Mid & South Essex Clinical Commissioning Groups Joint

Mid & South Essex Clinical Commissioning Groups Joint Committee Meeting

Part I Public Agenda Thursday, 20 May 2021 from 12.30 pm to 2.30 pm

Members of the public should click here to join the meeting

Action Papers Lead Time Page No. GENERAL BUSINESS 1. Welcome and apologies for To note Verbal Dr Anna Davey - absence 12.30 pm

2. Declarations of interest and To note Attached Dr Anna Davey review of Register of Interests 2

3. Questions from the Public To note Verbal Dr Anna Davey 12.40 pm -

SYSTEM REPORTS 4. Planning Guidance To approve To Karen Wesson and 12.50 pm follow Jo Cripps 5. Vanguard Theatre Contract To approve Attached Mark Barker 1.05 pm 9

6. Mid and South Essex NHS To note Attached Jo Cripps 1.20 pm 15 Foundation Trust Undertakings

7. Adult Mental Health To approve Attached Mark Tebbs 1.30 pm 19 Transformation Plan 2021/22

8. Mid & South Essex Medicines To approve Attached Simon Williams 2.00 pm 30 Optimisaton Committee

9. Committee summary reports:

9.1 Patient Safety & Quality To note Attached Rachel Hearn 43 Committees in Common 2.10 pm

9.2 Finance and Performance To note Attached Mark Barker 46 Committees in Common

10. Any Other Business To note Verbal Dr Anna Davey 2.15 pm -

11. Committee Workplan and To approve Attached Viv Barnes 2.20 pm 49 dates of future meetings.

1 MID & SOUTH ESSEX CCG JOINT COMMITTEE - REGISTER OF INTERESTS (MAY 2021)

Is the Declared Interest Type of interest Actions taken to mitigate First Name Surname Current Position (Name of the organisation and Interest Nature of Interest Date of Interest direct or risk nature of business) Declared indirect?

From To Financial Non-Financial Non-Financial Personal Interest Professional Interest Mark Barker Joint Chief Finance Officer Nil N/A Lesley Buckland Deputy Chair and Lay Member Tapestry UK, Charity/Social x Direct Trustee *2006 Ongoing On Register, further declared if - Governance Business relevant items on agenda Provides day care and home care potentially relate to area of of Elderly and Dementia Clients in declared Interest. Committee Havering Chair decides if not to participate in discussion or need to leave the meeting for particular item.

Anna Davey Chair of Mid Essex CCG and Coggeshall Surgery Provider of x Direct Partner in Practice providing 09/01/17 Ongoing Agreed with line manager that Partner at Coggeshall Surgery General Medical Services General Medical Services I will not be involved in any discussion, decision making, procurement or financial authorisation involving the Coggeshall Surgery or Edgemead Medical Services Ltd

Anna Davey Chair of Mid Essex CCG and Colne Valley Primary Care Network x Direct Partner at The Coggeshall *June Ongoing I will declare my interest if at Partner at Coggeshall Surgery Surgery who are part of the any time issues relevant to the Colne Valley Primary Care organisation are discussed so Network - no formal role that appropriate arrangements within PCN. can be implemented and will not participate in any discussion, decision making, procurement or financial authorisation involving the Colne Valley PCN.

2 MID & SOUTH ESSEX CCG JOINT COMMITTEE - REGISTER OF INTERESTS (MAY 2021)

From To Financial Non-Financial Non-Financial Personal Interest Professional Interest Daniel Doherty Alliance Director, Mid Essex Provide Community Interest x Direct Honorary Clinical Contract Ongoing I am not currently working Company under this contract, but it remains in place to perform clinical work if required. I will declare the interest if necessary so that appropriate arrangements can be implemented

Daniel Doherty Alliance Director, Mid Essex All Saints (CoE) Primary School x Direct Chair of Governors of All Ongoing Agreed with Line Manager that Maldon Saints Primary School it is unlikely that this interest is Maldon relevant to my current position, but I will declare my interest where relevant so that appropriate action can be taken

Daniel Doherty Alliance Director, Mid Essex Active Essex x Direct Board member 25/03/21 Ongoing Agreed with Line Manager that it is unlikely that this interest is relevant to my current position, but I will declare my interest where relevant so that appropriate action can be taken

Patricia D'Orsi NHS Alliance Director Nil N/A (CPR/Southend) Jose Garcia Lobera Southend CCG Chair and GP Partner at Pall x Direct 07/07/17 Ongoing Not part of the commissioning Clinical Lead for Mental Health Mall Surgery process/decision where conflict may occur Jose Garcia Lobera Southend CCG Chair and Trustee of x Indirect 07/07/17 Ongoing Not part of the commissioning Clinical Lead for Mental Health Southend United process/decision where Community and conflict may occur Education Trust

3 MID & SOUTH ESSEX CCG JOINT COMMITTEE - REGISTER OF INTERESTS (MAY 2021)

From To Financial Non-Financial Non-Financial Personal Interest Professional Interest Sunil Gupta Chair of Castle Point & Rushbottom Lane Surgery, x Direct General Practitioner *1995 On-going I will declare my interest if at Rochford CCG Benfleet any time issues relevant to the organisation are discussed so that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & Health Education England x Direct GP Trainer *2004 On-going I will declare my interest if at Rochford CCG any time issues relevant to the organisation are discussed so that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & Health Education England x Direct Associate Postgraduate GP *2018 On-going I will declare my interest if at Rochford CCG Dean for Mid Essex and any time issues relevant to the Basildon organisation are discussed so that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & Royal College of General x Direct Examiner *2004 On-going I will declare my interest if at Rochford CCG Practitioners any time issues relevant to the organisation are discussed so that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & Royal College of General x Direct Member of the Board of the *2013 On-going I will declare my interest if at Rochford CCG Practitioners Essex Faculty any time issues relevant to the organisation are discussed so that appropriate arrangements can be implemented

4 MID & SOUTH ESSEX CCG JOINT COMMITTEE - REGISTER OF INTERESTS (MAY 2021)

From To Financial Non-Financial Non-Financial Personal Interest Professional Interest Sunil Gupta Chair of Castle Point & Royal College of General x Direct Member of the Royal College *2014 On-going I will declare my interest if at Rochford CCG Practitioners of General Practitioners any time issues relevant to the Special Measures Support organisation are discussed so Team that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & Royal College of General x Direct Representative of the Essex *2015 On-going I will declare my interest if at Rochford CCG Practitioners Faculty at the UK Council of any time issues relevant to the Royal College of General organisation are discussed so Practitioners that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & Royal College of General x Direct Representative of the Royal *2016 On-going I will declare my interest if at Rochford CCG Practitioners College of General any time issues relevant to the Practitioners at the National organisation are discussed so Patient Safety Response that appropriate arrangements Advisory Panel can be implemented

Sunil Gupta Chair of Castle Point & Castle Point and Rochford CCG x Direct Member of the Governing *2012 On-going I will declare my interest if at Rochford CCG Body any time issues relevant to the organisation are discussed so that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & Castle Point and Rochford CCG x Direct Clinical Lead for Mental *2014 On-going I will declare my interest if at Rochford CCG Health, Dementia and any time issues relevant to the Primary Care organisation are discussed so that appropriate arrangements can be implemented

5 MID & SOUTH ESSEX CCG JOINT COMMITTEE - REGISTER OF INTERESTS (MAY 2021)

From To Financial Non-Financial Non-Financial Personal Interest Professional Interest Sunil Gupta Chair of Castle Point & East of England Clinical Senate x Direct Member of East of England *2013 On-going I will declare my interest if at Rochford CCG Council Clinical Senate Council any time issues relevant to the organisation are discussed so that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & East of England Clinical Senate x Direct Vice Chair of East of *2017 On-going I will declare my interest if at Rochford CCG Council England Clinicial Senate any time issues relevant to the Council organisation are discussed so that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & Care Quality Commission x Direct GP Advisor for Care Quality *2014 On-going I will declare my interest if at Rochford CCG Commission inspections of any time issues relevant to the General Practices organisation are discussed so that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & National Institute for Health and x Direct Member of the National *2016 On-going I will declare my interest if at Rochford CCG Care Excellence Institute for Health and Care any time issues relevant to the Excellence Quality organisation are discussed so Standards Advisory that appropriate arrangements Committee can be implemented

Sunil Gupta Chair of Castle Point & Anglia Ruskin University x Direct Member of the General *2017 On-going I will declare my interest if at Rochford CCG Practice Curriculum Working any time issues relevant to the Group organisation are discussed so that appropriate arrangements can be implemented

6 MID & SOUTH ESSEX CCG JOINT COMMITTEE - REGISTER OF INTERESTS (MAY 2021)

From To Financial Non-Financial Non-Financial Personal Interest Professional Interest Sunil Gupta Chair of Castle Point & Advisory Committee on Resource x Direct Member of the Advisory *2017 On-going I will declare my interest if at Rochford CCG Allocation Committee on Resource any time issues relevant to the Allocation organisation are discussed so that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & Essex EQUIP Limited x Direct Non-Executive Director of *2017 On-going I will declare my interest if at Rochford CCG Essex EQUIP Ltd any time issues relevant to the organisation are discussed so that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & Queen's Nursing Institute x Direct Trustee of the Queen's *2007 *2010 I will declare my interest if at Rochford CCG Nursing Institute any time issues relevant to the organisation are discussed so that appropriate arrangements can be implemented

Sunil Gupta Chair of Castle Point & Provide x Indirect My wife is a Consultant *2015 On-going I will declare my interest if at Rochford CCG Paediatrician working in Mid any time issues relevant to the Essex for Provide organisation are discussed so that appropriate arrangements can be implemented

William Guy NHS Alliance Director Nil N/A Rachel Hearn Executive(Basildon &Director Brentwood) of Nursing Nil N/A & Quality

Anil Kallil Chair of Thurrock CCG Orsett Surgery x Direct GP Partner 01/01/10 On-going I will declare my interest if at any time issues relevant to the organisation are discussed so that appropriate arrangements can be implemented

7 MID & SOUTH ESSEX CCG JOINT COMMITTEE - REGISTER OF INTERESTS (MAY 2021)

From To Financial Non-Financial Non-Financial Personal Interest Professional Interest Anthony McKeever Joint Accountable Officer and MACS et al Ltd x Direct Director of wholly owned 01/09/00 On-going I will declare my interest if at Executive Lead for Mid and company through which I any time issues relevant to South Essex ICS contract with the NHS for MACS et al Ltd are discussed interim and other services. so that appropriate arrangements can be implemented.

Boye Tayo Chair, Basildon & Brentwood Robert Frew Medical Centre x Direct GP partner *2003 Present To declare at all relevant CCG meetings and keep records updated.

Boye Tayo Chair, Basildon & Brentwood GP with special interest in x Direct Provides intermediate *2006 Ongoing To declare at all relevant CCG Ophthalmology ophthalmology care for meetings and keep records Thurrock and BBCCG updated. patients. Boye Tayo Chair, Basildon & Brentwood SEMC Ltd - APMS Provider x Direct Chair of Health staff owned *2011 Ongoing To declare at all relevant CCG company. Presently has no meetings and keep records contract. updated. Boye Tayo Chair, Basildon & Brentwood Mavens Medical Ltd – Healthcare x Direct Director of Private medical *2017 Ongoing To declare at all relevant CCG Consultancy company providing medical meetings and keep records staff and consultancy. updated. Boye Tayo Chair, Basildon & Brentwood Wickford Primary Care Network x Direct Member 01/07/19 Ongoing To declare at all relevant CCG meetings and keep records updated.

Mark Tebbs NHS Alliance Director Nil N/A (Thurrock)

Agenda Item 5

M&SE CCG JOINT COMMITTEE MEETING OF 20 MAY 2021

MID AND SOUTH ESSEX NHS FOUNDATION TRUST VANGUARD (MOBILE THEATRES) BUSINESS CASE

Purpose of Report: To brief the Joint Committee on the Mid and South Essex Foundation Trust (MSEFT) Vanguard (Mobile Theatres) Business Case.

Recommendations and The Joint Committee is asked to retrospectively ratify the decision made decision/actions: during the Covid-19 incident to invest in mobile theatres at MSEFT for complex General Anaesthetic activity.

Executive Summary Covid-19 Waves I and II caused MSEFT to respond in unprecedented (including financial impact): ways to manage the pandemic. Part of the response was the cessation/reduction of all elective activity. Despite efforts post Wave I to recover, the referral to treatment position has grown and it has now become untenable to deliver recovery without investment in some service areas. A key constraint has been access to theatres for complex General Anaesthetic activity, which it has not been possible to transfer to Independent Sector Partners. Consequently, MSEFT, as the only NHS acute provider within the system footprint, have entered into a contract for three mobile theatres, with an accompanying compliment of staff, to help address the elective activity backlog within the system.

The cost of the preferred option (Option 2) is £16.3m revenue (including £1.3m enabling works).

Written by/Presented by: Andy Ray, Chief Finance Officer for M&SE Joint Commissioning Team

Executive Director Mark Barker, Executive Chief Finance Officer (M&SE CCGs) Sponsor:

Fit with CCG Strategic Objective 2: Improve access to services for patients in line with NHS Objectives Plan requirements.

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

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

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

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

Risks / Link to BAF: Risk Ref FIN06

Conflicts of Interest: None identified

Escalation: None. To CCG Boards, other Committee or BAF

ELECTIVE RECOVERY FRAMEWORK (ERF) MSEFT VANGUARD (MOBILE THEATRES) BUSINESS CASE

Purpose

To brief the Joint Committee on the Mid and South Essex Foundation Trust (MSEFT) Vanguard (Mobile Theatres) Business Case.

Background

In 2020/2021 COVID19 Wave I and Wave II caused the Mid & South Essex NHS FT (MSEFT) to ro respond in unprecedented ways to manage the pandemic. Part of the response was reduction and cessation of all elective activity. As a result and despite efforts post Wave I to recover, the referral to treatment (RTT) position has grown and in particular services it has now become untenable to deliver recovery in this position without investment. A key constraint to management of elective activity has been access to theatres for complex General Anaesthetic (GA) activity as all other activity (Local Anaesthetic (LA) and GA) can and has been transferred to Independent Sector Partners.

Nationally, regionally and locally we are expected to reinstate all elective activity as soon as possible. MSEFT is a significant regional and national outlier with regard to 52 week waits, with an increase from 832 patients (April 2020) to 8,509 patients (24 March 2021) over the past 12 months.

Elective care recovery and associated expenditure is an important section of the local health and care system financial plan. Prior to the pandemic the local health system had one of the worst performances on RTT waiting times and the number of patients waiting has increased over the last year.

The discussions with ISPs about capacity have been encouraging and a significant increase in capacity is available for 2021/22. The decision to proceed to utilise this capacity has been agreed.

However the more this activity can be accommodated within current NHS capacity via productivity gains, the more cost effective this activity becomes to be delivered and mitigates against the system having to incur the additional ISP spend.

MSEFT, as the only NHS acute provider within the system footprint, have entered into a contract for three mobile theatres, with an accompanying compliment of staff, to help address the elective activity backlog within the system. The Trust have committed to an option to purchase three theatres for 12 months, with a break-clause after 6 months to allow the increased delivery of activity particularly in the two greater backlog areas of Trauma & Orthopaedics and Ophthalmology..

The Trust have modelled the expenditure of the mobiles against the expected elective incentive payments that should be generated as a result of the additional activity delivered within these specialties as a result of both internal improvements in productivity and additional activity performance within the organisations, as well as the additional activity

within the theatres. The gross cost of this (excluding elective incentive funding) is £16.3m, inclusive of £1.3m of enabling works.

This initiative should deliver at least 2,157 additional spells in 2021/22 if the theatres are retained for the whole year. The break clause gives the system the opportunity to terminate the agreement if the elective incentive scheme does not run for the whole year, or it the levels of activity are compromised by any further pandemic surges.

The mobile theatre scenarios and financials, as included in the final business case, are as follows:

Option 2 – Option 3 – Option 4 – 3 Theatres all 3 theatres 6 2 theatres 6 year months, 2 months theatres 6 months Cost £15.0m £12.2m £9.2m Estates Cost £1.3m £1.3m £0.6m Total Cost £16.3m £13.5m £9.8m Total Activity 2,961 2,673 2,157 Upside Elective £16.3m £13.7m £9.4m Incentive Average Tariff £12.4m £10.6m £7.4m Elective Incentive Risk based on £3.6m £2.9m £2m average tariff Additional patients 804 516 - treated compared to (£1,990 per (£1,744 per Option 3 (lowest risk) patient) patient) Additional Cost per £5,505 £5,050 £4,543 case *(Option 1 was a ‘do nothing’ option)

Whilst the modelling carried out suggests that appropriate utilisation of the theatres with a rich case mix, as is the case with the backlog, should cover the costs of the investment through the generation of the elective recovery fund, there is an element of risk to this which the Trust has estimated in the region of £2.5m to £3.5m. Following conversations with both the regional team and key leaders in the system, it was agreed that this was the right decision to take in the interests of the patients of our population.

Robust internal financial governance arrangements will be required to operate with clearly defined delegations and accountabilities on how expenditure is incurred to deliver the required elective activity.

Preferred Option

The case for investment for the preferred option (option 2) is £16.3m revenue including £1.3m enabling works.

Commitment to support the case for investment will result in an increase in delivery of the baseline activity plans as follows:

• Ophthalmology – increase to 111% of 2019/20 Baseline • Orthopaedics – increase to 135% of 2019/20 elective Baseline (option 2) or 128% of 2019/20 elective Baseline (option 3). Option 2 Detail

Three mobile theatres (Ophthalmology at Broomfield, T&O at Basildon, general surgery at Southend), Insourced theatre team for ophthalmology at Southend for 12 months.

• Fully resourced mobile unit – 3 x theatres and a mobile day stay ward - at Broomfield for Ophthalmology and Basildon for Trauma and Orthopaedics and General Surgery at Southend to release capacity in main theatres to do more T&O cases.

• Ophthalmology – 70 day cases per month rising to 200 day cases per month • Orthopaedics – 84 elective cases per month at Basildon and an additional 60 cases at Southend • Theatre staff provided by mobile unit suppliers, supplemented by temporary staffing solutions for other staff groups. • Insourced team to support in-house theatre activity for Ophthalmology at Southend • Ophthalmology – additional 50 cases per month The advantages of this option are:

• Reduces need for in house theatre team provides stable assurance on activity • On site patients would not be have to travel to another ISP provider site • Ring-fenced theatre dedicated to ophthalmology and trauma and orthopaedics • Potential to operate 7 days a week • Surgeons allocated theatre sessions with little chance of cancellations • Potential increase in activity if layout is designed to improve flow as well as offer to other specialities • Provides enhanced capacity for ophthalmology in Southend locality • Additional provision on two sites for Orthopaedics – meaning reduced travel for patients than having one site providing additional activity. Timescale

Latest discussions with the proposed supplier indicate a best case scenario start date of mid May, though this is subject to completion of required enabling works – in particular hard base for units on the Broomfield site. Activity profiling has assumed a June 2021 start with T&O a mid-June start and therefore there is the potential that there may be upside in

the case if we commence earlier, being able to capitalise more on the more advantageous months of the elective recovery fund.

Benefits Appraisal

• Reduced clinical harm • Reduction of 52 week waits for Ophthalmology and Trauma and Orthopaedics increase in activity on all sites if the service is provided with its own theatre staff/insource support. • Improvement in overall RTT position and will bring service down towards a sustainable 18 week target. • Releases theatre capacity at Broomfield (day case) from ophthalmology for use by other specialties. • Reduced dependency on Independent sector • Delivery of activity plan commensurate with 52 week wait reduction Recommendation

The Joint Committee is asked to retrospectively ratify the decision made during the Covid- 19 incident to invest in mobile theatres at MSEFT for complex General Anaesthetic activity.

Agenda Item 6

M&SE CCG JOINT COMMITTEE MEETING OF 20 MAY 2021

MID AND SOUTH ESSEX NHS FOUNDATION TRUST LEGAL UNDERTAKINGS SUMMARY POSITION

Purpose of Report: The purpose of this paper is to update the Joint Committee on progress made by the Mid and South Essex NHS Foundation Trust (MSEFT) against each of the five classes of undertaking.

Recommendations and The Joint Committee is asked to note the progress made against decision/actions: the Legal Undertakings.

Executive Summary: MSEFT has been found in breach of its licence and has agreed a set of undertakings with NHS England and NHS Improvement (NHSE/I) in respect of the following headline themes:

• Governance (Class 1) • Inadequate maternity services (Class 2) • Harm review process (Class 3) • Delayed diagnosis and treatment of cancer patients (Class 4) • Growth in elective backlog (Class 5) These undertakings were formalised in writing by NHSE/I on 14 December 2020 and formally approved by the MSEFT Board on 17 December 2020.

Plans for exiting each class of undertakings have been developed and will be taken to the System Oversight Assurance Group (SOAG) on 24 May for endorsement. The focus is on MSEFT’s ability to demonstrate change has been embedded and lessons learned throughout the Legal Undertaking process. In addition to this class by class exit approach, MSEFT also intends to produce a report which will examine, in a more holistic sense, the changes made over the course of the undertakings period. This recognises that whist undertakings are quite targeted in their areas of focus, this by definition means there is a risk of placing focus on these targets whilst failing to achieve more widespread change in performance.

Presented by: Jo Cripps, Programme Director, Mid and South Essex Health Care Partnership Integrated Care System

Executive Director Jonathan Dunk, Chief Commercial Officer, Mid and South Essex Sponsor: NHS Foundation Trust

Fit with CCG Strategic Aligns to the CCG objectives. Objectives

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this The Mid and South Essex System Oversight and Ongoing document). Assurance Group (SOAG) review progress against the undertakings on a monthly basis.

MSEFT Board monitors progress against the Legal Ongoing Undertakings.

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

Has an Equality/Quality/Privacy Impact Assessment Yes been carried out and issues addressed?

Details of Stakeholder, Patient Patient and stakeholder engagement is being undertaken to & Public Engagement: support continued improvement in relation to patient outcomes and experience.

Risks / Link to Board Delivery of the Legal Undertakings is key to Assurance Framework (BAF): addressing performance related risks outlined within the CCGs’ BAF in resepct of Covid restoration.

Conflicts of Interest: N/A

Escalation: To CCG Boards, other Committee or BAF

LEGAL UNDERTAKINGS SUMMARY POSITION

1. Background

1.1 Mid and South Essex NHS Foundation Trust (MSEFT) has been found in breach of its licence and has agreed a set of undertakings with NHS England and NHS Improvement (NHSE/I) in respect of the following headline themes:

1.2 These undertakings were formalised in writing by NHSE/I on 14 December 2020 and formally approved by the Trust Board on 17 December 2020.

1.3 The purpose is to update CCG Boards (via the Joint Committee) as lead commissioners on summary high level progress made against each of the five classes of undertaking and noting the more substantive assurance roles being undertaken by the MSEFT Board and the System Oversight and Assurance Group (SOAG).

2. Governance

2.1 Progress against the classes of undertaking is reported to the MSEFT Audit Committee and Board and external oversight is at SOAG where monthly updates are received. NHSE/I hold the legal responsibility on undertakings therefore agreement to exit Legal Undertakings will be formally approved at the Regional Steering Group.

2.2 To note, there was a pause to undertaking reporting during the Covid-19 pandemic related Major Incident, however this recommenced fully in March 2021.

3. Progress against classes of Undertaking

The 5 classes of undertaking are largely on track. The following table gives an extract of weekly reporting as at 6 May 2021:

Class Current Project Commentary Status Delivery Status

Governance Governance action plan is on track with ongoing oversight of plan and risks by the governance working group. Class of undertaking currently amber in recognition of risks around delivery of some milestones in the plan, in particular the single risk management system.

Inadequate Progress is in line with plans. Focus is on embedding change before requesting exit maternity services from Section 31.

Harm review Cancer and RTT harm review backlogs are cleared and services now in business as process usual. Final report on findings of harm to be presented at the MSEFT Quality Forum in May 2021. Ongoing monitoring of business as usual processes to ensure no further backlog is formed.

Delayed diagnosis Cancer improvement plan is on track and the Broomfield Chemotherapy new unit opened and treatment of on 27 April. Ongoing oversight of the plan by the Cancer Committee. Class currently cancer rated as amber to reflect the delay in receiving the Royal College of Surgeons’ recommendations and the volume of cancer activity cancelled due to the Major Incident.

Growth in elective Revised milestones endorsed by the MSEFT Board and SOAG in April 2021. Trajectory backlog for Q1 position was also agreed at the April SOAG and current performance is on track against the trajectory.

Agenda Item 7

M&SE CCG JOINT COMMITTEE MEETING OF 20 MAY 2021.

MID AND SOUTH ESSEX ADULT MENTAL HEALTH LONG TERM PLAN TRANSFORMATION PLANNING 2021/22

Purpose of Report: The purpose of this report is:

• To provide an overview of the Mid and South Essex (MSE) Adult Mental Health Long Term Plan (LTP) Transformation Programme. • To describe the Serious Mental Illness (SMI) Community Transformation – Integrated Primary and Community Care Mental Health to be embedded in Primary Care Networks (PCN) and delivered at Place as the focus for 2021-22 deliverables. • To present the Adult Mental Health Transformation 2021-22 Planning Submission which includes Workforce and Finance Plans for sign off.

Recommendations Members of the Joint Committee are asked to: and decision/actions: 1. Note the Adult Mental Health LTP Transformation Programme and the pro-active steps being taken to address gaps and improve services. 2. Endorse the SMI Community Transformation Integrated Primary and Community Care Mental Health Offer for PCNs/Place as outlined in the main report. 3. Approve the investments as per the 2021-22 Planning submission to enable contractual arrangements to proceed and flow funds to providers in a timely manner as described in the provider summary below and further in the finance overview.

PROVIDERS MSE EPUT 8,241 Vita Health 697 Thurrock Mind 303 Other 2,578 HPFT 805 CHC & Prescribing 395 MPFT 1,487 NELFT 2,576 AFC Reserve 1,885 Other Inflation 192 GRAND TOTAL 19,160

The committee is asked to note that work is still ongoing to further validate the workforce plan against the transformation plan. It is not expected that there will be any material change in the investment plans indicated, however the workforce plan will vary as the validation concludes in time for the final submission in June. Executive Introduction Summary There has been an inevitable impact in 2020/21 on the expansion and transformation of mental health services. Action is needed in 2021/22 to invest, expand and fast-track

(including financial the transformation of mental health services to ensure that people are able to access impact): the care they need. Covid-19 is expected to lead to a significant increase in demand for mental health services, with evidence of services already seeing increased acuity and referral rates.

Transformation plans had paused during the height of the pandemic to enable response and staff redeployment and ensure patient safety. The Mid and South Essex 24-7 Mental Health Crisis Response and Care service via 111 option 2 and complemented by 3 Voluntary Sector led Crisis Sanctuaries, launched in April 2020 and has played a crucial role in reducing the need for people to present at A&E receiving just under 31,000 calls over the 12 month period.

Much progress has been made on Mental Health Transformation in MSE including building of stronger collaborations and partnerships to ensure we meet needs as seamlessly as possible and improve the service offer and experience for people using mental health services.

In MSE the service models have been co-produced by local partners and stakeholders including service users and their families and carers. The development and Plan has been undertaken through the leadership of the Mental Health Partnership Board (MHPB) where all plans are signed off and any escalations are managed. There is acknowledgement that disparities in service offers and delivery exist across the system resulting in an Amber rating. Work is underway to review governance, clinical leadership, structures and processes to enable effective delivery of System/Place responsibilities and arrangements, with support from the NHS England/Improvement regional team to ensure MSE performance delivers standards as routinely as possible.

Recruitment is a challenge and, as new models of care have been co-produced, workforce plans have been developed in discussion with providers to ensure that the service offers are staffed with the right skills mix and capacity to meet the presenting needs. Various innovative options that include training to develop local capacity resilience are being explored and implemented as recruitment always presents with challenge.

More investment has been made to the Voluntary, Community and Social Enterprise Sector (VCSE) organisations which often support people in more flexible ways than Statutory organisations. Through Health Education England MSE has also been able to access training places to develop Peer Support Workers roles further, with a number of the VCSE providers taking up these opportunities. The workforce plans will be monitored by a workforce group that will report to the People Board.

Adult Mental Health Transformation Programme The MSE Adult Mental Health Transformation Programme that will deliver the NHS LTP commitments for Adult Mental Health covers three broad areas: • Urgent and Emergency Care Mental Health to improve on crisis response and care; • SMI Community – Integrated Primary and Community Care Mental Health offer to be delivered in PCNs integrating social care, mental health and physical health; • MH Accommodation to ensure a mix of types of housing and greater flexibility in its use to provide for short-term use in crises, mid-term support and long- term accommodation to meet the diverse needs and complexities.

Focus of Adult Mental Health Transformation in 2021-22 Community mental health services have long played a crucial role in the delivery of mental health care, providing vital support to people with mental health problems closer to their homes and communities. However, the model of care is now in need of fundamental transformation and modernisation as: • Neither primary nor community care mental health services are currently able to meet all presenting needs. There are significant gaps especially for those people whose needs are more complex than primary care alone can meet but at the same time do not meet the secondary care thresholds; • The current arrangements for the provision of psychological therapies for people with Severe Mental Illness (SMI) are significantly limited resulting in long waiting lists for both assessments and treatments. • There is recognition that people with Personality Disorders and Complex Needs e.g. Eating Disorders require a more personalised approach to their care to enable better outcomes and patient experience. The ambition for the NHS LTP is to “establish new and integrated models of primary and community mental health care to support at least 370,000 adults and older adults per year who have severe mental illnesses by 2023/24, so that they will have greater choice and control over their care, and be supported to live well in their communities.”

Finance overview The mental health programme has ringfenced and committed funding, which will be used to grow the workforce significantly and expand and transform mental health services. In 2021/22, this funding is supplemented by additional funding announced in the Spending Review to address the mental health impacts of Covid. All CCGs must, as a minimum, invest in mental health services to meet the Mental Health Investment Standard and need to demonstrate growth in core mental health services will be equal to or greater than the overall growth in mental health spend. MSE committed to invest over and above the MHIS in 2021-22 to ensure delivery of an offer that meets all Severe Mental Illness and complex care needs, completely transforming the current model that presents with barriers to seamless patient care, the focus of transformation in 2021-22. The investment plans were ratified by the CCGs Finance and Performance Committee in Common on 21.04.2021.

FUNDING B&B CPR MID SND THU MSE MENTAL HEALTH INVESTMENT STANDARD 1,742 923 1,938 1,777 1,219 7,599 COMPREHENSIVE SPENDING REVIEW 1,115 683 1,470 1,053 679 5,000 SERVICE DEVELOPMENT FUNDING 330 196 430 318 4,987 6,261 MSE INCREASED INVESTMENT - - 300 - - 300 GRAND TOTAL 3,187 1,802 4,138 3,148 6,885 19,160 MHIS Summary 2020/21 MHIS Outturn as at Month 12 £'000 180,644 2021/22 Growth in CCG allocations % 4.20% 2021/22 Minimum Mental Health spend to meet MHIS £'000 188,234 2021/22 Planned MHIS spend £'000 188,235 2021/22 MHIS achieved YES/NO Yes

2021/22 MHIS Planned Over/(Under) Achievement £'000 1

Contracts Due to the impact of Covid-19, routine contracting functions and mechanisms were reduced. This also included the roll out of a Covid financial regime which has temporarily changed how we are able to pay providers (previously facilitated by using the contract variation process outlined in the NHS Standard Contract (CVs).

In order to facilitate the roll out of funding to all Mental Health providers identified within the plan, it has been necessary to issue ‘Letters of Intent’ as an addition or alternative to providers, which should give the level of assurances they require to start recruiting or commence service provision. NHSE guidance states that providers should be paid as soon as possible. Block payments values should be adjusted at the earliest opportunity rather than at point of expected recruitment. Any unused monies should be returned to CCGs later in the financial year if recruitment or the development has not delivered as planned.

Risks and Issues The main risks to fully implementing the SMI Transformation in 2021-22 are: • recruitment especially of clinical staff; • interoperability of IT systems; • information sharing between providers; • starting point of each Place; • any delays linked to the ICS/White Paper developments. A risk and issues management plan is in place. PIA, EQIA and other assurance plans are in development.

Benefits realisation • MSE will be able to demonstrate meeting the LTP ambitions by increasing investment, growing the workforce and implement a PCN focused new model of care for community mental health. • Right place, right person, right time for patients improving patient experience and health outcomes. • Reduction of managing upstream needs as default on the UECMH system. • Measure a reduction in system service utilisation. • Ease pressure on GPs. Written Stephen Thatcher – Associate Director of Contract Finance by/Presented by: Jo Gansbhueler – Head of Contracts Lee Bushell – Deputy Chief Finance Officer Jane Itangata – AD MH Commissioning MSE and TCCG

Executive Director Mark Tebbs – Alliance Director and Mental Health SRO Sponsor:

CCG Strategic • Implementation of the NHS LTP Commitments for Adult Mental Health in 2021-22 Objectives • Restoration and Recovery – Covid

Approval Route: Group/Committee Date

MSE Mental Health Partnership Board 26.03.2021

(List F&P Joint committee 21.04.2021 Groups/Committees CCG Boards 28-29.04.2021 that have reviewed this document).

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

Details of Stakeholder, Patient & Public Engagement:

Risks / Link to BAF: The Adult Mental Health Transformation Programme is listed BAF Ref in the MSE BAF.

Conflicts of Interest: None identified

Escalation: System Oversight and Assurance Group (SOAG) To CCG Boards, other People Board Committee or BAF NHS E-I Assurance Board

MID AND SOUTH ESSEX ADULT MENTAL HEALTH LONG TERM PLAN TRANSFORMATION PLANNING 2021/22

SMI Community Transformation – Integrated Primary and Community Care Mental Health

National/Local The ambition for the NHS LTP is to “establish new and integrated standard or objective models of primary and community mental health care to support at least 370,000 adults and older adults per year who have severe mental illnesses by 2023/24, so that they will have greater choice and control over their care, and be supported to live well in their communities.”

Key Issue 1 Implementation of the SMI New Model of Care – no primary care/secondary care divide but a seamless, clinically appropriate offer based on needs and level of complexity embedded in PCNs and delivered at Place.

Key Issue 2 Provision of psychological therapies for people with Severe Mental Illness (SMI) and sustainably reduce long waiting lists.

Key Issue 3 Targeted implementation of the SMI Physical Health Checks

Key Issue 4 Personalised care for people with Personality Disorders and Complex Needs e.g. Eating Disorders to enable better outcomes and patient experience

Time scale for Q4 2021-22 benefits to be realised

Risks Workforce recruitment

Purpose

To provide the committee with the description of the SMI Community Transformation – Integrated Primary and Community Care Mental Health offer to be embedded in the 28 MSE PCNs and delivered at Place as the main focus for 2021-22 and enable investment sign-off.

Background

The current MSE CMH service largely viewed by stakeholders as a medical model, is characterised by delays in accessing treatment, waiting lists for psychological interventions, high did not attend (DNA) rates, cancellations with a Primary-Secondary Care divide accessed via GP referrals resulting in multiple assessments.

Data shows that under 40% of the referrals made by GPs receive a service, with a number delayed in the system as their needs are too complex for primary care but don’t meet secondary care thresholds; GPs are left holding this risk without the required expertise and support.

Patient experience and outcomes are variable but routinely reported as needing improvement. Consultants are vocal that this primary-secondary care model is unsustainable and inefficient as holding large outpatient caseloads of mainly social needs with little therapeutic input, doesn’t provide effective patient care.

In response, system stakeholders using learning from the Early Implementer sites embarked on a 4yr transformation programme to address needs by:

• Investing in community assets with a focus on recovery and person-centred care; • Strengthening co-production and decision-making as equal partners and building relationships to develop a holistic offer taking wider social determinants of health into account.

Key Points

The service will provide improved access to psychological therapies, improved physical health care, individual placement and support (IPS) / employment support, personalised and trauma-informed care, medicines management and support for self-harm and co-existing substance misuse to:

• Be delivered by Integrated MH teams in PCNs including consultant clinics which will mean people requiring support will be seen at the earliest time possible by the appropriate professional and removing the need for multiple assessments and ending the primary/secondary care divide; • Provide an appropriate MH Outpatients redesigned service offer that will be person- centred and holistic, promote independence and build resilience;

The new trauma-informed SMI model of care will improve access and treatment for people with a diagnosis of Personality Disorder, and those in need of Early Intervention in Psychosis (EIP), Adult Community Eating Disorder services and Mental Health Community-based Rehabilitation and further increase the number of people with Severe Mental Illnesses (SMI) receiving physical health checks and are supported via the Individual Placement and Support programme to get and maintain paid employment.

Next steps

• Progress contractual arrangements to enable funds to flow to providers and active recruitment to commence; • Complete the development of the MSE Transformation and Implementation Plans, aligned with the Workforce and Finance Plans and Performance; • Continue phasing in of the New Model of Care in PCNs • Complete service specifications, Equality/Quality/Privacy Impact Assessments; • Monitoring, finance and recruitment tracking processes to be embedded in the implementation.

Urgent and Emergency Care mental Health

National/Local • There will be 100% coverage of 24/7 age-appropriate crisis Standard or objective care, via NHS 111, including:  24/7 CRHT functions for adults, operating in line with best practice by 2020/21 and maintaining coverage to 2023/24;  A range of complementary and alternative crisis services to A&E and admission (including in VCSE- /local authority-provided services) within all local mental health crisis pathways; • Ambulance and mental health services work together so that mental health professionals are available to support triage, on-scene response and conveyance by ambulance of people with MH needs. Depending on local models, this may include integrated provision between 111/999 services. • Increase % of people detained under s.136 of the Mental Health Act, who are conveyed by ambulance (and reduce % conveyed by police). • Reduce avoidable conveyance to emergency departments.

Key Issue 1 Develop and implement with EEAST a model of MH support for Ambulance Crews responding to MH related incidents.

Key Issue 2 Implement a Crisis House offer to support admission avoidance and ease pressure on In-patient services

Timescale for benefits Q3 2021-22 to be realised

Risks Workforce recruitment

Purpose

To provide the committee with the description of the Urgent and Emergency Care Mental Health offer and in particular the support for Ambulance so as to reduce conveyances to A&E, ensure support for s136 detained patients and a crisis house offer to support admission avoidance.

Background

People facing a mental health crisis should have access to care 7 days a week and 24 hours a day in the same way that they are able to get access to urgent physical health care. Getting the right care in the right place at the right time is vital. Failure to provide care early on means that the acute end of mental health care and A&E Departments will routinely be under immense pressure.

24-7 MH Community Crisis Response and MH Crisis Sanctuaries – is a consultant led 24-7 MH Crisis service accessed via 111 that launched in April 2020 covering the whole of Mid

and South Essex. It is resourced to offer timely triage, assessments and intensive home treatment as an alternative to an acute inpatient admission. It is supported by 3 VCSE run non-accommodation MH Crisis Sanctuaries that provide the non-clinical support for needs that trigger crisis such as isolation, bereavement, unemployment, debt, relationship issues. The service has received about 30,943 calls in the first year of operation with the Sanctuaries supporting more than 1500 people.

The service also provides dedicated access lines to GPs, Police, Ambulance and other professionals such as Social Care. Ambulance also have been provided by EPUT ‘read only’ access to patient records so that crews can access care plans when they respond to any patients known to EPUT.

Key Points

• MSE successfully bid for £533k to set up the first MSE accommodation-based MH Crisis house (Sanctuary plus) to provide people in crisis short term respite as an alternative to inpatient admission and under the clinical supervision of the Home Treatment Teams, another initiative to avoid admission and ease pressure on inpatients beds. This will complement the current Crisis offer and supporting admission avoidance. • Work is due to commence to develop the last phase for the Ambulance support to ensure that crews are supported on the scene and MH takes over after patients have been medically cleared. • This will reduce need to convey, reduce multiple assessments and hand-offs improving patient experience and release Ambulance crews so they can respond to other emergencies.

Next steps

• Implement the Crisis House offer – a collaboration between EPUT and Thurrock & Brentwood Mind; • Continue recruitment into the 24-7 Crisis Response Service to further enhance and embed the service to offer a flexible and comprehensive response to those in a mental health crisis. • Co-produce the remaining aspect of the mental health support for Ambulance to enable on-scene response

Inpatient Services

National/Local • Deliver and maintain the ambition to eliminate all Standard or objective inappropriate adult and older adult acute out of area placements by end of Q2 2021/22. • Continue investment in improving the therapeutic offer to improve outcomes and experience from inpatient care, and work to decrease long lengths of hospital stay, with a focus on reducing the number of adults in acute care with a stay over 60 days. • Continue delivering the 72-hour post discharge follow-up standard.

Key Issue 1 Continue implementing lessons learned during the multi-agency discharge events (MADE) to support discharge and reduce Delayed Transfer of Care (DTOC).

Key Issue 2 Phase in the co-produced therapeutic offer in the MH Acute services to reduce length of stay (LOS)

Time scale for Q3 2021-22 benefits to be realised

Risks Workforce recruitment

Purpose To provide the committee with the description of the work in progress to reduce Length of Stay (LOS), Delayed Transfers of Care (DTOC) and inappropriate Out of Area Placements (OAP).

Background There is currently high demand on acute mental health inpatient beds, with a significant increase in use of out of area placements since June 2020. The pressure on acute inpatient beds is due to an increase in acute mental health presentations requiring inpatient intervention and management, further compounded by the need for some inpatient wards to reduce bed numbers to due to Covid-19 and the need to implement effective Infection Prevention and Control (IPC) measures in light of the pandemic.

On the Basildon Mental Health Unit site, dormitory accommodation is still provided comprising of 5 beds in each dormitory. The number of patients per dormitory has been reduced to 3 in order to meet social distancing requirements.

During Winter MSE received circa. £1.1m winter pressures/discharge funding and a number of initiatives were put in place to support admission avoidance, review discharge planning through the MADE events (supported by NHSE/I) targeted at the bottlenecks that cause DTOC, extended LOS resulting in OAP.

Key Points

• Through the Comprehensive Spending Review MSE has received just under £1.5m to further secure the lessons learned during the winter initiatives and MADE events so that updated discharge planning policies and protocols can be sustainably mainstreamed; • MSE is an outlier nationally for Length of Stay (LOS); • Work is underway to co-produce an enhanced therapeutic offer in inpatient services to improve patient experience and outcomes as well as reduce long lengths of hospital stay.

Next steps

Apart from discharge processes system partners are working together to review the mental health accommodation offer to ensure a mix of types of housing and greater flexibility in its use to provide for short-term use in crises, mid-term support and long-term accommodation to meet the diverse needs and complexities. The work will focus on:

• Developing a comprehensive service offer for people with complex psychosis and reduce the need to place them in out of area placements, away for their families and networks; • Improve the Inpatient services therapeutic offer as improving quality facilitates recovery and reduces LOS; • Redesign of the Local Authorities MH Accommodation Strategies to enable housing options that flex to meet diverse mental health needs including rough sleeping and, in the process, reduce Delayed Transfer of Care; • Dormitories redesign in the EPUT sites to meet CQC requirement for EPUT to move to single room provision.

Recommendations

Members of the Joint Committee are asked to:

1. Note the Adult Mental Health LTP Transformation Programme and the pro-active steps being taken to address gaps and improve services. 2. Endorse the SMI Community Transformation Integrated Primary and Community Care Mental Health Offer for PCNs/Place as outlined in the main report. 3. Approve the investments as per the 2021-22 Planning submission to enable contractual arrangements to proceed and flow funds to providers in a timely manner as described in the provider summary below and further in the finance overview.

Agenda Item 8

M&SE CCG JOINT COMMITTEE MEETING OF 20 MAY 2021

MID AND SOUTH ESSEX HEALTH AND CARE PARTNERSHIP MEDICINES OPTIMISATION COMMITTEE (MSEMOC)

Purpose of Report: The purpose of this paper is to clarify the decision making authority of the MSEMOC and, pending approval of the amended MSEMOC Terms of Reference, to ratify the recommendations made at the MSEMOC meeting on 5 May 2021.

Recommendations and The JC is asked to note the report and approve the amended decision/actions: Terms of Reference of the MSEMOC.

Executive Summary The Mid and South Essex Health and Care Partnership Medicines (including financial impact): Optimisation Committee (MSEMOC) is an over-arching local decision-making group for CCG commissioned medicines. The MSEMOC was established in October 2020 to have a single decision making committee for the system, after an extensive consultation with all system stakeholders. The MSEMOC memberships includes representation from all system partners.

As the original Terms of Reference of the MSEMOC did not specify its decision making authority, its recommendations have historically been presented to the Joint Committee for ratification. The Terms of Reference have now been amended to clarify that the MSEMOC has delegated authority to make decisions regarding the commissioning of new medicines and new uses of existing medicines commissioned by the mid and south Essex CCGs.

The financial implications of potential MSEMOC decisions will be considered by the Mid and South Essex CCGs Chief Finance Officer or appropriate CCG committee, determined by limits of financial delegation. This will be concluded prior to the MSEMOC meeting to inform the final decision making process. MSEMOC decisions will be summarised and presented for noting to the Joint Committee every quarter for oversight.

The amended MSEMOC Terms of Reference are set out in Appendix 1 to this report.

Pending approval of the amended Terms of Reference, the JC is also asked to ratify the following documents, guidelines and treatment pathways agreed by the MSEMOC at its meeting on 5 May 2021:

1. Joint infection formulary 2. Policy for the order of home oxygen to patients who are known to smoke

3. Principles and approach to biologic treatment pathway development and use of biologics in situations not covered by NICE Technology Appraisals 4. Guidelines for proton pump inhibitor (PPI) use in paediatric patients 5. Guidelines for the appropriate prescribing of specialist infant formulae (IF) 6. Guidelines for the appropriate use of oral nutritional supplements (ONS) for adult in primary care 7. Defining boundaries between NHS and private healthcare policy – East of England Priorities Advisory Committee (PAC) policy 8. Topical treatment pathway for management of psoriasis in primary care for adults, children and young people 9. Treatment of severe plaque psoriasis in adults AFTER the use of systemic treatments have failed 10. Position statement for Alprostadil cream 11. Position statement for Dapoxetine 12. Position statement for Low dose naltrexone 13. Position statement for Co-proxamol 14. Position statement for Lidocaine 5% medicated plasters 15. Position statement for Sucralfate suspension

Further information on the above decisions is available to Committee members on request.

Written by/Presented by: Sanjeev Sharma, Pharmacy Lead Commissioner Acute, Mid and South Essex CCGs, Acute Commissioning Team Simon Williams, Director of Partnerships and Integration, South East Essex CCGs

Executive Director Anthony McKeever, Executive Lead Mid and South Essex Health Sponsor: and Care Partnership & Joint Accountable Officer for its 5 CCGs

Fit with CCG Strategic Yes Objectives

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

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

Has an Equality/Quality/Privacy Impact Assessment N/A been carried out and issues addressed?

Details of Stakeholder, Patient Discussion with Chief Finance Officer, Mid and South Essex & Public Engagement: CCGs, Director of Governance & Performance, Mid Essex CCG 31

Risks / Link to BAF: N/A

Conflicts of Interest: Nil

Escalation: To CCG Boards, other N/A Committee or BAF

Appendix 1

Mid and South Essex Health and Care Partnership Medicines Optimisation Committee (MSEMOC)

TERMS OF REFERENCE

1. CONTEXT

The NHS Constitution for England provides patients with the right that:

• Medicines (and treatments) that have been considered by the National Institute for Health and Clinical Excellence (NICE) through the technology appraisal (TA) process and given a positive assessment should be made available to patients, where appropriate, and therefore be included in the formulary. • Medicines (and treatments) that have not yet been considered by, or have not received a positive recommendation for use in the NHS through a NICE TA process should be considered by the local NHS using a robust assessment of the best available clinical and cost effectiveness evidence.

After publication of the original NHS Constitution, the following key documents were published to support rational local decision-making and have been considered in the development of the MSEMOC Terms of Reference:

• The NHS Constitution for England

• Defining guiding principles for processes supporting local decision making about medicines Supporting rational local decision-making about medicines (and treatments)

• NICE Good practice guidance (GPG1) on developing and updating local formularies.

2. STATEMENT OF PURPOSE

The Mid and South Essex Healthcare Partnership Medicines Optimisation Committee (MSEMOC) is an over-arching local decision-making group for CCG commissioned medicines, for all stakeholders:

The purpose of MSEMOC is to: • assume delegated responsibility from all stakeholders and to represent the NHS and local health and care community in managing the entry of new medicines, wound care products and dietary products) into the NHS. • ensure a robust and consistent decision making process on new drugs, new uses of drugs and existing treatments commissioned by clinical commissioning groups or prescribed for use by NHS Healthcare providers. • approve standards/policy/pathways on prescribing and medicines optimisation for the Mid and South Essex system, including management of interface issues between primary care, secondary care and integrated care partnerships and identify associated resource implications for consideration by the commissioning organisations. • provide a forum for all providers and clinical commissioners to consider issues of clinical and cost effectiveness, needs of the patient and population, local priorities and affordability in the use of drugs and novel approaches to therapy (where there is a drug component) in the prevention and management of disease. The expectation is that such discussions will inform the Joint Commissioning Committee (JCC) of Mid and South Essex CCGs where a commissioning decision outside the delegated responsibility needs to be made for the 1.2million population. It is recognised that there will always be an exception but this can and should be managed via the Individual Funding Request Process. • review Public Health documents where there is an impact on medicines use across Mid and South Essex but ratification processes for Public Health documents lie outside of MSEMOC. It should therefore be noted that the purpose of MSEMOC in relation to Public Health documents is not to ratify but rather to review and advise.

3. BUDGETARY RESPONSIBILITY

NHS organisations have a statutory duty to break even within their allocated annual financial budget. Except where a policy in respect to a particular treatment is laid down by the National Institute for Health and Care Excellence as a technology appraisal (TA), organisations have to set their own priorities and policies in order to guide their officers as to how resources should be allocated between conflicting demands for treatment.

4. AIM:

To provide a strategic approach to medicines optimisation issues and clinical decision making, with due regard to clinical and cost-effectiveness in order to ensure patients have safe and consistent access to medicines in the context of care pathways which cross multiple providers

The MSEMOC is the single source of advice for the introduction of new drug therapies/pathways across all five CCGs within Mid and South Essex (and including contracted providers where pathways cross organisations) with subsequent funding support as required. This MSEMOC will therefore have decision-making powers in relation to the introduction of new drug treatments/pathways thereby ensuring standardised approach and equity of provision across all 5 CCGs.

The MSEMOC will make policy decisions on the introduction of new drugs and therapies (where there is a drug component) taking into account the priorities in the MSE CCGs local delivery plans/Operational Plans.

Where there are significant financial implications the MSEMOC will seek further guidance from relevant commissioner. Where there is an overall cost pressure to the local health economy, recommendations will be prioritised by the CCG Boards or their named delegated subcommittee before being finalised

5. OBJECTIVES

• To Horizon scan, plan for and manage entry of new drugs into the local health economy, develop prescribing guidelines and pathways and maintain the locality prescribing formulary within available resources.

• Review the commissioning, management and usage of medicines within the organisations contracted by Mid and South Essex CCGs to provide healthcare services in order to optimise therapeutic efficacy and cost- effectiveness between organisations and at the interfaces between organisations, and manage the financial implications of medicines usage across the health community.

• To foster engagement in medicines management issues at the highest level within related organisations.

• To establish and maintain a joint formulary between NHS Commissioner and Provider organisations. Examine the clinical and cost effectiveness of different preparations within particular clinical areas and agree on ‘medicines of choice' to be applied consistently across both primary and secondary care.

• To develop, prioritise and deliver an annual work programme for drug treatments/pathways not subject to a NICE TA, in consultation with MSEMOC members.

• To approve and maintain prescribing policies, formularies, traffic light classifications, shared care agreements and prescribing guidelines for implementation across primary care, secondary care and community health services and to support and advise on a robust governance framework for the delivery of medicines optimisation standards. Note: Decisions for mental health medicines only will be delegated to EPUT Medicines Management Group (MMG) with MSE commissioner endorsement. The EPUT MMG terms of reference will reflect this arrangement and all decisions will be taken to MSEMOC for ratification.

• To ensure consideration is given to the impact of formulary and policy decisions on patients and carers.

• To consider national guidance such as that produced by the Regional Medicines Optimisation Committees (RMOCs) and NHS England

• Maintain strong links with NHS England specialised commissioning teams in order to assess local implications of high cost and/or excluded from tariff medicines.

• To review and ratify clinical guidelines and protocols which identify place in therapy of treatments.

• To ensure the NICE TA implementation process is adhered to, with appropriate access to treatment for the population of Mid and South Essex.

• To assess the place in therapy and cost implications of the drug treatments in NICE guidelines and to make local decisions, noting that Commissioners are not mandated to provide funding for NICE guidelines.

• To review the decisions related to medicines prescribable on FP10s from provider organisations where these impact on health budgets (prescribing and activity costs) and advise providers and CCGs on the appropriateness of such decisions.

• To ensure that Mid and South Essex Individual Funding Request and Commissioner Contracting teams are kept up to date by sharing the final decisions.

• To ensure robust and timely implementation processes for committee decisions are in place in all provider organisations.

• To ensure mechanisms (including audit) are in place to monitor the implementation of decisions and their impact on the health system.

• Make decisions to, and actively, support care pathway design recognising wider service transformation and changes in service delivery

6. DECISION MAKING AND REPORTING

The MSEMOC is not accountable for the work of individual organisations and each member organisation retains its own line of accountability.

MSEMOC has the authority to make decisions regarding the commissioning of new medicines and new uses of existing medicines commissioned by the mid and south Essex CCGs. The MSEMOC will report its decisions following each meeting to the MSE CCG Joint Committee for noting.

Financial implications of potential MSEMOC decisions will be considered by the Mid and South Essex CCGs Chief Finance Officer or appropriate CCG committee, determined by limits of financial delegation. This will be concluded prior to the MSEMOC meeting to inform the final decision making process.

Reporting arrangements are outlined in below.

Mid and South Essex HCP CCG Joint Committee

Medicines Optimisation Committee (MSEMOC)

Secondary Care Medicines Primary Care Medicines Management Management Groups: Groups: Other EPUT Medicines Mid and South Essex (MSE) Hospitals BBCCG Prescribing subgroup commissioner Management and provider Group Medicines Optimisation Group Thurrock CCG Prescribing subgroup medicines NELFT Medicines Optimisation Group South East Essex CCGs Drug &Therapeutics Group management Mid Essex Medicines Optimisation Group groups

All Therapeutic Guidelines to be ratified by MSEMOC

The minutes of the Committee will be formally recorded and submitted to the MSE CCG Joint Committee and to committee members for submitting to the individual organisations appropriate internal governance process.

7. MEMBERSHIP ROLES, RESPONSIBILITIES AND DEPUTISING ARRANGEMENTS

MEMBERS Member Role Key Responsibility Deputising arrangement Medical Director, MSEFT (Broomfield site) Chair To facilitate and ensure effective Medical Director, MSEFT (1) stakeholder participation (BTUH or SUFT site)/ CCG GP prescribing Lead Pharmacy Lead Commissioner: Acute, Governance of process To ensure process is being followed Head of Pharmacy MSECCGs/ (1) and professional and to oversee inputs and outputs Department Basildon & secretary of the for each meeting including ensuring Thurrock University Hospital committee that papers meet requirements of the (1)/ Senior Prescribing committee. Advisor MSE CCGs

CCG/Place GP Prescribing Leads Represent their local To provide an overall CCG Designated Locality GP. (Basildon & Brentwood;Castlepoint & population and perspective to the discussions; to Rochford;Mid Essex;Southend;Thurrock) CCG/Place take decisions back to CCG. (4) To feedback GP view. To obtain engagement from GPs in their locality; to network with other GP prescribing leads within the CCG to obtain wider views. To be able to explain to locality GPs how decisions were arrived. CCG Head of Pharmacy and Medicines Governance of process To ensure process is being followed CCG Senior/Lead Optimisation (Basildon & pharmaceutical adviser Brentwood;Castlepoint & Rochford;Mid Represent their Provide a commissioning overview Essex;Southend;Thurrock (3) organisation and their for their CCG clinicians Chief, deputy or formulary Pharmacist Represent their To provide an overall view from the Chief, deputy or formulary from provider organisations organisation provider perspective including view pharmacist or a senior of the pharmacy department and pharmacist. (MSE Group, Provide, EPUT, NELFT) (4) consultant body in the provider. To facilitate meetings with specialists as part of pre-meeting preparation; to circulate discussion papers to relevant clinicians within the provider organisation and to ensure comments are received from all relevant specialists prior to meeting; to oversee the governance of implementation of decisions. Senior medical doctors (Consultant only) Provide additional To give a wider clinical input. Another senior doctor from MSEFT (3) clinical input (consultant only), MSEFT

ATTENDEES Pharmacy Lead, Public Health, on behalf Represent Public Provide a public health overview N/A of Essex County Council, Southend on Health Sea Borough Council and Thurrock Council (1) Pharmacy Lead, Independent Hospitals Represent their To provide an overall view from the Deputy/Senior Pharmacist (Nuffield, Ramsay Healthcare, Spire, BMI) organisation provider perspective including view (4) of the pharmacy department and consultant body in the provider Other providers (e.g. IC24, EEAST) Represent their To provide an overall view from the Deputy organisation provider perspective including view of the pharmacy department and consultant body in the provider Patient Representative (1) Provide a patient To give the views of a patient who N/A perspective has user experience of the NHS and medicines.

Essex Local Medical Committee (1) Represent GPs To give a wider view of GPs as Another LMC member providers.

Essex Local Pharmaceutical Committee Represent community To give a wider view of community Another LPC member (LPC) (1) pharmacists pharmacists

Senior Interface Pharmacist (MECCG), Present meeting Provide a Medicines Optimisation N/A Senior Clinical Pharmacist (High Cost papers overview Drugs- TCCG), Prescribing Advisor (Locality Lead- SECCG) (3) Head of Acute Contract Finance for Mid Represent contract and Provide financial overview Deputy/Contract Finance and South Essex CCG’s finance team (associated activity) Manager

Responsible for disseminating financial consequences Shared between Medicines Management Administrative For committee servicing Medicines Management Team Thurrock CCG and Acute support Team Thurrock CCG/ Commissioning Team for Mid and South Acute Commissioning Essex CCGs Team for Mid and South Essex CCGs

Chair and secretary reserve the right to coopt other specialists (e.g. contracts/finance leads) to the committee if required.

8. ARRANGEMENTS FOR QUORACY

For the committee to be quorate the following eight members need to be present and all 5 CCGs (commissioners) must be represented (or delegated deputy): • Chair (1) • Two CCG GP prescribing leads or deputy from each CCG (2) • Two provider representatives (one of which must be a medical doctor [Consultant]) (2) • Professional secretary (1) • Two CCG Head of Pharmacy and Medicines Optimisation or deputy (2)

If the meeting is not quorate by up to two members, the meeting can still go ahead at the Chair’s discretion but members will be contacted via correspondence to confirm endorsement of decisions prior to issue and a post-meeting record will be added to the notes. Quoracy will then be taken as agreed. If a decision made during a non-quorate meeting is not endorsed by an absent member required for quoracy, then that decision will be brought back to the next committee meeting for discussion. If the meeting is not quorate by three or more members then Chair’s action will be taken and clearly documented.

9. ATTENDING SPECIALISTS

When considered appropriate, the committee will invite specialist representation for specific topics so that the views of specialists may be taken into account. The specialist may not be present during the decision making process.

10. COMMITTEE SERVICING

The Committee shall be supported administratively by Mid and South Essex CCGs acute commissioning team and the medicines management team, Thurrock CCG whose duties in this respect will include: • Agreement of the Agenda with the professional secretary by administration support and collation of papers in-line with the Committee’s Cycle of Business; • Providing written notice of meetings to Committee members, and the papers, not less than seven working days before the meeting. • Taking the minutes and keeping a record of matters arising and issues to be carried forward. • Producing a single document to track the Committee’s agreed actions and report progress to the Committee • Producing draft minutes and action log for approval within seven working days of the meeting. • Setting up virtual meetings/booking a venue for the meeting which is accessible for the whole health community to ensure attendance by all members of the Committee.

11. CONFLICT OF INTEREST

Any conflicts of interest (potential or actual) must be declared, recorded and a report made available for public scrutiny. In the case of committee members, if appropriate, they will be asked to leave the room during the decision making process if a conflict of interest arises. CCG policies will be adhered to under these circumstances. • Committee members to complete a declaration of interests form on appointment and then re-confirm at least annually • The declaration of interests to be recorded in a register maintained by Mid and South Essex CCGs and made publicly available on individual CCG websites. • At each meeting committee members are required to make any new declaration of interest or declaration relating to matters on the Agenda, or to reconfirm current declarations on the Register of Interests are accurate and up-to-date. • Where a new declaration of interest or declaration relating to matters on the Agenda are made the following should be recorded in the minutes of the meeting: • Individual declaring the interest. • At what point the interest was declared. • The nature of the interest. • The Chair’s decision and resulting action taken. • The point during the meeting at which any individuals retired from and returned to the meeting - even if an interest has not been declared.

Anyone developing or commenting on papers/guidelines must declare any conflicts of interest or a nil return. When papers are circulated for comments they will be sent with a declaration of interest form for completion by anyone wishing to send comment or a request to respond with a nil return.

All committee members or anyone involved with the development of papers/guidelines must adhere to their organisational policies on conflicts of interest, gifts, hospitality, commercial sponsorship, working with the pharmaceutical industry, fraud and bribery and secondary employment. Committee members will be required to make an annual declaration.

Healthcare professionals must act in accordance with their profession’s code of conduct.

12. PRE-MEETING PREPARATION

• For treatments for which policy decisions are required by Mid and South Essex CCGs, the MSEMOC working group will produce review documents (which include critically appraised published evidence) as prioritised within the work plan. To note that all new drug applications must be accompanied by a treatment pathway showing the place in therapy. • If a local specialist applies for a treatment, a business case and up to date evidence, presented in MSEMOC format, to be submitted by providers to the secretary a minimum of six weeks in advance of the meeting. • Provider pharmacy representatives are responsible for co-ordinating responses from relevant specialists within their Trust. The presenter of the paper should collate consultation comments, which must include consultation with commissioners, and clarify points of discussion prior to the paper being finalised and circulated. • Papers will be sent out to provider pharmacy representatives, to obtain views of wider specialists, at least three weeks in advance of meetings. • Papers will be sent out to CCGs for consideration through relevant prescribing groups /GP prescribing leads, to obtain views of their locality practices, at least three weeks in advance of meetings. • Final papers will be sent out to members five working days in advance of meeting. • Members will read and review paperwork and bring comments to the committee for discussion.

13. METHODS FOR REACHING FINAL DECISIONS, RECORDING AND DISSEMINATING

At the meeting: • Committee members to give views on the evidence and specialists’ comments. • Committee members to make assessment against the ethical framework and make a commissioning decision. • Generally it is expected that at the committee meetings decision will be reached by consensus. Should this not be possible and all work on the item has been completed, the Chair will determine that a vote of members will be required. A vote could be deferred to a subsequent meeting if the committee agree that further information / evidence and stakeholder feedback needs to be obtained. The process for voting is set out below:

a) Eligibility – Voting Membership is as follows.

Deputy Medical Director, MSE Group/ CCG GP Prescribing Lead (MSEMOC Chair) (or nominated deputy) (1) Head of Pharmacy and Medicines Optimisation, Basildon & Brentwood CCG & Thurrock CCGs (or nominated deputy) (2)* Chief Pharmacist, Mid Essex CCG (or nominated deputy) (1) Head of Pharmacy and Medicines Optimisation, Castlepoint & Rochford CCG & Southend CCG (or nominated deputy) (2)* GP Prescribing Lead, Basildon & Brentwood CCG (or nominated deputy) (1) GP Prescribing Lead,Thurrock CCG (or nominated deputy) (1) GP Prescribing Lead, Mid Essex CCG (or nominated deputy) (1) GP Prescribing Lead, Castlepoint & Rochford CCG & Southend CCG (or nominated deputy) (2)* Chief Pharmacist, MSE (or nominated deputy) (1) Chief Pharmacist, NELFT (or nominated deputy) (1) Chief Pharmacist, Provide (or nominated deputy) (1) Chief Pharmacist, EPUT (or nominated deputy) (1) *on the basis that they represent 2 CCGs/Places

Under no circumstances may an absent member vote by proxy. Absence is defined as being absent at the time of the vote. A vote may only take place if the Committee meeting is quorate. a) Voting – At the discretion of the Chair all questions put to the vote shall be determined by oral expression or by a show of hands, unless they direct otherwise or it is proposed, seconded and carried that a vote be taken by paper ballot. If at least one-third of members present so request, the voting on any question may be recorded to show how each member voted or did not vote except where conducted by paper ballot. b) Majority (defined as more than half the votes of the present voting members) necessary to confirm a decision – every question put to the vote at a meeting shall be determined by a majority of votes of members present and voting. Members receive one vote only (the exceptions to this are detailed in table above), e.g. if a GP CCG Board member is deputising as the Chair of the meeting, they do not get a vote as the Chair and as the GP CCG Board member. c) Casting vote – In the case of an equal vote, the Chair of the meeting shall have the casting vote. d) Should a vote be taken the outcome of the vote must be recorded in the minutes of the meeting. e) Abstaining from the vote – Voting members can choose to abstain from the vote. The member’s vote may not be transferred to another voting member. f) Concerns raised / dissenting views – A record shall be made of any concerns raised / dissenting views in the minutes of the meeting.

14. POST MEETING ACTIONS

• Draft notes of the meeting to be agreed with the Chair. • Agreed draft notes of meeting to be sent to committee members. • Communication to applicants will be sent out outlining the interim position of the application and to advise on when final decision will be sent. • MSEMOC report to be made to the Joint Commissioning Committee and the Healthcare Partnership Board or their named delegated subcommittee. Treatments with a cost pressure require the aforementioned committee to approve MSEMOC decisions before implementation. • Final decision will be sent out by Mid and South Essex CCG and Medicines Management Teams (MMTs) to all participating organisations, and uploaded onto individual CCG web-sites. • Final decisions to be circulated by MSE CCG MMTs to GPs and uploaded onto individual CCG web-sites. • Final decisions to be circulated by MSE CCG MMTs to IC24 and local community pharmacists. • Process for dissemination is outlined in Flow chart for disseminating decisions (Appendix I) • MSEMOC meeting notes are ratified at the next committee meeting.

15. FREQUENCY OF MEETINGS

• A minimum of four to five meetings a year at approximately two to three monthly intervals. • Additional meetings may be held virtually by use of video/teleconferencing facilities or, at the discretion of the chair, by electronic circulation of a matter for discussion/decision

16. EMERGENCY DECISIONS

Should there be a requirement to make decisions between meetings the following process should be followed: • Full details of the decision required will be set out in a clear proposal with rationale as to why an urgent decision is needed • Proposal will be submitted via e-mail to Committee members • Minimum support required from at least 8 members of the Committee including the Chair. If there is a financial implication support is needed from the Chief Finance Officer, Mid and South Essex Acute Commissioning Team. • Report of the decision made presented to next scheduled meeting for endorsement.

17. ANNUAL REVIEW OF THE COMMITTEE

The committee will undertake an annual self-assessment to: • Review that these Terms of Reference have been complied with and whether they remain fit for purpose; • Determine whether its planned activities and responsibilities for the previous year have been sufficiently discharged; and, • Recommend any changes and / or actions it considers necessary, in respect of the above.

18. RELATIONSHIPS AND ACCOUNTABILITY

• The structure outlining the accountability arrangements to the Committee can be found in section 6 above • The local decision making process on medicines in Mid and South Essex can be found in Appendix I

Associated Documents 1. Ethical Framework 2. Formulary application for the use of a new medicine or existing medicine for a new indication 3. Policy for Clinical and Prescribing Responsibility

Appendix I - LOCAL DECISION MAKING PROCESS ON MEDICINES IN MID AND SOUTH ESSEX

Mid and South Essex HCP CCG Joint Committee (for noting)

Mid and South

System Essex System Medicines Lead/ Leadership Professional secretary, Non-drug related issue in clinical Executive MSEMOC guideline – MSEMOC chair to Group (for noting) feedback on advise on process to follow. any issues

Mid and South Essex Medicines Optimisation Committee (Local health economy wide committee) Stakeholders: All NHS commissioner and provider organisations within Mid and South Essex Health Care partnership. A minimum of four meetings a year

CCG Chief Finance New drug, or a new indication for drug, and Agenda item(s) consultation Officer or treatment guidelines, with cost implications with Stakeholders appropriate CCG (including savings). committee, +ive NICE TAs, -ive NICE TAs, MSEMOC ‘Not determined by Finance report for all Recommended’ decisions, or cost-neutral limits of financial agenda items ‘Recommended’ decisions for noting & submitted by delegation Professional secretary, ratification. MSEMOC four weeks NB any implementation issues to be discussed before meeting by HCP MSEMOC Working Group

Implementation of ratified MSEMOC outputs

HCP MSEMOC Working Group

ANNUAL WORKPLAN (prepared in January) informed by: Horizon scanning of new drugs & new uses of drugs, NICE guidance, individual funding requests, submissions from local

providers, QIPP agenda. Workplan is shared with committee members (Stakeholders).

PROCESS AS FOLLOWS: Pre -meeting • Workplan for the next meeting shared with stakeholders in advance at the previous meeting. • Financial implications of potential MSEMOC decisions will be considered by the CCG Chief Finance Officer or appropriate CCG committee, determined by limits of financial delegation. This will be concluded prior to the MSEMOC meeting to inform the final decision making process • Papers prepared by HCP MSEMOC working group that is led by Mid and South Essex CCGs (provider submissions via business case to include a review of evidence). Costs of whole pathway need to be provided as full costs will be considered. • Draft papers sent out to local specialists for views (three weeks in advance of meeting) and also to GP Prescribing leads, where treatment will impact primary care. Face to face meetings with specialists are requested in advance of next meeting. • Views received are summarised in final papers sent to committee members one week (minimum of five working days) before the meeting. During Meeting • Evidence and views received during consultation period discussed and assessed against an ethical framework that takes several factors into account and enables rationale for the decision to be explained. • The committee makes a commissioning recommendation. A decision is reached where there are no additional cost pressures in the treatment pathway or there are cost savings. Where an intervention will increase costs, a report is submitted to Finance and Performance Committee in Common for decision to Mid & South Essex CCG Joint Committee for prioritization and to Mid & South Essex Health Care Partnership Board for noting. Post Meeting • MSEMOC report prepared by Pharmacy Lead Commissioner Acute, MSE CCGs for Mid & South Essex CCG Joint Committee and Mid & South Essex Health Care Partnership Board. • Recommendations prepared by HCP MSEMOC working group and uploaded41 on MSEMOC website and disseminated to all stakeholders for implementation

IMPLEMENTATION OF MSEMOC DECISIONS PROCESS FOLLOWED BY COMMISSIONERS . Decisions circulated to all GP practice managers, GP prescribing leads, community pharmacies and other providers for onward circulation. . A summary of the decision prepared and linked to ScriptSwitch so that it appears on the GP electronic prescribing system when the drug name is entered. . The evidence and decision making process are discussed with commissioner pharmacy teams to enable the wider pharmacy team to understand how the decision was arrived at.

. Locality pharmaceutical advisers disseminate this learning to GP practices at prescribing meetings or equivalent. . GP prescribing leads are asked to disseminate the rationale for the decision at wider GP practice team meetings.

PROCESSES FOLLOWED BY LOCAL NHS PROVIDERS Mid and South Essex Hospitals Medicines Optimisation Committee (MSEHMOC) • The MSEHMOC Committee is used as a sub-committee of MSEMOC. • MSEHMOC committee meetings are scheduled roughly two weeks before each MSEMOC meeting. MSEMOC agenda is discussed at MSEHMOC meetings and relevant consultants are invited to meetings for discussion. • The MSEMOC decision spreadsheet produced after each MSEMOC meeting is a standing agenda item for noting and adoption at the next MSEHMOC. Decisions are circulated to the relevant consultant who attended the MSEHMOC meeting and the clinical director of the specialities for onward circulation. Relevant consultants may be invited back to the next MSEHMOC meeting if follow up is required. The formulary is updated, a pharmacy bulletin is produced and the decisions are displayed on the pharmacy information notice board. NELFT, EPUT • All pre-meeting papers are sent out to the relevant specialist nurses or clinicians for review. The feedback and comments are collected by pharmacy and submitted to MSEMOC. • All MSEMOC decisions are circulated to the relevant NELFT/EPUT clinicians once published. Local decisions published on the CCG website are forwarded to relevant team for information. Any MSEMOC decisions which require further discussion are tabled at NELFT Medicines Optimisation Group & EPUT Medicines Management Committee meetings which meet monthly. PROVIDE, IC24, Ramsay, Nuffield, BMI, Spire and all other providers • Relevant papers sent to specialists for comment before MSEMOC meetings • MSEMOC decisions circulated to all relevant specialists.

Agenda Item 9.1

M&SE CCG JOINT COMMITTEE MEETING OF 20 MAY 2021

PATIENT SAFETY AND QUALITY COMMITTEES IN COMMON UPDATE

Purpose of Report: To provide the Joint Committee (JC) with a summary of discussions held at the M&SE CCG Patient Safety & Quality Committees meeting held in common on 9 March 2021.

Recommendations and The JC is asked to note the content of the report. decision/actions:

Executive Summary The five M&SE CCG patient safety and quality committees (or (including financial impact): equivalent) and the JC PSQ Sub-committee meet in common on a bi-monthly basis. The report below provides a summary of discussions held on 9 March 2021.

Written by/Presented by: Sara O’Connor, Head of Corporate Governance, MECCG

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

Fit with CCG Strategic Strategic Objective 3: Make a step change in addressing Objectives inequalities and quality priorities to deliver outcomes in accordance with Constitutional Standards.

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this The minutes of the PSQ CiC meeting held on 9 March 11/05/2021 document). 2021 were approved at the meeting on 11 May 2021.

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

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

Details of Stakeholder, Patient & Public Engagement:

Risks / Link to BAF:

Conflicts of Interest: None identified

Escalation: To CCG Boards, other Committee or BAF

PATIENT SAFETY AND QUALITY COMMITTEES IN COMMON UPDATE

Purpose

To provide the Joint Committee with a summary of the issues discussed at the Patient Safety & Quality Committees in Common meeting on 9 March 2021.

Key Points

The following issues were discussed:

• The minutes of the previous meeting held on 9 December were approved, subject to a minor amendment.

• An early draft of the new Quality Strategy was submitted to members for review and comment upon. A series of workshops will be held to further develop the strategy. It is anticipated that an updated draft will be submitted to the CCGs’ PSQ committees in the summer.

• The committee reviewed the PSQ risks on the Board Assurance Framework. The risks have recently been reviewed again in readiness for the May round of CCG Board meetings.

• An NHS Patient Safety Update was reviewed, which focused on infection prevention and control guidance, the Ockenden review of maternity services, Never Events, epilepsy medicines used in pregnancy and COVID-19 (C-19) oximetry at home,.

• The Acute Commissioning Team update highlighted that there were 20 MRSA cases recorded to the end of 2020, with 2 further nosocomial outbreaks identified since the report was produced. A learning report had been requested to understand the causes. The preliminary findings of a Care Quality Commissioning (CQC) inspection at Basildon Hospital relating to infection prevention and control was largely positive. The report also confirmed that the second wave of C-19 had adversely impacted upon the reset of elective care, referral to treatment times and cancer services.

• The Essex Partnership University NHS Trust (EPUT) mental health (MH) update report advised that an interim MH quality lead had been appointed to support the Thurrock Nursing Team. Key Performance Indicators (KPIs) for a number of MH services were of concern and would be flagged at the next Clinical Quality Review Group meeting. The committee were advised that following a CQC inspection at the Linden Centre, the CCG MH nursing team had visited one of the wards and were assured that all actions had been implemented and progress was sustained. The Mental Health Commissioning Task Force had been established to review the pan-Essex mental health contracting and commissioning arrangements and was progressing well. Several recommendations had been generated with sub-group meetings set up to implement these.

• The Learning Disability (LD) update report highlighted that performance against LD healthchecks required improvement. The CCGs had received assurance from Primary Care Networks that they would focus on performing the checks. Retrospective Learning Disabilities Mortality reviews (LeDeR) for 2019/20 had been

cleared and assurances had been received from the Central Support Unit (CSU) that the 2018/19 backlog would be completed by March 2021. It was noted that an increase in LeDeR review investigations was expected as a result of the pandemic.

• The Basildon and Brentwood CCG update report highlighted that Ghyll Grove Care Home would be closing and work was ongoing to place a small number of CHC funded patients in appropriate accommodation.

• The Thurrock CCG update report highlighted that audits of care homes in response to the pandemic were progressing well and all deferred continuing health care assessments had been completed. The vaccination programme rollout was also progressing well. The quality and primary care teams were providing support to a GP practice which had received a rating of ‘inadequate’ following a CQC inspection.

• The Castle Point and Rochford and Southend CCG update report highlighted that the quality and primary care teams were also supporting another GP practice in this area which had received an ‘inadequate’ rating from the CQC.

• The Mid Essex CCG update report confirmed that community providers had completed their actions regarding the Invasive Group A Streptococcus action plan. The Deputy Director of Nursing was working with the Mid & South Essex Hospitals NHS Foundation Trust (MSEFT) to ensure completion of their actions within the agreed timeframe.

• The committee were invited to provide comment on the draft revised MSEFT Patient Access Policy.

• The committee were also invited to comment on the Children and Young People Neurodevelopment Pathway Programme.

• The patient story video detailed the experiences of two patients who had used maternity services at MSEFT during the C-19 pandemic.

• The committee supported revised PSQ Terms of Reference for submission to Boards for approval.

• The committee approved revised Terms of Reference for the Serious Incidents and Never Event Panel.

• The committee approved the draft review of its effectiveness for 2020/21.

Recommendation

The Joint Committee is asked to note the content of the report and seek any further assurance required.

Agenda Item 9.2

M&SE CCG JOINT COMMITTEE MEETING OF 20 MAY 2021

FINANCE & PERFORMANCE COMMITTEES IN COMMON UPDATE

Purpose of Report: To provide the Joint Committee with a summary of the issues discussed at the Finance & Performance Committees (F&P) in Common meeting on 21 April 2021.

Recommendations and The Joint Committee is asked to note the contents of the report. decision/actions:

Executive Summary Routine finance and performance monitoring reports were received with (including financial impact): no issues identified as requiring escalation to the Joint Committee and/or CCG Boards. No commissioning or contracting reports were reviewed that require Joint Committee approval.

Written by/Presented by: Viv Barnes, Joint Committee Secretary

Executive Director Mark Barker, Joint Chief Finance Officer Sponsor:

Fit with CCG Strategic Objective 2: Improve access to services for patients in line with NHS Objectives Plan requirements. Objective 4: Achieve key statutory financial duties including delivery of the system financial control total.

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

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

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

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

Risks / Link to Board Relevant F&P risks from the BAF are reviewed at Assurance Framework (BAF): each meeting

Conflicts of Interest: None identified

Escalation: N/A To CCG Boards, other Committee or BAF

FINANCE & PERFORMANCE COMMITTEES IN COMMON UPDATE

Purpose

To provide the Joint Committee with a summary of the issues discussed at the Finance & Performance Committees in Common meeting on 21 April 2021.

Key Points

The following issues were discussed:

• Financial and Performance Risks – the Committees in Common agreed the proposed 2021/22 financial risks for inclusion in the Board Assurance Framework.

• Month 12 Finance Report – the Committees in Common received a verbal briefing on the year end financial position and noted that SE Essex CCGs were expecting to report breakeven, Thurrock a surplus of circa £20k, Basildon & Brentwood CCG a surplus of approximately £150k and Mid Essex CCG a surplus of approximately £411k.

• JCT Finance Report – the Committees in Common received a report on the Month 11 JCT financial position and noted the key risks in relation to Independent Sector Provider contracting arrangements.

• Contract Planning 2021/22 – the Committees in Common received an update on the 2021/22 Contract Planning Round.

• Elective Recovery Framework (ERF) – the Committees in Common received a briefing on the framework and were advised that the two key financial issues were a potential cost pressure of £24.3m if Independent Sector Provider capacity was utilised fully and approximately £16.8m additional expenditure in the MSEFT elective recovery plan. These costs would be mostly offset by additional funding received from ERF. Members asked for future updates to provide a clear timescale for recovery and noted that system elective income could not be fully estimated at this time as national elective thresholds had not yet been issued.

• Performance report – the Committees in Common received a summary of performance against constitutional standards including Referral to Treatment, Diagnostics, Cancer, Integrated Urgent Care, Stroke, NHS111, Advice and Guidance and ambulance standards. It was noted that in April MSE FT had recorded the highest number of Accident and Emergency attendances across its sites for the last 2 years and that the Trust was carrying out a deep dive to understand the reasons for this. NHS 111 activity had also increased in relation to queries around Covid-19 and Covid- 19 vaccinations.

• Finance Planning update – the committees received an update on the latest financial planning assumptions, including the headline 2021/22 System Budget.

• Mental Health Transformation Plan – the Committees in Common received an overview of mental health planning priorities for 2021/22, Mental health investment, Mental Health workforce, Mental Health performance metrics and the proposed contracting and financial approach. Members noted the the risks around the ability to recruit additional staff to support the planned investment.

• Financial Services - the Committees in Common received a proposal to move to a hybrid financial services model with Arden & GEM Commissioning Support Unit in 47

2021/22 and supported a 12 month extension of the contract in line with the previously approved F&P paper.

• Patient Transport Services– the Committees in Common noted the recommencement of the Non-Emergency Patient Transport Services procurement process.

Recommendation

The Joint Committee is asked to note the contents of the report and seek any further assurance required.

Agenda Item 11

M&SE CCG JOINT COMMITTEE MEETING OF 20 MAY 2021

JOINT COMMITTEE WORKPLAN AND DATES OF FUTURE MEETINGS

Purpose of Report: To provide the M&SE CCG Joint Committee (JC) with a draft committee workplan for 2021/22.

Recommendations and The JC is asked to: decision/actions: • Approve the JC workplan for 2021/22, subject to inclusion of any additional items agreed by members; • Approve the proposed dates and times of future JC meetings during 2021/22.

Executive Summary The JC workplan for 2021/22 includes a number of standing reports that (including financial impact): will be routinely reported to the JC for information and assurance. In addition it sets out the key commissioning decisions that will be presented to the JC for approval as part of the 2021/22 system plan and these will be updated as the timescale by which other work programmes will be completed becomes clearer.

It is proposed that public Part I JC meetings will be held on the following dates:

• Thursday, 24 June 2021 • Thursday, 26 August 2021 • Thursday, 28 October 2021 • Thursday, 16 December 2021 • Thursday, 24 February 2022

It is suggested that meetings are held between 10.30 am and 12.30 pm.

Part II (confidential) JC meetings will be held on the same date (if required) commencing at 9.30 am.

Written by/Presented by: Viv Barnes, JC Secretary

Executive Director Anthony McKeever, Joint Accountable Officer, M&SE CCGs Sponsor:

Fit with CCG Strategic The workplan will assist the JC to ensure that it supports all strategic Objectives objectives.

Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this Draft workplan reviewed by JET, senior managers and April 2021 document). governance leads.

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

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

Details of Stakeholder, Patient & Public Engagement:

Risks / Link to BAF: The work plan includes regular review of risks on the Board Assurance Framework within the remit of the JC.

Conflicts of Interest: None identified

Escalation: N/A To CCG Boards, other Committee or BAF

50 MID AND SOUTH ESSEX CCG JOINT COMMITTEE WORKPLAN 2021/22

Lead Officer May June Aug Oct Dec Feb Comments 2021 2021 2021 2021 2021 2022 COMMISIONING DECISIONS Planning Guidance sign off Karen Wesson X Vanguard Theatre Contract Mark Barker X Adult Mental Health Transformation Plan Mark Tebbs X Adult Critical Care Transfer Service Business Case Emily Hughes X SRP and IFR updated policy and approach Paula Saunders X Sub Acute Frailty Bed Proposal Gerdalize Du Toit X ASD Back Log Investment Caroline McCarron X Mental Health Support Teams Helen Farmer X CYP MSE Continence Review (date to be confirmed) Liz Mansfield X Palliative and End of Life contract Karen Wesson / Andy Ray X Neurodevelopmental Business Case Helen Farmer X EWMHS Helen Farmer X

STANDING REPORTS Karen Wesson / Mark Further discussion needed about form and content of Performance Report (including MH and Community) X X X X X X Tebbs reporting from CiC/JC sub-committee Finance Report Mark Barker X X X X X X Patient Safety & Quality Report (incl. MH and Further discussion needed about form and content of Rachel Hearn X X X X X X Community) reporting from CiC/JC sub-committee Update reports from the F&P and PSQ Committees in Viv Barnes X X X X X X Common GOVERNANCE Review Register of Interests Sara O’Connor X X X X X X Board Assurance Framework Viv Barnes/Sara O’Connor X X X X X Reporting of Part II Decisions to Part I Viv Barnes X X X X X X Committee Workplan and Meeting Dates Viv Barnes X