mental Health Outpatients  Eating Disorders  Mental Health - Older Adults  Mental Health - Community  Mental Health - Acute  Mental Health - Early Intervention  Mental Health Sections  Mental Health Rehabilitation  Mental Health Community  Mental Health - Placements  Learning Disabilities (excludes forensic) Outpatients  Community Contacts  Children’s Learning Disability Nurses  Assessment and Treatment  Behavioural Psychological Services  Health Access  Dysphagia  Placements  Acute Liaison  Respite  EEG  Elderly Frail Electives  Outpatients  Community Contacts  Advanced Nurse Practitioners/Care Homes  Support to Nursing Homes  Domiciliary Fees  Stepdown  Care Homes - Emergency Admissions  Falls - Emergency Admissions 

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Dementia Home Support and Carer Awareness  Dementia Support Service  Alzheimer’s Service  Alzheimer’s Family Support  Palliative Medicine and End of Life Electives  Outpatients  End of Life Hub  Community Contacts  Children’s Packages of Care/Placements  Hospice Care  Macmillan Nursing  Children’s Palliative Care  Adult Palliative Care  Cancer Support  Elective inpatients  Palliative Care - Community  Primary Care Minor Surgery  Primary Care IT  Central Drugs charges  Practice Prescribing  Centrally funded drugs adjustment  Primary Care Premises  Dispensing  Enhanced Services  APMS Contract  GMS Contract  Other GP Services  QOF  Clinical Leads  Near Patient testing pathology  GP Practice Training  NHSE Enhanced Services  Community & Primary Urgent Care Community Rapid Response Team  Walk In Centre Attendance  Community Nursing Community contacts  District Nursing  Leg Ulcer  Children’s Nursing  Community Nursing  Free Nursing Care  Continuing Health Care  Hospital at Home Community Contacts  Excluded Drugs  Hospital Liaison Team

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Community Contacts  Intermediate Care Community Contacts  Care Homes  Stepdown  Local Authority Services  GP Respite Beds  A&E Diversion  Own Bed Instead (OBI)  Intermediate Care GP Support  Carers Carers Services  Chemical Pathology Electives  Outpatients  FH Testing  Equipment Services Tissue Viability  Childrens Equipment  Wheelchairs  Community Equipment Stores  Community Devices  Patient transport Non Emergency Patient Transport  Safeguarding CYP&F - Child Protection Service (Childrens safeguarding service  inc child protection) Looked after children  Domestic Abuse post (SWB Community contract)  Speech & Language Therapy Outpatients  Community Contacts  Childrens Community Contacts  Learning Disabilities  Childrens Contacts  Youth Offending Team  Direct Access  Urgent Care A&E attendances  Unplanned admissions  NHS 111/integrated OUTs  Urgent Care Centre 

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GOVERNING BODY Report Title: Report author and Title: Proposal for the creation of a single NHS Gemma Coldicott Head of Communications commissioning organisation Birmingham Cross City CCG for Birmingham and Solihull Presented by Claire Parker

Date of Governing Body: Contact Details: Wednesday 05 July 2017 Claire Parker Agenda No: 8.6 0121 612 1714 Enclosure no: 15 Sign off from Chief Officers:

Chief Finance Officer: NA

Chief Officer for Quality: Yes

Chief Officer for Operations: NA

Chief Officer for Partnership:

Supporting Documents/further Reading: None

Previous Decision None Summary of purpose and scope of the report: To provide assurance around the process for the creation of a single NHS commissioning organisation in BSOL and the steps being taken to engage the West Birmingham members and population of SWBCCG

Recommendations: to note the contents of the report

The Governing Body are requested to: Action Approve Assurance Note Decision Conflicts of Interests: The recommended action by the author of the report is: No conflict identified None Conflict noted, conflicted party can participate in clinical discussion but not decision Conflict noted, conflicted party can remain in committee but not participate in discussion Conflicted party is excluded from discussion (this would be rare circumstances only) Please state rationale for above decision:

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Sandwell and West Birmingham CCG Governing Body

Proposal for the creation of a single NHS commissioning organisation for Birmingham and Solihull

Purpose

This paper discusses the outline process and timeline for creating a single NHS commissioning organisation for Birmingham and Solihull by April 2018; the three Birmingham and Solihull CCGs have been working extensively with NHS England to develop plans on how this is progressed.

Current position

NHS Birmingham CrossCity, Birmingham South Central, and Solihull CCGs have stated a preferred option to create a single commissioning organisation by April 2018; this has been agreed as the strategic direction of travel with respective membership and governing bodies of each organisation.

To maximise the benefits of planning and partnership at the scale of Birmingham and Solihull STP, the CCGs recognise the need for a consistent and credible commissioning vision and voice. This is required to deliver the best possible outcomes for local people; tackling health inequalities and meeting the needs of a diverse population.

This vision of working towards the creation of a single commissioning organisation, subject to consultation, is the next logical progression to the steps the CCGs have taken over the past 12 months.

Process and timeline

NHS England’s formal application process requires a proposal, with a preferred option, be submitted by 31 July. This is followed by an iterative scrutiny and review process conducted by the local NHS England team in August 2017. This process culminates with a national NHS England decision making committee on 27 September. At this point, the committee decision would be either ‘not to proceed’ or ‘an agreement in principle’ to proceed. If an agreement is reached to proceed, there can be formal conditions attached to that agreement that will need to be resolved before end of March 2018.

Independent legal advice, local democratic requirements, precedent set in North of England and specialist engagement advice, all support an open and transparent engagement and consultation process with stakeholders and the public.

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Therefore, running parallel to the NHS England timeline, there has been a period of pre- consultation engagement, which will be followed by a period of compressed formal consultation; this is a four-stage process:

• Phase one – May/June 2017: Engagement with key strategic stakeholders (during purdah).

• Phase two – June 2017: Engagement with wider stakeholders and the public (after purdah).

• Phase three – 10 July to 18 August 2017: Formal consultation period on three options, including a preferred option; full organisational merger of the three CCGs (six week consultation period agreed by Birmingham and Solihull Health Overview and Scrutiny Committees). • Phase four – August/September 2017: Interim and final consultation data analysis and reporting. Scrutiny by NHS England and decision on whether to authorise proceeding with preferred option. Note: phase one and two engagement is now complete.

Pre-consultation engagement themes

Throughout the recent pre-consultation engagement with key partners across Birmingham and Solihull, we have consistently learnt that the following objectives are important to them in the CCGs pursuing a single commissioning voice:

• Overall improved health and better outcomes for patients; • A more sustainable local NHS; • Better integration with the local authorities, especially for social care and preventing poor health outcomes; • Consistency for patients across Birmingham and Solihull; • Ensuring that all patients can access the same high quality service, regardless of where they live in the area; • A strong and strategic NHS commissioning voice to match that of the provider organisations and local authority; • A larger and stronger pool of clinical expertise; and • Maximising on the existing partnerships that the three CCGs currently have. These will be included in the public consultation material and will be debated as part of the consultation.

Issues for consideration

The following issues have been persistently raised and will need to be addressed during consultation:

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• A transparent and genuine engagement and consultation process is expected; • Where the West Birmingham population would fit in any new arrangements for Birmingham and Solihull; • Concern that Birmingham resources will be used to address Solihull CCG’s financial problems; • Where a single CCG would fit within an accountable care system; including the need to maintain good local relationships and a sense of place; • The process if NHS England or stakeholders do not support the preferred option; and • That focus on patient pathways is not lost.

The Birmingham and Solihull Health Commissioning Board are required to duly consider the preferred option in July 2017, as part of the pre-consultation proposal, that will be submitted NHS England by 31 July.

In line with local democratic expectations, the outcome of the consultation will be presented to the HOSCs formally, after the consultation period has ended, and the feedback had been duly considered.

Recommendation

The Governing Body is asked to RECEIVE this report for ASSURANCE.

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Open Action Register : Wednesday 05 Jul 2017

Ref Action By Whom Deadline / Comment / Response Date update Completed 48/17 Quality & Safety Report: Mrs Parker/ Dr September 2017 Patient Falls and Pressure Ulcers are being Outcomes from CNO Scrutiny report Sam subjected to a CNO scrutiny report. Once relating to Patient Falls and Pressure Mukherjee plans are available, these will be shared at Ulcers to be shared with the Governing the SWBH Clinical Quality Review Meeting Body. (CQRM) and with members.

49/17 Quality & Safety Report: Mrs Parker/Dr June 2017 RTT incomplete pathway reached the 92% Referral-to-Treatment (RTT) incomplete Sam target in April 2017. Pathways reached 92% in February 2017. Mukherjee The Governing Body is to receive a further update at the May 2017 meeting.

62/17 Quality & Safety Report: Mrs Parker June 2017 Governing Body members to receive for The dashboard relation to the CQRM information the dashboard relating to reports to be presented at the June CQRM reports. meeting.

145/17 Transforming Care Partnership: Mr June 2017 Mr Williams and Mrs Parker to meet to Review of the proposed Governance Williams/Mrs discuss the governance in relation to the Structure. Parker proposed Governance Structure.

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Ref Action By Whom Deadline / Comment / Response Date update Completed 1138/17 SCR Committee Dr I Sykes June 2017 Following the SCR Committee decision to Following the decision made by the SCR disinvest into the CAB service. An update Committee regarding the disinvestment of about access to the new service was requested. the CAB service. Prof Harding asked that the Committee updates the Governing Body, on how vulnerable people can access the care required from the new service.

178/17 Quality & Safety Report: Mrs Parker/ Dr June 2017 Outcomes from the CQC visit at SWBH to Outcome of the CQC visit at SWBH. Sam be shared with members of the Governing Mukherjee Body.

221/17 Performance Report: Mr J Green An update to be provided by Mr Green to Incomplete RTT pathways. address the concerns raised by Mrs Rawlinson about the 8 patients at UHB who waited over 52 weeks in the trauma and orthopaedics speciality

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