CCG Headquarters 4th Floor 1 Guildhall Square (Civic Offices) Portsmouth PO1 2GJ Governing Board Meeting
A meeting will be held from 3.00pm – 5.00pm on Wednesday 18 March 2020 in Conference Room A, 2nd Floor, Civic Offices, Portsmouth
AGENDA
Subject Lead Attachment
1. Apologies for Absence and Welcome Dr E Fellows Verbal
Apologies received from Dr Nick Moore.
2. Register and Declarations of Interest Dr E Fellows Pink
3. Minutes of Previous Meeting Dr E Fellows White
a. To agree the minutes of the Governing Board meeting held on Wednesday 15 January 2020. b. Matters Arising
4. Chief Clinical Officer’s Report Dr L Collie Blue
5. Health and Care Portsmouth and Wider Systems I Richens
a. Portsmouth Verbal b. Portsmouth and South East Hampshire Verbal c. Hampshire and Isle of Wight Verbal
6. Finance and Performance Reports M Spandley
a. Finance Report Cream b. Performance Report White c. Programme Highlight Report Cream
7. Quality and Safeguarding Report I Richens White
8. Governing Board Assurance Framework and Corporate I Richens Cream Risk Register
9. 2020-21 Operating Plan – 1st Cut M Spandley White
10. Financial Strategy and Budget Setting 2020/21 M Spandley Cream
11. Full Register of Interest (All Staff) Dr E Fellows Green
12. Verbal Report from Committee Chairs and Minutes
Audit Committee A Silvester Verbal update.
Subject Lead Attachment
Health and Wellbeing Board I Richens Salmon Verbal update and minutes from 25 September 2019 and 8 January 2020 meetings.
Primary Care Commissioning Committee M Geary Lilac Verbal update and minutes from 29 October 2019.
Quality and Safeguarding Committee K Atkinson Verbal Verbal update.
Clinical Advisory Group Dr N Moore Verbal Verbal update.
13. Date and Time of Next Meeting in Public Dr E Fellows
The next Governing Board meeting to be held in public will take place on Wednesday 20 May 2020 at 2.00pm – 5.00pm in the Conference Room A, 2nd Floor, Civic Offices, Portsmouth.
Meeting Close
Distribution:
Members
Helen Atkinson - Interim Director of Public Health, Portsmouth City Council Karen Atkinson - Registered Nurse Dr Linda Collie - Chief Clinical Officer and Clinical Leader (GP) Dr Elizabeth Fellows - Chair of Governing Board/Clinical Executive (GP) Margaret Geary - Lay Member Alison Jeffery - Director of Children’s Services, Portsmouth City Council Dr Carsten Lesshafft - Clinical Executive (GP) Graham Love - Lay Member Dr Nick Moore - Clinical Executive (GP) Jackie Powell - Lay Member Innes Richens - Chief of Health and Care Portsmouth David Scarborough - Practice Manager Representative Andy Silvester - Lay Member Dr Simon Simonian - Clinical Executive (GP) Michelle Spandley - Chief Finance Officer Dr Tahwinder Upile - Secondary Care Specialist Doctor David Williams - Chief Executive, Portsmouth City Council
In Attendance
Jayne Collis - Business Development Manager Justina Jeffs - Head of Governance
GOVERNING BOARD
Date of Meeting 18 March 2020 Agenda Item No 2
Title Register and Declarations of Interest
In order to meet its statutory duty, the CCG has revised processes for managing conflicts of interests to reflect national guidance published by NHS England throughout 2016/17.
Purpose of Paper The Committee Register of Interest holds information on the Committees, its members and regular attendees. Members are also required to declare any conflicts of interest against agenda items for each meeting. These conflicts are recorded as per the guidance.
The Board are requested to: Recommendations/ note the Register of Interests and Actions requested declare any actual, possible or perceived conflicts against the agenda items of the meeting.
Engagement Activities – Not applicable Clinical, Stakeholder and
Public/Patient
Item previously Governing Board, Audit Committee considered at
Potential Conflicts of Interests for Board None Members
Author Justina Jeffs, Head of Governance
Sponsoring member Dr Elizabeth Fellows, Chair of Governing Board
Date of Paper 10 March 2020
NHS Portsmouth Clinical Commissioning Group Register of Interests - Governing Board/Committee Members
Name Current position (s) Declared Interest- (Name of the Type of Interest Nature of Interest Date of Interest Action taken to mitigate risk held- i.e. Governing organisation and nature of Is the interest From To Committee Body, Member business) direct or practice, Employee or indirect? other
Audit Audit
Interests Interests
Committee
PrimaryCare
Remuneration
Governing Board Board Governing
Financial Interests Financial
ExecutiveCommittee
Non-Financial Personal Non-Financial
Quality and Safeguarding Safeguarding and Quality
Non-Financial Professional Professional Non-Financial
Commissioning Committee Commissioning Nicola Andrews Quality Improvement Nil P Manager Karen Atkinson Registered Nurse Southern Health NHS Foundation Trust P Indirect Niece works at Matron for Current Declare conflict where appropriate in P P P Representative on MH Services discussions relating to mental health Governing Board services Karen Atkinson Registered Nurse Compass Independent Fostering P Direct Foster Carer Current Declare conflict where appropriate P P P Representative on Agency Governing Board Karen Atkinson Registered Nurse Nursing and Midwifery Council P Direct Registered Nurse Current Manage in line with CCG policy P P P Representative on Governing Board Karen Atkinson Registered Nurse Surrey and Borders NHS Trust P Direct Bank Employee Current Declare conflict where appropriate. P P P Representative on Manage in line with CCG policy Governing Board Roger Batterbury Chair, Healthwatch, Healthwatch Portsmouth P Direct Chair 2013 Current Manage in line with CCG policy Attendee Portsmouth Roger Batterbury Chair, Healthwatch, Rebound Carers Group P Direct Director/Trustee 2014 Current Would step aside should a grant be Attendee Portsmouth discussed. Roger Batterbury Chair, Healthwatch, Solent NHS Trust P Direct Bank SIRI Investigator 2016 Current Should any discussion relate to this Attendee Portsmouth role I would declare my role Roger Batterbury Chair, Healthwatch, East Shore Partnership P Direct Vice Chair Patient 2015 Current Manage in line with CCG policy. Attendee Portsmouth Participation Group Roger Batterbury Chair, Healthwatch, Nursing and Midwifery Council P Direct Member as RMN 1991 Current Would declare my membership if Attendee Portsmouth relevant Roger Batterbury Chair, Healthwatch, Care UK P Direct Chair Urgent Treatment 2018 Current Manage in line with CCG policy. Attendee Portsmouth Centre Patient Participation Group Nicola Burnett Deputy Chief Finance Healthcare Financial Management P Direct Member 2016 Current Manage in line with CCG policy. Attendee Attendee P Officer Association Nicola Burnett Deputy Chief Finance Association of Certified Chartered P Direct Fellow Member 2008 Current Manage in line with CCG policy. Attendee Attendee P Officer Accountants Dr Linda Collie Chief Clinical East Shore Partnership P Direct Partner Current Manage in line with CCG policy P P P Chair from Officer/Clinical Leader June 2017 Dr Linda Collie Chief Clinical Portsmouth Primary Care Alliance Ltd P Direct Practice is a Member Current Manage in line with CCG policy P P P Chair from Officer/Clinical Leader (PPCA) June 2017 Dr Linda Collie Chief Clinical Portsmouth Primary Care Alliance Ltd P Direct Sessional GP Work Current Manage in line with CCG policy P P P Chair from Officer/Clinical Leader (PPCA) June 2017 Mark Compton Deputy Director of Nil P P Transformation Simon Cooper Director Medicines Health Education England P Indirect Wife works for Health Current Manage in line with CCG policy P P Optimisation Education England Simon Cooper Director Medicines Specialist Pharmacy Services P Indirect Wife works for Specialist Current Manage in line with CCG policy P P Optimisation Pharmacy Services Simon Cooper Director Medicines NHS BSA P Direct Secondment 01/10/2019 31/03/2020 Review in any cross investment. P P Optimisation Michael Drake Director of Planning and Portsmouth Hospitals Trust P Indirect Wife works in Human 1999 Current Manage in line with CCG policy P Performance Resources Department Jason Eastman Associate Director of Nil P P IM&T
1 of 7 Name Current position (s) Declared Interest- (Name of the Type of Interest Nature of Interest Date of Interest Action taken to mitigate risk held- i.e. Governing organisation and nature of Is the interest From To Committee Body, Member business) direct or practice, Employee or indirect? other
Audit Audit
Interests Interests
Committee
PrimaryCare
Remuneration
Governing Board Board Governing
Financial Interests Financial
ExecutiveCommittee
Non-Financial Personal Non-Financial
Quality and Safeguarding Safeguarding and Quality
Non-Financial Professional Professional Non-Financial
Commissioning Committee Commissioning Dr Elizabeth Fellows Chair/Clinical Executive East Shore Partnership P Direct Partner Current Manage in line with CCG policy Chair P Dr Elizabeth Fellows Chair/Clinical Executive Portsmouth Primary Care Alliance Ltd P Direct Practice is a Member Current Manage in line with CCG policy Chair P (PPCA) Dr Elizabeth Fellows Chair of Governing Circle Health P Direct Shareholder Current Manage in line with CCG policy Chair P Board/Clinical Executive
Dr Elizabeth Fellows Chair of Governing NHS Portsmouth Clinical P Direct Designated Doctor for 01/07/2019 Current Manage in line with CCG policy Chair P Board/Clinical Executive Commissioning Group Looked After Children
Margaret Geary Lay Member Associate Member of Association of P Indirect Associate Member Aug-17 Current Manage in line with CCG policy P Interim Chair Chair Directors of Adult Social Services Margaret Geary Lay Member Age UK Portsmouth P Indirect Chair Apr-15 Current Manage in line with CCG policy P Interim Chair Chair
Margaret Geary Lay Member Roberts Centre Family & Children's P Indirect Trustee Sep-13 Current Manage in line with CCG policy P Interim Chair Chair
Margaret Geary Lay Member Action Hampshire P Indirect Trustee Oct-13 Current Manage in line with CCG policy P Interim Chair Chair
Meyrick Grundy Clinical Quality Manager Nil P
Jo Hanswenzl NHS England - Nil Attendee Assistant Contracts Manger (Acting) Christine Horan Primary Care Nil Attendee Improvement Manager Dr Jason Horsley Governing Board Portsmouth City Council/Southampton P P Direct Director of Public Health 07/01/2017 Current In decisions where there is a potential Left 22/11/19 Member City Council employed jointly conflict of interest between the CCG and either or both Councils, I would be acting in an advisory capacity that would not vote on the Governing Board. Dr Jason Horsley Governing Board Southampton City Clinical P Direct Member of Governing Body 07/01/2017 Current If deemed necessary by the Chair, I Left 22/11/19 Member Commissioning Group will abstain from voting decisions on or taking part in discussions where Southampton CCG may be a beneficiary. Dr Jason Horsley Governing Board Hampshire Healthcare Foundation P Indirect Wife works as a doctor in 07/01/2017 Current In decisions related to commissioning Left 22/11/19 Member Trust Infectious Diseases and of these services I would not be a Microbiology voting member, but may still act in an advisory capacity. Dr Jason Horsley Governing Board Genito-urinary Medicine, Portsmouth P Indirect A close friend works as a 07/01/2017 Current In decisions related to commissioning Left 22/11/19 Member consultant locally of these services I would not be a voting member, but may still act in an advisory capacity. Dr Jason Horsley Governing Board Faculty of Public Health P Direct Fellow 07/01/2017 Current Manage in line with CCG policy Left 22/11/19 Member Katie Hovenden Clinical Associate Portsmouth Hospitals Trust P Indirect Sister is Senior Orthopaedic Current Manage in line with CCG policy P P Secretary Katie Hovenden Clinical Associate General Pharmaceutical Council P Direct Registered Current Manage in line with CCG policy P P Alison Jeffery Governing Board Nil P Member Justina Jeffs Head of Governance Nil P Aug-17 Current None required. Attendee Attendee Attendee Attendee Attendee P
2 of 7 Name Current position (s) Declared Interest- (Name of the Type of Interest Nature of Interest Date of Interest Action taken to mitigate risk held- i.e. Governing organisation and nature of Is the interest From To Committee Body, Member business) direct or practice, Employee or indirect? other
Audit Audit
Interests Interests
Committee
PrimaryCare
Remuneration
Governing Board Board Governing
Financial Interests Financial
ExecutiveCommittee
Non-Financial Personal Non-Financial
Quality and Safeguarding Safeguarding and Quality
Non-Financial Professional Professional Non-Financial
Commissioning Committee Commissioning Rochelle Kneller Assistant Director, HR, Nil Attendee Portsmouth City Council
Dr Carsten Lesshafft Clinical Executive Trafalgar Medical Group P Direct Salaried GP Current Manage in line with CCG policy P
Dr Carsten Lesshafft Clinical Executive NHS Portsmouth Clinical P Indirect In a relationship with a 03/06/2019 Current Manage in line with CCG policy P Commissioning Group Commissioning Manager Dr Carsten Lesshafft Clinical Executive British Medical Association P Direct Member Current Manage in line with CCG policy P
Dr Carsten Lesshafft Clinical Executive Fine-Line Medical Aesthetic P Direct Sole Trader Current Manage in line with CCG policy P Treatments
Dr Carsten Lesshafft Clinical Executive NHS England/Wessex P Direct Appraiser Current Manage in line with CCG policy P
Graham Love Lay Member Western Sussex Hospitals NHS P Direct Head of Employee Relations Dec-17 Present Manage in line with CCG policy P Chair P Foundation Trust
Graham Love Lay Member Chartered Institute of Personnel and P Direct Member Jun-05 Present Manage in line with CCG policy P Chair P Development Sylvia Macey Primary Care Estates Kings Training Solutions P Indirect Husband owns Kings 11/09/2019 Current Manage in line with CCG policy. P Programme Manager Training Solutions which Exclusion from involvement in related delivers First Aid and commissioning of decision making. Resuscitation Training to GP and Dental Practices in Hampshire Steve McInnes Primary Care Nil P Relationship Manager Dr Nicholas Moore Clinical Executive Derby Road Group Practice P Direct Salaried GP Aug-19 Current Manage in line with CCG policy P Dr Nicholas Moore Clinical Executive GP Trainer, Health Education England, P Direct Delivery of training to GPs Jan-12 Current Manage in line with CCG policy P Wessex Dr Nicholas Moore Clinical Executive Portsmouth Primary Care Alliance Ltd P Direct Shareholder Nov-11 Current Manage in line with CCG policy P (PPCA) Dr Nicholas Moore Clinical Executive Wessex GP Appraisal Service P Direct Appraiser Jul-19 Current Manage in line with CCG policy P Dr Nicholas Moore Clinical Executive Craneswater Group Practice P Direct GP Partner Nov-11 30/06/2019 Manage in line with CCG policy P Dr Nicholas Moore Clinical Executive Craneswater Group Practice P Indirect Ex-wife remains a partner Nov-11 Current Manage in line with CCG policy P Dr Nicholas Moore Clinical Executive Craneswater Group Practice P Direct I remain financially invested Nov-11 Current Manage in line with CCG policy P in Waverley Road site awaiting buy out. Trevor Nicholas Senior Finance Trusted Numbers Ltd, Financial P Direct Director of Trusted Numbers Dec-15 Current Business not currently active. Left 30/10/19 Manager Consultancy Business Ltd, financial consultancy business previously providing services to health Trevor Nicholas Senior Finance Aspire Ryde P Direct Trustee - community based Feb-18 Current Manage in line with CCG policy. Left 30/10/19 Manager charity Trevor Nicholas Senior Finance ACCA (Association of Chartered P Direct Member 2001 Current None Left 30/10/19 Manager Certified Accountants)
3 of 7 Name Current position (s) Declared Interest- (Name of the Type of Interest Nature of Interest Date of Interest Action taken to mitigate risk held- i.e. Governing organisation and nature of Is the interest From To Committee Body, Member business) direct or practice, Employee or indirect? other
Audit Audit
Interests Interests
Committee
PrimaryCare
Remuneration
Governing Board Board Governing
Financial Interests Financial
ExecutiveCommittee
Non-Financial Personal Non-Financial
Quality and Safeguarding Safeguarding and Quality
Non-Financial Professional Professional Non-Financial
Commissioning Committee Commissioning Julia O'Mara Practice Nurse Advisor J2S Limited P Direct Director in Nurse training 01/01/2011 Current Will always declare this interest if P company providing training involved in discussions regarding the locally provision of nurse education and will Stephen Orobio Clinical Quality Manager Nil Attendee
Anna Plumbly Quality Improvement Nil P Officer Jackie Powell Lay Member Solent NHS Trust P Direct Associate Hospital Manager 2013 Present Declare conflict where appropriate in P P P P discussions relating to Solent and Mental Health Services Jackie Powell Lay Member Southern NHS Foundation Trust P Direct Mental Health Act Manager 2013 Present Declare conflict where appropriate in P P P P discussions relating to Mental Health Services Jackie Powell Lay Member Off The Record - a Young Persons P Direct Director 2013 Present Declare conflict where appropriate in P P P P Support and Counselling Service discussions regarding mental health and wellbeing of young peoples' services Jackie Powell Lay Member Off The Record - a Young Persons P Direct Counsellor 2013 Present Declare conflict where appropriate in P P P P Support and Counselling Service discussions regarding mental health and wellbeing of young peoples' services Jackie Powell Lay Member You Trust P Direct Counsellor Jan-18 Present Declare conflict where appropriate in P P P P discussions regarding mental health and wellbeing of young peoples' services Jackie Powell Lay Member Relate - Young Persons Counsellor P Direct Counsellor Oct-17 Present Declare conflict where appropriate in P P P P discussions regarding mental health and wellbeing of young peoples' services Innes Richens Chief of Health & Care Portsmouth City Council P Direct CCG role is dual role with Apr-16 Current CCG/City Council joint risk mitigation P Attendee Attendee P P Portsmouth Portsmouth City Council that agreement is in place for this role includes statutory responsibility for Adult Social Care Innes Richens Chief of Health & Care Portsmouth City Council P Indirect Father in Law is a service Apr-16 Current Manage in line with CCG policy P Attendee Attendee P P Portsmouth provider within the City Council commissioned Shared Lives scheme Innes Richens Chief of Health & Care Portsmouth City Council P Direct Non-voting member of the Sep-19 Current Manage in line with CCG policy. P Attendee Attendee P P Portsmouth Board for The HIVE, a not- Where any decisions relating to The for-profit company delivering HIVE are required, consider exclusion services in Portsmouth from the discussion and exclude from the decision.
Innes Richens Chief of Health & Care Portsmouth City Council P Indirect Partner is a self-employed IT Apr-16 Current Manage in line with CCG policy P Attendee Attendee P P Portsmouth and software developer working across the south coast, including supporting the community and voluntary sector in Portsmouth.
4 of 7 Name Current position (s) Declared Interest- (Name of the Type of Interest Nature of Interest Date of Interest Action taken to mitigate risk held- i.e. Governing organisation and nature of Is the interest From To Committee Body, Member business) direct or practice, Employee or indirect? other
Audit Audit
Interests Interests
Committee
PrimaryCare
Remuneration
Governing Board Board Governing
Financial Interests Financial
ExecutiveCommittee
Non-Financial Personal Non-Financial
Quality and Safeguarding Safeguarding and Quality
Non-Financial Professional Professional Non-Financial
Commissioning Committee Commissioning Suzannah Rosenberg Director of Transition Solent NHS Trust P Direct Substantively employed by 01.07.19 Current Declare interest and abstain from P Solent NHS Trust commissioning decisions relating to Solent NHS Trust Suzannah Rosenberg Director of Transition Solent MIND P Indirect Friends with Director Current Declare interest and abstain from any P funding decision Terri Russell Deputy Director Nil P P (Primary Care) Tracy Sanders Managing Director Sandpiper Associates P Direct Director 14.12.16 Current Approval provided via T&Cs of Attendee Attendee P employment to undertaken work for other NHS organisations. Little activity undertaken by company at present but when identified will consider any mitigating actions required if necessary. Tracy Sanders Managing Director University of Portsmouth P Indirect Husband is Lecturer 14.12.16 Current Unlikely to present a conflict but to Attendee Attendee P remain alert when CCG dealing with the University. Tracy Sanders Managing Director Chartered Institute of Management P Direct Associate Member 14.12.16 Current Unlikely to present a conflict but to Attendee Attendee P Accountants and a Chartered Global remain alert should the CCG ever be Management Accountant dealing with the CIMA/CGMA. Tracy Sanders Managing Director Sandpiper Associates P Indirect Husband is a Director of 14.12.16 Current Any conflicts when identified will be Attendee Attendee P Sandpiper Associates declared in line with CCG policy David Scarborough Practice Manager NHS Portsmouth Clinical P Indirect Wife is Deputy Director of Current Not in report chain. Manage in line P P Representative on Commissioning Group Quality and Safeguarding with CCG policy Governing Board David Scarborough Practice Manager Trafalgar Medical Group P Direct Business Manager Current Manage in line with CCG policy P P Representative on Governing Board David Scarborough Practice Manager Portsmouth South Coast Primary Care P Direct Business Lead Jul-19 Current Manage in line with CCG policy P P Representative on Network Governing Board Tina Scarborough Deputy Director Quality NHS Portsmouth Clinical P Indirect Husband is Practice Current Manage in line with CCG policy. P P and Safeguarding Commissioning Group Management Lead Tina Scarborough Deputy Director Quality Trafalgar Medical Group P Indirect Husband is Business Current Manage in line with CCG policy. P P and Safeguarding Manager for Trafalgar Group Practice Sarah Shore Head of Safeguarding Nil P Clare Sieber Medical Director, Wessex Local Medical Committee P Direct Local representative body Present Manage in line with CCG policy P Wessex LMC for GPs and their practices
Andrew Silvester Lay Member Portsmouth Civil Service Sports P Direct Chair and some CCG staff 1996 Current Manage in line with CCG policy P P Chair P Council are CSSC members Andrew Silvester Lay Member Portsmouth Hospitals Trust P P Indirect Spouse is an employee 2016 Current Manage in line with CCG policy P P Chair P Andrew Silvester Lay Member Portsmouth City Council P Direct Chair of Portsmouth Event 2019 Current Manage in line with CCG policy P P Chair P Safety Advisory Committee
Andrew Silvester Lay Member Office of the Police and Crime P Direct Independent Custody Visitor Current Manage in line with CCG policy P P Chair P Commissioner (OPCC) Simon Simonian Clinical Executive Simonian Medical Limited P Direct Director 2014 Current Manage in line with CCG policy P Simon Simonian Clinical Executive Winbell Limited P Direct Helps father with business Current Manage in line with CCG policy P
5 of 7 Name Current position (s) Declared Interest- (Name of the Type of Interest Nature of Interest Date of Interest Action taken to mitigate risk held- i.e. Governing organisation and nature of Is the interest From To Committee Body, Member business) direct or practice, Employee or indirect? other
Audit Audit
Interests Interests
Committee
PrimaryCare
Remuneration
Governing Board Board Governing
Financial Interests Financial
ExecutiveCommittee
Non-Financial Personal Non-Financial
Quality and Safeguarding Safeguarding and Quality
Non-Financial Professional Professional Non-Financial
Commissioning Committee Commissioning Simon Simonian Clinical Executive Lola Alvarez Psychotherapist P Indirect Clinical Trustee Current Manage in line with CCG policy P
Simon Simonian Clinical Executive Portsmouth Primary Care Alliance Ltd P Direct Sessional GP Work Current Manage in line with CCG policy P (PPCA) Michelle Spandley Chief Finance Officer Chartered Institute of Management P Direct Member Current Manage in line with CCG policy P Attendee Attendee P P Accountants (CIMA) and Chartered Global Management Accountants (CGMA) designation. Michelle Spandley Chief Finance Officer Healthcare Financial Management P Direct Member Current Manage in line with CCG policy P Attendee Attendee P P Association Michelle Spandley Chief Finance Officer NHS Portsmouth Clinical P Indirect Daughter is employed in the Current Daughter does not report directly to P Attendee Attendee P P Commissioning Group Finance Department Michelle. There are systems in place to ensure that segregation of duties is addressed. Rebecca Spandley Finance Manager NHS Portsmouth Clinical P Indirect Mother is Chief Finance Current Rebecca and Michelle do not discuss P Commissioning Group Officer for the CCG CCG business outside of the workplace. Not involved in the same approval processes/approval hierarchy. Rebecca Spandley Finance Manager Chartered Institute of Management P Direct Member Current Manage in line with CCG policy P Accountants Tahwinder Upile Secondary Care University Hospitals Southampton NHS P P Direct Secondary and Primary Current Manage in line with CCG policy P P Specialist Doctor on Foundation Trust & Hampshire Care Physician Governing Board Hospitals NHS Foundation Trust Tahwinder Upile Secondary Care Concordia Healthcare P P Direct Secondary and Primary Jan-17 Current Manage in line with CCG policy P P Specialist Doctor on Care Physician Governing Board Tahwinder Upile Secondary Care Harley Street LMA Group P P Direct Consultant Aug-12 Current Manage in line with CCG policy P P Specialist Doctor on Governing Board Tahwinder Upile Secondary Care Kent Surrey Sussex Deanery P P Direct Secondary and Primary Current Manage in line with CCG policy P P Specialist Doctor on Care Physician Governing Board Nigel Watson Chair of Local Medical NHS England P Direct Worked for DHSC Jun-18 31/01/2019 Manage in line with CCG policy Left Oct 19 Committee Partnership Review reporting to Secretary of State and CEO of NHSE David Williams Governing Board Portsmouth City Council P Direct Chief Executive 2007 Current None P Member David Williams Governing Board Gosport Borough Council P Direct Chief Executive 2006 Current None P Member David Williams Governing Board Solent NHS Trust P Direct Appointed Governor 2010 Current None P Member David Williams Governing Board Portsmouth University Technical P Direct Member 2014 Current None P Member College (UTC) David Williams Governing Board Victory Energy Services Limited P Direct Director 2019 Feb-20 None P Member David Williams Governing Board Portsmouth Harbour Marine CIC P Direct Director 2020 Current None P Member Jo York Director (New Models of Nil P P Care)
6 of 7 Name Current position (s) Declared Interest- (Name of the Type of Interest Nature of Interest Date of Interest Action taken to mitigate risk held- i.e. Governing organisation and nature of Is the interest From To Committee Body, Member business) direct or practice, Employee or indirect? other
Audit Audit
Interests Interests
Committee
PrimaryCare
Remuneration
Governing Board Board Governing
Financial Interests Financial
ExecutiveCommittee
Non-Financial Personal Non-Financial
Quality and Safeguarding Safeguarding and Quality
Non-Financial Professional Professional Non-Financial
Commissioning Committee Commissioning STAFF LIST Marcel Britton Executive Assistant Nil Minutes Jayne Collis Business Development Portsmouth Hospitals Trust P Indirect Sister in Law works at PHT Current Manage in line with CCG policy Minutes Manager Victoria Sexton Business Development Nil Minutes Minutes Manager Lisa Stray Business Assistant Nil Minutes
7 of 7
GOVERNING BOARD
Date of Meeting 18 March 2020 Agenda Item No 3
Title Minutes of Previous Meeting
Purpose of Paper To agree the minutes of the Governing Board meeting held on Wednesday 15 January 2020.
Recommendations/ Approve Actions requested
Engagement Activities – Clinical, Stakeholder and N/A Public/Patient
Item previously N/A considered at
Potential Conflicts of Interests for Board N/A Members
Author Jayne Collis, Business Development Manager
Sponsoring member Dr Elizabeth Fellows, Chair of Governing Board
Date of Paper 10 March 2020
DRAFT
Minutes of the NHS Portsmouth Clinical Commissioning Group Governing Board Meeting held on Wednesday 15 January 2020 at 3.00pm in Conference Room A, 2nd Floor, Civic Offices, Portsmouth
Summary of Actions Governing Board Meeting held on Wednesday 15 January 2020
Agenda Action Who By Item 3 Minutes of Previous Meeting – Amend errors as identified. J Collis Mar 20 3a Minutes of Previous Meeting – Summary of Actions - L Collie Mar 20 (4, Chief Clinical Officer’s Report – Winter Pressures Grant – 20.11.19) 111 Hospital Avoidance Scheme – Check if scheme is to provide one social worker in or out of hours. Update to be circulated to Board members. 3a Minutes of Previous Meeting – Summary of Actions - J Jeffs Mar 20 (6c, Programme Highlight Report – Urgent Care Charter – Share 20.11.19) Charter, that was circulated to GPs, with Board members. 3a Minutes of Previous Meeting – Summary of Actions – I Richens/ Mar 20 (7, Quality & Safeguarding Report - Bring a briefing on Core 24 J Jeffs 20.11.19) to a future Governing Board or Development Session. 4 Chief Clinical Officer’s Report – Joint Targeted Area A Jeffery/ Feb 20 Inspection – Share feedback once received with Governing J Jeffs Board members 4 Chief Clinical Officer’s Report – Wheelchair Services – I Richens Jul 20 Update to be provided in six months. 4 Chief Clinical Officer’s Report – Translation and Interpreting L Collie Mar 20 Services – Confirm if service will continue during reprocurement. 5b Health and Care Portsmouth and Wider Systems – I Richens Mar 20 Portsmouth & South East Hampshire – Bring briefing paper on the work ongoing across the system with regards to frailty pathways to a future meeting. 5b Health and Care Portsmouth and Wider Systems – I Richens/ Future Portsmouth & South East Hampshire - Population Health J Jeffs mtg Demand Management to be topic for a future Governing Board Development Session. 5c Health and Care Portsmouth and Wider Systems – I Richens/ Feb 20 Hampshire and Isle of Wight – February Governing Board J Jeffs Development Session to include a focus on Hampshire and Isle of Wight Commissioning Roadmap developments. 6b Performance Report – Confirm length of pilot for recording M Spandley Mar 20 ED performance with Portsmouth Hospitals Trust. 6b Performance Report – Clarify use of the term Out of Area M Spandley Mar 20 Placements and Extra Contractual Referrals (ECRs) (as used in the reports) as to whether they refer to the same or different arrangements. 6b Performance Report – Circulate a summary to Governing I Richens Mar 20 Board members of the range of pilots and projects being undertaken in respect of managing emergency care. 1
Agenda Action Who By Item 6c Programme Highlight Report – Update to be provided on M Spandley Mar 20 the Responsible Clinician for Paediatric Psychiatric Liaison service.
Present:
Jackie Powell - Lay Member (Chair) Karen Atkinson - Registered Nurse Dr Linda Collie - Chief Clinical Officer and Clinical Leader (GP) Margaret Geary - Lay Members Alison Jeffery - Director of Children’s Services, Portsmouth City Council Graham Love - Lay Member Dr Nick Moore - Clinical Executive (GP) Innes Richens - Chief of Health and Care Portsmouth David Scarborough - Practice Manager Representative Andy Silvester - Lay Member Michelle Spandley - Chief Finance Officer Dr Tahwinder Upile - Secondary Care Specialist Doctor David Williams - Chief Executive, Portsmouth City Council
In Attendance
Jayne Collis - Business Development Manager Justina Jeffs - Head of Governance Tina Scarborough - Director of Quality and Safeguarding (Item 8)
Apologies
Dr Elizabeth Fellows - Chair of Governing Board/Clinical Executive (GP) Dr Carsten Lesshafft - Clinical Executive (GP) Dr Simon Simonian - Clinical Executive (GP)
1. Apologies and Welcome
Apologies were received from Dr Elizabeth Fellows, Dr Carsten Lesshafft and Simon Simonian.
Jackie Powell, chairing the meeting on behalf of Dr Elizabeth Fellows, welcomed everyone to the meeting. She reminded those present that although the meeting was being held in public it was not a public meeting and therefore during the CCGs formal business, members of the audience would not be invited to participate.
2. Register and Declarations of Interest
The Committee Register of Interests was presented for noting. It was noted that the entry for Jane Cole had now been removed.
The Governing Board noted the Register of Interests.
3a. Minutes of Previous Meeting
The minutes of the Governing Board meeting held on Wednesday 20 November 2019 were approved as an accurate record subject to the following amendments:
Page 2, Item 1, 2nd paragraph, change “Dr Fellows she said” to “Dr Fellows said”. 2
Page 3, table, change “age range is 10-18 years.” to “age range is 8-18 years”. Page 5, Item 4, last paragraph, change “would like into” to “would look into”. Page 5, Item 5a, change “Glossup” to “Glossop”. Page 8, Item 8, 3rd paragraph change “ financial reasonability” to “financial responsibility”. Action: J Collis
An update on actions from the previous meeting was provided as follows:
Agenda Action Who By Progress Item 2 Register and Declarations of J Jeffs Jan 20 Complete. Interest – Update register as required. 3 Minutes of Previous Meeting E Fellows/ Jan 20 Complete. – Amend error as identified. J Collis 4 Chief Clinical Officer’s L Collie/ Jan 20 Session planned. Report – Work on Veterans to S Rosenberg be topic for future Governing Board Development Session. 4 Chief Clinical Officer’s L Collie Jan 20 Dr Collie reported that she Report – Winter Pressures had not managed to clarify Grant – 111 Hospital the issue and agreed to Avoidance Scheme – Check if email round an update to scheme is to provide one members. Action: L social worker in or out of Collie hours. 4 Chief Clinical Officer’s A Silvester Jan 20 Has been raised at Audit Report – Suggestion to be put Committee. to Audit Committee for Deep Dive on Patient Transport to be undertaken. 6b Performance Report – Page M Drake Jan 20 Complete. 15, Mental Health, anticipated improvement date to be changed from September 2019 to September 2020. 6c Programme Highlight Report M Drake Jan 20 Justina Jeffs reported that – Urgent Care Charter – Check Fareham and Gosport when paper version was CCG have been asked to launched. send the Charter out again. It was agreed the Urgent Care Charter would be circulated to Board members. Action: J Jeffs 6c Programme Highlight Report M Drake Jan 20 Justina Jeffs reported that – Community Health and Care this months Programme Scheme – Timescale for Highlight Report notes that nursing roll-out to be checked. this has been paused. 7 Quality & Safeguarding M Geary/ Jan 20 Complete. It was agreed a Report – Check and update T briefing session on Core Risk 6 in report as still refers to Scarborough 24 would be a topic for a mental health assessment unit. future Governing Board Development Session. Action: I Richens/J Jeffs 7 Quality & Safeguarding A Jeffery Jan 20 Alison Jeffery noted that 3
Agenda Action Who By Progress Item Report – Look into issues there were issues around health checks for regarding the flow of asylum seekers. information from Social Workers to the CCG and this has now been resolved. Complete. 8 NHS Long Term Plan For A Jeffery Jan 20 It was noted that the Long Mental Health – Access and terms Plan covered all Waiting Times – Age range ages. details to be checked.
3b. Matters Arising
None.
4. Chief Clinical Officer’s Report
Dr Linda Collie presented the Chief Clinical Officer’s Report and highlighted the following:
Joint Targeted Area Inspection
Portsmouth was subject to a Joint Targeted Area Inspection (JTAI) of Children’s Mental Health from 9-13 December 2019. The letter containing formal feedback will not be published until 31 January 2020, however some positive verbal feedback has been received. Thank you to everyone involved for the coordinated approach.
Andy Silvester asked if the JTAI feedback would be made public after 31 January 2020. It was confirmed this was the case and it was agreed the feedback would be shared with members once received. Action: A Jeffery/J Jeffs
National Child Safeguarding Review Panel
The National Child Safeguarding Practice Review Panel are undertaking their second national review looking at Sudden Unexpected Death in Infancy (SUDI) in families where the children are considered at risk of harm. The reviewers have visited 12 sites across the country and Portsmouth have undertaken a Serious Case Review which is due to be published shortly. The final report will be published in March 2020 and will seek to provide recommendations that will be applicable nationally.
EU Exit
The likelihood of a no deal EU Exit is now considered extremely low and planning for this has currently been suspended. The most likely scenario is that the UK will leave the EU on the 31 January 2020 with a deal (although another option is that a further extension could be requested). Locally the Hampshire and Isle of Wight Local Resilience Forum has also stood down plans for Operation Transmission.
Positive Minds
Positive Minds opened on 23 December 2019. It is a service for people who are living through low mood, anxiety, or who feel overwhelmed by problems such as housing, money, relationships, work, bereavement, leaving the Forces, or living away from home
4
at university – anything that can lead to feelings of hopelessness. The service operates both a drop-in and appointment system.
Integrated Primary Care Contract
The new interim contract with the Portsmouth Primary Care Alliance for the provision of an Integrated Primary Care Service commences in January 2020 and expires in May 2021. The interim contract enables the CCG to align several contract expiry dates in preparation for the commissioning of a new service, incorporating a wider array of integrated urgent care provision.
Wheelchair Services
An additional two-month wheelchair backlog contract extension is required to the AJM Mobility waiting list initiative contract. The change does not affect the contract financial value or activity targets. The extension of the backlog contract until 31 March 2020 will support AJM having a smooth start to the new contract.
Margaret Geary asked if the CCG was confident the backlog will be cleared. Dr Linda Collie said that she understood that it would. Justina Jeffs said that any cases passed from Millbrook Health to AJM during this time would not be handed back as the service is transferring to AJM on 1 April 2020.
Graham Love asked about the reasons for the backlog and it was noted that there were a number of reason causing the backlog including a number of patients on the original list whose needs hadn’t already been addressed.
Jackie Powell asked if the CCG was more confident on the way data is collected going forward. Michelle Spandley explained that this is now built into the contract so will improve. Innes Richens said that we have a lot of confidence in AJM Mobility in delivering the service. Jackie Powell suggested an update be provided in six months. Action: I Richens
Portsmouth Parent Voice and Dynamite
In order to fulfil the obligation for CCGs and NHS England to promote the involvement of patients and carers in decisions which relate to their care or treatment. Portsmouth CCG has agreed to part-fund Parent Voice and Dynamite services who support engagement with families of children with disabilities.
Clinical Executive Nominations
Dr Linda Collie reported that one of the Clinical Executive’s term of office is due to end of 30 April 2020. The position is currently out for nominations with member practices and the outcome will be reported at the next meeting.
Margaret Geary asked about the impact of the delay in reprocurement of the translation and interpreting services. Dr Linda Collie said that as she understood it the service would continue until reprocured but would check. Action: L Collie
The Governing Board accepted the Chief Clinical Officer’s Report.
5. Health and Care Portsmouth and Wider Systems
5a. Portsmouth
5
Innes Richens reported that some of the areas had already been covered in the Chief Clinical Officer’s report such as Positive Minds and the recent JTAI inspection and provided an update on other areas as follows:
Continuing to see an improvement in Care Quality Commission ratings for Portsmouth nursing and residential care homes. The result of this has meant that we have moved out of one of the national lower performing areas. However work continues to improve this situation even further and Portsmouth will continue to be monitored by the CQC. Graham Love asked if there was a timetable and Innes Richens explained that as we have to work with individual homes it is difficult to set a broad target, although our aim is to improve across the city. Other indicators are also used to determine improvement and quality of service, not just those of the CQC.
There is a single Health and Care Portsmouth team for Children and Families now in place between the CCG and the Council. As a consequence of this, a review is taking place across Health and Care Portsmouth to ensure alignment and meeting our integration plans. We have reviewed and revised the role and function of our CCG/PCC Quality Board, widening its scope to include providers from the care sector in the work.
Helen Atkinson appointed as Interim Director of Public Health for Portsmouth and we are already committed to working with her and the team on the integrated approach.
5b. Portsmouth and South East Hampshire
Innes Richens provided an update as follows:
Community Health and Care Programme – A frailty audit is being completed with system partners, to examine the current emergency pathway taken in order to identify areas for improvement.
It was agreed a briefing on the work ongoing across the system with regards to frailty pathways would be presented to a future meeting. Action: I Richens
The Emergency Department redirection project continues with encouraging results.
Progress is being made on two key procurements for the system – Integrated Urgent Care specification and Transforming Urgent and Elective services (TrUE).
Population Health Demand Management – work continues to establish what this means for Portsmouth and South East Hampshire and are looking at how we can build capacity both locally and at the Hampshire and Isle of Wight level. It is anticipated that this would be a 3-4 year strategy. Members requested that this was included in a future Governing Board Development Session. Action: I Richens/J Jeffs
5c. Hampshire and Isle of Wight
The STP co-ordinated the production of the HIOW Long Term Delivery Plan.
We have been working with Hampshire Partnership CCG Accountable Officer (Maggie McIsaac), to develop a proposal for how the CCGs in HIOW will deliver a single commissioning function at the HIOW STP/ICS tier. It was agreed the February Governing Board Development Session would include a focus on Hampshire and Isle of Wight Commissioning Roadmap developments. 6
Action: I Richens/J Jeffs
6. Finance and Performance Reports
6a. Finance Report
Michelle Spandley presented the Month 8 Finance Report noting that it was showing a similar pattern to that we have been experiencing for most of the financial year. The CCG is on track to achieve the expected year-end financial position despite over spending in a number of areas including: mental health extra contractual referrals, prescribing and continuing healthcare. However, these were balanced out by some areas of underspend.
We have worked with NHS Property Services to continue to clear 2018/19 issues. This will assist in performance indicators regarding creditors.
Month 9 is a similar picture and we are looking at contingency and reserves and talking to system partners.
With regards to the system, Solent are on trajectory to achieve year-end financial position and Portsmouth Hospitals Trust are continuing to predict achieving their year-end financial position.
David Scarborough commented that it was good news with regards to NHS Property Services and asked if there was any progress on Primary Care issues. Michelle Spandley explained that the agreement to clear 2018/19 will help focus on discussions and that they continue to meet with NHS Property Services on a regular basis.
David Williams asked about the first risk detailed on the Financial Risk Rating page of the report and what Amber meant. Michelle Spandley explained that the parameter is around Portsmouth and South East Hampshire and that our sister CCGs look ok financially. It is about reorganising underspends and opportunities in the area including payments to help reduce activity. David Williams asked about the outcome for Portsmouth CCG. Michelle Spandley informed members that we are in discussions on how we can support our partners to help them achieve their targets and further our transformation in the future.
David Williams asked about specialised commissioning. Michelle Spandley explained that Hampshire and Isle of Wight STP/ICS are working through the requirements and impact of taking this on. There have been conversations regarding risk share arrangements and location of activity in Portsmouth Hospitals Trust and UHS. Allocations would need to be adjusted accordingly.
Jackie Powell commented that it is the first time that the risk rating is amber and asked if there was sufficient contingency. Michelle Spandley explained that we routinely reviewing our contingency plans.
Jackie Powell asked what STP funding meant. Michelle Spandley this was transformation funding. Innes Richens commented that according to guidance for NHS plans, it is a trend we will have to face as funding will go to Hampshire and Isle of Wight STP to be disseminated to areas considered most in need. Members agreed that if this is the direction of travel we need to think about local ambition and priorities.
The Governing Board accepted the contents of the Finance Report.
6b. Performance Report
Michelle Spandley presented the Performance Report dated 15 January 2020 which provided a high level overview of CCG performance against key targets and standards. 7
She reported that there are a number of areas of improvement such as diagnostics; incidents of Cdiff and MRSA. Where we are underachieving, we are working hard to improvement performance, however for most there is an improving position. The following areas were highlighted:
A&E and Ambulance Handover – The system has worked better together this year and when we have experienced difficult days has been able to recover better than in the past. Improvements in length of stay and reduced levels of delayed transfers of care has helped.
SCAS – Continue to do well in the 999 new response times category despite delays in ambulance handovers.
David Williams asked about the A&E pilot and if the performance was being reported to the CCG. Michelle Spandley noted that Portsmouth Hospitals Trust are reporting to NHSI and we need to remember that there has been a change in the reporting/data collection criteria which is part of the pilot. Dr Nick Moore asked when the pilot would end and it was agreed this would be checked and reported back. Action: M Spandley
Graham Love commented on the table detailed on page 9 of the report and the number of 62 day waits. Michelle Spandley explained that the figures relate to where patients have transferred in and out of different providers and it is therefore done proportionately.
Graham Love asked about the Dermatology waiting list. Dr Linda Collie explained that this was one of the focus areas of the 100 day programme and we should see some improvements. Jackie Powell asked when the 100 day programme ended and Dr Linda Collie explained that it is a 100 days of action.
Karen Atkinson asked about the terminology for Out of Area Placements and Extra Contractual Referrals (ECRs) and if they were the same thing. Michelle Spandley agreed to check this and report back. Action: M Spandley
Jackie Powell asked about Ambulatory Care at A&E and what the triage process was and whether the Governing Board could have further information on the Redirection Pilot. Dr Linda Collie explained that Ambulatory Care and the Redirection Pilot are separate schemes focussed on different cohorts of patients. The Redirection Pilot has been has been extended to March. Jackie Powell said it would be useful to have a summary of the range of pilots and projects being undertaken in respect of managing emergency care. Action: I Richens
The Governing Board accepted the contents of the Performance Report.
6c. Programme Highlight Report
Michelle Spandley presented the Programme Highlight Report which provided a progress update on each of the Programmes and their underpinning projects, highlighting areas that are progressing well and areas for concern. The front sheet gives a summary of the work for each programme.
She noted that there was nothing specific to escalate and drew attention to the Executive Summary on the first page of the report which detailed areas that were progressing well as well as areas for concern. This dovetails into our progress with Health and Care Portsmouth and the wider system and is important as we develop plans for 2020/21.
8
Dave Scarborough asked for more details regarding Respiratory as mentioned on page 4 of the report and the potential for a pilot scheme to be set up.
Post Meeting Note: Information has now been shared with Dave Scarborough regarding the PCN respiratory programme.
Jackie Powell asked if the 10 beds on Jubilee ward had opened. Innes Richens confirmed this, explaining that Solent NHS Trust owned the building with Southern Health as the provider. Dr Linda Collie commented that the CQC had given approval for the ward to open. Innes Richens said that Portsmouth City Council would have safeguarding responsibility. Karen Atkinson said from a quality perspective we are ensuring there is no negative impact on Solent side linking in with Julia Barton’s team.
Jackie Powell asked about the Responsible Clinical for the Paediatric Psychiatric Liaison Service as mentioned on page 7 of the report. Michelle Spandley agreed to report back but said she believed there are interim arrangements in place. Action: M Spandley
The Governing Board noted the Programme Highlight Report.
6d. Hampshire and Isle of Wight STP Long Term Plan Response
Michelle Spandley presented the Hampshire and Isle of Wight STP Long Term Plan Response related to Portsmouth CCG. The CCG has produced a draft financial plan modelling the overall STP assumptions supplemented with local intelligence. Portsmouth CCG is currently indicating it is able to meet its financial trajectories set by NHS England. There are ongoing discussions regarding a £52m deficit off the 2020/21 target. Michelle explained that we do not know if it is acceptable to be off trajectory and as an organisation we need to ensure we are working on what the plans mean for us.
The operating plan documentation is expected next week and the draft plan submission is due mid-late February with final plans due for submission in early April. The paper presented shows the situation at a moment in time and things have moved on since it was produced.
Dr Nick Moore asked if this meant the CCG was in a deficit position. Michelle Spandley explained that we are showing a surplus position and there is no guarantee we will receive any of this back.
The Governing Board accepted the contents of the briefing.
7. Quality and Safeguarding Report
Karen Atkinson presented the Quality and Safeguarding Report for December 2019 that was discussed at the Quality and Safeguarding Committee (QSC) held on 18 December 2019. She drew attention to the points highlighted on the front sheet noting that 4 risks are still be monitored and a new risk relating to SCAS 999/PHT Handover delays at Queen Alexandra Hospital and Care UK vacancies. It was noted that some actions in the Performance Report needed to be included in the Quality Risk Register.
Two risks have been reduced relating to Portsmouth Hospitals NHS Trust relating to the use of restraints and improved safeguarding leadership, staff resource and training compliance. Healthcare Associated Infections (HAI) – No new MRSA cases recorded in November. 5 cases of C Diff investigated which showed there were no lapses in care.
Jackie Powell commented positively on the format and layout of the report.
9
Alison Jeffery commented on the target regarding the use of restraints. Tina Scarborough confirmed that the use of restraints has now stopped with formal reporting processes in place.
Jackie Powell asked about Portsmouth Hospitals Trust (PHT) maternity department and if they were struggling to manage. Karen Atkinson explained that there had been issues around informing GPs of babies being born and Dr Nick Moore commented that this had been addressed. Tina Scarborough stated that there had been issues regarding communication and IT systems, however these had improved. Portsmouth Hospitals Trust are doing a deep dive to find out where things are going wrong with regards to GPs not getting discharge letters after births
Members raised the issue of IT systems within PHT. It was acknowledged that these were, in some instances, not fit for purpose.
Jackie Powell asked about the use of chemical restraints as mentioned on page 11 of the report. Tina Scarborough explained that a task and finish group had undertaken an assessment of this. There will always be some level of restraint that may be required however we are trying to manage it and the whole process has been changed. It is not known if this is because the use of mechanical restraints had been stopped or due to training.
Jackie Powell asked about the Children’s Outreach and Support Team (COAST) service. Tina Scarborough explained that the service was stopped because it was not staffed. The service has re-opened however it is currently not available to GPs.
The Governing Board noted the Quality and Safeguarding Report.
8. Safeguarding Annual Report 2018-19
Tina Scarborough gave a presentation on the Portsmouth CCG Safeguarding Annual Report for 2018-19. The report gave an overview of safeguarding across health services in Portsmouth during 2018-19. The report reviews the work across the year, giving assurance that the CCG has discharged its statutory responsibility to safeguard the welfare of children and adults across the health services it commissions. It includes the actions taken over the previous year to meet these responsibilities and identifies priorities for 2019/20.
Jackie Powell commented that following the recent case of exploitation of young women in Manchester are we confident we have robust processes in place to prevent this. Tina Scarborough explained that there had been a case locally and it was reassuring that it had been recognised and a robust investigation had taken place which gives us a high level of assurance. Alison Jeffery said that we rely on disclose by young people and would take any such disclosure seriously and undertake appropriate actions. However other than individual disclosure it remains difficult to get a full understanding of the situation regarding levels of exploitation.
Members discussed cases from other areas of the country where the transition from children’s services to adults services had not been successful and recognised that we needed to learn from these.
Jackie Powell thanked Tina Scarborough for her presentation.
9. Verbal Report for Committee Chairs and Minutes
Audit Committee
10
Jackie Powell gave a brief update on the meeting held on 11 December 2019 noting that internal and external audits were discussed as well as local counter fraud and financial matters. There were no areas of concern.
The minutes of the Audit Committee meeting held on 11 September 2019 were presented.
Health and Wellbeing Board
Innes Richens gave a brief update on the meeting held on 8 January 2020 noting that the Adults Safeguarding Board Annual Report and Domestic Abuse Strategic Review 2019-23 were accepted by the Board. It was agreed that a development session would be held in February to refresh and review the Health and Wellbeing Board strategy.
David Williams noted that the Board had agreed a letter would be sent from the Joint Chairs to the Home Office, the Police Crime Commissioner and the Ministry of Justice regarding longer term funding for domestic violence.
Innes Richens reported that a letter had also been sent to NHS England inviting them to attend the next meeting to discuss the reprocurement of dental services.
Primary Care Commissioning Committee
Margaret Geary reported that no further meeting had taken place since October 2019.
Quality and Safeguarding Committee
Karen Atkinson reported that the January 2020 meeting had been cancelled and therefore no further meetings had taken place since December 2019.
The minutes of the Quality and Safeguarding Executive Committee meetings held on 16 October 2019 and 20 November 2019 were presented.
Clinical Advisory Group
Dr Nick Moore gave a brief update from the meetings held in December and January noting that the following areas had been discussed:
- A new pathway for Gastroenterology to help reduce the number of colonoscopies required. - Evidence Based Interventions Programme which aims to reduce demand and include efficiency savings. - The Optimal Lung Cancer pathway. - A new Urology pathway using advice and guidance. - An updated on the Gastroenterology pathway FIT test.
The Governing Board noted the updates and minutes above.
10. Date and Time of Next Meeting in Public
The next Governing Board meeting to be held in public will take place on Wednesday 18 March 2020 at 2.00pm – 5.00pm in Conference Room A, 2nd Floor, Civic Offices, Portsmouth.
11
Jayne Collis 11 February 2020
Governing Board - Attendance Log Member Name May 19 Jul 19 Sep 19 Nov 19 Jan 20 Mar 20 Helen Atkinson Karen Atkinson A A Dr Linda Collie A Dr Elizabeth Fellows A Margaret Geary A Dr Jason Horsley A A A Alison Jeffery Dr Carsten Lesshafft A Graham Love Dr Nick Moore A Jackie Powell Innes Richens A David Scarborough A Andy Silvester A Dr Simon Simonian A A Michelle Spandley Dr Tahwinder Upile A David Williams A A
Key: - Present A - Absent
12
GOVERNING BOARD
Date of Meeting 18 March 2020 Agenda Item No 4
Title Chief Clinical Officer’s Report
This paper provides an update to the Governing Board on key decisions and actions undertaken by the Clinical Executive under the leadership of the Chief Clinical Officer.
Purpose of Paper
The Governing Board is requested to accept this report and to Recommendations/ consider the requests for decisions as set out under items 7 and 8 of Actions requested the report.
Engagement Activities – Clinical, Stakeholder and Not applicable Public/Patient
Item previously Not applicable considered at
Potential Conflicts of Interests for Board None Members
Author Senior Management Team
Sponsoring member Dr Linda Collie, Chief Clinical Officer and Clinical Leader
Date of Paper 8 March 2020
REPORT FROM THE CHIEF CLINICAL OFFICER
1 Introduction
This report summarises the key decisions and actions taken by the Clinical Executive under the leadership of the Chief Clinical Officer on behalf of the Governing Board since the previous Governing Board meeting in January 2020.
2 Covid-19 Novel coronavirus (COVID-19) is a new strain of coronavirus first identified in Wuhan City, China. Public information regarding coronavirus and the situation in the UK can be found on the www.gov.uk website and further information about how it is spread, self-isolation and treatment can be found on the www.nhs.uk website. The government published its action plan on the 3 March – this sets out: What is known about the virus and the disease it causes How the UK has planned for an infectious disease outbreak, such as the current coronavirus outbreak The actions taken to date Future plans, depending upon the course the current outbreak takes The role the public can play in supporting this As of 9am on 8 March 2020, 23,513 people have been tested in the UK, of which 23,240 were confirmed negative and 273 were confirmed as positive. Daily updates are made by Public Health England and this is a quickly changing picture.
Nationally actions are being over seen through established COBR arrangements that was due to meet on the 9 March to determine next steps.
Locally a Hampshire and Isle of Wight co-ordinated approach is being taken utilising existing EPRR arrangements and mechanisms and building on existing planning for the health protection incidents and outbreaks. Key points to note from a Hampshire and Isle of Wight point of view include:
The significant pressures 111 (this is also being reflected nationally) in acting as the point of contact for those concerned which significantly escalated since the definition changed to include Italy. Additional support has been sought. A national flu service is operational from 4 March with an additional 500 call handlers and will operate as an overflow service for 111 Significant interest from the media both in relation to suspected individual cases and in the subject in general Priority assessment services (Pods) are now in place in all acute hospital and Urgent Treatment Centres – for Portsmouth these are located in Portsmouth Hospitals and the St Mary’s Treatment Centre A home/community testing model has been put in place Co-ordination service to provide tracking of patient numbers is being drafted A Covid-19 management service to support low risk patients self-managing at home with remote support from primary care is planned to be put in place by the 10 March
Page 1 Primary care resilience is being focused upon to ensure that current services can be maintained we as little disruption as possible.
A rhythm of meetings and teleconferences has been put in place locally and nationally to ensure good communications flows and escalation of risks and issues as well as dissemination of updates and further actions to be taken. There are regional calls daily; LHRP calls weekly, national calls weekly and CCG internal calls to collate all matters weekly as well. This is further supplemented by the collation of daily sitreps. Our CCGs EPRR team are co-ordinating our input into these arrangements.
3 Safe Sleep Campaign
The Safeguarding Children Partnerships are teaming up across HIOW area promote safe sleeping for infants to reduce the number of Sudden Infant Death in the area. The initiative will be launched on Monday 09 March to coincide with National Safe Sleep Week. It is be a joint initiative involving health and social care professionals, housing services, police and children’s/family centres to spread the word on safer sleeping and reduce the risk of Sudden Infant Death Syndrome (SIDS).
At the launch:
Derek Benson, Independent Chair of the Hampshire, Isle of Wight, Portsmouth and Southampton Safeguarding Children Partnerships (HIPS), will share the new protocols with elected members and senior leaders from partners in the Hampshire and Isle of Wight area; Tina Scarborough will be presenting alongside other health colleagues and will be the health spokesperson for the local campaign. A local ambassador for The Lullaby Trust will speak about the importance of safer sleep practices and the work of the charity in supporting bereaved parents; A Safer Sleep public information stand, staffed by local health professionals, will be open at the venue after the launch;
This will be followed by a number of events throughout the week to trained and inform professionals and families on reducing the risk of Sudden Infant Death.
4 Joint Targeted Area Inspection Report Published
The final report following the visit undertaken in December 2019 by Ofsted, the Care Quality Commission, HMI Constabulary and Fire & Rescue Services (HMICFRS) and HMI Probation (HMI Prob). As reported to the Governing Board in January this multi-agency inspection reviewed our local arrangements across agencies involved in providing support to children in Portsmouth.
The report praised organisation across Portsmouth for their support for children who need mental health support as well as those suffering from abuse, neglect and exploitation.
Schools, the NHS, the police, the council and voluntary organisations are particularly commended for working closely together in a strong partnership, for their learning culture and for their innovation and creativity, helping to ensure that children in Portsmouth are receiving the emotional well-being and mental health services they need. The quality and flexibility of the specialist mental health service, Children and Adolescent Mental Health Service (CAMHS), is highlighted, as is the effective response to children presenting to the A&E department at the QA Hospital. Hampshire Police were commended for their commitment and understanding of children's needs and for responding in an appropriate way. It was noted that public resources were being used efficiently through good joint commissioning of services.
Page 2 The report identifies ways in which services could be further improved, including a consistent focus during planning and assessment of services on how they impact on children at the point of delivery.
The full report can be found at https://files.ofsted.gov.uk/v1/file/50144233
5 Clinical Executive Appointment
As one of the CCG’s Clinical Executives is coming to the end of their tenure in May 2020, elections for the role were held between January and February 2020. In keeping with our Constitution, the Local Medical Committee managed this election on our behalf. Nominations were invited from GPs working in the local area. The process ended on 28 February 2020 and I am delighted to inform you that Dr Nick Moore has been successfully re-elected to this post.
6 Equality and Diversity Annual Report
The Governing Board is asked to note that the CCGs Equality and Diversity Annual Report 2019 was considered and approved at the Executive Committee meeting held on the 27 January 2020 for publication on the CCGs website.
7 Pharmacy First Minor Ailments Scheme
NHS Portsmouth CCG commissions local community pharmacies to provide a minor ailments service. This supports patients to obtain over the counter treatments with a consultation within a community pharmacy. Those exempt from prescription charges are able to access treatment free of charge, preventing patients from requesting an appointment within GP practice in order to get a prescription. The contract for this scheme is due for renewal in April 2020.
In March 2018, NHS England published the policy: Conditions for which over the counter items should not routinely be prescribed in primary care. This policy can be found: https://www.england.nhs.uk/publication/conditions-for-which-over-the-counter-items- should-not-routinely-be-prescribed-in-primary-care-guidance-for-ccgs/
The continued commissioning of the minor ailments scheme in its current format would contradict the recommendations within the policy. However, there are concerns that the complete removal of this service may lead to patients returning to GP surgeries in order to obtain a prescription.
An options appraisal was taken to the Clinical Advisory Group in February. The committee supported the downscaling of the service, limiting the products available with a bias towards paediatric formulations, and tightening the payment exemption categories so only those with lower incomes are eligible.
The Governing Board are asked to support the contract renewal of the minor ailments service with a reduced number of products, and restricted eligibility to those on lower incomes.
8 Specialist Perinatal Mental Health Community Service
The current Specialist Perinatal Mental Health Community service is delivered by Southern Health NHS Foundation Trust. The service provides assessment, intensive support and treatment for childbearing women with serious mental ill health who cannot be managed effectively by primary care services. The service aims to ensure that all women of reproductive age with current or previous serious mental ill health have access to timely
Page 3 advice and information. This information includes the risks of pregnancy and childbirth on their mental health and that of their unborn baby/infant, including the risks and benefits of psychotropic medication. The service works closely with the specialised mother and baby unit, which is based in Winchester commissioned separately by NHS England specialist commissioning.
The original contract, supported with NHS England funding, was for 3 years and commenced during 2016/17 to bring Portsmouth, Isle of Wight (IOW) North East Hampshire and Farnham CCG's in line with the rest of Hampshire with a contract end date of March 2019. From April 2019, the service became part of a pan Hampshire contract led by West Hampshire CCG in collaboration with North Hampshire, North East Hampshire & Farnham, Southampton, Isle of Wight, South Eastern Hampshire, Fareham & Gosport and Portsmouth CCGs. The current contract is due to cease on 31st March 2020 with a value of £345k per annum for Portsmouth. Commissioners wish to propose extending the current contract for a further year.
A full service review was planned to take place during the last year of the three-year contract (18/19) as commissioners wanted assurance against a number of outcome measures. This review has been delayed and is now anticipated during quarter 4 (19/20) / quarter 1 (20/21).
The findings from the review will support future recommendations for service provision to ensure an equitable pathway across the whole contract. Commissioners are also reviewing other available support across the Portsmouth system for women with lower level needs and are due to attend Clinical Advisory Group on the 4th March to update the group on the current position and seek views and feedback on the current service configuration.
The service received 156 Portsmouth referrals between Jan - Dec 19 managing an average monthly caseload of 44 women.
It is important to note Perinatal mental health is one of a number of key service lines within the Mental Health five year forward view and The Mental Health Long Term Plans 2019/20 - 2023/24 for which there are a mix of fixed and flexible ambitions to be achieved by 2024 supported by some central transformation funding to be allocated to CCG baselines;
Fixed ambition; o to increase access to support services for women - numbers to be determined for Portsmouth Flexible ambitions to be achieved by 2024; o Care and support to be extended from 12 months to 24 months post delivery o Offer evidenced based assessments for partners of women accessing specialist community care and signposting to support
Southern Health are currently building a business case for commissioners to identify how the above ambitions can be met and the level of resources needed.
The Governing Board is requested to approve the extension of the current contract for a further year.
9 Isle of Wight NHS Trust and Portsmouth Hospitals NHS Trust Partnership
A partnership between Isle of Wight NHS Trust (IWT) and Portsmouth Hospitals NHS Trust (PHT) will improve hospital-based services for people living on the Isle of Wight.
The partnership will see IWT and PHT build on current joint working and strengthen close working relationships.
Page 4
It has been agreed by the Boards of both Trusts and work has started to explore how the two organisations can plan together to better share expertise, ways of working and resources to improve services for local people and deliver more sustainable services for the future.
The acute partnership is one of a number of partnerships being established as part of the Isle of Wight Health and Care Plan. The Plan was launched in September 2019, sets out a shared vision across health, and care to ensure sustainable, high-quality services for local people. Isle of Wight NHS Trust, Hampshire and Isle of Wight Partnership of Clinical Commissioning Groups and Isle of Wight Council are working together to change services to better meet the needs of the local community on the island. The acute partnership is one of the ways in which this positive change will be delivered.
This announcement follows news published in October 2019 that Solent NHS Trust would partner with Isle of Wight NHS Trust to continue to transform mental health services for local residents.
Isle of Wight NHS Trust has also been working in a successful partnership with South Central Ambulance Service NHS Foundation Trust to support the island’s ambulance service for more than 18 months.
10 NHS Operational Planning and Contracting Guidance
National Approach
The National Operational Planning and Contracting Guidance 2020/21 was published on the 30th January 2020. The submission deadlines for operating plans are the 5th March for the first cut operating plan and the 29th April for the final submission. Contract signature is scheduled for the 27th March.
The national requirements for the CCG operating plan for 2020/21 are:
Financial Plan 20/21 Activity Plan 20/21 Performance Metrics 20/21
In addition, the CCG will be required to provide areas of narrative that will be used by the HIOW STP as well as supporting an STP level plan for Primary Care Workforce.
HIOW STP is required to agree individual commissioner and provider plans to ensure they are consistent with the goals, assumptions and financial trajectories within the HIOW STP Long Term Plan. In addition, HIOW STP will provide a short operational narrative to describe the action that will be undertaken during 2020/21.
Local Approach
The planning team will ensure the CCG operating plan demonstrates delivery of required national and local priorities and contributes to the delivery of:
Health and Care Portsmouth Strategic Priorities The NHS Long Term Plan The 2020/21 planning guidance The Hampshire and Isle of Wight (HIOW) Sustainability and Transformation Partnership plan The Portsmouth and South Eastern Hampshire (PSEH) Integrated Care Partnership (ICP) Blueprint
Page 5
A first draft CCG operating plan was circulated to the Executive Committee for review on the 21st February. This consisted of a short introduction, CCG priorities, programme hierarchies and project plans for 20/21. Comments and feedback have been received and will be incorporated into the final submission document.
11 Care Quality Commission (CQC) Ratings
The Care Quality Commission announced updated ratings for local NHS providers in January 2020.
Portsmouth Hospitals NHS Trust were inspected in October and November 2019 to look at the quality of care being provided to people using their services. Following this inspection, the overall rating of the trust has improved from requires improvement to good. The trust was rated as good for being caring, effective, well-led and responsive to people’s needs, and will remain requires improvement for being safe. CQC inspected five core services and leadership at the trust. Ratings for medical care (including older people’s care) and surgery had both improved overall and are now rated good, outpatients remains rated good overall, whilst urgent and emergency services and outpatients both remain rated as requires improvement. CQC has also published the trust’s Use of Resources report, which is based on an assessment undertaken by NHS Improvement. The trust has been rated as good in this area.
Catherine Campbell, CQC’s Head of Hospital Inspection for the South East said: "Portsmouth Hospitals NHS Trust has made improvements since our last inspection. Overall, the trust has improved from requires improvement to good which is great news for people using these services. Our inspectors found that the culture within the trust had improved and patients benefited from more coordinated care with local organisations. We found that care was inclusive, and staff supported people’s needs and preferences. All the staff at Portsmouth should be proud of the positive progress that has been made. However, although people told us they were treated with kindness and compassion, further improvements are required in safety to some areas of the trust, which we rated as requires improvement. These include the need for rapid improvement in the emergency department where we have concerns about people being cared for safely and in a timely way. I expect to see improvements in this area when we return, and we will continue to monitor this closely.”
Southern Health NHS Foundation Trust received a revised rating from there Care Quality Commission as Good overall. The Trust is now rated as Good for being safe, caring, responsive to people’s needs and well-led and Requires Improvement for being effective. Previously the Trust was rated as Requires Improvement.
The CQC noted that their ‘our inspectors found a really strong patient-centred culture with staff committed to keeping their people safe and encouraging them to be independent. Patients’ needs came first, and staff worked hard to deliver the best possible care with compassion and respect. Inspectors saw many areas of good practice, with care delivered by compassionate and knowledgeable staff. Several teams led by example with a continuous focus on quality improvement. The trust did face some challenges and there are still some areas of improvement required but there has been a significant improvement in the services at this trust. Staff, patients and the leadership team should be proud of the work done so far. We will continue to monitor the trust and our inspectors will look to return to check on its progress’.
12 Southern Health Chief Executive
At the end of January 2020 Dr Nick Broughton, Chief Executive of Southern Health Foundation Trust announced that he would be leaving the Trust in May to take up the
Page 6 position of Chief Executive at Oxford Health NHS Foundation Trust. The process has already begun to appoint his successor.
13 Solent Executive Arrangements
Governing Board members may be already aware that Sarah Austin, Chief Operating Officer Portsmouth and Commercial Director, will be leaving Solent for a new role as Director of Integrated Care at Guy’s and St Thomas’ NHS Foundation Trust in April.
Sue Harriman, Chief Executive has been reviewing portfolios and arrangements in light of Sarah’s departure and as part of this, and in line with Solent’s succession planning process, Suzannah Rosenberg, Deputy Chief Operating Officer, will be stepping into the role of Interim Chief Operating Officer Portsmouth. Helen Ives, Chief Organisational Effectiveness and People Officer will be broadening her responsibilities to include the commercial portfolio.
14 SHIP Priorities Committee Activities
Following evidence reviews, the SHIP Priorities Committee have produced the following updated commissioning policies
Priority Statement 001 - Interventional procedures for varicose veins. The current policy has been updated to facilitate early referral for treatment of varicose veins in patients with a venous leg ulcers Priority Statement 013 - Bariatric surgery procedures in severely obese adults. An evidence and guideline review was undertaken but this has not resulted in any change to the current policy Priority Statement 60 - Spinal Pain. The Clinical Advisory Group previously reviewed Policy Statement no 59 for low back pain and sciatica, which was produced by the SHIP Priorities committee following publication of two major national reports on low back pain. However, the general consensus amongst commissioners and providers was that it would be helpful if the local policy was also extended to cover interventions for back, pain originated from other parts of the spine e.g. the cervical and sacral regions. Hence one combined policy has been produced covering all of the major areas of the spine
The Clinical Advisory Group reviewed and recommended approval of these updated policies
15 South Central Armed Forces Network
NHS Portsmouth CCG has the role of Co-ordinator of the South Central Armed Forces Network, Chaired by Dr Elizabeth Fellows. A network event has been arranged for 24 March 2020 to showcase the work undertaken in Portsmouth in support of our Armed Forces. Organisations from across the South Central region will be attending the event in order to share good practice and learning. A range of speakers will be sharing their experiences of setting up and delivering services for armed forced personnel across acute, primary and specialist’s services.
16 Annual General Meeting
Preparations are underway for the CCG’s Annual General Meeting to be held on 16 September 2020 in the Lord Mayor’s Banqueting Suite, Guildhall. We are currently reviewing a theme for the meeting, which will include the work of Health & Care Portsmouth, and welcome any suggestions. I would like to take this opportunity to invite members of the public to this event to see the work of the CCG and its partners. Invitations
Page 7 will be sent to stakeholder groups and organisations across the city, over the coming months.
17 Other Key Actions
Other key actions undertaken by members of the Clinical Executive which I would like to report to the Governing Board include:
Considered the success and learning from the recent Business Continuity Emergency Staff Communication Cascade test and actions to be taken Reviewed freedom of information requests and responses received in the quarter Agreed the principals for the CCGs draft financial strategy and budget setting approaches for 2020/21 Considered forthcoming communication and engagement requirements and programmes Reviewed and approved Recruitment and Selection Policy, Substance Misuse Policy, Data Protection Impact Assessment Framework and template, Information Asset Owner and Data Custodian Handbook and the Risk Management Policy. Reviewed progress of plans and programmes identifying actions to mitigate risks and issues. Provided leadership and input into the STP programme and the Portsmouth and South East Hampshire integrated care partnership Oversight and escalation of matters related to constitutional and other standards delivery and also assurance arrangements with NHS England
18 Conclusion
The Governing Board is asked to accept this report.
8 March 2020
Page 8
GOVERNING BOARD
Date of Meeting 18 March 2020 Agenda Item No 6a
Title Finance Report – M10 2019/20
To update the Governing Board on the financial position (Month 10) for the 2019/20 financial year.
Purpose of Paper
Recommendations/ The Governing Board is asked to accept the contents of the Finance Actions requested Report.
Engagement Activities – Clinical, Stakeholder and N/A Public/Patient
Item previously N/A considered at
Potential Conflicts of Interests for Board N/A Members
Author Nicola Burnett, Deputy Chief Finance Officer
Sponsoring member Michelle Spandley, Chief Finance Officer
Date of Paper 12 February 2020
Finance Report
January 2020 - Month 10
Prepared 12th February 2020
ImprovingImprovingImproving health healthhealth services… services...services… Finance Dashboard
Indicator Target Actual Variance % RAG
In year position - Year to date (variance) £0.00m -£0.00m 0% G
In year position - Full year forecast (variance) £0.00m £0.00m 0% G
Cumulative position - Year to date (variance) -£6.05m -£6.05m 0% G
Cumulative position - Full year forecast (variance) -£7.26m -£7.26m 0% G
QIPP - Year to date £8.33m £8.33m 0% G
QIPP - Full year forecast £9.99m £9.99m 0% G
Running costs allocation v forecast (per head) £21.17m £18.95m -10% G
Running costs allocation v forecast £4.90m £4.38m -11% G
Running costs plan (inc savings) v forecast (per head) £19.01m £18.95m 0% G
Running costs plan (inc savings) v forecast £4.40m £4.38m 0% G
BPPC performance - invoices paid within Better Payment 95% 100% 5% G Practice Code - Value
BPPC performance - invoices paid within Better Payment 95% 99% 4% G Practice Code - Volume
Cash Utilisation - percentage of drawdown remaining at <= 1.25% 24.77% 24% A month end (£M) £0.36m 7.06m
2% Debtors - percentage over 90 days (£) < 10% -8% R £0.007m
25% Creditors - percentage over 90 days (£) < 10% 15% R £1.12m January 2020 - Month 10 Improving health services… Finance Summary
Key Headlines & Risks
• At Month 10 the CCG remains on track to deliver its plan of an in-year break even position, with a surplus at the end of 2019/20 will be £7.3m.
• The forecast for Acute has remained relatively stable on the M09 positon, discussions are ongoing across the ICP to mitigate any residual financial risk surrounding the delivery of winter capacity plans. • A second tranche of LD TCP funding was received in month supporting the financial position as the monthly run rate of ECR expenditure increases. The forecast outturn for ECR’s remains at an estimated a £1.5m pressure.
• The forecast for Children's Continuing Healthcare costs has risen at m10 following investigation of the packages of care with Local Authority colleagues.
• NHS Property Services’ (NHSPS) invoices remain the predominant reason for the high level of creditors, however the value has decreased due to the payment of outstanding old year invoices from NHSPS (NHS Property Services).
• The cash position remains high due to hosting the Winter Capacity Plan funds for the Portsmouth & SE Hants system. The CCG will continue to monitor the cash position closely to ensure the CCG meets the expected target.
• The ‘Over 90 days’ debtor position relates to a single invoice due for payment with NHS England, the team continue to work closely with local partners to resolve any outstanding queries promptly.
January 2020 - Month 10 Improving health services… Summary Financial Performance
Summary: The CCG is on target to achieve an in-year break-even position, in line with its control total
Annual MONTH 10 - JANUARY 20 Forecast Budget YTD Budget YTD Actual YTD Variance Outturn Variance £'m £'m £'m £'m £'m £'m Acute Commissioning 154.7 128.9 130.2 1.3 155.7 1.0 Mental Health Commissioning 40.0 33.3 34.3 1.0 41.5 1.6 Community Services Commissioning 34.9 29.1 29.2 0.1 35.0 0.1 Primary Care Commissioning 67.2 56.0 56.4 0.4 67.9 0.6 Continuing Care 18.5 15.4 16.0 0.6 19.1 0.6 Other Commissioning 11.9 9.9 8.6 -1.4 10.7 -1.3 Running Costs 4.4 3.7 3.6 -0.0 4.4 -0.0 Reserves & Contingencies 5.9 5.0 3.0 -1.9 3.3 -2.7 In Year Reporting 337.6 281.3 281.3 -0.0 337.6 0.0
To reflect our control total reported position:
In Year Reporting 337.6 281.3 281.3 -0.0 337.6 0.0 Cumulative Surplus 7.3 6.0 0.0 -6.0 0.0 -7.3 Cumulative Surplus 344.9 287.4 281.3 -6.0 337.6 -7.3
Please note regarding variances – Negative represents a favourable variance, Positive represents an adverse variance
January 2020 - Month 10 Improving health services… Detailed Financial Performance
Annual MONTH 10 - JANUARY 20 Forecast Budget YTD Budget YTD Actual YTD Variance Outturn Variance £'m £'m £'m £'m £'m £'m Portsmouth Hospitals NHS Trust 128.8 107.3 107.7 0.3 128.8 0.0 University Hospital Southampton FT 3.3 2.7 2.9 0.2 3.5 0.2 Western Sussex Hospitals FT 0.6 0.5 0.5 0.0 0.6 0.0 London Providers 1.4 1.2 1.1 -0.1 1.3 -0.1 Acute Spire Healthcare 1.3 1.1 1.1 -0.0 1.3 -0.0 Commissioning South Central Ambulance FT 8.8 7.3 7.7 0.4 9.2 0.3 Clinical Assessment and TCs 6.7 5.6 5.7 0.1 6.8 0.1 NCAs / OATs 2.1 1.8 2.2 0.4 2.6 0.4 Other Acute Commissioning 1.6 1.3 1.4 0.0 1.7 0.0 Solent NHS Trust (MH) 29.4 24.5 24.5 0.0 29.4 0.0 Mental Health Southern Healthcare FT (MH) 0.6 0.5 0.5 0.0 0.6 0.0 Commissioning Other Mental Health Commissioning 9.9 8.3 9.3 1.0 11.5 1.6 Solent NHS Trust (Community) 29.4 24.5 24.6 0.1 29.5 0.1 Southern Healthcare FT (Community) 0.5 0.5 0.5 0.0 0.5 0.0 Joint Equipment Store 1.2 1.0 1.0 -0.0 1.2 -0.0 Community Health Wheelchair Service 0.9 0.7 0.7 -0.0 0.9 0.0 Commissioning Hospices 0.2 0.2 0.2 0.0 0.2 0.0 CCN Consumables 0.0 0.0 0.0 0.0 0.0 0.0 Other Community Commissioning 2.6 2.1 2.1 0.0 2.6 0.0 Practice Primary Care Prescribing 32.0 26.7 27.5 0.8 33.0 1.0 Local Commissioned Services 4.9 4.1 3.9 -0.2 4.7 -0.2 Primary Care Delegated Commissioning 28.2 23.5 23.4 -0.1 28.1 -0.1 Commissioning Primary Care Transformation 2.1 1.8 1.6 -0.2 2.1 -0.0 OOH 0.0 0.0 0.0 0.0 0.0 0.0 Adult Continuing Care 15.3 12.8 13.1 0.4 15.7 0.4 Continuing Care CHC Children 0.9 0.8 0.9 0.2 1.1 0.2 Funded Nursing Care 2.2 1.8 1.9 0.1 2.3 0.1 Recharges NHS Property Services Ltd 0.8 0.7 0.7 0.0 0.8 0.0 Childrens ECRs and S56/S257 0.5 0.4 0.3 -0.1 0.4 -0.1 Other IVF / IFR 0.1 0.1 0.1 0.0 0.1 0.0 Commissioning BCF 7.9 6.6 6.6 0.0 7.9 0.0 111 Service 0.9 0.8 0.8 0.1 1.0 0.1 Other Commissioning 1.7 1.4 0.1 -1.3 0.4 -1.3 HQ / Directorates, Agency & Assurance 2.9 2.4 2.4 -0.0 2.9 -0.0 Running Costs CSU Charges 1.2 1.0 1.0 0.0 1.2 0.0 Estate Management 0.3 0.2 0.2 -0.0 0.3 -0.0 Centrally Managed Commissioning Reserve Programmes 5.9 5.0 3.0 -1.9 3.3 -2.7 In Year Reporting 337.6 281.3 281.3 -0.0 337.6 0.0
To reflect our control total reported position:
In Year Reporting 337.6 281.3 281.3 -0.0 337.6 0.0 Cumulative Surplus 7.3 6.0 0.0 -6.0 0.0 -7.3 Cumulative Surplus 344.9 287.4 281.3 -6.0 337.6 -7.3
Please note regarding variances – Negative represents a favourable variance, Positive represents an adverse variance January 2020 - Month 10 Improving health services… Financial Risk Rating
Risk Mitigation RAG rating
IF health partners within the system are under extreme financial - Accurate financial modelling of contract baselines pressures, THEN there might be an impact on the CCG within the - Set aside contingencies to cover potential risks/over-performance AMBER overall context of system sustainability. - Savings plans
IF cuts in Public Health and Adult Social Care Funding are made, - Assess impact of cuts on services, and impact on providers and CCG THEN there would be an impact on service delivery and - Clarification of CCG financial risks and mitigating plans outcomes for patients, together with potential financial - Regular meetings with the Council AMBER consequences for the CCG, particularly around the Better Care - Joint planning Fund (BCF)
- Continued implementation of CCG IT strategy IF there is lack of coherent IT solutions to support the integrated - Resource projects appropriately care agenda, THEN there could be an impact on the pace of AMBER - Monitoring progress of KPI’s change
- Set aside reserves/contingencies IF the costs of meeting NHS Constitutional obligations are higher - Active involvement in system-wide projects AMBER than planned, THEN there may be a financial impact on the CCG
January 2020 - Month 10 Improving health services… Glossary of Terms
Acronym Acronym Description ACS Accountable Care System AMH Adult Mental Health BCF Better Care Fund BPPC Better Payment Practice Code CCG Clinical Commissioning Group CHC Continuing Healthcare CSU Commissioning Support Unit CYP Children and Young People ECR Extra Contractual Referral EOL End of Life FNC Funded Nursing Care FT Foundation Trust HQ Headquarters IAPT Improved Access to Psychological Therapies ICP Integrated Care Provider ICS Integrated Care System IFR Individual Funding Request IVF In Vitro Fertilisation KPI Key Performance Indicator LDS Local Delivery System MH Mental Health MHIS Mental Health Investment Standard NCA Non-Contracted Activity NHSPS NHS Property Services NR Non-Recurrent OOH Out of Hours OPMH Older People's Mental Health PD Physical Disability PSEH Portsmouth and South Eastern Hampshire QIPP Quality, Innovation, Productivity & Prevention TC Treatment Centre WLI Waiting List Initiative YTD Year to date
January 2020 - Month 10 Improving health services…
GOVERNING BOARD
Date of Meeting 18 March 2020 Agenda Item No 6b
Portsmouth Governing Board Performance Title Report
The Performance Report provides the Governing Board with a high- level view of; CCG performance against key constitutional targets and other standards that define an effective commissioner. Key performance related risks and mitigating actions where applicable.
Additionally, the Board are asked to note the following performance exceptions;
Increase in calls relating to Covid-19 impacting on SCAS 111 call Purpose of Paper answer performance.
Ambulance holds at QAH remain an issue with an increase in delays noted for January 2020 when compared to December 2019. Improvements noted in the CCG’s RTT waiting list size, this has reduced for the third consecutive month but remains off target. Achievement of the Cancer 62 Day Waiting Time standard from GP referral to Treatment. The diagnostic 6 week wait standard continues to improve but remains off target. Extended waiting times for MRI at Portsmouth Hospitals NHS Trust impacting on performance.
Recommendations/ The Board are asked to accept the contents of the Performance Actions requested Report.
Engagement Activities – Clinical, Stakeholder and Not Applicable Public/Patient Item previously Not Applicable considered at
Potential Conflicts of Interests for Committee Not Applicable Members
Michael Drake Author Director of Planning and Performance
Michelle Spandley Sponsoring member Chief Finance Officer
Date of Paper 6 March 2020
NHS Portsmouth CCG Governing Board Meeting 18th March 2020
Performance Report
1
Report Contents
1. Performance Summary ...... 3 2. Performance Exceptions ...... 4 Unscheduled Care ...... 4 Scheduled Care ...... 10 Mental Health ...... 16
2
1. Performance Summary The table below details the CCG’s performance in the last three months in relation to NHS Constitution standards and other key performance indicators; NHS Portsmouth CCG Constitutional Target Performance Organisation Frequency Target Oct-19 Nov-19 Dec-19 Perf Dir Q2 2019/20 Q3 2019/20 2019/20 Trend 111 Calls answered within 60 seconds SCAS M 95.0% 90.8% 91.1% 85.4% 92.7% 88.9% 91.1% Category 1 - 7 minutes mean response time SCAS M 00:07:00 00:07:28 00:07:25 00:07:31 Category 1 - 15 minutes 90th percentile response time SCAS M 00:15:00 00:13:20 00:13:34 00:13:38 Category 2 - 18 minutes mean response time SCAS M 00:18:00 00:19:27 00:18:59 00:19:47 Category 2 - 40 minutes 90th percentile response time SCAS M 00:40:00 00:40:07 00:38:50 00:41:35 Category 3 - 120 minutes 90th percentile response time SCAS M 02:00:00 02:30:05 02:19:27 02:30:23 Category 4 - 180 minutes 90th percentile response time SCAS M 03:00:00 03:28:18 03:09:31 03:24:49 Trolley Waits in A&E - Total (>12 Hours) PHT M 0 0 0 0 0 0 0 Cancer: 2 Week Wait CCG M 93.0% 95.5% 97.5% 95.3% 96.7% 96.1% 96.1% Cancer: 2 Week Wait (Breast Symptoms) CCG M 93.0% 95.3% 95.6% 96.4% 97.3% 95.8% 94.8% Cancer: 31 Day Wait for First Treatment CCG M 96.0% 98.8% 100.0% 95.5% 98.4% 98.2% 97.4% Cancer: 31 Day Subsequent Surgery CCG M 94.0% 94.7% 88.0% 100.0% 96.6% 93.3% 95.5% Cancer: 31 Day Subsequent Anti Cancer Drug Regimen CCG M 98.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Cancer: 31 Day Subsequent Radiotherapy CCG M 94.0% 100.0% 91.2% 100.0% 93.9% 97.0% 96.1% Cancer: 62 Day Wait for First Treatment CCG M 85.0% 83.3% 90.3% 93.1% 80.5% 88.5% 82.22% Cancer: 62 Day Wait for First Treatment Screening Referral CCG M 90.0% 33.3% 100.0% 100.0% 95.8% 66.7% 93.1% RTT: Incomplete Waiting List Size CCG M 12313 13674 13419 13307 RTT: Incomplete Performance CCG M 92.0% 81.2% 80.8% 80.3% 83.7% 80.7% 82.90% RTT: Patients waiting more than 52 Weeks CCG M 0 1 1 0 1 2 3 Diagnostic Test Waiting Times CCG M 99.0% 97.1% 97.8% 98.3% 95.3% 97.7% 96.2% Audiology: Incomplete Waiting List Performance CCG M 92.0% 58.0% 59.9% 61.8% 54.1% 59.8% 53.7% Incidents of C.Diff CCG M 31 2 2 2 5 6 11 Incidents of MRSA CCG M 0 0 0 0 0 0 0 Mixed Sex Accommodation Breaches CCG M 0 0 0 0 3 0 4 Dementia Diagnosis Rate CCG M 66.7% 68.7% 68.2% 67.8% 68.6% 68.2% 68.6% IAPT: People entering treatment CCG M 4.75% 4.8% 5.12% #N/A 4.4% 5.0% 4.5% IAPT: People moving into recovery as a % of those finishing treatment CCG M 50.0% 56.1% 56.3% #N/A 56.6% 56.2% 57.6% IAPT: First Appointment Within 6 Weeks of Referral CCG M 75.0% 86.4% 87.4% #N/A 86.7% 86.9% 88.3% IAPT: First Appointment Within 18 Weeks of Referral CCG M 95.0% 99.3% 99.2% #N/A 100.0% 99.3% 99.8% Early Intervention in Psychosis - Started Treatment CCG M 56.0% #N/A #N/A #N/A 90.9% #N/A 76.7% Out of Area Placements for Mental Health Active at Period End CCG M 0 0 0 #N/A 5 0 15 Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/ , NHS Digital https://digital.nhs.uk/search/document-type/publication/publicationStatus/true?area=data&sort=date , GOV.uk https://www.gov.uk/government/statistics
3
2. Performance Exceptions The report outlines the performance exceptions across key constitutional standards and operating plan commitments and related risks.
The paper provides a summary of the latest nationally published data and any local intelligence relating to ‘in month performance’ or ‘latest positions’.
Unscheduled Care South Central Ambulance Service (SCAS) 111 Calls Answered within 60 Seconds Organisation Frequency Target Nov-19 Dec-19 Jan-20 111 Calls answered within 60 seconds SCAS M 95.0% 91.1% 85.4% 95.6% In January 2020, the 111 Calls answered within 60 seconds target was met for the first since March 2019. Demand was down by 10.6% in January 2020 compared with the previous month. However compared with the same period last year, demand was up by 3.2%.
Early indications suggest that performance has deteriorated in February 2020 mainly as a result of the outbreak of Covid-19. Provisional data as at the week ending on the 15/02/20 places the Trust’s performance at 84.4%. SCAS’ performance was trending around 46% and nationally performance is averaging 56% during the week commencing 23/02/2020 hence the month end position is likely to be adversely impacted.
The SPC chart above illustrates the Trust’s weekly performance over time. It shows a deterioration in performance over the Christmas period but this has since improved and the Trust has achieved the standard in January 2020. However, significant deterioration in the trend is anticipated as a result of the Covid-19 outbreak once February 2020 data has been fed through.
Action(s) The Trust is continuing to focus on call length as well as utilising benchmarking to identify opportunities to reduce call handling times.
Managers continue to closely manage sickness absence across the Trust. Sickness levels are now low.
4
Quality Assurance Coaches (QACs) have been embedded into the call centre to provide support to new staff. QACs focused on helping new staff to reduce their call length times.
SCAS 999 Ambulance Response Times (ARP)
Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/
SCAS achieved 5 of the 6 national response time targets in January 2020, marginally failing the Category 1 (7 minutes mean response time) by 0.05 seconds. No Trust achieved the Category 1 Mean Response time target in January 2020
The Trust however met all 6 national standards in relation to the SHP contract in January 2020. The table below provides the details in relation to SCAS’ performance for the SHP contract.
Target Performance Cat 1 (7 minute) 00:07:00 07:00 Cat 1 (15 minute) 00:14:00 12:09 Cat 2 (18 Minutes) 00:18:00 14:54 Cat 2 (40 Minutes) 00:40:00 30:04:00 Cat 3 (2 hr) 02:00:00 01:28.2 Cat 4 (3 hr) 03:00:00 02:15:44
Provisional data for February 2020 month to date (23/2/20) suggests that the Trust is meeting 4 of the 6 national targets at SCAS level and 5 out of 6 at SHP contract level. The Trust is failing the Category 1 (7 minutes mean response time) standard at both SCAS and SHP Contract level. The tables below provide the details;
SCAS Level Performance
SCAS Level Target As at 23/2/20 Cat 1 - Mean 0:07:00 0:07:26 Cat 1 - 90th Percentile 0:15:00 0:13:20 Cat 2 - Mean 0:18:00 0:17:54 Cat 2 - 90th Percentile 0:40:00 0:35:44 Cat 3 - 90th Percentile 2:00:00 2:07:03 Cat 4 - 90th Percentile 3:00:00 2:52:24
5
SHP Contract Level Performance SHP Contract Target As at 23/2/20 Cat 1 - Mean 0:07:00 0:07:17 Cat 1 - 90th Percentile 0:15:00 0:12:39 Cat 2 - Mean 0:18:00 0:17:39 Cat 2 - 90th Percentile 0:40:00 0:35:42 Cat 3 - 90th Percentile 2:00:00 1:50:21 Cat 4 - 90th Percentile 3:00:00 2:21:23
Demand has continued to grow in January 2020 in relation to the SHP Contract but the pace has slowed with demand 0.5% above plan in January 2020 and up 2% when compared with the same period last year. YTD as at the end of January 2020 demand was 7.0% above plan and 9.0% above the same period last year.
Handover delays continue to be a significant challenge.
There was an increase in the number of reported ambulance delays in January. This increased to 1,193 hours (1192:54:07) compared to 815 (815:20:23) hours in December 2019. The highest number of reported delays was on 1st January, where 117 hours (116:32:31) were lost due to delays. There were 23 delays of 30-60 minutes and 50 delays of 60+ minutes. The hours lost on 1st January 2020 are the equivalent of 5 ambulances being held for just under 24 hours each waiting to handover. The Trust has taken the following actions in response to the challenge of increasing demand and ambulance availability;
Action(s) In response to recommendations made following a review into fleet operating capacity, fifteen new double crewed ambulances are now in operation across SCAS. A comprehensive fleet improvement action plan is now in place. Weekly ‘forward looks’ now in place with operations to manage vehicle availability. Recruitment of Paramedics from India and overtime incentives for key periods being utilised to support availability.
The following chart shows the 30-60 minute ambulance holds at QAH. We can see that there is still a significant amount of variability in the data reflecting the fragility of the system. Looking at the 7 day rolling average, the number of holds throughout January and February 2020 have remained high.
6
In response PHT has in place an Ambulance Handover Recovery plan but report that the following actions relating to capacity and flow are currently off trajectory;
Action(s) PHT’s Gold command structure has remained in place throughout January, supported by all Divisional leadership teams focusing on the 4 key areas outlined in the Ambulance Handover Recovery Plan Use of existing and additional community capacity to support improvement in Medically Fit for Discharge list and patient flow. Full utilisation of Discharge to Assess (D2A) and Integrated Intermediate Care (IIC) Capacity to sustain pull into alternative urgent care pathways from the Emergency Department.
SCAS has reported that it does not expect to achieve full compliance until the beginning of 2020/21 financial year despite the actions being taken.
A&E Portsmouth Hospitals NHS Trust participation in the ongoing national pilot in relation to the new national urgent and emergency care access standard is still taking place. Consequently, the Trust is not reporting their A&E 4 hour performance during the period of the pilot in line with national directive. The latest 2020/21 planning guidance does not give an indication of the future waiting time target or timescales as to when this will be rolled out. The guidance states that for 2020/21; “all providers should plan to deliver a material improvement against a 2019/20 benchmark. To achieve this, systems and organisations will be expected to reduce general and acute bed occupancy levels to a maximum of 92%.”
In terms of A&E demand, progress has been made towards understanding and fixing the data quality issues affecting the reported A&E activity numbers. The problem relates to PHT’s Emergency Commissioning Data Set upload and a fix is currently being developed by the Trust. We are currently awaiting confirmation from the Trust on timescales to fix and backdate the data. In the interim, the Trust has provided provisional data to support our analysis. This provisional data has been used to ‘manually’ correct the data for Portsmouth Hospitals NHS Trust to provide the following summaries.
CCG A&E Total Attendances Total A&E Attendances (Excluding Planned Follow-Up Attendances) (E.M.12) 2018-19 v 2019-20 v 2018-19 2019-20 Plan 2019-20 % Plan % APRIL 7,348 7,618 7,431 270 3.7% 187 2.5% MAY 8,028 7,792 8,085 -236 -2.9% -293 -3.6% JUNE 7,585 7,484 7,634 -101 -1.3% -150 -2.0% JULY 8,019 8,005 8,315 -14 -0.2% -310 -3.7% AUGUST 7,323 7,458 7,797 135 1.8% -339 -4.3% SEPTEMBER 7,443 7,174 7,699 -269 -3.6% -525 -6.8% OCTOBER 7,919 7,691 8,125 -228 -2.9% -434 -5.3% NOVEMBER 7,521 7,347 7,727 -174 -2.3% -380 -4.9% DECEMBER 7,726 7,788 7,895 62 0.8% -107 -1.4% Grand Total 68,912 68,357 70,708 -555 -0.8% -2,351 -3.3% 7
The table above shows the overall A&E attendances from the CCG’s patients for the period April to December. The data shows that the CCG’s overall A&E attendances for the period of review are down by -2,351/-3.3% against plan and -555/-0.8% when compared to the same period last year;
The decrease in the CCG’s A&E attendances mainly at occurred at PHT where the CCG’s overall related attendances are down by -931/-2.7% year on year.
CCG A&E Total Attendances by Provider Total A&E Attendances (Excluding Planned Follow-Up Attendances) (E.M.12) By Provider 2018-19 v 2018-19 2019-20 2019-20 % Frimley Health NHS Foundation Trust 85 97 12 14.1% Hampshire Hospitals NHS Foundation Trust 164 160 -4 -2.4% Other 3,147 3,190 43 1.4% Portsmouth Hospitals NHS Trust 34,156 33,225 -931 -2.7% Royal Surrey County Hospitals NHS Foundation Trust79 89 10 12.7% Southampton NHS Treatment Centre 157 158 1 0.6% Southern Health NHS Foundation Trust 109 122 13 11.9% St Marys NHS Treatment Centre 30,241 30,579 338 1.1% University Hospital Southampton NHS Foundation Trust438 418 -20 -4.6% Western Sussex Hospitals NHS Foundation Trust 336 319 -17 -5.1% Grand Total 68,912 68,357 -555 -0.8%
For Type 1 A&E attendances, the CCG’s related activity is showing a decrease by -117/-0.3% against plan but an increase of +287/+0.8% compared with the same period last year;
CCG A&E Type 1 Attendances Total Type 1 A&E Attendances (Excluding Planned Follow-Up Attendances) (E.M.12a) 2018-19 v 2019-20 v 2018-19 2019-20 Plan 2019-20 % Plan % APRIL 3,594 3,787 3,660 193 5.4% 127 3.5% MAY 4,030 3,954 3,984 -76 -1.9% -30 -0.8% JUNE 3,779 3,820 3,750 41 1.1% 70 1.9% JULY 4,096 3,963 4,134 -133 -3.2% -171 -4.1% AUGUST 3,740 3,791 3,857 51 1.4% -66 -1.7% SEPTEMBER 3,698 3,645 3,796 -53 -1.4% -151 -4.0% OCTOBER 3,968 3,957 4,019 -11 -0.3% -62 -1.5% NOVEMBER 3,780 3,755 3,824 -25 -0.7% -69 -1.8% DECEMBER 3,847 4,147 3,912 300 7.8% 235 6.0% Grand Total 34,532 34,819 34,936 287 0.8% -117 -0.3%
8
Looking at the Type1 A&E Attendances by Provider, the year on year growth in the CCG’s attendances is mainly seen at PHT where attendances have increased by +353/+1.1% year-on-year. The table below details the CCG’s Type1 attendance by provider;
CCG A&E Type 1 Attendance by Provider Total Type 1 A&E Attendances (Excluding Planned Follow-Up Attendances) (E.M.12a) 2018-19 v 2018-19 2019-20 2019-20 % Frimley Health NHS Foundation Trust 85 94 9 10.6% Hampshire Hospitals NHS Foundation Trust 147 145 -2 -1.4% Other 1,885 1,802 -83 -4.4% Portsmouth Hospitals NHS Trust 31,661 32,014 353 1.1% Royal Surrey County Hospitals NHS Foundation Trust73 78 5 6.8% University Hospital Southampton NHS Foundation Trust345 367 22 6.4% Western Sussex Hospitals NHS Foundation Trust 336 319 -17 -5.1%
Grand Total 34,532 34,819 287 0.8%
The following chart shows Type 1 A&E attendances at Portsmouth Hospitals NHS Trust over time. The average level of weekly demand prior to May 2018 was 2,136 attendances per week. Post May 2018 this increased to 2,309 attendances per week (+7.6%). Overall demand is continuing to trend upwards;
Source: Portsmouth Hospitals NHS Trust Information Services
The system has Integrated Care Programme Urgent Care Programme in place. The programme aims to deliver safe and effective urgent care flow throughout the system; ensuring people are in the right place for care, focusing on 4 main determinants of good flow outlined below:
1. Population health. 2. ED processes and admission avoidance. 3. Bed occupancy.
9
4. Out of hospital services.
In the past month there has been a continued focus across all live schemes to ensure the benefits and impact are maximised;
Additional winter capacity - all additional winter capacity now mobilised; o 10 additional beds at Jubilee House opened 10/01/2020 (Hampshire patients). o 12 additional beds at Portsmouth Hospital NHS Trust opened 24/12/2019 providing net impact for Medicines and Older Persons Medicine. o 40 interim beds open in South East Hampshire (Hampshire patients). o Capacity for 13 new starts per day through Hampshire IIC service. Emergency Department Redirection pilot extended to March 2020. For the period 4th November - 19th January, there have been a total of 1,820 patients redirected by the service averaging 24 per day against a target of 30 per day. Integrated Urgent Care Programme – the system have worked with PHL to increase capacity within the Hampshire CAS to enable increased numbers of cat 3&4 revalidations. Urgent treatment centres (UTC) development - Agreement in place to incorporate wider UTC development at Gosport and Petersfield into TRUE procurement programme. South Central Ambulance Services redirection schemes now combined under single governance structure. Continued focus on direct access to Acute Medical Unit (AMU) and Surgical Assessment Unit (SAU) plus updated criteria for Ambulatory Emergency Care (AEC) pilot to increase referrals. Numbers remain small overall. PHT Ward improvement: Medicine to take out (TTO) project work ongoing with further focus and education at ward level. All care group improvement initiatives in PHT underway. MIDOS (Software) – Business case to be presented to Unified Exec in March 2020. Work has commenced to data assure 111 Directory of Service (DoS ) and engaged with Hampshire County Council and Portsmouth City Council around community service directories. Working with general practice to scope how MIDOS can support primary care.
All the current projects and schemes are undergoing evaluation as part of 2020/21 planning. This includes review of all additional investment committed to schemes in 2019/20.
Risk: IF demand for A&E services at Portsmouth Hospitals NHS Trust continues to grow THEN there is a risk that patient waiting times will increase further impacting on performance and potentially patient outcomes.
Scheduled Care Cancer Standards The CCG achieved 7 of the 8 National Cancer Standards in December 2019, failing 31 Day Wait for First Treatment with a performance of 95.5% against a target of 96%. There were a total of 67 patients treated of which 64 were treated within standard. The standard was therefore missed by 1 patient.
10
PHT achieved all the National Cancer Standards in December 2019. Below are the details in relation to the Trust’s Cancer performance;
Referral to Treatment (RTT) Incomplete Waiting List Size NHS Portsmouth CCG Constitutional Target Performance Organisation Frequency Target Oct-19 Nov-19 Dec-19 RTT: Incomplete Waiting List Size CCG M 12313 13674 13419 13307 RTT: Incomplete Performance CCG M 92.0% 81.2% 80.8% 80.3% RTT: Patients waiting more than 52 Weeks CCG M 0 1 1 0
The CCG’s RTT incomplete waiting list size reduced by 0.8% in December 2019 when compared with the previous month. The list size as at the end of December 2019 was 13,307 pathways against a monthly trajectory of 13,340 and year-end threshold of 12,313 pathways. There was no reported breach of the 52 week incomplete standard.
Provisional data for January 2020 places the waiting list size at 13,509. No breach of the 52 weeks standard is anticipated in January 2020
Looking at the data for key providers;
March 2019 November December Provider October 2019 baseline 2019 2019 St. Marys Treatment 3,534 3,405 3,049 3,212 Centre PHT 33,052 36,043 36,195 35,270
December 2019 data for Care UK showed an increase in the overall waiting list size by +163/+5.3% compared with the previous month. Care UK’s waiting list jumped from 3,049 in November 2019 to 3,212 in December 2019. However, Care UK’s overall waiting list size remains below the March 2019 threshold.
11
In Contrast, PHT’s overall waiting list size decreased by -2.6%/-925 pathways in December 2019 to 35,270, down from 36,195 in November 2019. PHT’s position however, remains above the year end threshold of 33,052 pathways. The following chart details the waiting list trend over time for the specialties highlighted, the growth seen in Cardiology is relatively small however the other specialties are on an increasing trajectory;
Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/
In response to the issues highlighted the Trust has taken the following actions; Action(s) The Trust is participating in a national validation exercise, and the offer also includes external validators and on- line RTT training which will commence in March 2020. 3 external validators, have been identified to support the Trust Specialties are working on recruitment to address clinical and administrative shortfalls and reviewing pathways to optimise potential for early clock stops and with commissioners to manage increased demand for some services. Speciality level action plans to deliver improvement are being developed and progressed within divisions, this includes pathway improvements and options to affordably increase capacity and reduce waiting list size.
The system has agreed a priority programme to address the underlying demand and capacity mismatch, linking with the NHS Long Term Plan and informed by GIRFT, RightCare data, High Impact Intervention Programmes, best practice from Elective Care Speciality Based Transformation Handbooks, current contractual performance and waiting lists, local system pressures and BI information. The standardised approach includes implementation of digital first such as advice & guidance as the first point of contact, common condition pathways to support primary care management and forming speciality working groups within identified areas to discuss opportunities. Additional capacity realised as a result of the programme will be used to support back log reduction. Key programme highlights and actions include;
Action(s) Ophthalmology – Agreement to work with local optometrist service to become a pilot site for setting up optometrists to use Electronic Referral Service (eRS). Next steps – Medical Retina Service to move to Referral Assessment Service from Mid-March 2020.
12
Urology - Digital First service delivery model for all routine referrals went live on 27th January (including virtual single point of access stone clinic). Early indications of significant reduction in conversion from triage to first appointment. Next steps – Monitor pathway changes and regular engagement with the speciality. Follow up meeting to be scheduled. Respiratory – Common Conditions Optimal cancer pathway launched with positive results. Following a joint discussion with Primary Care Network (PCN) leads, Clinical Director for Respiratory and Clinical Record Interactive Search (CRIS) team representatives a virtual multidisciplinary team (MDT) clinic pilot is going to be designed to take place in the 20/21. This will allow practice nurses from one PCN to discuss cases via virtual MDT consisting of secondary and community service staff. Next steps are co design pilot specification and associated pathways, communications to PCN staff in preparation for go live. Gynaecology - Menstrual bleeding pathway (including new one-stop hysteroscopy service) launched 18th November. PHT admin infrastructure issues have led to utilisation issues of the new service, which have now been resolved. Next steps – Development of long term plans to redesign the women`s health continence service provision, ensuring robust provision of physio provision. Gastroenterology - Gastro audit results are expected to be received in early March ahead of FIT implementation from April 2020. Next Steps – Gastro strategy meetings continue to be held on a monthly basis along with smaller working groups to finalise the process for Faecal Immunochemical Test (FIT) implementation. 100 day outpatient transformation programme – Nephrology: Having gained primary care input from local GPs for the roll out of the agreed pathways, the Nephrology working team is now working with partners from Salisbury and West Sussex. Dermatology: Three projects and key individuals to work up each project have been identified and project groups are underway. It is anticipated a teledermatology service extension will be piloted as part of the 100 day challenge. Next steps – Agreement around the details of the pilot to be worked up during March 2020. RDS/Cancer workshops - Rapid Diagnostics Service (RDS) Task & Finish groups looking at referral criteria, commissioning and finance and demand and capacity in relation to the RDS are taking place over the coming months ahead of launch in April 2020. The Sovereign PCN has been successful in its application to become a pilot site for the project. ENT - Microsuction leaflet is now ready to be circulated. Engagement with ENT department around transformation programme is ongoing. Further audits to be undertaken before scope of project can be agreed. Next steps – Advice and Guidance Audit is in the process of being set up. Final meeting with nursing team around revised microsuction criteria to be held ahead of leaflet launch with GP communications to support role out. Advice and Guidance - Primary care knowledge survey and additional admin practice training has been completed. Training guidelines have been reviewed which identified a gap in application of knowledge to practice identified. Next steps - Development of virtual Skype training, Advice & Guidance in development within PHT Minestrone single clinical system.
Risk: IF the imbalance between elective demand and capacity at PHT is not addressed THEN the there is a risk to delivery of the RTT standard, the CCGs operating plan commitment in relation to RTT waiting list size and an increased risk of long waiting patients.
13
Diagnostics Waiting Times NHS Portsmouth CCG Constitutional Target Performance Organisation Frequency Target Oct-19 Nov-19 Dec-19 Diagnostic Test Waiting Times CCG M 99.0% 97.1% 97.8% 98.3%
Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/
The Diagnostics standard remains a challenge. The CCG missed the Diagnostic standard in December 2019, reporting 98.3% against the 99% standard. There were a total of 43 breaches with the majority occurring at PHT (31). The CCG missed the standard by 18 diagnostics. Significant reduction in the over 6 weeks breaches at St. Marys Treatment Centre compared with the previous month as a result of exclusion of audiology breaches in line with national guidelines. Provisional data for January 2020 places the CCGs performance at 98%.
The table below provides details in relation to the diagnostic breaches by provider as at the end of December 2019.
> 6 Weeks
Breaches PORTSMOUTH HOSPITALS NHS TRUST 31 ST MARY'S NHS TREATMENT CENTRE 7 UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST 3 BRIGHTON AND SUSSEX UNIVERSITY HOSPITALS NHS TRUST 1 INHEALTH LIMITED 1 TOTAL BREACHES 43
The table below shows PHT’s overall performance (Total Trust / All Commissioners) by test. The majority of reported breaches were in MRI and Ultrasound;
< 6 Weeks > 6 Weeks Total Performance MRI 1121 56 1177 95.2% Non Obstetric Ultrasound 2067 36 2103 98.3% Colonoscopy 274 8 282 97.2% Gastroscopy 266 5 271 98.2% Echocardiography 357 2 359 99.4% Cystoscopy 71 2 73 97.3% Flexible Sigmoidoscopy 109 2 111 98.2% CT 622 1 623 99.8% Sleep Studies 1 0 1 100.0% Dexa Scan 135 0 135 100.0% Audiology 264 0 264 100.0% Peripheral Neurophysiology 359 0 359 100.0% Barium Enema 130 0 130 100.0% 5776 112 5888 98.1%
14
The Trust has undertaken a number of actions to address these issues including the following;
Action(s) Continued use of Waiting List Initiatives (WLI) in Ultrasound to maintain waiting times Current capacity for Cardiac MRI to increase from 65 slots 81 slots per month from March 2020 Ultrasound - additional WLI capacity commenced February 2020 and being planned for March 2020 Computer tomography (CT) - Continue to work with clinical teams to ensure robust demand management. The mobile unit will be operational for six days a week from the end of February 2020 Development of cardiac MRI plan to be delivered by April 2021 The ICP team held a strategy meeting with leaders from PHT diagnostics to discuss 20/21 strategy for the programme. The next step is to produce co-written plan which will then be submitted to Executive Contract Review Meeting for agreement. Aspects will include a focus on pathway driven diagnostic access and alignment of strategic direction.
Audiology Waiting Times The CCG continues to miss the Audiology Incomplete pathway standard but showing steady improvement albeit small progress. The CCG’s performance improved from 59.9% in November 2019 to 61.8% in December 2019.
NHS Portsmouth CCG Constitutional Target Performance Organisation Frequency Target Oct-19 Nov-19 Dec-19 Audiology: Incomplete Waiting List Performance CCG M 92.0% 58.0% 59.9% 61.8% Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/
The CCG’s performance continues to be impacted by capacity issues at PHT. The Trust’s Audiology waiting time performance improved to 57.9% in December from 55.9% in November 2019.
Provisional data suggest that there has been significant improvement in the waiting list size and the number of patients waiting in excess of 52 weeks. The waiting list size has fallen from 4,068 as at 06/11/2019 to 3,606 as at 05/02/2020. The number of patients waiting in excess of 52 weeks has also dropped from 133 to 7 for the same period. The table below provide details of the trends; Snapshot Date 06/11/2019 13/11/2019 20/11/2019 27/11/2019 04/12/2019 11/12/2019 18/12/2019 27/12/2020 02/01/2020 08/01/2020 15/01/2020 22/01/2020 29/01/2020 05/02/2020 Total Waiting List 4068 3977 3808 3723 3721 3690 3627 3597 3605 3593 3625 3629 3637 3606 WL Increase -1.4% -2.2% -4.2% -2.2% -0.1% -0.8% -1.7% -0.8% 0.2% -0.3% 0.9% 0.1% 0.2% -0.9% Over 18 Weeks 1972 1912 1809 1744 1628 1557 1528 1519 1524 1521 1493 1455 1456 1433 Over 26 Weeks 1457 1397 1281 1227 1110 1053 996 1001 1024 1039 1013 974 963 947 Over 35 Weeks 903 825 718 690 583 511 492 480 496 512 480 463 464 445 Over 52 Weeks 133 104 65 86 32 19 17 18 18 11 19 10 9 7
As a result of workforce challenges and the resulting capacity issues, there is a risk that the waiting list size may grow.
In response, the following actions have been taken; Action(s) Locum capacity now in place at the Trust with a focus on reducing the backlog of long waiting patients. Discussions relating to the longer term sustainability of the Audiology service delivered by the Trust remain ongoing.
15
Mental Health The CCG is currently meeting all the mental health standards. This is set out in the table below:
NHS Portsmouth CCG Constitutional Target Performance Organisation Frequency Target Oct-19 Nov-19 Dec-19 Dementia Diagnosis Rate CCG M 66.7% 68.7% 68.2% 67.8% IAPT: People entering treatment CCG M 4.75% 4.8% 5.12% #N/A IAPT: People moving into recovery as a % of those finishing treatment CCG M 50.0% 56.1% 56.3% #N/A IAPT: First Appointment Within 6 Weeks of Referral CCG M 75.0% 86.4% 87.4% #N/A IAPT: First Appointment Within 18 Weeks of Referral CCG M 95.0% 99.3% 99.2% #N/A Out of Area Placements for Mental Health Active at Period End CCG M 0 0 0 #N/A Data source: NHS Digital
16
GOVERNING BOARD
Date of Meeting 18 March 2020 Agenda Item No 6c
Title Programme Highlight Report
To provide the Governing Board with a progress update on each of the Programmes and their underpinning projects, highlighting areas that are progressing well and areas for concern.
Programme highlights: Community Health & Care: • The future development of the Enhanced Care Homes Team is currently being reviewed. This will form part of the future Primary Care Network (PCN) Directed Enhanced Service and will be discussed at the PCN Directors meeting on 4th April 2020. • Work continues to test new models of working within the Emergency Department (ED) and Frailty interface Team (FIT). Although this work has gained momentum, pace in progressing the Frailty programme of work continues to be delayed due to a requirement for a more joined-up strategic approach. • End of Life (EoL) patient and carer engagement has begun with workshops planned for April and May. Urgent Care: • The business case for MiDoS will be presented to the PSEH ICP Unified Exec in March. • Adult Social Care in the SCAS control room has now gone live for
Portsmouth. Purpose of Paper • Medically Fit for Discharge (MFFD) numbers have reduced to
around target levels (40) with the majority of MFFD waits in 0-3 days. Work is progressing to scope the 2020/21 planning with particular focus around strengthening bridging support offer. Maternity & Children’s: • The Prior Information Notice (PIN) for the paediatric liaison service has closed with no challenge raised, therefore plans will now progress to direct award. Recruitment is underway to ensure service delivery from 1st April 2020. • iCCN has now opened to referrals for ED at PHT and the service are working at streamlining the process for primary care to refer into the service. • The ICP group will be represented at the forthcoming STP Children’s strategy workshop in March 2020 whereby discussions will be held regarding the strategic focus and organisation membership of the STP group will be proposed and consequently the interface with this layer for our local ICP programme. • Delay in the availability of the review of the Community Paediatric Medical Service (CPMS) service and pathway has led to a slight delay in progression of the next steps for the project.
Vulnerable Adults: • The Mental Health Acute Pathway project remains on hold. A paper was presented to Unified Exec in January seeking strategic direction for the inpatient pathway project; The outcome was for the Southern & Solent CEOs to meet to agree a position, a meeting was held and further meeting is scheduled for April 2020. • It is planned that a Psychiatric Liaison business case will be presented to the ICP Finance Working Group and then ICP Unified Exec in April for funding commitment post the financial year 20/21. • The Emotional Dysregulation pathway work has concluded and it is recommended the pathway is implemented as part of the Southern community services redesign; the options paper is proceeding through governance processes. Planned Care: • It is anticipated a teledermatology service extension will be piloted as part of the Transforming Outpatients National Programme 100 day challenge. • Urology Digital First service delivery model for all routine referrals went live on 27th January (including virtual single point of access stone clinic). • The one-stop single point of access stones clinic and access via advice and guidance for routine referrals model went live on 27th January 2020. • Agreement reached at the Gastro Strategy meeting to focus on phase 1 of the strategy, which focusses on the introduction of Faecal Immunochemical Test (FIT) to support reductions in outpatient and endoscopy demand.
• Support and promote strategic discussions with all PSEH System Partners to support delivery of key project areas and system Recommendations/ priorities. Actions requested • Re-enforce to programme and project leads the CCG requirement to follow the approved project management processes.
Engagement Activities – Clinical, Stakeholder and Not applicable Public/Patient
Item previously Not applicable considered at
Potential Conflicts of Interests for Board Not applicable Members
Debbie Bishop Author Michael Drake
Michelle Spandley Sponsoring member Chief Finance Officer
Date of Paper 4 March 2020
NHS Portsmouth CCG Programme Highlight Report March 2020
Executive Summary The Programme Highlight Report provides the Executive Committee with a high-level overview of each of the CCG’s Programmes of work, and their underpinning Projects, which make up the CCG’s project portfolio.
Programme highlights:
Community Health & Care: • The future development of the Enhanced Care Homes Team is currently being reviewed. This will form part of the future Primary Care Network (PCN) Directed Enhanced Service and will be discussed at the PCN Directors meeting on 4th April 2020. • Work continues to test new models of working within the Emergency Department (ED) and Frailty interface Team (FIT). Although this work has gained momentum, pace in progressing the Frailty programme of work continues to be delayed due to a requirement for a more joined-up strategic approach. • End of Life (EoL) patient and carer engagement has begun with workshops planned for April and May. Urgent Care: • The business case for MiDoS will be presented to the PSEH ICP Unified Exec in March. • Adult Social Care in the SCAS control room has now gone live for Portsmouth. • Medically Fit for Discharge (MFFD) numbers have reduced to around target levels (40) with the majority of MFFD waits in 0-3 days. Work is progressing to scope the 2020/21 planning with particular focus around strengthening bridging support offer. Maternity & Children’s: • The Prior Information Notice (PIN) for the paediatric liaison service has closed with no challenge raised, therefore plans will now progress to direct award. Recruitment is underway to ensure service delivery from 1st April 2020. • iCCN has now opened to referrals for ED at PHT and the service are working at streamlining the process for primary care to refer into the service. • The ICP group will be represented at the forthcoming STP Children’s strategy workshop in March 2020 whereby discussions will be held regarding the strategic focus and organisation membership of the STP group will be proposed and consequently the interface with this layer for our local ICP programme. • Delay in the availability of the review of the Community Paediatric Medical Service (CPMS) service and pathway has led to a slight delay in progression of the next steps for the project. Vulnerable Adults: • The Mental Health Acute Pathway project remains on hold. A paper was presented to Unified Exec in January seeking strategic direction for the inpatient pathway project; The outcome was for the Southern & Solent CEOs to meet to agree a position, a meeting was held and further meeting is scheduled for April 2020. • It is planned that a Psychiatric Liaison business case will be presented to the ICP Finance Working Group and then ICP Unified Exec in April for funding commitment post the financial year 20/21. • The Emotional Dysregulation pathway work has concluded and it is recommended the pathway is implemented as part of the Southern community services redesign; the options paper is proceeding through governance processes. Planned Care: • It is anticipated a teledermatology service extension will be piloted as part of the Transforming Outpatients National Programme 100 day challenge. • Urology Digital First service delivery model for all routine referrals went live on 27th January (including virtual single point of access stone clinic). • The one-stop single point of access stones clinic and access via advice and guidance for routine referrals model went live on 27th January 2020. • Agreement reached at the Gastro Strategy meeting to focus on phase 1 of the strategy, which focusses on the introduction of Faecal Immunochemical Test (FIT) to support reductions in outpatient and endoscopy demand.
Improving health services… 2019-20 Community Health & Care Programme Update Programme Overview Key Risk & Issues
Project Updates: Portsmouth Enhanced Care Home Team (ECHT): The Telehealth pilot went live on 2nd January with 18 homes to be trained to access the service. The pilot is undergoing a thorough monitoring process. The future development of the Enhanced Care Homes 2 1 Team is currently being reviewed. This will form part of the future Primary Care Network (PCN) Directed Enhanced Service and will be discussed at the PCN Directors meeting on 4th April 2020. Portsmouth Neighbourhood Model: The team have been testing the new SystmOne development in the live environment for the past couple of weeks, however this has Top Programme Risks/Issues Mitigating Actions not been conclusive as the team currently does not have a nurse and/or a physiotherapist to be able to test the assessment across multiple units. An urgent 1. Capacity across the system to deliver: There is a risk Discussions underway about how to re-focus existing that there is a lack of capacity and resource across the transformational management time across organisations meeting has been set to work through blockages to move forward. system to deliver the projects within the programme . to identify some dedicated project management support The Assistant Product Specialist secondment to assist with the MCP programme ends st to ensure delivery of the programme. on 31 March, the project team are keen to resolve the remaining issues before this This has been escalated to Senior leaders and on going date. discussions are taking place with PHT, Solent and wider PSEH Frailty Interface Team (FIT) and Frailty: Work continues to test new models of system meetings working within the Emergency Dept and FIT. Although this work has gained momentum, 2. Benefits Realisation: Due to the scale of the Some further work is still required to understand the pace in progressing the Frailty programme of work continues to be delayed due to a programme some of the projects have had financial impact and alignment of the benefits within this requirement for a more joined-up strategic approach. A presentation was given to the benefits identified and aligned to AIC contracts but there programme. Work will continue with BI and Operational and Programme Delivery Group on 4th February and a direction was given is more work to do for the other projects within this Performance leads to work through this. to produce a position statement on the model for supporting patients with frailty within programme to understand what the impact will be. the first 72 hours of requiring urgent care, outlining challenges and concerns. The production of this model will also enable us to work through differing medical and clinical opinions. The PSEH Frailty Task and Finish Group are meeting on Tuesday 10th Project Performance Update March to agree the work streams and work stream leads for each key element of the Portsmouth It was anticipated that this project would save 21 Type 1 A&E attendances and 35 Non Elective programme. Enhanced Care Admissions over the course of 2019/20. PSEH End of Life (EOL): The PSEH End of Life Programme Board met on 3rd March and Home Team was presented with updates from programme work streams; a patient representative (EHCT) As at the end of November 2019, the project has yet to deliver the intended A&E deflection at PHT has now joined the board: with 178 attendances from in scope Care Homes against a year to date target of 166. • Strategy and Vision (Demand and Capacity): Patient and staff surveys are now live, Non elective admissions from Portsmouth CCG in scope Care Homes continues to perform better to date 52 patients have responded and 17 members of staff. The survey end date is than plan with 123 admissions November year to date against a target of 133. still to be decided depending on number of responses. Workshops have been planned for April and May with involvement from patients with regards to planning the events. PSEH Frailty It was anticipated that this project would deliver an additional 912 avoided admissions for over 75s • End of life Transportation Task and Finish Group presented the recommended Interface Team based on FIT improving the conversion rate between admissions avoided and supported process which will support patients, families and patients to make difficult decisions (FIT) and Frailty discharges. with regards to transporting patients who chose to move to their preferred place of death. This process will be shared with other providers for comment. Overall FIT avoided admission numbers remain off target. For the period 28/10/2019 - 12/01/2020 the average number of weekly avoided admissions was 30 against a weekly target of 63. Community Enhanced Response (CER) including SCAS Specialist Practitioner: The There was no noted reduction in performance over the Christmas period with W/C 23/12/2019 the project is currently being reviewed to establish a proposed way forward with a plan being best week year to date in terms of avoided admissions with a total of 54. The average for the developed to identify system wide approach to improve the current criteria for the SCAS falls financial year is 34. referrals into the community teams.
Planning Leads Key Concerns: The programme itself has been restructured and many gaps have been filled which is a great improvement. Some of the projects are still in the scoping stage so do not have robust plans with granular detail. The Planning Lead continues to meet with leads to support this work. 2019-20 Urgent Care Programme Update Programme Overview Key Risk & Issues Project Updates: 1. Population Health and Demand: Top Programme Risks/Issues Mitigating Actions In-Hours Clinical Assessment Service (CAS) - ED and Primary Care dispositions: A new Service 1. Patient Flow: IF the issues affecting The system are undertaking a number of Development Implementation Plan (SDIP) has been agreed with the provider for the Integrated patient flow at Portsmouth Hospitals NHS schemes aimed at improving patient flow at Primary Care Service (IPCS). Over the 17 month contract the CCG and Provider will work towards: Trust are not addressed , then there is a risk the trust with a focus on: • CAS diversification to identify further potential pathways which would benefit from a CAS that A&E performance will not improve. •Admission avoidance. response •Reduction in patient length of stay •Bed occupancy improvement • Review of potential for a Direct Provision of Overnight Services •Urgent Care Capacity • Further Workforce Diversification 2. ED Pathway/ CQC findings: If pressure on •Urgent care plan revised and focussing on 4 • Establish data reporting mechanism with CSU PHT emergency department continues to rise key themes; emergency care, patient flow, • Develop and Implement a Communications and Engagement Strategy and fluctuate and if there is inadequate admission avoidance and workforce staffing then care may fall short of required •Quality recovery plan in place and being Implementation of MiDoS Directory of Services online system: Business case will be presented to standards resulting in compromised safety, implemented Unified Execs in March; ambition to go live in March will be delayed. experience and quality of care. •Quality recovery plan metrics developed.
HCC Adult Social Care in SCAS Control Room: SystmOne training has been completed and the service went live for Portsmouth on the 13th Jan. Programme Management Risks/Issues Concerns SCAS Conveyance to Non-ED areas: SAU Pilot to go live on 2 March 2020 and will operate 7 days 1. Lack of visibility of PHT led Escalation via ICP discussions. per week 08.00-20-00. Pilot has one bed open and anticipates being able to see 4 patients per day plans and processes (Ward E1 and E level). The final number will be dependent on the time period between each patient’s arrival to allow appropriate triage, assessment and tests to be carried out etc. the pilot is based on the 2. Full set of project plans for Work is ongoing to support plan development. 2021 delivery Southampton Model. SCAS to phone ahead to confirm acceptance; SAU will only accept if there is capacity. SCAS can take direct to at East Entrance where oncology patients go to and has easy access to lifts. Time and motion study needs to be undertaken to inform any future development. Performance Update Pathway/comms have been developed by PHT but is being ‘SCAS’ branded so that it feels familiar to Provisional data for January 2020 indicates an improvement across all Ambulance Response SCAS staff. Time standards with the Trust forecasting to achieve 5 of the 6 national targets. Although the Category 1 Mean response time target is forecast to be missed, the average response time did 2. ED Processes and Admissions Avoidance: improve to 00:07:05 (HH:MM:SS) up from 00:07:31 in December 2019. Ambulance handover Seven-day Emergency Dept Redirection Pilot: Plans are being finalised regarding how and where to delays at Portsmouth Hospitals NHS Trust continue to impact on ambulance availability and continue the redirection once the pilot ends at the end of March; current plan is to locate onsite at SCAS’ performance. PHT for a further 6 month pilot. Business case is in process and will be presented to Unified Execs in March. Average weekly Trust bed occupancy remains high and off target with the latest data point (WE 02/02/2020) placing the weekly occupancy at 96.7%, against a target of 92%. Please note these 3. Out of Hospital Services: numbers include escalation beds. The average weekly Bed Escalation usage also remains Urgent Care Capacity Project 19/20 (Winter): extremely high and off target with the latest data point (WE 02/02/2020) placing the total at 42 All additional winter capacity is fully mobilised and 2019/20 schemes are in evaluation phase to inform beds against a target of 15.
2020/21 planning. Overall system pressure remains despite progress made in some areas (e.g MFFD There has been an increase in the number of reported Delayed Transfers of Care (DTOC) at the OBD reduction). Overall acute bed occupancy remains above target levels Trust with the latest weekly snapshot placing the total at 47 patients against a target of 33. We Focus largely on 2020/21 planning in respect of application of £6.2m investment plan (as per last year) have seen an increase in reported delays across both the Portsmouth and Hampshire systems and overall system priorities . Business case to be presented to Unified Execs in March. with the majority of delays resulting from patients awaiting care home placement or PIDs in development alongside this to articulate how the benefit will be achieved . availability.
Key Programme Concerns Overall Trust MFFD numbers remain off target but are relatively stable. The reduction in the Visibility of internal PHT ED Processes and Bed Occupancy elements of the Urgent Care recovery plan average number of days lost also remains stable with Portsmouth patient delays on average 4.3 are not fully visible. This is improving through frequent Urgent Care meetings. days and Hampshire at 7.5 days. Work is being progressed to define plans for 20/21 delivery; work is in process with support from the planning and performance team. 2019-20 Maternity & Children's Programme Update Programme Overview Key Risks & Issues Project Updates: Children’s Community Nursing Integration (iCCN): The COAST service has now been open to referrals for 8 weeks as part of an agreed transitioned service specification with our partners in acute and primary care and commissioning. During this stage we have been open to the Children’s Assessment Unit. The CAU are aware of our capacity and are able to redirect GPs to our service. On 17th February we extended our 1 scope to accept referrals from the Emergency Department. Due to these new ways of working it has taken time for the teams in CAU and ED to appropriately refer children who could be seen by COAST. Our team is supporting our colleagues in QA by visiting ED and CAU every day and jointly discussing all the children either on the wards or in ED. Acute Paediatric Mental Health Service in ED: Project is on track and ready for full delivery from the 1st April 2020. The only issue at this stage relates to the requirement of the service to deliver training to PHT staff which will be a challenge with regards to capacity as the demand from 16 - 17 olds mean that the staff within the team are not likely to have any capacity to undertake anything other than clinical assessments. With regard to the contract, this will sit within the NHS standard contract and therefore the Top Programme Risks/Issues Mitigating Actions Spec and KPIs need to be agreed and signed off by mid March 2020. With regard to the SOP, the service aims to complete during mid-March. It will then be trialled alongside PHT for a period of 3-4 months to 1. Identifying a Responsible Discussions continue to identify a ensure it is reflective of our joint standards/expectations and processes. clinician for the Paed Psych resolution to this issue Community Epilepsy Nurse (CENS): This project is moving into business as usual as the CENS is now Liaison service fully established in post. This project will stay live to ensure it is meeting the required outcomes, as per the business case. Monitoring milestones have been added. Community Paediatric Medical Service (CPMS) and pathway review (acute and community): . Solent have produced a report which reviews current pathways – currently under review and discussion with CCGs. Project plan will require update following the outcome of these discussions. Mental Health Support Teams (MHST) : MHST staff have commenced the training at Southampton University. The MHST Team Manager is now in post and is meeting with school leaders. We are due to submit an expression of interest to scale up the teams from two to three which if successful will cover all Programme Management Concerns junior/primary schools and the two FE colleges in the city. Plans to recruit Youth Mental Health Champions Risks/Issues across all secondary schools are also in place which will help schools to develop a whole school mental health approach. Projects without robust plans with Granular detail is missing such as KPIs Spacer Protocol: Posters have been sent out to all practice managers via the primary care team for both granular detail and risks. Some risks that have been Portsmouth and FGSEH primary care teams. It is difficult to monitor if the posters are being used and we flagged as the highest risk are missing are working with the quality team to ensure monitoring on outcome measures. Plan for year 2 is ensuring mitigating actions, key controls and a 'spacer in every space' includes schools and other establishments. assurance updates. The Planning team Better Births Programme: The service is working through an action plan following recommendations from CQC. Commissioners will monitor through monthly meeting and the quarterly contract review. are supporting project teams to improve Working with the LMS project manager has enabled us to close off some of the actions from the LMS this. project which sits under the maternity programme. Acute Paediatric Service Pathway Review: Date arranged for pathways meeting for March- to include discussion on how we work together with CPMS work. Draft PID and Project plan complete. To be sent to Performance Update quality for review and input. We are currently reviewing the key performance indicators associated with this Key Programme Concerns programme and linking these to the NHS oversights framework. • Identifying a Responsible clinician for the Paed Psych Liaison service and the associated additional costs • Slippage on CPMS service and pathway review Planning Leads Key Concerns: • Some projects require robust plans with granular detail 2019-20 Vulnerable Adults Programme Update Programme Overview Key Risk & Issues Project Updates: Positive Minds – The Portsmouth Well-being House (WBH): Positive Minds continues to operate since opening in December 2019. Phase 2 of the project is in planning and this will focus on further development of the service, measuring performance and outcomes, exploring opportunities to be a Mental Health front 1 door for Portsmouth, with a formal, big launch after Easter.
Emotional Dysregulation: The options paper for the way forward for this project has been completed and will be presented to the relevant boards in February/March 2020. The key recommendation is that the pathway is implemented as part of the Southern community services redesign.
Mental Health Acute Pathway This project is experiencing some issues regarding its strategic direction. Top Programme Risks/Issues Mitigating Actions There is a positive and collaborative relationship between Southern, Solent and the CCGs and a genuine 1. The programme is reliant on strong Cross organisational willingness to work together. Despite this, the pressure of operational challenges which reinforce a single collaborative working practice and governance structures in organisational lens and the absence of an aligned STP strategy for inpatient beds across HIOW, the project there is a risk that due to competing place to support the has reached an impasse on how to progress. A paper was presented to Unified Exec in January 2020 seeking organisational priorities this may mitigation of the risk. strategic direction for the inpatient pathway project; the main outcome of this was for the Southern & Solent negatively impact the delivery of the CEOs to meet to agree a position. These conversations are ongoing and this project will remain on hold until programme and effect financial then. commitment.
Psychiatric Liaison Core 24: The Implementation Working Group (IWG) discussed key issues around benefits realisation and measures of success, workforce, recruitment and accommodation. The key Project Performance Update accommodation position at present is that the Mental Health Liaison team (MHLT) will retain a space within ED and the remainder of the team will be housed in the Quad building for Phase 1. The highest risks to the Psychiatric Liaison A number of high level KPIs have been project remain recruitment and accommodation. It is planned that a Psychiatric Liaison business case will be Core 24 identified in line with national guidance, presented to the ICP Finance Directors and then Unified Exec for funding commitment post the financial year however national data is not yet available. 20/21. Discussions remain ongoing in relation to benefit realisation and a meeting has been had CHC Market Management: The CCG has improved it’s position against the National Target of 80% of with the CSU principal analyst to explore the referrals assessments completed within 28 Days; the most recent published result for quarter 3 in financial possibilities of using SUS data for the benefit year 19/20 is 69.7%, which is a steady growth from last quarter and a big improvement on previous quarters. realisation assessment. Further discussion are ongoing. The CHC Team continue to work with colleagues to improve this percentage. Financial year 19/20 Quarter 3 Continuing The bed occupancy target for Latham Lodge data for the Number of Decision Support Tools (DSTs) completed in Acute Setting is at 7%, which is a really Healthcare (CHC) and Cosham Court continues to be achieved. good achievement against a target of 15%. Since the closure of Discharge to Assess beds at Jubilee House the contract beds at Cosham Court and Latham Lodge have been carrying very few voids and the demand is Published data for Q3 2019/20 indicates: there to consider further procurement for contract beds/Discharge to assess (D2a). CHC Strategic Leads • 69.7% of referrals completed within 28 Meeting have now been set up monthly from March 2020 to consider the strategic and operational aspects Days against a target of 80%. The CCG is of CHC and other areas of individual patient commissioning. improving on previous performance. • 6.67% of the number of Decision Support Planning Leads Key Concerns: Tools (DSTs) completed in Acute Setting • The issues affecting the strategic direction of the mental health acute pathway project could cause it to threshold of 15%. The CCG is therefore be postponed or cancelled. Senior stakeholders are working through this issue to come to a resolution. performing well. 2019-20 Planned Care Programme Update (1/2) Programme Overview Key Risk & Issues
Programme Summary The Planned Care programme focuses on transformation of elective pathways across all Top Programme Risks/Issues Mitigating Actions specialties to ensure each contact adds value, is delivered in the most effective way, in the 1. With out full system engagement no elective The Unified Executive offers a point of most appropriate setting and by the right person first time. Significant focus on achievement change can be implemented in a sustained way escalation to support the programmes along of all 8 cancer waiting times, reduction in average waits for elective services, achieve 92% of and this will prevent the programme from with the CCGs Clinical Delivery Group and all patients waiting under 18 weeks for treatment and a maximum 6 week wait for diagnostics. achieving its objectives Executive Committee The Programme will bring demand and capacity in balance and prevent service users from 2. If competing organisational priorities meant The Unified Executive offers a point of ending up on a non-elective journey by offering timely preventative and elective services. that implementation cannot be taken forwards escalation to support the programmes along
then the work programme will have to be with the CCGs Clinical Delivery Group and Main Programme Updates amended. Executive Committee Outpatient Modernisation: Key target enablers: Cancer Targets, RTT Target and waiting list reduction Ongoing project meetings are taking place with: Gastroenterology, ENT, Respiratory, Project Performance Update Dermatology, Nephrology, Urology, Ophthalmology, Cardiology, Gynaecology and MSK. Following each meeting a set of actions are identified and a joint project document agreed Diagnostic As of the end of November 2019, the Dermatology RTT waiting list size reduced Programme when compared to last month but remains up against the March 2019 listing ICP and internal work programmes .The overall strategy is to implement advice and baseline. guidance as the first point of contact and implement joined up pathways of care. Specific key We continue to see an increase in GP referrals across PSEH CCGs when project updates are as follows: compared to 2018/19. In contrast, the number of 'Other' referrals from all Ophthalmology: Agreement to work with local optometrists to become pilot site for setting CCGs remains down year on year. up optometrists to use eRS. Next steps – Medical Retina Service to move to Referral As at the end of November 2019, first outpatient activity remains up against Assessment Service (RAS) from Mid-March 2020. plan. Advice and Guidance utilisation remains consistently up when compared to ENT: Microsuction leaflet is now ready to be circulated. Engagement with ENT department 2018/19 volumes. Outpatient The Trust's reported incomplete waiting list size as at the end of December around transformation programme is ongoing. Further audits to be undertaken before scope Modernisation 2019 was 35,270 pathways against a monthly trajectory of 32,035 pathways of project can be agreed. Next steps – Advice & Guidance Audit in the process of being set up. and In-Depth (year-end target 32,642). Final meeting with nursing team around revised microsuction criteria to be held ahead of Specialty Focus Overall the Trust's waiting list size decreased by 925 pathways in December leaflet launch with GP communications to support role out. 2019 to 35,270, down from 36,195 in November 2019. Incomplete performance in December 2019 has seen a reduction when compared to November 2019 Gynaecology: Menstrual bleeding pathway (including new one-stop hysteroscopy service) final position. Latest data places the performance at 79.54%. launched 18th November. PHT admin infrastructure issues have led to utilisation issues of The number of patients waiting in excess of 26 weeks increased in December the new service, which have now been resolved. Next steps – Development of long term 2019 to 3,102 pathways in December 2019, an increase of 443 pathways when compared to November 2019 final position of 2,659. plans to redesign the women`s health continence service provision, ensuring robust provision The largest cohort of long waiting patients remains in; of physio provision. • Gastroenterology = 686 • T&O = 561 Urology: Digital First service delivery model for all routine referrals went live on 27th January • General Surgery = 403 (including virtual single point of access stone clinic). Early indications of significant reduction • X01 (Other) = 297 in conversion from triage to first appointment. Next steps – Monitor pathway changes and • Gynaecology = 291 regular engagement with the speciality. Follow up meeting to be scheduled. • ENT = 280 • Urology = 212 • Ophthalmology = 169 Gastroenterology: Gastro audit results are expected to be received in early March ahead of There were no breaches reported of the 52 week incomplete standard in Faecal Immunochemical Test (FIT) implementation from April 2020. Next Steps – Gastro December 2019. The next longest waiting patient was reported in ENT waiting strategy meetings continue to be held on a monthly basis along with smaller working groups >51-52 weeks. to finalise the process for FIT implementation. The Trust reports they under achieved against the planned levels of activity as set out in the Operating Plan for November 2019. 2019-20 Planned Care Programme Update (2/2) Programme Overview
Main Programme continued Supplementary Programmes continued Respiratory: Common Conditions Optimal cancer pathway launched with positive results. IFR/Prior Approval service redesign: Following a joint discussion with Primary Care Network (PCN) leads, Clinical Director for In partnership with West Hampshire CCG the planned care team are reviewing the process Respiratory and CRIS team representatives a virtual MDT clinic pilot is going to be designed to and the way the IFR service is delivered to ensure standardisation across the Partnership. take place in the 20/21. This will allow practice nurses from one PCN to discuss cases via This includes several audits and a new service specification designed to increase efficiency virtual MDT consisting of secondary and community service staff. Next steps – Co design pilot and ensure clinical decisions are not delayed. specification and associated pathways, communications to PCN staff in preparation for go live. Elective Care Services Redesign Diagnostics: Key target enablers: Cancer Targets, RTT Target, DM01 target and waiting list reduction Key target enablers: Cancer Targets, DM01 target Working with Portsmouth CCG to redesign the local and community elective services to The ICP team held a strategy meeting with leaders from PHT diagnostics to discuss 20/21 ensure they complement system sustainability and are fit for the future. strategy for the programme. Next steps: Produce a co-written plan which will then be submitted to ECRM for agreement. Aspects will include a focus on pathway driven diagnostic Diabetes Transformation Programme access and alignment of strategic direction Foot care Project: As a result of continued transformation funding from NHSE an additional podiatrist is in post, offering support to ward rounds, inpatients and Supplementary Programmes QA@home. A business care is being developed to support continuation of this project Transforming Outpatients National Programme: once the transformation funding ends. Nephrology: Having gained primary care input from local GPs for the roll out of the agreed pathways, the Nephrology working team is now working with partners from Salisbury and Treatment Target Improvement Project: SENSE Project has begun practice engagement West Sussex. and 15 surgeries have already signed up to take part, incorporating 7 of the 9 PCN’s. The team have started data collection to report back to the surgeries and make follow up Dermatology: Three projects and key individuals to work up each project have been appointments to feedback their findings and plan how to use this to improve patient care. identified and project groups are underway. It is anticipated a teledermatology service The SENSE team are planning to present their project to the PCN directors meeting over extension will be piloted as part of the 100 day challenge. Next steps – Agreement around the the next couple of months. details of the pilot to be worked up during March 2020.
Advice and Guidance (A&G): Key target enablers: Cancer Targets, RTT Target waiting list reduction Primary care knowledge survey and additional admin practice training has been completed. Training guidelines have been reviewed which identified a gap in application of knowledge to practice identified. Next steps: Development of virtual Skype training, A&G in development within PHT Minestrone single clinical system.
Rapid Diagnostics Service(RDS)/Cancer Workshops Rapid Diagnostics Service (RDS) Task & Finish groups looking at referral criteria, commissioning and finance and demand and capacity in relation to the RDS are taking place over the coming Key Programme Concerns months ahead of launch in April 2020. The Sovereign PCN has been successful in it’s • Constraints in recruitment may result in non-delivery of targets, specifically in application to become a pilot site for the project. Audiology and Diagnostics • Ongoing conflicting priorities due to System Pressures • Risk of patient harm from lack of HCQ retinopathy monitoring service • Changes to provider on-call rotas changing priorities from planned to emergency patients • Inappropriate 2ww referrals, leading to extended waiting times for suspected cancer Annex 1 – Programme Highlight Reports
Programme Highlight Reports
Community Health & Care Available on request
Urgent Care Available on request
Planned Care Available on request
Vulnerable Adults Available on request
Maternity & Children’s Available on request
8 Annex 2 – Maturity Matrix: Community Health & Care (1/2)
Defining the Tracking Project Dependencies and Expected Project Use of Project Planning Category Project Status Project Aim and Milestones Project Governance KPIs Finances Background Assumptions Outcomes Outcomes Risk Registers Leads RAG Description Progress All milestones are Project manager has completed Dependencies: If the identified in the necessary supporting success of the project The Project A Project Risk The project scope is project plan on The Project is dependendt on Manager updates Register is used documentation: well-defined and Pentana: Manager updates Clear background other factors that the expected to document emphasis what is to The outcomes are Granular Detail the Pentana Assessment of the project with have been clearly outcome to reflect project risks and be accomplished clear, concise Milestones in regularly to track against clear case for detailed. the true reality of their and addresses the and measurable exception have project criteria change. Assumptions: They the project corresponding Evaluation Criteria long-term project forecast dates and completion QIA EIA PIA are well-defined, delivering at this risk mitigation outcomes. explanation on how against schedule. assesssed and moment in time. to bring back on strategies. It is prioritised. well-maintained agreed? finances been Have
What stage is the project at? project the is stage What track
Prioritisation Score Prioritisation Score Achievability and up-to-date. up? and set agreed KPIs been Have Project Programme Tier 3 - 1 - 1 - Enhanced Care Requi This This Home Team (ICP) CH&C ICP Implementation reme area area nts3 - is3 - is tbc tbc Amber Yes Yes Enhanced Care Requi Requi Home Team reme reme (Potrsmouth) CH&C MCP Delivery nts3 - nts2 - N/A2 - 90% 55% Amber Yes Yes Trusted Assessor Requi Some Some (Portsmouth) reme work work CH&C P CCG Delivery nts is is 57% 76% Amber 1 - 2 - 1 - NHS Mail Roll Out This Some This (Portsmouth) CH&C P CCG Development area work area tbc tbc Amber 3 - 1 - 1 - Hydrate Requi This This (Portsmouth) CH&C P CCG Implementation reme area area tbc tbc Amber PCCG Humanising 1 - 1 - 1 - HealthCare This This This CH&C P CCG Pipeline area1 - area1 - area1 - Red PCCG Restore This This This CH&C P CCG Implementation area1 - area1 - area1 - tbc tbc Amber PCCG Telemedicine This This This area area area CH&C P CCG Pipeline is is is tbc tbc Amber No No Frailty 1 - 1 - 1 - This This This CH&C ICP Pipeline area1 - area1 - area1 - tbc tbc Amber No No End of Life (EOL): This This This Advanced Care area area area Planning & Future is is is Planning System missi missi missi Configuration ng ng ng CH&C ICP Pipeline vital1 - vital1 - vital1 - tbc tbc Red No No End of Life (EOL): This This This Education & area area area Training is is is CH&C ICP Pipeline missi missi missi tbc tbc Red No No 1 - End of Life (EOL): This Health Needs area Assessment CH&C ICP Pipeline is N/A N/A tbc tbc Amber No No KEY 1 - This area is missing vital information and/or 2 - Some work is done in this area, but still needs 3 - Requirements are fully met in this 9 underdeveloped. improvement. area. Annex 2 – Maturity Matrix: Community Health & Care (2/2)
Defining the Tracking Project Dependencies and Expected Project Use of Project Planning Category Project Status Project Aim and Milestones Project Governance KPIs Finances Background Assumptions Outcomes Outcomes Risk Registers Leads RAG Description Progress All milestones are Project manager has completed Dependencies: If the identified in the necessary supporting success of the project The Project A Project Risk The project scope is project plan on The Project is dependendt on Manager updates Register is used documentation: well-defined and Pentana: Manager updates Clear background other factors that the expected to document emphasis what is to The outcomes are Granular Detail the Pentana Assessment of the project with have been clearly outcome to reflect project risks and be accomplished clear, concise Milestones in regularly to track against clear case for detailed. the true reality of their and addresses the and measurable exception have project criteria change. Assumptions: They the project corresponding Evaluation Criteria long-term project forecast dates and completion QIA EIA PIA are well-defined, delivering at this risk mitigation outcomes. explanation on how against schedule. assesssed and moment in time. to bring back on strategies. It is prioritised. well-maintained agreed? finances been Have
What stage is the project at? project the is stage What track
Prioritisation Score Prioritisation Score Achievability and up-to-date. up? and set agreed KPIs been Have Project Programme Tier 1 - End of Life (EOL): This Strategy and Vision area for PSEH is CH&C ICP Development missi N/A N/A tbc tbc Amber No No Wheelchair Re- procurement CH&C ICP Development N/A 73% 72% No No Neighbourhood Models (PCCG Part) CH&C ICP Development TBC tbc tbc Neighbourhood Models (FGSEH Part) CH&C ICP Development tbc tbc 1 - 1 - 1 - Enhanced This This This Community area area area Response inc SCAS is is is Specialist missi missi missi Practitioner CH&C ICP Implementation ng2 - ng2 - ng2 - 48% 92% Amber No No LTC Hubs Some Some Some MCP MCP Development work work work TBC TBC Amber No No Closer Working 2 - 2 - 1 - (Leg Ulcer Pilot) Some Some This MCP MCP Development work work area TBC TBC Amber No No Headaches 1 - 1 - 1 - MCP MCP Pipeline This This This TBC TBC Red No No One Point of 1 - 1 - 1 - Access This This This MCP MCP Development area1 - area1 - area1 - TBC TBC Amber No No Community This This This Strategy For area area area Gastroenterology is is is MCP MCP Pipeline missi missi missi TBC TBC Red No No 1 - 1 - 1 - Tackling MSK This This This Demand MCP MCP Delivery area area area TBC TBC Amber Yes
KEY 1 - This area is missing vital information and/or 2 - Some work is done in this area, but still needs 3 - Requirements are fully met in this underdeveloped. improvement. area.
10 Annex 2 – Maturity Matrix: Urgent Care
Defining the Tracking Project Dependencies and Expected Project Use of Project Planning Category Project Status Project Aim and Milestones Project Governance KPIs Finances Background Assumptions Outcomes Outcomes Risk Registers Leads RAG Description Progress All milestones are Project manager has completed Dependencies: If the identified in the necessary supporting success of the project The Project A Project Risk The project scope is project plan on The Project is dependendt on Manager updates Register is used documentation: well-defined and Pentana: Manager updates Clear background other factors that the expected to document emphasis what is to The outcomes are Granular Detail the Pentana Assessment of the project with have been clearly outcome to reflect project risks and be accomplished clear, concise Milestones in regularly to track against clear case for detailed. the true reality of their and addresses the and measurable exception have project criteria change. Assumptions: They the project corresponding Evaluation Criteria long-term project forecast dates and completion QIA EIA PIA are well-defined, delivering at this risk mitigation outcomes. explanation on how against schedule. assesssed and moment in time. to bring back on strategies. It is prioritised. well-maintained agreed? finances been Have
What stage is the project at? project the is stage What track
Prioritisation Score Prioritisation Score Achievability and up-to-date. up? and set agreed KPIs been Have Project Programme Tier 3 - 3 - 3 - 24/7 Integrated Requi Requi Requi Care (Integrated reme reme reme Primary Care Urgent Care P CCG Development nts nts nts Service) are are are Portsmouth fully fully fully tbc tbc Amber Yes Yes 3 - 3 - 3 - IUC/ CAS Requi Requi Requi Urgent Care ICP Implementation reme2 - reme2 - reme2 - tbc tbc Green Yes No Primary care Some Some Some provision in ED (inc work work work redirection) is is is Urgent Care ICP Development done done done tbc tbc Amber No No SCAS non- 2 - 2 - 2 - conveyances Some Some Some Urgent Care ICP Development work work work tbc tbc Amber No No Same Day 1 - 1 - 1 - Emergency Care This This This (SDEC) area area area Urgent Care ICP Pipeline is1 - is1 - is1 - tbc tbc Red No No Patient transport This This This Urgent Care ICP Development area1 - area1 - area1 - tbc tbc Amber Yes Yes Urgent Care This This This Charter area area area Urgent Care ICP Delivery is is is tbc tbc Amber No N/A Gosport War 1 - 1 - 1 - Memorial Hospital - This This This UTC area area area Urgent Care ICP Pipeline is is is tbc tbc Amber No No Urgent Care Capacity Urgent Care ICP Implementation N/A N/A N/A tbc tbc Green Yes Yes
KEY 1 - This area is missing vital information and/or 2 - Some work is done in this area, but still needs 3 - Requirements are fully met in this underdeveloped. improvement. area.
11 Annex 2 – Maturity Matrix: Maternity & Children’s
Defining the Tracking Project Dependencies and Expected Project Use of Project Planning Category Project Status Project Aim and Milestones Project Governance KPIs Finances Background Assumptions Outcomes Outcomes Risk Registers Leads RAG Description Progress All milestones are Project manager has completed Dependencies: If the identified in the necessary supporting success of the project The Project A Project Risk The project scope is project plan on The Project is dependendt on Manager updates Register is used documentation: well-defined and Pentana: Manager updates Clear background other factors that the expected to document emphasis what is to The outcomes are Granular Detail the Pentana Assessment of the project with have been clearly outcome to reflect project risks and be accomplished clear, concise Milestones in regularly to track against clear case for detailed. the true reality of their and addresses the and measurable exception have project criteria change. Assumptions: They the project corresponding Evaluation Criteria long-term project forecast dates and completion QIA EIA PIA are well-defined, delivering at this risk mitigation outcomes. explanation on how against schedule. assesssed and moment in time. to bring back on strategies. It is prioritised. well-maintained agreed? finances been Have
What stage is the project at? project the is stage What track
Prioritisation Score Prioritisation Score Achievability and up-to-date. up? and set agreed KPIs been Have Project Programme Tier 1 - 1 - 1 - Acute Paediatric This This This Service & Pathway area area area Review MaCH ICP Pipeline is is is Amber No No CPMS 3 - 3 - 2 - Transformation Requi Requi Some MaCH ICP Development reme3 - reme3 - work 77 44 Amber Partial No Acute Paediatric Requi Requi Mental Health reme reme Service in ED & nts nts Wards MaCH ICP Development are are N/A 77 44 Amber No No Children's 3 - Community Requi Nursing Integration reme nts MaCH ICP Development are3 - N/A3 - N/A3 - 52 60 Amber Partial No Community Requi Requi Requi Epilepsy Nurse reme reme reme MaCH ICP Implementation nts nts nts 52 54 Amber Partial No 1 - 2 - 2 - Neuro This Some Some Developmental area work work pathway for is is is Children & Families missi done done (Portsmouth ng in this in this Pilot)(Neuro vital area, area, Diversity Pathway) infor but but MaCH ICP Development matio still still tbc tbc Amber Spacer Protocol MaCH ICP Pipeline tbc tbc No No Mental Health 3 - 2 - 2 - Support Teams In Requi Some Some Schools MaCH ICP Pipeline reme work work 88 78 Partial No
KEY 1 - This area is missing vital information and/or 2 - Some work is done in this area, but still needs 3 - Requirements are fully met in this underdeveloped. improvement. area.
12 Annex 2 – Maturity Matrix: Vulnerable Adults
Defining the Tracking Project Dependencies and Expected Project Use of Project Planning Category Project Status Project Aim and Milestones Project Governance KPIs Finances Background Assumptions Outcomes Outcomes Risk Registers Leads RAG Description Progress All milestones are Project manager has completed Dependencies: If the identified in the necessary supporting success of the project The Project A Project Risk The project scope is project plan on The Project is dependendt on Manager updates Register is used documentation: well-defined and Pentana: Manager updates Clear background other factors that the expected to document emphasis what is to The outcomes are Granular Detail the Pentana Assessment of the project with have been clearly outcome to reflect project risks and be accomplished clear, concise Milestones in regularly to track against clear case for detailed. the true reality of their and addresses the and measurable exception have project criteria change. Assumptions: They the project corresponding Evaluation Criteria long-term project forecast dates and completion QIA EIA PIA are well-defined, delivering at this risk mitigation outcomes. explanation on how against schedule. assesssed and moment in time. to bring back on strategies. It is prioritised. well-maintained agreed? finances been Have
What stage is the project at? project the is stage What track
Prioritisation Score Prioritisation Score Achievability and up-to-date. up? and set agreed KPIs been Have Project Programme Tier Transformation of 3 - 3 - 3 - ECR Budget Requi Requi Requi responsibilities Vulnerable reme reme reme with Solent Project Adults P CCG Implementation nts nts nts 87 74 Green Yes Yes New Community 3 - 3 - Rehab Model Vulnerable Requi Requi Adults P CCG Implementation reme reme N/A 75 50 Green Partial Yes Mental Health 3 - 2 - 2 - Acute Pathway Vulnerable Requi Some Some Adults ICP Development 3reme - 2work - work 87 27 Green No N/A MHAU Vulnerable Requi Some Adults ICP Implementation reme work N/A 70 28 Amber Partial N/A 2 - 2 - Emotional Some Some Dysregulation Vulnerable work work (EmDys) Adults ICP Development 2is - 2is - 3N/A - tbc tbc Amber No Yes Portsmouth & Some Some Requi South East work work reme Hampshire Crisis Vulnerable is is nts Project Adults ICP Implementation done done are 77 74 Green Partial N/A Positive Minds - 2 - 2 - 2 - Wellbeing House Vulnerable Some Some Some Adults P CCG Implementation work work work 58 58 Amber Partial N/A 3 - Expansion of IAPT Vulnerable Requi to LTC Project Adults P CCG Delivery reme N/A N/A 82 74 Green Yes N/A Psychiatric Liaison 1 - 1 - 1 - Vulnerable This This This Adults ICP Development 3area - 3area - area tbc tbc Amber No N/A Continuing Requi Requi Healthcare Market reme reme Management nts nts CHC P CCG Implementation are are N/A 78 52 Green Yes Yes
KEY 1 - This area is missing vital information and/or 2 - Some work is done in this area, but still needs 3 - Requirements are fully met in this underdeveloped. improvement. area.
13 Annex 2 – Maturity Matrix: Planned Care
Defining the Tracking Project Dependencies and Expected Project Use of Project Planning Category Project Status Project Aim and Milestones Project Governance KPIs Finances Background Assumptions Outcomes Outcomes Risk Registers Leads RAG Description Progress All milestones are Project manager has completed Dependencies: If the identified in the necessary supporting success of the project The Project A Project Risk The project scope is project plan on The Project is dependendt on Manager updates Register is used documentation: well-defined and Pentana: Manager updates Clear background other factors that the expected to document emphasis what is to The outcomes are Granular Detail the Pentana Assessment of the project with have been clearly outcome to reflect project risks and be accomplished clear, concise Milestones in regularly to track against clear case for detailed. the true reality of their and addresses the and measurable exception have project criteria change. Assumptions: They the project corresponding Evaluation Criteria long-term project forecast dates and completion QIA EIA PIA are well-defined, delivering at this risk mitigation outcomes. explanation on how against schedule. assesssed and moment in time. to bring back on strategies. It is prioritised. well-maintained agreed? been finances Have
What stage is the project at? project the is stage What track
Prioritisation Score Prioritisation Achievability Score Achievability and up-to-date. up? and set agreed KPIs been Have Project Programme Tier Outpatient 3 - 2 - 1 - Modernistaion and Requi Some This In Depth Speciality reme work area Focus Planned nts is is Care ICP Development are done missi 93% 56% Amber Partial No 2 - 2 - 2 - Diagnostic Planned Some Some Some Programme Care ICP Development work work work 93% 66% Amber No No
KEY 1 - This area is missing vital information and/or 2 - Some work is done in this area, but still needs 3 - Requirements are fully met in this underdeveloped. improvement. area.
14
GOVERNING BOARD
Date of Meeting 18 March 2020 Agenda Item No 7
Title Quality & Safeguarding Report
This report provides an update to the Governing Board on the quality & safety exceptions relating to the services that the CCG commission.
It highlights the actions to ensure services for the people of Purpose of Paper Portsmouth are safe, of high quality and that there is effective monitoring and management of any quality concerns and risks
It was reviewed in detail at Quality and Safeguarding Committee on 19th February 2020 The Board is asked to note the full content of the report and specifically; Current Risks: Portsmouth Hospitals NHS Trust (4) Safeguarding (7) Governance (8) communication between provider ~ risks reduced ~ to discuss with SEH CCG to check status and monitor as BAU Solent NHS Trust (1) Withdrawal of Coast and CCN service ~ risk reduced Care UK (1) Clinical vacancies ~ risk escalating. Added to corporate risk register. Safeguarding: Recurring concern regarding unaccompanied asylum seeking minors not being referred to Solent NHS Trust for their initial Recommendations/ health assessment from social care colleagues. Actions requested SCAS have raised a SI relating to 670 safeguarding alerts for adults and children not being raised to MASH PHT: CQC report published. Rating overall Good Continued significant pressure on the urgent and emergency care pathway Solent: Commissioner visit to Jubilee House gave assurance that the opening of East Wing by PHT has not compromised the quality of care to patients in the West Wing PPCA: 1. CQC report published. Rating overall Good with Requires Improvement in Safe domain ~ action plan in place
Engagement Activities – Clinical, Stakeholder and Not Applicable. Public/Patient
Item previously Quality and Safeguarding Committee – 19 February 2020 considered at
Potential Conflicts of None Interests for Board
Members
Author Karen Atkinson
Sponsoring member Innes Richens
Date of Paper February 2020
Quality & Safeguarding Report
February 2020
This monthly report updates the Quality and Safeguarding Executive Committee (QSEC) on the work carried out by the Quality and Safeguarding Team. Through review and discussion at the QSEC meeting the report supports the Committee in meeting its terms of reference, primarily, to assure the Governing Board that the services the CCG commissions on behalf of the people of Portsmouth are safe, of high quality and that any quality concerns and risks are monitored and managed effectively.
The membership will review quality exceptions, risks relating to commissioned services (including GP Practices), directing and mandating the Quality and Safeguarding team to undertake further actions to ensure required improvements are made, risks are mitigated and progress is evidenced. The committee will ensure exceptions and risks are formally escalated to the Governing Board where it deems necessary.
Contents
1(a) Risk Summary ...... 2 1(b) Current Risks ...... 3 2. Healthcare Associated Infections ...... 17 3. Safeguarding ...... 19 4. Providers: ...... 20 4(a) Portsmouth Hospitals NHS Trust ...... 20 4(b) Solent NHS Trust ...... 21 4(c) South Central Ambulance Service NHS Foundation Trust – 111 ...... 22 4(ci) South Central Ambulance Service NHS Foundation Trust – 999 ...... 23 4(cii) South Central Ambulance Service NHS Foundation Trust –Non-Emergency Patient Transport Service (NEPTS) . 24 4(d) Portsmouth Primary Care Alliance (PPCA) ...... 25 4(e) Care UK St Mary’s Treatment Centre & Havant Diagnostics ...... 26 4(f) Millbrook Healthcare – Wheelchair Service ...... 27 4(g) Rowans Hospice: End of Life Care Service ...... 28 4(h) Spire Healthcare Limited – Spire Portsmouth Hospital ...... 29 4(i) Primary Care ...... 30
1
1(a) Risk Summary
PHT 1: DELAYS IN PLANNED CARE (16) PHT 3: ED & URGENT CARE PATHWAY (16) Millbrook 1: WHEELCHAIR SERVICE LONG WAITS (15 Page 6 Page 8 Page 5 If delays continue in assessment and treatment then If pressure on ED continues to rise and fluctuate and if If Millbrook does not deliver a service which fully meets care may fall short of constitutional and best practice there is inadequate staffing then care may fall short of the specification, then there may be negative impact on standards resulting in patients potentially suffering required standards resulting in compromised safety, patient outcomes and a lack of confidence in the service. harm/ deterioration in their clinical condition. experience and quality of care.
Care Homes 2: LOSS OF Care Homes 1: QUALITY & SCAS 999/PHT 1: IMPACT OF PHT 5: PATIENT SAFETY PHT 6: MENTAL HEALTH CARE PROVISION (12) SAFETY CONCERNS (12) HANDOVER DELAYS (12) INVESTIGATIONS (12) PROVISION (12) Page 16 Page 10 Page 11 Page 4 Page 3 If homes are closed at short If there is not sufficient capacity If challenges in being able to If there lack of support and If there is inadequate mental notice then there is potential for of good quality residential care handover patients at PHT within resourcing for new patient health support available in PHT harm or negative clinical then the flow in and out of the the current time frames safety investigation processes then care for patients (adults & outcomes and experience. urgent care system is severely continue then there is the then we will have no assurance children) with mental health potential for patient welfare to compromised. that learning from incidents will concerns may fall short of deteriorate; leading to harm and defined/required standards occur, resulting in compromised poor patient experience within safety of service users and resulting in compromised the community. safety of the service user. potential for harm.
CARE UK 1: UTC CLINICAL PHT 4: SAFEGUARDING (9) PHT 2: RESTRAINT PRACTICES (9) Solent 1: COAST & CCN WITHDRAWAL (8) VACANCIES (9) Page 15 Page 9 Page 7 Page 14
If the number of clinical If there is inadequate SG leadership, resource If there is failure to implement the There is a risk of harm to children and young vacancies in the UTC continues in the team and training staff compliance then recommendations of the restrictive people as a result of the temporary or increases then there is the there is a risk that the adults and children’s SG practices group then there is a risk that withdrawal of the Children’s Outreach & possibility that patient safety, capacity, governance, leadership and there will be continued instances of Support Team (COAST) and Children’s care and experience may be procedures are not optimal resulting in a risk inappropriate restraint resulting in Community Nursing (CCN) services. Page 14 compromised. of harm and missed chances for learning. potential harm to service users.
PHT 8: PHT/ Solent NHS Trust: Risk of harm from PHT 7: GOVERNANCE (6) communication challenges between providers (6) Page 13 Page 12
There have been significant issues relating to the If there is inadequate oversight, transition and process by which the Portsmouth Health Visiting Pagehandover 7 of governance processes then processes Service receives notification of expectant mothers may fall short of required standards resulting in from PHTs Maternity2 Service, especially in undetected quality concerns and risks, gaps within relation to those deemed most vulnerable. the monitoring and assurance systems.
1(b) Current Risks
RISK REF R.Ports. QUA16 DATE OPENED Nov 2017 CARE HOMES: Quality and Safety Concerns across Portsmouth Risk administered by Nicola Andrews RISK 1: City Residential Service Provision SCORING Impact Likelihood Score Original 4 major 3 Possible 12 REPORTING MONTH February 2020 LAST UPDATED 4 February 2020 Current 4 major 3 Possible 12
DESCRIPTION MITIGATING ACTIONS Portsmouth Clinical Commissioning Group and Portsmouth Adult Social Care rely on residential There are a number of initiatives to improve the landscape service providers to provide safe quality care for vulnerable residents. If there is not sufficient across Portsmouth City Residential Service Provision underway capacity of good quality residential care then the flow in and out of the urgent care system is including the Enhanced Care Home Team, the Quality severely compromised. Improvement Team and the Independent Visitor Service. The Quality Improvement Team is prioritising care homes with a CQC Concerns from key health and social care professionals across the care economy about the quality rating of ‘Requires Improvement’ to support through their and safety of residential services and the absence of sustained improvement have been raised. This quality audit process. is reflected within Care Quality Commission inspection ratings across residential service provision. CURRENT POSITION Between 9 December 2019 and 3 February 2020 one CQC report was published. Ormsby Lodge has increased the number of domains rated as good from one to three although remains on an overall Requires Improvement rating. The percentage of Portsmouth care homes rated as Requires Improvement or Inadequate by CQC therefore continues to be thirty one percent. There are two nursing homes and nine residential homes rated by CQC as ‘Requires Improvement’ and one residential home rated by CQC as ‘Inadequate’.
ASSURANCE STATEMENT A joint Quality Board involving Portsmouth Adult Social Care, Portsmouth Clinical Commissioning Group, Portsmouth Healthwatch and the Care Quality Commission meets bi-monthly to provide strategic oversight to quality issues across the sector.
RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE
Maintain current risk score whilst work to support the care homes is embedded.
3
RISK REF R.Ports. QUA19 DATE OPENED Nov 2017 CARE HOMES: Patient care & patient experience - loss of Risk administered by Nicola Andrews, PCCG RISK 2: provision at short notice SCORING Impact Likelihood Score Original 4 major 3 Possible 12 REPORTING MONTH February 2020 LAST UPDATED 4 February 2020 Current 4 major 3 Possible 12
DESCRIPTION MITIGATING ACTIONS There are concerns that care homes may be closed by CQC at short notice. If homes are closed at The Quality Improvement Team is prioritising involving care short notice then there is potential for harm or negative clinical outcomes and experience. homes rated by CQC as Requires Improvement in their audit process, to reduce the chance of the homes being rated as Inadequate with the associated risk of closure. CURRENT POSITION Kinross is currently participating in the Quality Improvement Kinross, a residential care home, is rated by CQC as inadequate. team’s audit process.
ASSURANCE STATEMENT The Quality Improvement Team has been established to provide support to care homes. The Quality Improvement Team has developed an audit process and is working in partnership with care homes. Other services including the Safeguarding team and the Enhanced Care Home Team also provide support where required. The home closure framework is in place to support the closure process where homes are forced to close to reduce the potential for adverse outcomes and experience. RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE
Maintain current risk score whilst there continues to be homes rated as inadequate and whilst work to support the care homes is embedded.
4
RISK REF R.Ports.QUA21 DATE OPENED Sept 2016 Risk administered by Meyrick Grundy, PCCG RISK 1: Millbrook: Wheelchair service long waits SCORING Impact Likelihood Score Original Concern – became a risk Sept 2018 REPORTING MONTH February 2020 LAST UPDATED February 2020 Current 3 moderate 5 certain 15
DESCRIPTION MITIGATING ACTIONS If Millbrook does not deliver a service which fully meets the specification, then there may be Ongoing combined CRMs/CQRMs negative impact on patient outcomes and a lack of confidence in the service. Each CCG to continue to manage the long waiters from CURRENT POSITION their locality No changes of note although staff resignations may have had a long term impact on ability to Ongoing combined CRM/CQRMs provide service. They however are not commissioned beyond April 2020 and are currently using Monitoring of action plan developed through the service staff who work nationally to cover vacancies. They are also using sub-contractors who they usually review work with, as previously outlined. It is very much as case of business as usual and they are New arrangement for the school clinics implementing several new ways of working to make better use of clinical time. The overall impact Eligibility process revamp before contract end may be minimal but should at least prevent a last minute rapid increase in PWB introduction cases. Waiting list initiative. Collaborative workshops with providers A meeting has taken place between commissioners and the new provider, AJM. They are aware of Retention plans for staff the challenges they face when commencing the contract but are confident they will deliver a service which tackles the backlog and meets the number of new referrals.
ASSURANCE STATEMENT There has been an increase in level of CSU support for the contract. There are clearer more defined KPI’s with a new style of report which has helped CCG’s better see where current issues are. Criteria for referral has been strengthened and distributed so that expectations on what is deliverable are better communicated. User satisfaction of contact remains high at 90% rating service as good or very good. Complaints are down year on end. RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE Note current situation
5
RISK REF PHT.29 DATE OPENED Aug 2017 Risk administered by Simon Freathy, SEH CCG RISK 1: PHT: Delays in assessment & treatment for planned care SCORING Impact Likelihood Score Original 3 moderate 5 certain 15 REPORTING MONTH February 2020 LAST UPDATED February 2020 Current 4 major 4 almost certain 16 DESCRIPTION MITIGATING ACTIONS If delays continue in assessment and Weekly PHT Divisional performance reviews against operational plan and Point of Delivery (POD) level treatment then care may fall short of Paper detailing recommendations for waiting list management, oversight and validation to be ratified by the constitutional and best practice standards Operational Delivery Group and progressed to Trust Leadership Team – main recommendation being formation of resulting in patients potentially suffering a substantive corporate validation team harm/deterioration in their clinical condition. Sustain theatre uptake and utilisation at current levels (6% increase over 2018/19 average uptake YTD) Recovery plans actions in place where capacity is driver.
CURRENT POSITION •Waiting list size has decreased by 194 from the November position, but it is not reducing at the rate required to deliver the planned March 20 position of 33000. •RTT <18W for M09 79.5%. There has been an increase in referrals compared to same period last year of 4.2% with significant increases in ENT, Ophthalmology and Dermatology. •Audiology long waiters continue to improve. •Elective cancellations due to the current operational position across the trust, is creating an additional pressure. •Diagnostic 6wk standard met for M09 at 98%; currently 112 patients waiting past 12 wks. •Emerging risk due to the loss of 3 head and neck radiologists with locums being sought. •Cancer pathways – waiting times for endoscopy remain a concern as does treatment capacity within urology – action plans in place. •These continued performance trends are reflected in ‘Outpatient Appointment Delay/Cancellation’ having the largest growth (up 62%) in complaints received by PALS at the Trust. Ophthalmology and ENT have been a focus of recent complaints. The current Transforming Outpatients project includes feedback from patients as to how experience can be improved.
ASSURANCE STATEMENT •Quality risks discussed at ICP elective leads meeting •Harm review for ophthalmology complete Cardiology performance within standards - good levels of advice and guidance utilisation Plan in place to support audiology >52 weeks backlog elective care and diagnostics discussed at monthly PHT quality and performance committee. Gaps in Assurance • No systematic trust process for reviewing harm in all specialities or clinical oversight of waiting lists • Audiology has highest number of long waits but improving. ENT and Gastroenterology also of concern • Vacancies in all specialities with recruitment challenges affecting wait times.
RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE To note and feedback any concerns or questions to the Portsmouth Clinical Quality Manager.
6
RISK REF PHT.38 DATE OPENED Apr 2019 Risk administered by Simon Freathy, SEH CCG RISK 2: PHT: Restraint Practices SCORING Impact Likelihood Score Original 4 Almost certain 4 Almost certain 16 REPORTING MONTH February 2020 LAST UPDATED February 2020 Current 3 Almost certain 3 Possible 9
DESCRIPTION MITIGATING ACTIONS If there is failure to implement the recommendations of the restrictive practices task and finish •Delivery of PHT action plan in line with CCG recommendations group then there is a risk that there will be continued instances of inappropriate restraint resulting in potential harm to service users and damage to organisational reputations and the potential for litigation and regulatory sanction. CURRENT POSITION •Higher level of assurance - good leadership on agenda at PHT •Episodes of restraint occurring but better clinical oversight and valid reasons. •Ongoing work by PHT to improve Police response - new PCSO in place covering QAH. •Use of force forms to be adapted to include time in restraints. •Training to be arranged for security staff in completion of forms as are a legal document. •PHT work recognised by NHSI.
ASSURANCE STATEMENT •CCG participation in PHT Safeguarding Committee. •Discussion of all cases of mechanical restraint at PHT Incident Review Panel. •Revised Restrictive Practice policy in use. •Oversight by Portsmouth and Hampshire Safeguarding Board. •CQC and NHSI have been informed. •All mechanical restraint episodes will be subject to a SWARM. Gaps in Assurance: •Not all Engie staff received Maybo training. •Use of use form not routinely containing full detail needed RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE To note reduction and feedback any concerns or questions to the Portsmouth Clinical Quality Manager.
7
RISK REF PHT.05 DATE OPENED April 2015 Risk administered by Simon Freathy, SEH CCG RISK 3: PHT: Emergency Department & Urgent Care Pathway SCORING Impact Likelihood Score Original 4 major 5 certain 20 REPORTING MONTH February 2020 LAST UPDATED February Current 4 major 4 almost certain 16 2020
DESCRIPTION MITIGATING ACTIONS If pressure on PHT emergency department continues to rise and fluctuate and if there •System-wide urgent care improvement programme in place and being is inadequate staffing then care may fall short of required standards resulting in implemented compromised safety, experience and quality of care. •System-wide urgent care improvement programme metrics developed. •A/E Delivery Board & sub-committees to deliver the work streams to support system management CURRENT POSITION •Integrated Care Partnership work programme. •Contingency and winter planning, planning. •Continued significant demand on the urgent and emergency care pathway with significant ambulance holds throughout quarter 3 with a period of improvement early December. During heightened times of demand / pressure there continuous to be an increased risk that patients may come to harm due to: overcrowding in the ED department, care being provided in corridors and non-clinical spaces and in back of ambulances, required (clinical) care being delayed, ambulance resource not available to dispatch as required to 999 calls. The trust has been issued with a Section 29a warning notice under the Health & Social Care Act, by the CQC, in relation to ambulance holds and lack of governance arrangements for self-presenting patients to the ED department with the requirement that improvement requirements are to be made by mid-January 2020. •ED redirect project has been extended to 31 March 2020 however there are challenges to ensure rota fill. SCAS conveyance avoidance pilot via access to an acute physician continues to provide advice and guidance / direct access to AEC. •Older persons medicine has successfully delivered the revised frailty assessment unit service model. SCAS paramedic is working in ED to support flow. CCG quality team undertook regular observational visit to ED during December 2019 to support identification of areas of good practice and improvement
ASSURANCE STATEMENT Assurance CCG Quality Team attendance at PHT Quality and Performance committee and A&E delivery board Comprehensive plan devised as part of the system-wide urgent care improvement programme Majority of CQC Section 31 lifted. System ability to manage surges in demand has improved although variability still present. Gaps in assurance A number of actions from the system-wide urgent care improvement programme are still being worked up and not in place. CQC Inspection report published on 29 January 2020 rated the Trust as 'Good' overall with ‘Requires Improvement’ in the safe domain. The trust does not manage risks to self-presenting patients because they do not have clear oversight and understanding of the risks: the risk of delays of triage of patients; risk of patients not being assessed in order of arrival at the department; risk of patients not receiving time critical treatment; risk of undetected deterioration of patients. The trust does not have accurate information about how long self-presenting patients wait before being triaged. There is lack of significant improvements to reduce the ambulance waiting times. The CQC issued a Section 29a warning notice to the trust under the HSCA and It identified 12 actions the Provider must take. RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE To note and feedback any concerns or questions to the Portsmouth Clinical Quality Manager.
8
RISK REF PHT.30 DATE OPENED Aug 2017 Risk administered by Simon Freathy, SEH CCG RISK 4: PHT: Safeguarding SCORING Impact Likelihood Score Original 4 major 3 possible 12 REPORTING MONTH February 2020 LAST UPDATED February 2020 Current 3 possible 3 possible 9
DESCRIPTION MITIGATING ACTIONS If there is inadequate safeguarding leadership, resource in the team and •Review of delivery of safeguarding actions against the CQC findings (in conjunction with training staff compliance then there is a risk that the adults and children’s the Local Authority. safeguarding capacity, governance, leadership and procedures are not optimal •Training programme in place and being reviewed from Trust to ward level resulting in a risk of harm and missed opportunities for learning. •Trust internal audit programme in place •2 Simulation sessions and 4 face-to-face classroom MCA and DoLS training sessions delivered. Level 3 Prevent training has been delivered once by the Safeguarding Team. All Divisions have several Prevent Trainers who are able to deliver locally as required. CURRENT POSITION •The adult safeguarding team supported the quarterly Dementia Awareness event with delivery of MCA / DOLS education session •There has been an increase in staff contacting the team for advice in regard to the use of MCA. This includes requests from areas not traditionally associated with the use of MCA, such as Maternity. •Theatres/Anaesthetics are leading on a revision of a pathway for adults who have an impairment of mind or brain and therefore lack capacity and who require a procedure/anaesthetic.
ASSURANCE STATEMENT •Named trust safeguarding doctors and nurses/midwives in post •Additional support to wards to achieve enhanced compliance on MCA and DOLS •CQC, in its January 2020 report, has acknowledged staff understood how to protect patients from abuse and the service worked well with other agencies to do so •Safeguarding training programme revised and in place and •Safeguarding oversight through Safeguarding Boards •Trust BAF actions rated complete or on track •Overall audit plan to cover all areas within the action plan •Safeguarding improvement board stood down •Mental Capacity Act & DoLs training exceeds target rate for level 1 •Trust Maternity Committee re-established. Gaps in Assurance: •Safeguarding training compliance for level 3 children's safeguarding consistently below target •PREVENT training compliance below target for level 2/3 •slight drop off on MCA DoLS level 2 training compliance RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE To note reduction in risk and feedback any concerns or questions to the Portsmouth Clinical Quality Manager. 9
RISK REF PHT.41 DATE OPENED Sept 2019 Risk administered by Simon Freathy, SEH CCG RISK 5: PHT: Patient Safety Investigation Processes SCORING Impact Likelihood Score Original 4 major 3 possible 12 REPORTING MONTH February 2020 LAST UPDATED February 2020 Current 4 major 3 possible 12
DESCRIPTION MITIGATING ACTIONS If there lack of support and resourcing for new patient safety investigation processes then we will have no assurance that timely and effective learning from incidents will occur, resulting Review of current processes being undertaken by PHT Senior compromised safety of service users and potential for harm. Patient Safety Team
CURRENT POSITION Ambition to move to single joint SIRI sign off panels. •CCG attendance at PHT Incident Review Panel •CCG attendance at PHT Care Group Incident Panels Independent review commissioned of processes •CCG attendance to PHT Mortality Review Group •CCG SI panels •Joint CCG/PHT SAIP meetings Discussion planned at February 2020 shared assurance & improvement programme meeting to include PHT processes, implementation of national patient safety strategy and process for CCG oversight of patient safety incidents that do not meet serious incident criteria.
ASSURANCE STATEMENT Patient Safety metrics in PHT IPR PHT IRP meeting notes PHT Quality and Performance Committee minutes PHT Mortality Review Group minutes RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE To note and feedback any concerns or questions to the Portsmouth Clinical Quality Manager.
10
RISK REF PHT.27 DATE OPENED Jul 2017 PHT: Safety of patients who require mental health care Risk administered by Simon Freathy, SEH CCG RISK 6: provision for both adults and children SCORING Impact Likelihood Score Original 4 major 4 almost certain 16 REPORTING MONTH February 2020 LAST UPDATED February 2020 Current 4 moderate 3 possible 12 DESCRIPTION MITIGATING ACTIONS If there is inadequate mental health support available in PHT then Temporary (agency and bank) nursing staff used to cover staffing establishment concerns in the care for patients (adults & children) with mental health concerns emergency decision unit may fall short of defined/required standards resulting in Commissioning actions regarding agreement of service specifications for both adult and children compromised safety of the service user. liaison support Progression to implement Core 24 psychiatric liaison. CURRENT POSITION •The Mental Health (MH) Matron is now in place, commencing on 2 days a week at present. The Matron has provided significant advice in several areas particularly relating to restrictive practice, also providing positive assurance in areas when witnessing patient centred care. •NHSE have recognised the Trust work on restrictive practice and the Head of Safeguarding has been asked to Chair a task and finish group in the STP locality on this topic. •There has been a 93% return rate from wards/areas on the ligature assessments with analysis taking place during January 2020.
ASSURANCE STATEMENT System Mental Health Board in place with partner organisations Vulnerable Adults plan in place Executive leadership for mental health Adult psychiatric liaison service contract in place Mental Health Assessment Unit proposals progressing but operational plan needs finalising PHT dementia lead nurse in post Funded establishment of 5 registered mental health nurses to the urgent care corridor. Overall sustained performance of Mental Health Risk Assessments in ED - above target of 95% Flagging system in place for identification of vulnerable patients and vulnerable adults plan Escalation process for patients detained under Mental Health Section Hospital wide ligature risk assessment complete. Works to be completed. Training programme in place CQC has lifted MH Section 31, except for DOLS element CAMHS designated resource in ED to recommence in the hospital from 4pm- midnight seven days a week September 2019 MH matron commenced in December. Gaps in assurance: • Difficulty recruiting to ED RMN and CAMHS provision •Restraint practices as detailed in separate risk PHT.38 •Dementia risk assessment performance decreased Q3 19/20 RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE To note reduction and feedback any concerns or questions to the Portsmouth Clinical Quality Manager.
11
RISK REF PHT.28 DATE OPENED Aug 2017 Risk administered by Simon Freathy, SEH CCG RISK 7: PHT: Governance SCORING Impact Likelihood Score Original 4 major 4 almost certain 16 REPORTING MONTH February 2020 LAST UPDATED February 2020 Current 3 moderate 2 unlikely 6
DESCRIPTION MITIGATING ACTIONS If there is inadequate oversight, transition and handover of governance processes •Increase leadership and capacity for corporate and clinical governance then processes may fall short of required standards resulting in undetected quality •CCG engagement in corporate governance meetings concerns and risks, gaps within the monitoring and assurance systems. •Revised Board Assurance Framework in place •Review of Corporate Risk Register at Quality & Performance Committee CURRENT POSITION CCG Deputy Director of Nursing and Quality has revised the MOU regarding shared governance processes and is in discussion PHT Chief Nurse and Director of Governance.
ASSURANCE STATEMENT •Quality and performance measures aligned with four divisions •Divisional performance and accountability monthly meetings in place with quarterly reporting to Quality & Performance committee •Revised Clinical Effectiveness Committee in place •Ward to board walk-arounds •CCG engagement in quality assurance committees.
•CCG unannounced site and see visits. Gaps in Assurance •Serious incident outstanding reports over 60 working days not improving.
RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE To note and feedback any concerns or questions to the Portsmouth Clinical Quality Manager.
12
PHT-SOL November RISK REF DATE OPENED PHT/ Solent NHS Trust: Risk of harm from communication Qua.01 2019 RISK 8: Risk administered by Simon Freathy, SEHCCG challenges between providers SCORING Impact Likelihood Score Original 3 3 9 REPORTING MONTH February 2020 LAST UPDATED February 2020 Current 3 2 6
DESCRIPTION MITIGATING ACTIONS There have been significant issues relating to the process by which the Portsmouth Health Visiting New Risk Service receive notification of expectant mothers from PHTs Maternity Service, especially in relation Action Plan agreed between services-Monthly reviews. to those deemed most vulnerable. The health visiting service require notification of these women Monthly meetings between providers as well as CCG/PCC from maternity at the earliest stage to enable them to begin planning their caseloads and book in involvement the required number of visits for these high risk women. Issues raised with PHT Governance lead CURRENT POSITION Quarterly feedback to commissioners (Next 08 April) Action plan agreed after discussion between commissioners and providers. HVs are currently receiving scan lists weekly and monthly-Now only to be sent weekly. HVs are receiving 12 week scan lists- These lists are not required so are no longer to be sent. 20 week scans lists are confusing as in no particular order-PHT to look into whether scan lists can be sent in A-Z order There are currently 80 women who have an EDD for January that HV have received no notification for-HV to send list of names to Maternity services who have agreed to review all 80 cases and ascertain if there are any identifiable themes. Maternity admin have been keeping a record of all antenatal bookings and have yet to share this with HV team-HV have requested that they are sent the monthly lists since they started in August 2019. Maternity to action request. There are currently two processes for antenatal alerts as Hampshire HV services do not request the booking data. It is acknowledged that this causing some confusion amongst midwives- For Hampshire CCG to implement the same process for their HV service To explore the feasibility of having a coordinator across Solent and PHT
ASSURANCE STATEMENT CCG raising issue with PHT through Governance lead; To be followed up through SAIP/CQRM; Joint PHT/CCG/PCC/Health Visiting Team meetings and ongoing action plan. RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE To note reduced risk and feedback any concerns or questions to the Portsmouth Clinical Quality Manager.
13
RISK REF Solent.QUA.R.01 DATE OPENED June 2019 Solent NHS Trust: Risk of harm from temporary withdrawal of RISK 1: Risk administered by Meyrick Grundy, PCCG COAST & CCN Services SCORING Impact Likelihood Score Original 4 major 3 possible 12 REPORTING MONTH February 2020 LAST UPDATED February 2020 Current 4 major 2 Unlikely 8
DESCRIPTION MITIGATING ACTIONS There is a risk of harm to children and young people as a result of the temporary withdrawal of the To support the new and current workforce, Solent are Children’s Outreach and Support Team (COAST and Children’s Community Nursing (CCN) services carrying out wellbeing sessions with staff to help develop team cultures and dynamics. If services are not provided then demand is compounded on alternative providers PHT, CAU and GP There is a phased implementation of urgent care service to OOHs. ensure staff are fully competent and to manage demand, CURRENT POSITION these are being agreed within the working group (which The urgent care service (formally COAST) opened on 11th November. The service is operating 5 days includes PHT, commissioners, GP's and Solent a week and takes referrals from CAU. GP's can refer in, but they need to contact the consultant representatives) advice and guidance helpline first. Work has been undertaken to ensure the competency and skills of the workforce is of a high standard with a competency document that all clinical staff will undertake to evidence appropriate knowledge and skills. Due to a low number of referrals, it is taking longer for staff to meet the level of competencies and skills required to work across the urgent care pathway. Referrals are now increasing as awareness of the new service increases. The CCN team are now fully recruited to and new staff are going through induction and training.
ASSURANCE STATEMENT The CCN service has been operating at GREEN level since December 2019. RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE To note reduction and feedback any concerns or questions to the Portsmouth Clinical Quality Manager.
14
RISK REF CUK.QUA.R.01 DATE OPENED Dec 2019 Risk administered by Stephen Orobio, PCCG RISK 1: CARE UK: Urgent Treatment Centre (UTC) clinical vacancies SCORING Impact Likelihood Score Original Moderate Possible 9 REPORTING MONTH February 2020 LAST UPDATED February 2020 Current Moderate Possible 9
DESCRIPTION MITIGATING ACTIONS If the number of clinical vacancies in the UTC continues or increases then there is the possibility Care UK are monitoring this risk on their own risk register that patient safety, care and experience may be compromised. A new workforce plan has been developed and is in action from Dec 2019 CURRENT POSITION As part of the workforce review, clinical salaries in the UTC There has been a growing concern about the number of clinical staff vacancies over the last six have been revised and increased, although the service is months. At June 2019 there were 6 vacancies; at 7 February vacancies stand at 13.2 WTE (60% unable to match the salaries in primary care vacancy rate). Initiatives in place to engage staff, e.g. “great place to work forum”, “healthcare heroes” – staff survey is being rolled The Care UK Head of Nursing has advised that the majority of leavers (circa 80%) are taking up roles out in December which should give insight into support within primary care which both pays more and offers more attractive hours (daytime). required to retain and develop existing staff
The service is covering vacancies using agency staff and building up its bank workforce. The Review and modification of initial assessment process situation is putting current staff under increasing pressure, impacting on staff well-being and ensures patients are seen based on clinical need reducing the time available for staff training. Further discussion and update from provider due at the CRM in March 2020.
ASSURANCE STATEMENT There is a concern that as the service goes into Winter staff sickness rates may rise and more staff may leave. While agency and bank can provide some cover, quality may be impacted. As IUCs and ICSs develop and offer clinicians more attractive working conditions the situation may get even worse. Care UK has reviewed the initial assessment process to ensure patients are seen based on clinical need and this gives some assurance.
RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE To note and feedback any concerns or questions to the Portsmouth Clinical Quality Manager.
15
RISK REF SCAS-PHT.01 DATE OPENED Nov 2019 Risk administered by Amy Smith, SEH CCG RISK 1: SCAS 999/PHT: Impact of handover delays SCORING Impact Likelihood Score Original 4 3 12 REPORTING MONTH February 2019 LAST UPDATED February 2019 Current 4 3 12
DESCRIPTION MITIGATING ACTIONS If challenges in being able to handover patients at PHT within the current time frames continue Progress review of welfare calls. Deep Dive workshops then there is the potential for patient welfare to deteriorate; leading to harm and poor patient Progress SDIP throughout 19/20. experience within the community. Review of policies and procedures; with a new roster roll out due to completed by year end. CURRENT POSITION Investigate individual incidents reported on Datix where Continued significant pressure on the urgent and emergency care pathway with significant harm may have been caused by delay. ambulance holds throughout December. Specialist paramedic role on the urgent care desk in the EOC The Trust supported an internal critical for two weeks with the aim to support improvements in to increase clinician capacity. flow and a subsequent reduction in holds during this period. Further discussion is ongoing around the potential to For M09 the total number of ambulance handover delays >60mins reduced by 437 to 300, and combine the 999 and 111 clinician workforce. those waiting 30-60mins reduced by 442 to 315. The initial improvement focus is on Increase in the number of ambulances, new resource of 52 elimination of >60min holds. ambulances in December 2019 14% of all Ambulances conveyed to QA waited longer than 30 Minutes to handover, down from Reduction in servicing of ambulances during the periods of 37% the previous month. Average waiting times reduced for admitted patients by over an hour. highest demand. Bed occupancy levels remain high with continued use of escalation capacity. A SCAS HALO (Hospital Ambulance Liaison Officer) is based at Ongoing work to understand increases in ambulance conveyances, especially category 3/4 ED PHT to assist in the coordination of patients/ambulances ambulance calls. upon arrival to the hospital. No patient safety incidents identified for M09. Commissioners to continue to monitor SIs, incidents and Impact expected on patient experience; however this is currently not quantified with feedback etc. regarding delays. reductions in waits potentially improving patient experience. Review the long waits reports each month. Weekly review of NHSE Ambulance Balance Scorecard.
ASSURANCE STATEMENT SCAS attend A&E delivery board which holds actions to address delays. Escalation processes in place and under constant review. Implementation of urgent care pathways to improve conveyance rate to non ED. S&T H&T supports patients and partner agencies at the same time to obtain best patient care. Overall SCAS RAG rating on NHS Choices continues to be at 5 star rating out of 5, from 20 ratings and performing well when compared to other ambulance trusts Clinical visit in November with SCAS to see positive effect HALO (Hospital Ambulance Liaison Officer) in ED has on staff wellbeing and that of patients. RECOMMENDATION FOR THE QUALITY & SAFEGUARDING EXECUTIVE COMMITTEE: To note and feedback any concerns or questions to the Portsmouth Clinical Quality Manager 16
2. Healthcare Associated Infections
HCAI update for monthly provider report for activity January 2020 This information is based on any cases within Solent NHS Trust and those relating to NHS Portsmouth CCG.
MRSA BSI Summary Update of MRSA BSI Dec 19 37 year old male admitted to PHT following a collapse. PMH of substance abuse and although was previously known to substance misuse services had not been engaging for several months. He did not engage with primary care services either. No previous MRSA identified and therefore the panel concluded that the MRSA BSI was unavoidable.
Summary of MRSA BSI Jan 20 There have been two cases of MRSA BSI identified in January.
Case 1: 34 year old male, overseas student studying at Portsmouth University. Became acutely unwell with respiratory symptoms and attended GP where following examination he was issued with antibiotics. His condition deteriorated and following contact with 111 he revisited GP surgery and was advised to continue with antibiotics and monitor fever. His condition deteriorated further and he called 999 and was admitted to ITU via ED where combined Influenza and MRSA BSI were identified. A meeting is scheduled at the surgery to share learning.
Case 2: PHT reported the case on 2.1.20 for a Portsmouth CCG resident. The RCA and panel for this case will be held on 07.2.20 and any learning shared.
January CDI:
Case 1: Community Onset. Under the age of 65 years. CDI positive following a recent course of amoxicillin prescribed for a chesty cough. Recent admissions to PHT Emergency Department on 22.12.19 for abdo pain and possible sepsis. Possible high risk antibiotics given in PHT. Practice nurse also reported patient had recent gastroenteritis with ongoing diarrhoea and raised CRP. Healthcare Worker. PPI: Unknown. No lapse in care identified in the community.
Case 2: Community Onset. Over the age of 65 years. Patient prescribed amoxicillin for clinical signs of chest infection on 08.1.20. Diarrhoea commenced 10/7 after and tested positive for CDI 20.01.20. PPI: lansoprazole – requested review. No other risk factors. No lapse of care identified in the community.
17
Case 3: Community Onset. Under the age of 65 years. No known recent antibiotics. Tested positive for CDI during outpatient admission. PMH: Ulcerative colitis and Inflammatory Bowel Disease. No PPI. No lapse of care identified in the community.
Case 4: Community Onset. Over the age of 65 years. Recent antibiotics for chest infection and CAUTI: all deemed appropriate. No known hospital admission. No known co-morbidities or PMH. No PPI. No lapse of care identified in the community.
For the purpose of these reports the graph shows actual accumulative cases against trajectory. Please note these are cases that fall into the community criteria for investigation in accordance with the current service specification between Solent NHS Trust and the CCG. It does not include post 72 hour cases in PHT of patients who reside within Portsmouth. Those cases will be added at year end to give true total number.
18
3. Safeguarding
Safeguarding
REPORTING MONTH February LAST UPDATED 10/02/2020
CURRENT RISKS No Current Risks
CURRENT CONCERNS Unaccompanied Asylum Seeking Minors are not being referred to Solent NHS Trust for their initial health assessment from Social Care colleagues – it has been identified there are potentially another 13 outstanding health assessments. This has been raised to the Deputy Director of Children Services. This was previously a risk and was reduced to a concern on 16/10/19 as at that time there were no further reported issues. The committee needs to consider whether this should remain as a concern with regular review or whether this should be escalated to a risk at this time.
SCAS have raised a SI relating to 670 safeguarding alerts for adults and children not being raised to MASH – both MASHs have been made aware as there is expected to be an influx of safeguarding concerns. To date we have not had a copy of the SI and we have been informed that SCAS cannot identify the patients into CCGs so we are not aware of how many of these cases relate to Portsmouth patients.
We have one GP practice currently refusing to undertake their two yearly Section 11 audit. Portsmouth Safeguarding Children Partnership have escalated this to the CCG and may consider further action if the practice refuses to comply
MATTERS OF NOTE Operation Cravat – is investigating the finding of a body of a new born baby. Alerts have been sent out to all health colleagues – to date the mother has not been found. A domestic homicide review has been agreed by the DHR sub-group and a chair has been appointed. It is anticipated that the review will take approximately a year to complete as the case may have to be placed on hold whilst court proceedings are undertaken. There was a Joint Targeted Area Inspection of Services for Children with a focus on Children’s Mental Health in December and the report has been published. Overall Portsmouth was identified as having good Mental Health Services for our children – especially CAMHS.(see separate agenda item) A Safeguarding Adult Review has been agreed for a resident in one of the cities residential homes. The coroners verdict was that whilst she died of natural causes this was contributed to by neglect. Three other cases were reviewed by the SAR Group but they did not meet the criteria for a SAR. A recent audit indicates that GP Surgeries are not aware of when a child is removed from a Child Protection Plan; this is being discussed with Solent NHS Trust as they have the ability to monitor and update records. Interviews for the Safeguarding Nurse Specialist role have been arranged for the 5th March 2020. National Safe Sleep week commences 9th March – there will be numerous workshops for professional throughout the week with a main HIPS wide launch on the 9th.
19
4. Providers: 4(a) Portsmouth Hospitals NHS Trust Portsmouth NHS District general hospital providing comprehensive range of acute Quality managed by Fareham and Gosport and South and specialist services East Hants CCG. Monthly SAIP, Quarterly CQRM. Hospitals Trust Latest quality data summary REPORTING MONTH February 2020 LAST UPDATED February 2020 AREA RESULT PERIOD
CONCERNS requiring enhanced monitoring or watching brief through FG&SEH CCG Oct CQC rating GOOD Stroke services - Previous under performance against SSNAP-Moved from SSNAP level C to B despite challenges in workforce 2019 (nursing, medical, therapies)Direct admission to stroke ward and SALT SSNAP indicators remain low compliance. Hospital standardised 99.6 Lack of follow up on test results – Processes around follow up-minimal numbers monitored through QUASAR/SAIP Mortality Ratio (HSMR) Maternity Services- Concerns in respect of compliance with safeguarding principles, records management, domestic violence Summary Hospital level 103.26 requirement’s, supervision, leadership, capacity and governance- CCG Quality and Commissioning representation at PHT Mortality Indicator (SHMI) Maternity Board 17/12/19. No medical attendance noted. Ongoing work programmes and response to National Maternity Audit Grade 3+4 Hospital 0 discussed and assurance gained. acquired pressure ulcers Medication Management - Concern about process for MM- •Practical oxygen simulation sessions and training continue. Initial Falls per 1,000 occupied 0.13 results of an audit of oxygen prescribing are positive. Patients receiving oxygen having an oxygen prescription (Increase-59.7% to bed days 76.5%) •A snapshot audit of drug trolley security found 100% (66) were locked. •The number of medication safety learning Serious Incidents 3 events reported in November remains much higher than previous months. However, the rate of reported events causing harm Total patient safety has reduced in November to 10% from an average of 17.8% over the last 6 months. 1455 incidents UEC ECG interpretation/review – Concern about recording/interpretation-Action plan in place and being monitored Number of complaints 21 Clinical letters- Late/delayed-All practices now receiving letters via e-Distribution. CCG Monitoring any concerns. Complaints per 1,000 Workforce- Shortages-Focus on recruiting international nurses has brought positive results and vacancy rate now 5.5%. 0.32 (Nov) Dec Unregistered staff 3.2% vacancy rate reduced from 18.9%. Continued bank usage across professions when needed has reduced contacts 2019 FFT Inpatient & day case agency spend. 97.6% Pathology sample review backlog-Concern around delays in diagnosis-Concern closed. WLI and locums have cleared. (recommend +ve =*) Restrictive Practices-Chemical Restraint-Concern inappropriate use. Focus on mechanical currently. See also PHT risk 2 FFT ED * 89.2% Never Events related to failure to adhere to WHO surgical safety checklist (SSC) and local Strategic Service Implementation Plan FFT Maternity* 98% (LocSSIP)- As outlined previously, Recurrent themes of failure to adhere to recommended procedures in line with WHO SCC and LocSSIPs-A comprehensive list of actions has been put in place including the introduction of a theatre safety team, Mixed sex accommodation recommencement of the Safer Procedure Steering Group in January 2020, implementation of a revised WHO checklist to be breaches (non-clinically 0 known as surgical safety checklist. justified) MATTERS OF NOTE **CQC Visit Outcome-CQC Report published and improved rating of “Good”. Full report available via CQC website**. Number of patient moves 4.71 Service Demand- Continued significant pressure on the urgent and emergency care pathway with significant on average PM of non- rd (Avg per day) ambulance holds throughout December and into January. Opel 4 declared Monday 3 February. clinical after 21:00
20
4(b) Solent NHS Trust
Solent NHS Trust Community and Mental Health Services Latest quality data summary
REPORTING MONTH February 2020 LAST UPDATED February 2020 AREA RESULT PERIOD CONCERNS requiring enhanced monitoring CQC RATING Good Feb 2019 Jubilee House-Quality of Care-A further unannounced commissioner visit took place in response to the In-patient falls (MH & Comm) 0 Dec 2019 opening of the previously shut East Wing by SHFT and PHT to deal with Winter Pressures. No issues were Number of serious incidents 1 Dec 2019 identified. Patient safety incidents MH 106 Service Demands-Demand v Capacity- Extreme service pressures in all areas with local action plans in place Patient safety incidents Child E 22 to mitigate. Very much linked to concern below. Patient safety incidents Comm 105 Workforce-Shortages- Lack of substantive Consultant Psychiatrists (MH) and nursing vacancies across both Number of complaints (all) 16 Dec 2019 Adults Portsmouth and MH (Both national issues). Recruitment has focused on obtaining a Community SLT for a critical vacancy which remains unfilled. Money provided by commissioners to backfill via agency. There FFT MH –would recommend % 76.9 has been activity to secure temporary psychiatry medics and planning strategy of permanent doctors. FFT Comm – would recommend % 99.1 Recruitment activity has also included planning of PRRT open event to highlight unfilled vacancies. Mixed sex accommodation breaches 0 Environment issues in Mental Health Inpatient Units-Suitability of facility- A list of works and costings has Last commissioner visit Jubilee Jan 2020 now been established and they are now undertaking risk assessment for each individual item of works for House current state and future state to be able to demonstrate impact of work Next commissioner visit TBC SLT Service- Capacity and Demand- A review of the service has been completed and the recommendations Staff Vacancy Rate 2.6% Dec 2019 are being presented to the Quality Improvement and Risk Group in February. CRHT-Capacity to meet core fidelity and SOP frequently impaired by various and differing factors. Frequent Annual Turnover 14.7% Dec 2019 use of Bank and Agency to meet demand but still “fragile”. Ongoing staff development continues though. Safeguarding Training Level 1 84.1% Dec 2019
MATTERS OF NOTE Quality Assurance Visits- Reports have been provided to Solent for visits to AMH Recovery services and EIP also CAMHS and revisits to Jubilee House. There were no major issues of concern noted. Plans for 2020-2021 are underway and will look to include visits out and about with community services. Quality Account Q3-Highlights include,: All corporate and service line priorities have begun and are showing consistent progress; Increased community involvement (supporting carers, learning from complaints and experience of care metrics; Development of centralised recording of clinical supervision; Expansion of the “Academy of Research and Improvement”; Approval of “The Learning and Development Strategy 2019-24” with Implementation now underway Learning Disability Strategy- Ongoing three year action plan now in second year. Various recommendations are ongoing in areas such as Respecting and Protecting Rights; Inclusion and Engagement; Workforce Engagement; and, Specialist Learning Disability Services. System1 developments include a “vulnerable patient checklist” and a generic “reasonable adjustments consideration” care plan. They are also looking at ensuring Hospital Passports are available. Family Liaison Manager- Solent are receiving positive feedback on this role especially the proactive approach around SI’s and Learning from Death (LfD) CAMS-(Collaborative Assessment and Management of Suicidality) training- This is a therapeutic framework for suicide-specific assessment and treatment of a patient’s suicidal risk. There are 2 groups of staff going through this training in the first half of year.
21
4(c) South Central Ambulance Service NHS Foundation Trust – 111
South Central Ambulance Service NHS 111 Latest data summary - reported quarterly
REPORTING MONTH February 2020 LAST UPDATED February 2020 AREA RESULT PERIOD
CONCERNS requiring enhanced monitoring CQC rating Good Aug 2018 No current concerns. FFT–would recommend 91% May – Sept 19
MATTERS OF NOTE Number of complaints 11 Q3 19/20 Q3 update Number of concerns 26 Q3 19/20 The number of complains & concerns remain low compared to activity levels (0.006% for Number of HCP feedback items 22 Q3 19/20 complaints, 0.01% for concerns). All complaints were acknowledged and responded to within Number of compliments 14 Q3 19/20 NHS timeframes. No complaints were referred to the Ombudsman % compliant – Call handler 90% Q3 19/20 Trends in feedback (including HCP) have been identified as call back delays (GP OOHs), % compliant - Clinician 94% Q3 19/20 Call communication errors and care provider errors. Learning and action planning is in place. Audit numbers: audit Call audit compliance remains high, although the required number of audits of clinical Requirement met Non clinician Yes Q3 19/20 advisors calls was not met; This was due to staff from the audit & education team being Requirement met Clinician No Q2 19/20 redeployed in December to reduce the number of 111 events transferring to 999 Last commissioner visit February 2020 Of the 75 incidents recorded in Q3, 6 incidents involved Portsmouth patients 70 were Next commissioner visit February 2021 categorised by severity as none or insignificant, 3 were moderate and 2 were catastrophic (serious incidents in which 111 involvement was minimal or insignificant) The main categories of reported incidents were: - Patient treatment (52) - Delay (12) - Abuse/abusive behaviour (8) – 3 of which were Portsmouth patients
Most incidents reported as “delay” involved GPOOH services and were not caused by NHS 111 failures in care. NHS 111 were found not to have been the cause of the issue reported in a significant proportion of incidents, particularly where inappropriate dispositions were found to be appropriate from the information given to the CH at the time of the call but differing significantly from that encountered by other services such as 999 crews and GPOOHs. Learning and action plans are in place
Two commissioner quality visits took place at the beginning of February 2020. A report is being complied and will be available to the QSEC shortly.
22
4(ci) South Central Ambulance Service NHS Foundation Trust – 999
South Central Ambulance Service 999 Latest data summary
REPORTING MONTH February 2020 LAST UPDATED February 2020 AREA RESULT PERIOD
CONCERNS requiring enhanced monitoring (Dec 2020 position) CQC rating Good Aug 2018 Delays in 999 response – Pressure and Demand 12% higher than compared with previous December, continues to be Number of complaints 8 Dec 2019 challenging Number of concerns 12 Dec 2019 Hospital handover delays continue albeit slightly improving with just under 2500 hours lost Number of HCP feedback items 18 Dec 2019 compared to 3000 hours in November. Vacancies in Thames Valley (TV) impacting on performance- Positive to see recruitment review now in place to look at new ways to recruit in TV area 15 new ambulances operational by end of December - Comprehensive fleet improvement action plan now in place. Operations to weekly look forward re: management of vehicle availability . 111 - 999 referrals remain above the 10% target and relates to high levels of CAT 2 calls . SCAS CCC (Clinical co-ordination centre) education and audit team provided floor walking advice for call handlers in 111 to aim to reduce the levels of referrals to 999.
Clinical Advisor vacancies If challenges recruiting clinical advisors continue then there is the potential for welfare calls to not take place; leading to deteriorating patients not receiving the appropriate level of response and intervention resulting in harm to the patient outcome. Clinical desk staffing remains a challenge has the potential to impact on the ability to perform welfare calls Northern House Bicester had an annual open day 12th January 2020 with a many visitors showing a keen interest in roles available within the CCC. Further understanding of numbers/ applications will be known in Q4 Recruitment of paramedics from India.
Safeguarding level 3 compliance If the safeguarding training to level 3 is not achieved in a timely way (in line with the children’s intercollegiate document), then SCAS will not be compliant with contractual requirements and there is potential for negative outcomes for patients resulting in harm. SCAS provided a brief Safeguarding update at Novembers CQRM and advised that the Safeguarding training package did not include a bespoke ambulance module as expected and this had resulted in budget planning to enable the development of content to meet the level 2 to level 3 requirements. Training time has been signed off at the Executive meeting. Awaiting paper with full training plan and trajectories which is in progress
23
4(cii) South Central Ambulance Service NHS Foundation Trust –Non-Emergency Patient Transport Service (NEPTS) Non-emergency patient Latest data summary South Central Ambulance Service transport (NEPTS) REPORTING MONTH February 2020 LAST UPDATED February 2020 AREA RESULT PERIOD
CONCERNS requiring enhanced monitoring (Dec 2020 position) CQC rating Good Aug 2018 Delays in non-emergency patient transport FFT–would recommend (n=6) 67% Nov 2019 Following continued reviews of quality data it is apparent that delays/non-attendance continue to be a Number of complaints 4 Dec 2019 recurring theme, however patient safety and harm is not being identified in complaints, concerns, HCP 2 complaints related to delays/non attendance feedback or incidents. A pilot to relax the current KPIs commenced on 1 December for a 3 month trial Number of concerns 11 Dec 2019 period in order to support on-the-day discharges from acute trusts. 85% of the activity within the 6 concerns related to delays/non attendance contract is for outpatient clinics and discharges account for approximately 12% of the activity. Number of HCP feedback items 65 Dec 2019 Engagement has taken place across providers and within the CCG. By amending the KPIs (renal KPIs remain unchanged) it is anticipated that this will release capacity to support OTD discharges without 58 HCP feedback items related to delays/non attendance the need for any further investment from the CCGs. From a quality perspective we would not Number of compliments 3 Dec 2019 anticipate seeing a drop in current performance but would anticipate KPIs then being met. There is a need to ensure that any patient safety incidents for outpatients are robustly captured, and shared, as Number of incidents 22 Dec 2019 soon as possible to determine if there is a need to stop the pilot. Number of serious incidents 0 Oct 2019
Poor performance against call answering targets The new KPIs are now in place for the trial period. For call answer time this has now changed from 60 seconds to 90 seconds Performance declined with overall end position of 79.67% 9 days achieved green rating % answered in target 90 secs with the 24th & 26th December achieving 100% 13 days RAG rating red and 9 days RAG rating amber. With the lowest performance day being 20th December Large number of calls abandoned at 6.1% - this correlates to the 13 days that failed to achieve % answered in target 90 secs Positive to note that 2 Daily SitRep updates have been introduced into the CC’s daily 0930 – 1430 to escalate any perform challenges and provide mitigation. Sickness has gone down to 8.2% from 8.7% November but still an impact on performance targets Good to see actions identified following call audit failures Workforce - rota review noted re Flexible working requests and review to ensure they meet requirements of the Trust Achieved 100% performance for contractual year for complaints acknowledged within 3 working days and complains resolved within 25 working days Note that stats have been run for January 2020 and there is increased performance and as of 14/01/20 of Statutory & Mandatory - 9 modules are all over 90% compliant.
24
4(d) Portsmouth Primary Care Alliance (PPCA)
Portsmouth Primary Acute Visiting Service, Extended Access , Out of Latest data summary Care Alliance (PPCA) Hours Service & In Hours Clinical Assessment REPORTING MONTH February 2020 LAST UPDATED February 2020 AREA RESULT PERIOD
Concerns requiring enhanced monitoring CQC rating Good Jan 2020 No concerns identified. FFT would recommend 89.4% Dec 2019 FFT would not recommend 4.5% Dec 2019 MATTERS OF NOTE http://www.portsmouthpca.org.uk/reviews/ During December 2019, there were a total of 3,462 patients seen across the four services. This breaks Number of incidents 13 Oct 2019 down by service as follows; AVS = 338, EAS = 2168, OOH =720, IHC =236. Includes 8 cases of failed auto ambulance dispatches (Adastra) Acute visiting service (AVS) - “Prescribed medication”, “Referral to GP” and “No further action Number of serious incidents 0 Dec 2019 required” were the top three final dispositions. These represent 88.5% of all final dispositions for AVS. Number of complaints 0 Dec 2019
Extended access service - “Ring own GP if no better, prescribed medicines” and “direct admission” Number of complaints remain low represented 85.6% of all cases. Number of HCP feedback items 0 Dec 2019 Clinical audit compliance 98.53% Oct 2019 Out of hours service – “Patient advised to contact own GP” and “No follow up” represented 69.7% of Results remain above 95% for 19/20 all referrals. Mandatory training compliance 92.68% Dec 2019 In hours clinical assessment service -“Clinician advice”, “successfully booked” and “prescribed Safeguarding referrals 0 Dec 2019 medications” represented 79.2% of all cases. Last commissioner visit 2 & 3 November 2019
In December there were 224 ED and cat 3/4 ambulance dispositions referred to the service. Next commissioner visit Winter 2020 Following revalidation 70% were diverted away from ED & ambulance dispatch.
Adastra incidents – PPCA now use SCAS Adastra to revalidate ED & cat 3/4 calls. 8 of the 13 incidents raised this month relates to a known failure of the system to automatically dispatch an ambulance on some occasions. In these cases PPCA have to call SCAS to request an ambulance.
CQC inspected the service on 4 December 2019 and the service was rated as Good overall with requires improvement for the safe domain. Two key improvements were required; The monitoring and management of prescription stationery. PPCA had been using Lake Road’s stationery and are now arranging to obtain their own and to review control processes. There will be a single point of ordering, maintaining and monitoring the use of prescription stationery in the future.
The management of emergency medicines. PPCA use the Lake Road emergency trolley. The list of medicines required was not all stored on the trolley (some pain relief and anti-emetics, while on the premises, were not on the trolley). Some medications that were on the trolley needed a tamper proof seal and a clear process for stock control needed to be in place to ensure medicines are replenished when needed.
PPCA have an action plan in place and CQC have noted in their report that the service has already taken mitigating actions. 25
4(e) Care UK St Mary’s Treatment Centre & Havant Diagnostics Urgent Treatment Centre, Day Surgery Unit, Diagnostics, ENT, Latest data summary – reported quarterly Care UK Dermatology, Audiology, Ophthalmology REPORTING MONTH February 2020 LAST UPDATED December 2019 AREA RESULT PERIOD
CONCERNS requiring enhanced monitoring CQC rating: None ST Mary’s Treatment Centre Good Oct 2015 Havant Diagnostics Good Jan 2019 CQC Inspection for St Mary’s due Winter 2019 MATTERS OF NOTE Number of complaints 11 Q2 19/20 The number of incidents is comparable to Q1. Documentation/notes/scheduling was the highest 5 upheld (45%), 4 partially upheld (37%), 2 not upheld (18%) category (n=17) and a process change has recently been implemented as a result which has reduced Healthcare Professional feedback 33 Q2 19/20 incidences. Number of compliments 39 Q2 19/20
Healthcare Professional Feedback was not being passed on to Care UK from the Fareham & Gosport FFT % that would recommend 99% Q2 19/20 and SE Hampshire Quasar. This has now been remedied and is included in Q2 figures. Care UK was High response rate 1,000+ per month already aware of some of this feedback through other processes. Of note, one item of feedback Poorest performer UTC @ 95.1% identified a surgery that had not being receiving discharge summaries for a number of months – this Number of incidents 85 Q2 19/20 was an IT issue which has now been resolved. Number of serious incidents 0 Q2 19/20 Last commissioner visit 12 September 2019 The Care UK “Over to You” Staff Survey is taking place in December 2019. Results and findings actions will be reported by the end of Q4. Next commissioner visit Autumn 2020
A News2 Real Time Audit was carried out 80 patients in October 2019. All 80 patients had their observations, O2 score and correct escalation process completed. Areas of improvement were identified as 2 patients not having their scoring complete and 4 patients being scored incorrectly. These issues are being followed up with the Ward Lead and a further audit will be carried out in December 2019.
A WHO surgical safety checklist audit of 20 randomly selected patients who had undergone a procedure under general anaesthetic was carried out during Q2. Scoring was 100% for observational audit and 99% for surgical safety checklist (2 patients did not have their temperature taken within the last hour pre-discharge).
The next CRM will be 16 March 2020.
26
4(f) Millbrook Healthcare – Wheelchair Service Latest data summary –Monthly data although CQRM quarterly
Millbrook Healthcare Wheelchair service (next due 26 February 2020) REPORTING MONTH February 2020 LAST UPDATED February 2020 AREA RESULT PERIOD CONCERNS requiring enhanced monitoring % of NHS community provider 100% Nov 2019 Change of Provider- With the change of provider happening there has been staff resignations and there was Incidents acknowledged < 3 days concern that the waiting list would grow. However, Millbrook have set a new trajectory with the triage % complaints rec’d as a total of job 0.57% Nov 2019 team, backfilled staff from elsewhere and ensured staff know referral criteria. Waiting list has actually activity/contacts PCM reduced although this may also be due to waiting list initiative. A data cleanse continues around the actual % of complaints acknowledged < 3 100% Nov 2019 cases on the waiting list. AJM remain confident they will able to make inroads into this once the new working days PCM contract begins. % complaints responded to within 0%= Nov 2019 agreed timescales PCM Staff -% compliance Statutory and 95%↓ Nov 2019 Mandatory Training MATTERS OF NOTE Staff-% compliance with Mental 97% Nov 2019 Ordering Process improved so that system not reliant on just manager dealing with order emails. Capacity Act 2005 Training New clinical schedule introduced with weekly management of appointments which includes staff Portsmouth CCG – waiting list 266↓ Dec 2019 attempting to fill slots from cancelled appointments. They are also overbooking so that better use is adults made of time. Portsmouth CCG – waiting list 79 Dec 2019 Consideration being given to overtime and evening clinics. children Review and discussion with complainants and meetings agreed for those who wish to be seen. Ave waiting time PCCG Adult 34.6↑ Dec 2019 Clinical pathways review underway. weeks
Ave waiting time PCCG child weeks 24.8↑ Dec 2019
27
4(g) Rowans Hospice: End of Life Care Service
Rowans Hospice Palliative Care Latest data summary – reported yearly or should the need arise
REPORTING MONTH February 2020 LAST UPDATED February 2020 AREA RESULT PERIOD CONCERNS requiring enhanced monitoring CQC rating Outstanding Aug 2017 None Last commissioner visit Oct 2019 Next commissioner visit Oct 2020
MATTERS OF NOTE The Rowans refurbishment is still ongoing, anticipated that by April 2020 they will be back to the full number of beds. There were delays in admission due to bed issues in early January 2020 but happened for the first time. The system continues to work together in these situations and everyone throughout the service is mindful of the refurbishment so is understanding of situation.
28
4(h) Spire Healthcare Limited – Spire Portsmouth Hospital Trauma & Orthopaedics, General Surgery & Latest data summary – reported quarterly Spire Portsmouth Unbundled Diagnostics REPORTING MONTH February 2019 LAST UPDATED November 2019 AREA RESULT PERIOD
CURRENT concerns requiring enhanced monitoring CQC rating Good April 2016 No current concerns identified. Operational Standards Met Q2 19/20 NHS Safety Thermometer 100% Q2 19/20 MATTERS OF NOTE Number of complaints 0 Q2 19/20 Q2 FFT % that would recommend 99% Q2 19/20 Audits Number of incidents 37 Q2 19/20 Spire has carried out its quarterly antimicrobial and drug chart audits – results will be discussed with All were low or no harm bar 1 – see below the CCG’s Lead Medicines Optimisation Pharmacist who visited the service last quarter. Number of serious incidents 0 Q2 19/20
Incidents Last commissioner visit There has been an increase in incidents in Q2 (Q1, n=21, Q2, n=38). There was one moderate incident, Next commissioner visit Feb 2020 currently under investigation, which involved a patient with possible hyponatremia following surgery.
Of the other incidents the most common were; 9 cancellations; 6 for clinical reasons, 3 for non-clinical reasons, e.g. equipment failure/availability 9 medication incidents – all no or minimal harm, e.g. admin and documentation error 5 unplanned inpatient admission following day case surgery
The next commissioner visit will take place on 27 February 2020 and the next quarterly CRM is due end of February/beginning of March 2020.
29
4(i) Primary Care
General Practice Quality Dashboard Summary
REPORTING MONTH February2020 LAST UPDATED February 2020
CONCERNS – red ratings Vaccine supplies hindered practices during 18-19. PHE commission the Maternity Unit at PHT Flu Vaccination Uptake – Pregnant women 49% Jan 19 to deliver on the Flu programme for pregnant women. The CCG is looking into the data sharing and recording process as it is believed that not all data is being captured. Breast Screening 3 year coverage (50-70yrs) 60.2% Feb 19 Target of 70% incentivised in this year’s Primary Care CQUIN. Cervical Screening 3.5/5.5-year coverage % (25-64yrs) 67.1% Feb 19 Target = 80%. PHE incentivised in 18/19, impact expected to be seen from Oct 19 GP Patient Survey (GPPS) overall experience of making Target = 65.7%. Figures nationally are declining for patient satisfaction and there is a national appointment - % Good 56.56% 19/20 review underway regarding access. The CCG is reviewing the latest publication in early September 2019 to consider what other actions may be required to support improvements. GPPS overall experience of GP Surgery – % Good 75.5% 19/20 Target = 82.9%
MATTERS OF NOTE There are now only 3 contractual and quality visits outstanding. Of note, most Practices managed complaints and incidents effectively and had processes in place for internal learning and action planning; most needed to review their related policies/procedures; all had Patient Safety Champions; one did not have a PPG. Each Practice has been given feedback and is being monitored. The quarterly primary care shared learning sessions are now being used for practice champions to share learning. The next meeting is in May 2020.
CQC ratings – All bar one Practice is rated “Good”. This practice is rated “Requires Improvement” but it is anticipated that the rating will improve following the re-visit from CQC.
Incident reporting to NRLS is infrequent. This will continue to be encouraged through the Patient Safety Champions and the work to promote shared learning will ensure learning is at a minimum shared locally. No serious incidents have occurred this year to date.
FFT – numbers that would recommend stands at 88% for November 2019, 5% below the figure for England which was 93%.
30
GOVERNING BOARD
Date of Meeting 18 March 2020 Agenda Item No 8
Governing Board Assurance Framework and Title Corporate Risk Register The attached highlight the current risks associated with the strategic objectives of the CCG. The GBAF and Corporate Risk Register are overseen by the Audit Committee.
Of Note: GBAF GBAF 002 – Score reduced from 12 to 8. This is due to additional controls and assurances identified. GBAF 003 – score reduced from 10 to 5 as system working has become more embedded and additional decision-making arrangements have been put in place. GBAF 005 – additional comment in respect of shared resources across the STP (staff)
Corporate Risk Register Purpose of Paper Following discussion at the December Audit Committee, the EPRR Flu Pandemic risk was including in staffing. IT 001 – score reduced as the controls and assurances have strengthened. IT 002 – new risk. Members are asked to note information in the further action column in respect to financial penalties. PP02 – staffing for Planning and Performance was removed and a Corporate Risk has been included CR005 – as this is about workforce capacity it is proposed that this is incorporated into CR007 which represents workforce capacity across the whole CCG. CR007 – new risk and includes pandemic flu as discussed at the last meeting R.Ports QUA21 – new risk CUK.QAU.R.01 – new risk identified as a patient safety issue.
Recommendations/ The Governing Board are asked to note the GBAF and Corporate Risk Actions requested Register.
Engagement Activities – Clinical, Stakeholder and Not applicable Public/Patient
Item previously The GBAF and Corporate Risk Register are reviewed by the Audit considered at Committee at each of their meetings.
Potential Conflicts of Interests for Board none Members
Author Justina Jeffs, Head of Governance
Sponsoring member Innes Richens, Chief of Health & Care Portsmouth
Date of Paper 9 March 2020
NHS Portsmouth CCG Governing Board Assurance Framework
Area Current Risk Strategic Responsibl L I Further action needed for Description of risk risk Key controls / processes Sources of assurance Movement Ref Objective e officer (C) (C) any identified gaps score GBAF GP engagement A If the CCG does not Deputy 1 5 5 Clear and ongoing Primary Care Commissioning No identified gaps but work 001 in Commissioning engage with member Director of communication methods Committee (includes NHSE/I continuing with the practices then there is a primary already established within the attendees from Primary Care and the development of Primary Care risk that strategic priorities Care CCG: LMC) Networks will not be met Commissioning evenings NHSE/I Assurance Meetings Weekly GP update Practice Visits Lead CCG Clinical Executives assigned to each practice GBAF Patient B If the CCG does not Exec Team 2 4 8 Procurement rules support Health Overview and Scrutiny Panel 002 engagement engage with patients and significant changes. review of key service (re)design. the public then it may fail to Legal Advice sought as Health & Wellbeing Board meet its statutory duty required Annual Report includes patient which may lead to legal engagement activity challenge Procurement processes Previously and a reputational risk 12
GBAF Work with our C If the CCG does not Exec Team 1 5 5 Hosted Services including: NHSE/I Assurance meetings/calls and Issues around legislation 003 partners to collaborate with partners Planning and Performance the Annual Assurance Framework supporting decision-making. collaborate to then there is a risk that it Aspects of Commissioning process Partners continue to work to deliver will not deliver its priorities Finance – mean that there determine the best course of improvements in is an overview of the System-wide meetings to review action as individual decisions health outcomes priorities of the 3 local progress against planned need to be made. Previously CCGs. workstreams. 10 Plans developed across the local system MCP Programme Board supports new ways of working across partner MCP Plans approved by the organisations Governing Board Governing Board and Portsmouth City Committees in Common Council Cabinet approval of the established where appropriate proposed Health & Care Portsmouth Operating Model
1
Area Current Risk Strategic Responsibl L I Further action needed for Description of risk risk Key controls / processes Sources of assurance Movement Ref Objective e officer (C) (C) any identified gaps score GBAF invest in D If the CCG does not Exec Team 2 5 10 5 Year plans developed and Governing Board meetings outlining Progress of the integration 004 improving and support health and aligned with ICP partners. financial planning and performance agenda will further support this better health and wellbeing then there is a which determines the level of demand objective. wellbeing risk that demand will MH Investment Standard on services. NHSE/I currently reviewing increase on acute services review undertaken (report not proposed operating model. available at this time) Integration with Portsmouth City Council provides closer working with Public Health and the prevention agenda.
Better Care Fund schemes The Better Care Fund overseen by a MCP Programme of work Programme Board determines new ways of working to support delivery and investment of and in services.
The MCP Programme Board support new ways of working across partner organisations GBAF manage our E If the CCG does not Exec Team 2 4 8 Governing Board receive Internal Audit reports including use of Strengthen the collaboration 005 resources operate within its financial finance updates at each of its resources are reviewed by the Audit regarding workforce across effectively remit then it is at risk of: meetings Committee the local Portsmouth & South breaching its statutory East Hampshire system. duty Workforce savings plans in Governing Board scrutiny of the use of not be able to operate place and workforce control resources. effectively in meeting its panel newly established to priorities review all posts going for NHSE/I Assurance meetings being subject to special recruitment. measures External Audit examination of the Control Totals determined by CCG’s accounts. NHSE/I and signed up to by the CCG.
National Finance Planning Guidance
Working with partners within the STP/ICP through shared resources. GBAF ensure that our F If the CCG does not focus Director of 2 4 8 Quality & Safeguarding Quality & Safeguarding Committee It is acknowledged that a 006 services are safe on quality then there is a Safeguardin Committee hold a separate risk now established and reporting in to the number of actions sit within and focused on risk of patient harm and g and register for provider Governing Board at each of its external organisations and maintaining and reputational risk Quality organisations which is meetings therefore outside the control of improving quality reviewed very month at its the CCG. The CCG meet with meeting. Procurement processes for new providers regularly and Previously services include a review of quality of discuss action plans 10 CQC inspections and action the potential providers 2
Area Current Risk Strategic Responsibl L I Further action needed for Description of risk risk Key controls / processes Sources of assurance Movement Ref Objective e officer (C) (C) any identified gaps score plans H&CP Quality Board receive regular Procurement Processes report on all residential, nursing and domiciliary care services. SIRI reporting is via the CCG Quality Assurance Visits undertaken Quality Review meetings held for all providers at least annually. with providers Regulators reports and actions from provider services. GBAF develop the CCG G If the CCG does not have Exec Team 2 4 8 Annual 360 degree stakeholder IPSOS MORI annual 360 degree The NHS Architecture is 007 as a mature credibility then it may not review determined that the stakeholder survey reported to the changing which poses a risk organisation deliver its plans and CCG performs well within the Remuneration Committee and for the future. considered as priorities thereby local health and care economy. Governing Board. credible and disadvantaging the competent with population of Portsmouth in the appropriate access, treatment and capacities and sufficient health and care capabilities provision.
3
NHS Portsmouth CCG Corporate Risk Register
Area Strategic Responsible L I Current Description of actions (Key Further action needed for any Risk Ref Description of risk Sources of assurance Movement Objective officer (C) (C) risk score controls / processes) identified gaps IT 001 GPIT F Delays in the Capital Associate 3 3 9 Capital plan being managed GPIT Capital Programme Board programme for GP IT, Director of jointly by the HIOW CCGs. reports in to HIOW Digital Replacement and IM&T Commissioners Forum additional hardware (PCs) not being ordered, GPIT Programme Board out of warranty devices established From 12 being used increasing vulnerability CCGs are in competitive SOEPS processes and procurement stage through procedures are audited by Internal procurements processes with Audit on a regular basis. SOEPS CCG has a procurement framework detailing all legislative procurement requirements. This is overseen by the Audit Committee. IT 002 IT Infrastructure F Financial penalty if the Associate 2 5 10 HIOW HSCN Programme Board Programme Board reports to Note: NHSE/I have advised any NEW move from N3 to HSCN Director of overseeing the delivery. Digital Commissioners Forum and N3 site which is still in use post is not achieved within the IM&T STP Digital Portfolio Board August 2020 will be subject to a specified timeframe (Aug reduction in allocation of £90k 2020) Bi-weekly calls with NHSE/I NHSE/I reporting per month regional team to monitor progress
Weekly calls with supplier (BT) Com.08 ED Target F If local providers have Deputy 4 4 16 Key Controls Assurance insufficient capacity to Director of - Actions monitored through A&E - Daily monitoring of ED activity Gaps in Controls meet anticipated demand Commissioning Delivery Board and performance - Delays in implementing more for emergency care, then (SEH/F&G) - Key actions being progressed at - A&E Delivery Board oversight effective working practices in ED; the CCG may be unable front door in ED including: - Escalation plans and triggers to commission high Senior leaders exploring are not aligned across the quality emergency care alternative options and service system. for local people, resulting models to address outstanding in (for example) patient care packages for Hampshire Actions experience, safety, work stream within phase 2 - Action Plan being monitored compliance and recovery plan to discuss staffing through the A&E Deliver Board reputational impacts. in ED weekends/evenings - Action Plan being progressed Simple discharge dashboard through individual Task and focussing on process changes at Finish Groups. ward level - System resilience meetings to - Options Appraisal of Clinical review system wide planning and Utilisation Review Tools to be escalation under taken by Clinical, Operational and IT teams. Proposal to be submitted to Quality Improvement Programme Meeting 4
Area Strategic Responsible L I Current Description of actions (Key Further action needed for any Risk Ref Description of risk Sources of assurance Movement Objective officer (C) (C) risk score controls / processes) identified gaps - UCC re-modelling to ensure it maximises capacity
Fin.P.34 19/20 Efficiency D IF detailed and robust Exec Team 4 4 16 - P3B - Use of Pentana to monitor plans - curtail investment by use of Savings (QIPP) plans for Efficiency - Regular Monitoring of QIPP - Monthly reporting to P3B reserves to mitigate QIPP Savings (QIPP) schemes plans and delivery - Contract Monitoring are not developed, and - SRO's in place for all key QIPP - Delivery Unit meetings subsequently delivered, delivery areas - ICS workstream meetings and THEN this will affect the - Budgets reduced to reflect QIPP plans CCGs ability to deliver it's requirements at start of financial - Alignment of financial plans in-year control total or year - Ensure SROs and ability to utilise reserves Commissioners have fully worked for transformation. up plans Fin.P.29 Financial D, E, F IF health partners within Chief Finance 3 4 12 - COMPACT agreement PSEH - CCG Finance Reports - accurate financial modelling Sustainability of the system are under Officer and ICS - Provider Finance Reports - set aside contingencies to Health extreme financial - ICS - Alignment of cover potential Partners/ACS pressures, THEN there -Finance Board financial/activity/QIPP/CIP plans risks/overperformance might be an impact on - Financial Framework and strategies - QIPP plans the CCG within the - Board to Boards - Contract Monitoring overall context of system - Joint Assurance process with - CQRM sustainability. NHSE/NHSI - Modelling impact of - Aligned Incentive Contract commissioning intentions on key providers - Finance Board - regular meetings of CFOs - STPs - ICS assurance process - Joint QIPP/CIP/Efficiency Plans
5
Area Strategic Responsible L I Current Description of actions (Key Further action needed for any Risk Ref Description of risk Sources of assurance Movement Objective officer (C) (C) risk score controls / processes) identified gaps CRR 001 Health & Care D, E, F If the Health & Care Chief of Health 3 4 12 Initial discussions with NHSE/I Decision to be taken in Autumn Integration Portsmouth Operating & Care indicated support for the model 2019 Model is not approved by Portsmouth/ NHSE/I then the CCG Exec Team may need to re-assess its plans for delivery within this agenda CRR 002 Brexit E, F, G If the CCG is unprepared Exec Team/ 3 5 15 National workshops and guidance Brexit Assurance Framework for the impact of Brexit on Managing in place attended by the CCGs developed nationally and adapted its business then this Director as SRO to reflect local situation/needs. could result in issues SRO Lead CCG Business Continuity regarding business arrangements in place if required. continuity within its own services and those it commissions CRR 003 Cyber Security and F If the CCG does not Exec Team 3 4 12 Policies and procedures adopted CSU have achieved Cyber Fraud follow approved policy from the CSU essentials plus status (industry and processes then it standard). may result in increased cyber security incidents Routine penetrative system and potential fraud testing undertaken by CSU
Encrypted IT equipment used by the CSU
CRR 004 System Working C There is a risk that the Exec Team 4 4 16 A range of groups and forums are Discussions through CCG groups CCG’s pace of change established to discuss more including the Governing Board. may disadvantage its formal system business including partners. Alternatively if the Unified Exec, A&E Delivery Scheme of Delegation partner organisations are Board, Clinical leaders group etc. determining where and how not able to meet the pace decisions are made. of change, the CCG may not be able to deliver against its plans and priorities CRR 005 Primary Care G NHSE/I will be Deputy 4 4 16 No controls identified at present No assurance identified at present Further discussion and review of delegation transferring additional Director of additional primary care primary care services to Primary Care responsibilities required. the CCG to manage. There is a risk of capacity issues within the primary care team to meet this additional demand
6
Area Strategic Responsible L I Current Description of actions (Key Further action needed for any Risk Ref Description of risk Sources of assurance Movement Objective officer (C) (C) risk score controls / processes) identified gaps CRR 006 Information F, G If the CCG does not Data 2 5 10 National Guidance and IG reports in to the Audit Potential gap in working across Governance ensure arrangements are Protection requirements from the ICO Committee at each of its organisations e.g Local in place for the changing Officer and meetings. Authorities. Discussions are NHS then it may breach Data underway between the CCG and GDPR, DPA legislation Custodians The Data Protection Officer PCC to progress this where reviews all Data Privacy Impact possible. Assessments associated with new work/schemes in order to ensure that these meet the requirements. CRR 007 Workforce Capacity If there are insufficient Executive 3 3 9 Contract notice periods Remuneration Committee Key issue regarding Primary staffing levels for the Team Recruitment processes in place oversees workforce issues Care team capacity to manage New CCG teams then the additional delegated functions quality of service to the Workforce control panel in place from NHSE which are CCGs will suffer. to review all proposed recruitment transferring as they arise. to ensure that it is suitable for the CCG. R.Ports Wheelchairs F If Millbrook does not Quality Team 3 5 15 Ongoing combined There has been an increase in QUA21 deliver a service which CRMs/CQRMs level of CSU support for the New fully meets the Each CCG to continue to contract. There are clearer more specification, then there manage the long waiters from defined KPI’s with a new style of may be negative impact their locality report which has helped CCG’s on patient outcomes and Ongoing combined better see where current issues a lack of confidence in CRM/CQRMs are. Criteria for referral has been the service. Monitoring of action plan strengthened and distributed so developed through the that expectations on what is service review deliverable are better New arrangement for the communicated. school clinics User satisfaction of contact Eligibility process revamp remains high at 90% rating PWB introduction service as good or very good. Complaints are down year on Waiting list initiative. end. Collaborative workshops with providers Retention plans for staff CUK Care UK staffing F If the number of clinical Quality Team 3 3 9 Care UK are monitoring this There is a concern that as the QUA.R.01 vacancies in the UTC risk on their own risk register service goes into Winter staff New continues or increases A new workforce plan has sickness rates may rise and more then there is the been developed and is in staff may leave. While agency possibility that patient action from Dec 2019 and bank can provide some safety, care and As part of the workforce cover, quality may be impacted. experience may be review, clinical salaries in the As IUCs and ICSs develop and compromised. UTC have been revised and offer clinicians more attractive increased, although the working conditions the situation service is unable to match the may get even worse. Care UK salaries in primary care has reviewed the initial Initiatives in place to engage assessment process to ensure staff, e.g. “great place to work patients are seen based on clinical need and this gives some 7
Area Strategic Responsible L I Current Description of actions (Key Further action needed for any Risk Ref Description of risk Sources of assurance Movement Objective officer (C) (C) risk score controls / processes) identified gaps forum”, “healthcare heroes” – assurance. staff survey is being rolled out in December which should give insight into support required to retain and develop existing staff Review and modification of initial assessment process ensures patients are seen based on clinical need Further discussion and update from provider due at the CRM in March 2020.
8
GOVERNING BOARD
Date of Meeting 18 March 2020 Agenda Item No 9
Portsmouth CCG 2020/21 Operating Plan – Title st 1 Cut
The first draft of the Portsmouth CCG Operating Plan for 20/21 is presented to the Board for initial review and as a progress update ahead of bringing the final 2020/21 Operating Plan to the Governing Board at a later date for sign-off and ratification.
Unlike previous years, for 2020/21 there is no national requirement for CCGs to produce an Operating Plan document. However, it was felt to be important that the CCG had an operating plan, albeit a more succinct and ‘slimmed down’ version, compared to previous years.
Purpose of Paper This was to ensure that our CCG had a document that set out the
Transformative Programmes of work that would be undertaken through 20/21, which will demonstrate ‘how’ we would be delivering our CCG priorities; objectives; national and local target / commitments (Long Term Plan).
As well as incorporating any feedback from the Governing Board into a final version, as plans are finalised for 2020/21 we will include summary slides for areas such as finance, activity, risk and quality. We are also planning some cosmetic changes, final operating plan.
Recommendations/ The Board are asked to note progress made on the 2020/21 Operating Actions requested Plan to date and provide comment/feedback as appropriate.
Engagement Activities – Clinical, Stakeholder and Not Applicable Public/Patient
Item previously Not Applicable considered at
Potential Conflicts of Interests for Committee Not Applicable Members
Michael Drake Author Director of Planning and Performance
Michelle Spandley Sponsoring member Chief Finance Officer
Date of Paper 6 March 2020
NHS Portsmouth CCG Operating Plan 2020/21
Improving health services…1 Contents
Item Page No. Introduction 3 Programme Details • Urgent Care 4 • Community Health & Care 10 • Planned Care 15 • Vulnerable Adults (including Mental Health and Continuing Health Care) 21 • Maternity and Children’s 27 • Primary Care 33 • MCP 37
2 Introduction Health & Care Portsmouth 2020-21 Operating Plan CCG Priorities The CCG Operating Plan describes the programmes and projects which will be the The operating plan supports the CCG’s priorities. focus and priority for 2020/21 which ensure we achieve both national and local targets and improve patient experience and health outcomes for our local population 1. We want everyone to be able to access the right health services, in the in 2020/21 and beyond. For 2020/21 these will be delivered across 6 right place, as and when they need them. Transformational programme areas: 2. We will ensure that when people receive health services they are treated • Community Health and Care with compassion, respect and dignity and that health services are safe, • Primary Care effective and excellent quality. • Urgent & Emergency Care • Planned Care 3. We want health and social care services to be joined up so that people only have to tell their story once. People should not have unnecessary • Vulnerable Adults (including Mental Health and Continuing Health Care assessments of their needs, or go to hospital when they can be safely cared • Children’s & Maternity for at home or stay in hospital longer than they need to. Focus and Delivery 4. With our partners, we will tackle the biggest causes of ill health and early Our focus continues to be the delivery of our Portsmouth Blueprint through our death and promote wellbeing and positive mental health. Health & Care Portsmouth programme. The NHS Portsmouth CCG Operating Plan 2020/21, provides details of how we will deliver the longer term ambition for health & care in the City, the operational priorities of the CCG in 2020/21 and how we contribute to delivery of the priorities set out within:
Delivery of CCG Objectives • A Blueprint for health and care in Portsmouth • The Operational Planning Guidance 2020/21 The operating plan will be driven by and underpinned by the CCG’s • The NHS Long Term Plan objectives. • The Portsmouth and South Eastern Hampshire (PSEH) Integrated Care Partnership (ICP) Strategy 1. Enable our GP surgeries as members to engage and drive • The Hampshire and Isle of Wight (HIOW) Integrated Care System plan commissioning • Investment and Evolution: A five-year framework for GP contract reform to 2. Engage with our patients and our public in our commissioning and our implement the NHS Long Term Plan decision making 3. Work with our partners to collaborate to deliver improvements in health Collaborative Working outcomes We are committed to working collaboratively with our health and social care partners 4. Invest in improving and better health and wellbeing to improve services for our service users, and meet our financial obligations. Our 5. Manage our resources effectively partners include Portsmouth City Council, Fareham & Gosport Clinical 6. Ensure that our services are safe and focused on maintaining and Commissioning Group, South Eastern Hampshire Clinical Commissioning Group, improving quality Portsmouth Hospitals NHS Trust, Solent NHS Trust, Southern NHS Foundation 7. Develop the CCG as a mature organisation considered as credible and Trust, South Central Ambulance Services Trust and voluntary, independent and competent with the appropriate capacities and capabilities private sector providers.
3 Urgent Care Programme
The following pages set out the Urgent Care programme of work for 20/21, showing:
• The major areas of the programme and their underpinning projects • The deliverables from the programme, highlighting: • the key outcomes and benefits • the oversight framework metrics that will be impacted on as a result of the programme • the national standards to which the programme will support delivery • A high level description of the projects within the programme, alongside any associated impact on finance, activity and performance
4 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
URGENT CARE (ICP) (for Plans see Appendix 1)
Core Schemes – Core Schemes – Other Schemes Enabling Cross Cutting Admissions Length of Stay impacting on key Schemes: Schemes Avoidance Reduction: deliverables:
PHT Ward Process End of Life Primary Care TrUE IUC Improvements (TTO’s, MiDoS (Community Front Door procurement Early birds, etc) Health & Care)
Building Better Frailty Vital Few (High Discharge Planning System Emergency Care (Community Intensity Users) on Day 1 (IDS) Resilience (BBEC) - PHT led Health & Care)
Frailty Interface Home Based Care Paediatrics Team (FIT) (IIC/PRRT)
Community SDEC Mental Health Bed Capacity
SCAS Direct Conveyance to Complex Care Specialty Access
Readmissions Interlinked projects
ED Process Improvements - PHT led
Urgent Care Sensitive Conditions 5 Benefits & Outcomes – Urgent Care The projects within this programme will deliver:
Key Programme Quality and Performance Outcomes and Benefits
. Achieve 90% A&E access target . ED Attendances reduced by 50 per day . Reduced ED Admissions . Achieve consistent Bed Occupancy of 92% . Delayed transfers of care – Reduced to 3.5% national target . Reduction in occupied bed days . Stranded and super-stranded reduced to 40% of inpatient population (national Target) . Better utilisation of UTCs and OOH Urgent Care provision . Reduced SCAS call-outs and conveyances
Oversights Framework
Metric PCCG England Value 105c Percentage of deaths with three or more emergency admissions in last three months of life 4.83% 7.4% 106a Inequality in unplanned hospitalisation for chronic ambulatory care sensitive and urgent care sensitive conditions 2144 2109 127b Emergency admissions for urgent care sensitive conditions 2299 2409 127c Percentage of patients admitted, transferred or discharged from A&E within 4 hours 83.6% 86.6% 127e Delayed transfers of care per 100,000 population 8.5% 10.2% 127f Population use of hospital beds following emergency admission 476 499 Lowest Performing Quartile Interquartile Range Highest Performing Quartile
Performance Metrics
Deliverable Target Bed Occupancy 92% DToC 3.5% Ambulance Handover delays Zero 60min; 30- 60mins/month Reduce ED attendances 50 per day 6 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
URGENT CARE (ICP) (for Plans see Appendix 1) Planned Activity Project Name Brief Description Lead Org POD Financial Impact Performance Impact Start Date Impact
Primary care provision in ED; Project is predicted to enable a further reduction of ED attendances during 2020/21 to bring up to the target of 48 ED Attendance reduction - Increased patient safety/quality in Aim is to achieve utilisation of 48 dedicated -24 20/21 -£926,545 Primary Care daily ED, reduction of time spent in ED, primary care appointment slots per day 7 days a 01/04/2020 CCG Provision in ED positive impact on ambulance week re-directed from ED (Mon-Sun) = 336 per -8,760 FYE -£926,545 ED Attendance reduction - FYE handover delays and corridor care week. In addition the project will increase the numbers directly discharged from navigation to own GP, pharmacy, alternative services or for self management
Improved support for patients with frailty to avoid emergency admissions; improving community based support for people with NEL Admission reduction - Increased patient safety/quality in medium and high frailty is a key objective. -2.1 20/21 - £778,625 Frailty Interface Daily ED, reduction of time spent in ED, Focus on faster turnaround at front door 0-72 01/04/2020 CCG/PHT Team (FIT) positive impact on ambulance hours, changing approach of FIT and rapid -756 FYE - £778,625 NEL Admission reduction - FYE handover delays and corridor care community response, as well as a single approach to assessment through the hospital rather than continued re-assessment.
Project will focus on prevention of emergency Admission reduction - Daily -0.7 20/21 -£128,841 readmissions - with first phase in Medicine and Readmissions Q2 PHT Urgent Care specialties where there are on Admission reduction - FYE -267 FYE -£128,841 average 15 readmissions per day.
ED Attendance reduction - daily -2 ED Attendance reduction - -642 20/21 -£103,931 Project aims to focus on the high intensity users 20/21 -699 FYE -£113,238 Vital Few/ high in PHT, what MDT support can be offered to Further system savings on SCAS 01/04/2020 PHT ED Attendance reduction - FYE Intensity Users them to prevent future conveyances, ED conveyance reduction? -0.5 20/21 -£90,894 attendances and NEL admissions. Admission reduction - Daily -155 FYE -£99,034 Admission reduction - 20/21 -169 Admission reduction - FYE
Integrated Admission reduction - Daily -4 20/21 -£843,570 DToC Focus on out of hospital services to reduce OBD Intermediate Care 01/08/2020 SHFT Admission reduction - 20/21 -819 Reduction in LoS and LoS, increase flow. (IIC) Level 3) Admission reduction - FYE -1460 FYE - £1,503,800 improved Flow 7 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
URGENT CARE (ICP) (for Plans see Appendix 1) Planned Activity Project Name Brief Description Lead Org POD Financial Impact Performance Impact Start Date Impact
Admission reduction - Daily -5 20/21 net savings Project will improve the use of same day SDEC increase - Daily Increased patient safety/quality in ED, -5 -£169,178 emergency care pathways by reducing NEL for reduction of time spent in ED, positive SDEC Q2 PHT patients who are staying < 12hrs and Admission reduction - impact on ambulance handover delays -1370 FYE net savings increasing Same Day Emergency Care. 20/21 and corridor care -1,825 -£225,570 Admission reduction - FYE Admission reduction - SCAS Direct Daily -5 20/21 -£323,025 - Reductions in ED Conveyances Project will focus on conveyance directly to Conveyance to Mar-20 PHT - Reduction in A&E Attendances AEC, AMU, SAU, Minors etc. Specialty Access Admission reduction - -1825 FYE - £323,025 - Reduction in NEL Admissions FYE Urgent Care Sensitive Project being scoped, data requested. PHT TBC TBC TBC Conditions CCG/PHT Excess Bed Days Project being scoped, data requested. TBC TBC TBC
Increased patient safety/quality in ED, ED Process reduction of time spent in ED, positive Project being defined for 20/21 - PHT led PHT TBC TBC TBC Improvements impact on ambulance handover delays and corridor care
PHT Ward Process DToC Improvements Project being defined for 20/21 - PHT led PHT TBC TBC TBC Reduction in LoS (TTO’s, Early birds, improved Flow etc)Discharge Planning DToC on Day 1 (IDS) Project being defined for 20/21 - PHT led PHT TBC TBC TBC Reduction in LoS improved Flow Community Bed DToC Capacity Project being scoped. ICP TBC TBC TBC Reduction in LoS improved Flow DToC Complex Care Project being scoped. ICP TBC TBC TBC Reduction in LoS improved Flow 8 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
URGENT CARE (ICP) (for Plans see Appendix 1) Planned Activity Project Name Brief Description Lead Org POD Financial Impact Performance Impact Start Date Impact
Benefits: - Visibility of alternative care pathways quickly and easily The aim of this project is to introduce - Visibility of community support services MiDoS, a Directory of Services(DoS) tool for patients admitted as an emergency (eg into Portsmouth and South East Hampshire support for pets etc) Integrated Care Partnership (PSEH ICP), - Improved Patient Flow supporting out of hospital health and - Access to support groups for patients to MiDoS social care professionals, primary care, Feb-20 CCG TBC TBC TBC self-manage to improve physical and social prescribers and public in finding the mental health outcomes most appropriate care pathway for - Reduce conveyances to ED either through themselves, their patient or service user by non-conveyance or conveyances to a more searching across multiple service appropriate service directories. - Greater visibility of gaps in service provision
System Resilience Being scoped for 20/21 CCG TBC TBC TBC
A number of existing urgent and elective care contracts within the Portsmouth and - Reduction in calls to 111 and 999 South East Hampshire (PSEH) Integrated - Reduction in SCAS attends at homes Care Partnership (ICP) system are due to - Reductions in ED Conveyances TrUE Procurement expire by May 2021, presenting an CCG No Impact in 20/21 - Reduction in A&E Attendances (IUC) opportunity to review, and improve, - Reduction in NEL Admissions current service provision. This - Reduction in SCAS dispatches without procurement will seek to fulfill these conveyances requirements with the aim for a new contract to begin June 2021. Building Better Emergency Care Business case in process - PHT led PHT No Impact in 20/21 (BBEC)
9 Community Health and Care Programme
The following pages set out the Community Health & Care programme of work for 20/21, showing:
• The major areas of the programme and their underpinning projects • The deliverables from the programme, highlighting: • the key outcomes and benefits • the oversight framework metrics that will be impacted on as a result of the programme • the national standards to which the programme will support delivery • A high level description of the projects within the programme, alongside any associated impact on finance, activity and performance 10 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
COMMUNITY HEALTH AND CARE (ICP) (for Plans see Appendix 1)
Intermediate care - Care homes Frailty End of Life (EoL) High intensity users Development of (Humanising PCNs/ placed based development and improving the quality of care for implementation of a system wide Delivery of the 6 national healthcare) approaches implementation of the residents of FGSEH care homes, approach to how patients with ambitions for Palliative new models of reducing inappropriate hospital frailty should be supported both and End of Life Care. working for services admissions by ensuring homes are proactively and in moments of crisis. supporting Support skilled and able to better manage Supporting teams and resources will Development of intermediate care resident's needs through the be owned, staffed and run by all integrated PSEH High development services within the training and empowerment of providers in a system approach; staff Intensity Users Service of PCN Clinical community. EoL Strategy Development Directors staff. will integrate into one cohesive Effectively manage, A clear strategy, vision and action leadership role team across community and the coordinate and sign post acute. plan co-design with local people. High Intensity Users of Implementation Enhanced Care Home Including Health Needs the local A & E within of the developed Assessment the CCG footprint by Teams Support practitioner led Development of Frailty utilising new and current model within Strategy multi-agency services. implementatio n of PCN DES PRRT, Spinnaker Implement a PSEH Frailty Workforce Development including new Ward RESTORE and Strategy and production of workforce Provision of high quality NEWS an agreed set of PSEH frailty models and Education, training and principles the 5 services workforce development across Specialist Frailty health, social care and the Provision third sector Hydrate Strengthening support for Embedding patients from ED to home <72 Use of PHM to developments hours of hospital . develop a and further enhancing the Continue to develop, test and place based approach to Specialist Frailty implement a community offer NHS Mail improving Provision health/ reducing health Creation of a Alignment with inequalities Frailty Hub PCN contract specification
Implementation of a Telehealth service Implemented within Portsmouth initially
11 Benefits & Outcomes – Community Health & Care The projects within this programme will deliver:
Key Programme Quality and Performance Outcomes and Benefits
. Delayed transfers of care – Reduced to 3.5% national target . Reduction in ambulance conveyances . Reduction in A&E attendances . Reduction in NEL admissions . Patients able to access a variety of same day services in response to their health needs in primary, community and acute care . Increased direct booking into services from 111 . Reduced emergency conveyances and admissions of care home residents to Acute hospital
Oversights Framework
Metric PCCG England Value 104a Injuries from falls in people aged 65 and over 2108 2051 105c Percentage of deaths with three or more emergency admissions in last three months of life 4.83% 7.4%
Lowest Performing Quartile Interquartile Range Highest Performing Quartile
Performance Metrics
Deliverable Target NEL Admissions Reduce Reduce ED Attendances 50 per day ED Conveyances Reduce FIT Avoided Admissions 2 per day
12 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
COMMUNITY HEALTH AND CARE (ICP) (for Plans see Appendix 1)
Planned Activity Financial Project Name Brief Description Lead Org POD Performance Impact Start Date Impact Impact
Reducing ambulance call outs and conveyances and subsequent - Reduction in calls to 111 and 999 admissions of care home residents where these could be better - Reduction in SCAS attends at homes Enhanced Care managed in the community. Ongoing - Reductions in ED Conveyances CCG Home Teams project - Reduction in A&E Attendances - Reduction in NEL Admissions - Reduction in SCAS dispatches without conveyances The project will support homes and health professionals to; - Reduction in calls to 111 and 999 - Recognise when a resident may be deteriorating or at risk of - Reduction in SCAS attends at homes physical deterioration - Reductions in ED Conveyances RESTORE and NEWS - Act appropriately according to the residents care plan to protect Jul-19 CCG - Reduction in A&E Attendances and manage the resident - Reduction in NEL Admissions - Reduction in SCAS dispatches without conveyances Telehealth/telemedicine is the remote exchange of data - Reduction in calls to 111 and 999 between a patient at home or in a care/nursing home and - Reduction in SCAS attends at homes clinician(s) to assist in the diagnosis and monitoring of their - Reductions in ED Conveyances medical conditions. - Reduction in A&E Attendances Telemedicine Jan-20 CCG The project proposes a Telehealth Service specifically for Care - Reduction in NEL Admissions Homes with or without nursing will help ‘homes’ care for people - Reduction in SCAS dispatches without conveyances in their usual place of residence, and thereby reduce inappropriate admissions. Implement a PSEH Frailty Strategy and production of an agreed The project will produce an agreed set of principles that set of PSEH frailty principles. This project will enable the will enable staff within all organisations to support Frailty Strategy & agreement and implementation of system wide principles to Dec-19 CCG/PHT patients with frailty at the right place at the right time in Vision support patients with frailty both proactively and in moments of a way in which will reduce the amount of inappropriate crisis. urgent care they require. Continue to develop, test and implement a community offer - Contribute towards reducing ED attendances strengthening support for patients from ED to home <72 hours of - Reduced ED admissions Strengthening the hospital. This project will focus on supporting patients with frailty - Increase in patients being supported in the community Urgent Care journey who require urgent care to remain within the community, be Jan-20 CCG/PHT - Reduction in hospital LoS for patients with supported at ED to return home as soon as possible and those - Increased patient satisfaction Frailty who do require acute support in hospital to be discharged as soon as possible.
13 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
COMMUNITY HEALTH AND CARE (ICP) (for Plans see Appendix 1) Planned Activity Financial Project Name Brief Description Lead Org POD Performance Impact Start Date Impact Impact
The project will aim to co-produce an End of Life strategy and - Co-produce an End of Life strategy and vision based on vision based on the experiences of the local population to the experiences of the local population End of Life Strategy develop a consistent view of what 'good' looks like, defining the Jul-19 CCG - Use local and national needs data to inform future purpose of End of Life care from the patient's perspective. service development and delivery. - Develop future services based on what good looks like. Increase support and education to patients and their faimilies - Increase role of specialist palliative care services in earlier in the End of Life pathway to better support them in their providing education and training to other professionals choices. The project will also focus on upskilling all professionals - Upskill all professionals across the system to provide across the system to provide 'good' End of Life care. good end of life care End of Life Dec-19 CCG - Strength based social care training Education & Training - Scoping the current resource and seeing how that may be used to meet the five-year plan, and which additional support may be required. - Communities and self-directed support and resilience
14 Planned Care Programme
The following pages set out the Planned Care programme of work for 20/21, showing:
• The major areas of the programme and their underpinning projects • The deliverables from the programme, highlighting: • the key outcomes and benefits • the oversight framework metrics that will be impacted on as a result of the programme • the national standards to which the programme will support delivery • A high level description of the projects within the programme, alongside any associated impact on finance, activity and performance
15 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
PLANNED CARE (ICP) (for Plans see Appendix 1)
Pathway redesign Diagnostics Working with acute and Cancer Strategy community providers to transform end to end pathways.
Create sustainable and Implement the Rapid rapid access diagnostic Diagnostic Service to Enabling digital first services across the deliver faster and clinical contacts rather system, supporting earlier diagnosis, and than traditional referral early diagnosis and an improved and outpatient improved access. experience for cancer processes (e.g. Advice patients. The service and Guidance) will deliver:
In line with STP priorities, redesign MSK services
Facilitate the NHS England 100 day challenge in Dermatology and Nephrology
Work with system partners as part of Transforming Urgent and Elective Care project
16 Benefits & Outcomes – Planned Care (slide 1 of 2) The projects within this programme will deliver:
Key Programme Quality and Performance Outcomes and Benefits
• Every patient waiting 6 months or longer to be contacted and offered faster treatment at another provider • No patient to wait more than 52 weeks for treatment. • Providers to accelerate non face to face redesign in outpatients, using national outpatient improvement dashboard. • Further improvement of waiting list during 20/21 • Implement agreed standards as set out in the Clinical Review Standards Review • No more than 1% of patients should wait 6 weeks or more for a diagnostic test • The delivery of all 8 cancer waiting times remains a priority.
Oversights Framework
Metric PCCG England Value Diabetes patients that have achieved all the NICE recommended treatment targets: three (HbA1c, cholesterol and blood 103a 39.9% 38.7% pressure) for adults and one (HbA1c) for children 103b People with diabetes diagnosed less than a year who attend a structured education course 3.77% 8.54% 122a Cancers diagnosed at early stage 51.8% 52.2% 122b People with urgent GP referral having first definitive treatment for cancer within 62 days of referral 89.4% 77.3% 122c One-year survival from all cancers 71.7% 72.8% 122d Cancer patient experience 8.9 - 129a Patients waiting 18 weeks or less from referral to hospital treatment 82.8% 86.7% 129b Overall size of the waiting list 129c Patients waiting over 52 weeks for treatment 130a Achievement of clinical standards in the delivery of 7 day services - 133a Percentage of patients waiting 6 weeks or more for a diagnostic test 2.8% 2.47% 144a Utilisation of the NHS e-referral service to enable choice at first routine elective referral 61.7% 99.8%
Lowest Performing Quartile Interquartile Range Highest Performing Quartile
17 Benefits & Outcomes – Planned Care (slide 2 of 2)
Constitutional Standards
Deliverable Target RTT Incomplete Pathway 92% RTT 52 Week Waits 0 Diagnostic Test Waiting Times 99% Cancer Waiting Times - 2 Week Wait 93% Cancer Waiting Times - 2 Week Wait (Breast Symptoms) 93% Cancer 28 day waits (faster diagnosis standard) TBC
Performance Metrics
Deliverable Target PHT WL size to reduce by offering choice at 26 weeks TBC Reduction of Outpatient Follow-Ups TBC Reduction in Outpatient First Appointments TBC Deliver diagnostic standard of 99% in 6 weeks and sustain TBC
18 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
PLANNED CARE (ICP) (for Plans see Appendix 1)
Planned Activity Project Name Brief Description Lead Org POD Financial Impact Performance Impact Start Date Impact
Transformation: The Planned Care 14 Outpatient FA Single Prof • No patients waiting 52 weeks or more Transformation programme will look at 12 Con -10% reduction -415 -30,960 • Reduction in average waiting times Urology 01/04/2020 CCG/ PHT Outpatient specialties across the system, • Reduction in backlogs 17 Outpatient FU Single Prof working with acute and community providers to Con -20% reduction -1,758 -64,678 • Free up significant medical and nursing time. transform end to end pathways to create a 14 Outpatient FA Single Prof • 20-30% Reduction in Outpatient Demand with system where patients receive equitable care Con - 20% reduction -737 -48,220 increased use of A&G and implementation of ENT where every contact adds value and improves 01/04/2020 CCG/ PHT common conditions pathways. patient experience. The programme will 17 Outpatient FU Single Prof • Reduce provider waiting lists. Con -30% reduction -2,475 -69,622 include; • 20% Reduction in Acute Follow up 14 Outpatient FA Single Prof • Enabling digital first clinical contacts rather Con - 15% reduction -566 -46,527 appointments. Gynaecology than traditional referral and outpatient 01/04/2020 CCG/ PHT • Reduction of System Costs. processes (e.g. Advice and Guidance) 17 Outpatient FU Single Prof • Reduction in unwarranted clinical variation. • Where appropriate using non face to face Con -25% reduction -1,271 -48,817 • Empowering patients to self-management consultations 14 Outpatient FA Single Prof where appropriate Con - 20% reduction -719 -51,708 • Facilitating straight to test pathways • Improved pre-op assessment pathway to Ophthalmology 01/04/2020 CCG/ PHT • Creating “one stop” clinics where patients 17 Outpatient FU Single Prof optimise patient’s fitness for surgery. receive the care, diagnostic or treatment they Con -15% reduction -1,019 -31,986 • Reduction in footfall on the acute sites. Dermatology require in a single contact where the patient 01/04/2020 CCG/ PHT sees the right clinician is seen first time 14 Outpatient FA Single Prof Gastroenterology 01/04/2020 CCG/ PHT • Supporting by the role out of supporting Con - 20% reduction -499 -55,054 digital programmes such as My Medical Record 14 Outpatient FA Single Prof • In line with STP priorities, redesign MSK Con - 10% reduction -331 -38,453 Respiratory services 01/04/2020 CCG/ PHT • Facilitate the NHS England 100 day challenge 17 Outpatient FU Single Prof Con -20% reduction -1,501 -77,973 in Dermatology and Nephrology 14 Outpatient FA Single Prof • Work with system partners as part of Con - 10% reduction -384 -32,159 Cardiology Transforming Urgent and Elective Care project 01/04/2020 CCG/ PHT • Enhance the use of community services with a 17 Outpatient FU Single Prof greater emphasis on patient empowerment and Con -10% reduction -332 -14,007 17 Outpatient FU Single Prof Nephrology lifestyle management 01/04/2020 CCG/ PHT Con - 30% reduction -1,568 -105,191 • Enable current resources be used to invest in 14 Outpatient FA Single Prof faster, modern diagnostics and other needed Con - 20% reduction -168 -25,031 Haematology capacity 02/04/2020 CCG/ PHT 17 Outpatient FU Single Prof Con -30% reduction -3,027 -204,713 14 Outpatient FA Single Prof Con - 25% reduction -1,327 -194,023 Rheumatology 03/04/2020 CCG/ PHT 17 Outpatient FU Single Prof Con -30% reduction -3,393 -168,682
14 Outpatient FA Single Prof Con - 30% reduction -5,847 -512,463 MSK 04/04/2020 CCG/ PHT 17 Outpatient FU Single Prof Con - 30% reduction -10,058 -348,250 19 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
PLANNED CARE (for Plans see Appendix 1)
Planned Activity Financial Project Name Brief Description Lead Org POD Performance Impact Start Date Impact Impact
Evidence-Based Interventions: Knee arthroscopy with osteoarthritis 01/04/2020 CCG/ PHT 09 Daycase -12 -23,086 Prevent avoidable harm to Injection for low back pain w/o sciatica 09 Daycase -20 -12,043 patients by avoiding Hysterectomy for heavy bleeding 07 Ordinary Elective -72 -231,205 unnecessary operations and to Carpal tunnel syndrome release 09 Daycase -101 -118,856 free up clinical time by only Dupuytren’s contracture release 09 Daycase -23 -43,699 offering interventions on the Ganglion excision 09 Daycase -5 -5,517 NHS that are evidence based Trigger finger release 09 Daycase -30 -35,607 and appropriate. • A single point of access to a diagnostic • Achievement of the cancer targets (including pathway for all patients with symptoms that the new Faster Diagnosis Standard (FDS) by April could indicate cancer 2020) • An initial assessment service, not constrained • Shorter pathway for patients-new 28 day by geographical locations, ensuring access is pathway roll out for complex cancer pathways Cancer 01/04/2020 CCG TBC TBC TBC equitable • Earlier cancer diagnosis and treatment starts • A personalised, accurate and timely diagnosis • Improve patients ‘experience of patients’ symptoms • Progress against Long Term Cancer plan • An improved method for diagnosing serious ambition to diagnose 75% of patients at an early non-cancer conditions more efficiently stage. • Increase use of mobile technologies and • Achievement of the DM01 standard patient-centered diagnostic applications • Improve time to diagnosis for cancer patients • Carry out more diagnostics in non-acute • Reduction in duplicated diagnostics environments • Increase the use of mobile technologies and • Identify areas of best practice and areas of patient centred diagnostic applications where variations using updated models in clinically appropriate Diagnostics combination with benchmarking and outcome 01/04/2020 CCG/ PHT TBC TBC TBC measures • Increase access across thr Hampshire and Isle of Wight STP and reduce waiting times • Work with AHSN and STP Digital Transformation team to explore potential opportunities in new technologies Care UK TBC TBC CCG TBC TBC TBC Spire TBC TBC CCG TBC TBC TBC
20 Mental Health & CHC Programme
The following pages set out the Mental Health programme of work for 20/21, showing:
• The major areas of the programme and their underpinning projects • The deliverables from the programme, highlighting: • the key outcomes and benefits • the oversight framework metrics that will be impacted on as a result of the programme • the national standards to which the programme will support delivery • A high level description of the projects within the programme, alongside any associated impact on finance, activity and performance
21 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
MENTAL HEALTH / VULNERABLE ADULTS (for Plans see Appendix 1)
Mental Health Psychiatric Early Intervention Low Level Mental Long Term Care & Emotional Access Crisis Acute Pathway liaison/ (PositiveMinds) Health Support Dysregulation (ICP) Core24 (ICP) (ICP)
Deliver integrated Bring together Home Further development Pilot next day Working with all care and improved Treatment & Crisis Align common Options of PositiveMinds appointments partners to make referral pathway Assessment Teams to systems and To implement paper following 6month through Solent's Portsmouth a for people with better meet demand & processes for Phase one of a under review A2i team trauma informed city long term activity Portsmouth three phased review – conditions (@ LTC and South East expansion of the plan to be Hub) Hampshire PHT Mental developed Launch Recovery Introduce daily (7/7) Further develop Expand & develop locally Health Liaison following College curricular for Multi Disciplinary supported living Support Multi NHS 111 Mental managed acute Team to outcome / Students & Veterans Team (MDT) meetings options (Oakdene) Disciplinary Team Health Triage Service in-patient and meet the decision (MDT) meetings @ - self referral to ensure the Crisis and intensive Psychiatric requirements of Service functions as a support offer from the Mental Pilot extended PositiveMinds Intensive Care virtual ward community rehab Health Five Year opening hours for a Unit (PICU) bed Childrens Services, team Forward View to "Crisis Lounge" at stock for Implemented Achieve access & redesign existing deliver the PositiveMinds flexible use, to as business recovery targets services to better Expansion of adult standard of Core (referral only) improve as usual meet the needs of psychiatric liaison 24 mental health Reduce the waiting inpatient flow people up to 25 service @QA Hospital liaison within times for secondary and out of area yrs. from 1/4/20 Acute hospital Develop a business care psychology placements settings. case for a Social Enterprise & New CAMHS Veterans support liaison service @ @ Lumps Fort QA Hospital from Analyse the 1/4/20 demand for OPMH and AMH inpatient Extend DBT training and beds & develop improve cross options to improve Deliver grant funded organisational working for care and safety veteran and serving people with emotional personnel mental dysregulation health support Employ peer supporters (via MIND) to work as part of the crisis team Please note: these project ideas are Redesign crisis offer for currently under review by the older people, working with Adult Social Care and Solent Portsmouth Health & Care Committee Adult Services
22 Benefits & Outcomes – Mental Health The projects within this programme will deliver: Key Programme Quality and Performance Outcomes and Benefits
• 25% IAPT access rate • At least 50% of people who complete IAPT should recover • 75% referred to IAPT should begin treatment within 6 weeks of referral • 95% referred to IAPT should begin treatment within 18 weeks of referral • 95% of CYP Eating Disorder routine cases started within 4 weeks of referral • 95% of CYP Eating Disorder urgent cases started within 1 week of referral • Zero Out of Area Placements - active at period end • At least 75% of people on the learning disability register should have had an annual health check • At least two thirds (66.7%) of people with dementia, aged 65 and over, should receive a formal diagnosis
Oversights Framework
Metric PCCG England Value 123a Improving Access to Psychological Therapies – recovery 59.8% 51.8% 123b Improving Access to Psychological Therapies – access 4.93% 4.48% People with first episode of psychosis starting treatment with a NICE-recommended package of care treated within 2 weeks 123c 81.3% 75% of referral 123f Mental health out of area placements 3 124 123g Proportion of people on GP severe mental illness register receiving physical health checks 33.1% 30.3% 124b Proportion of people with a learning disability on the GP register receiving an annual health check 45.5% 51.4% 126a Estimated diagnosis rate for people with dementia 68.9% 68.7% 126b Dementia care planning and post-diagnostic support 74.9% 77.5%
Lowest Performing Quartile Interquartile Range Highest Performing Quartile
Performance Metrics
Deliverable Target IAPT access rate 25% Out of Area Placements - active at period end 0 23 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
MENTAL HEALTH / VULNERABLE ADULTS (for Plans see Appendix 1)
Planned Start Activity Financial Project Name Brief Description Lead Org POD Performance Impact Date Impact Impact
Positive Minds opened on 23rd December Service users say that they feel the support they received 2019. impacted positively on their mental health The project is now in its second phase (Phase Service users achieve the goals in their recovery plans 2) which will run throughout 2020 Project Referrals receive their first face to face appointment within 2 Positive Minds CCG Started weeks Further KPIs to be established as the project progresses linking the positive mind service to a reduction in access to primary and secondary care services The project aims to align common systems and Reduction in Out of Area Placements processes for Portsmouth and South East Optimal Length of Stay Project Hampshire locally managed acute in-patient Improved clinical outcomes and patient experience Mental Health Started - and Psychiatric Intensive Care Unit (PICU) bed CCG No Impact in 20/21 Acute Pathway Currently on stock for flexible use, to improve inpatient Pause flow and out of area placements.
To implement Phase 1 of a three phased Improvement in Psychiatric Liaison Waiting Times expansion of the PHT Mental Health Liaison Reduction in Length of Stay Team to meet the requirements of the Mental Reduction in inappropriate inpatient admissions, Psychiatric Liaison Health Five Year Forward View to deliver the Project Reduction in delayed transfers of care, Core 24 - Phase 1 CCG TBC TBC TBC standard of Core 24 mental health liaison started Improvement in patient experience. Implementation within Acute hospital settings. Reduction in re-referrals into mental Health Liaison Team Improvement in Urgent/Routine ward referrals, response within 24 hours This key aim of this project is to implement a Latham Lodge % of Bed Occupancy at 85% range of market management schemes to Cosham Court % of Bed Occupancy at 85% Market improve quality and control the cost of Ensure that in more than 80% of cases with a positive NHS Management for domiciliary and residential care Project Continuing Healthcare (CHC) Checklist, the NHS CHC eligibility CCG N/A N/A TBC Continuing Started decision is made by the CCG within 28 days from receipt of the Healthcare Checklist Less than 15% of all full assessments for NHS CHC funding take place in an acute hospital setting
24 Benefits & Outcomes – CHC The projects within this programme will deliver:
Key Programme Quality and Performance Outcomes and Benefits
• Ensure that less than 15% of NHS continuing healthcare full assessments take place in an acute hospital setting • 80% of referrals completed within 28 Days (Standard NHS CHC) • Ensure there are no referrals breaching 28 days by more than 12 weeks
Oversights Framework
Metric PCCG England Value 8 Percentage of NHS continuing healthcare full assessments taking place in an acute hospital setting 8.0% 6.91%
Lowest Performing Quartile Interquartile Range Highest Performing Quartile
Performance Metrics
Deliverable Target Referrals completed within 28 days >80% NHS continuing healthcare full assessments taking place in an acute hospital setting <15%
25 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
CONTINUING HEALTH CARE (for Plans see Appendix 1)
Market Management for CHC
Increase block purchase contracts
Framework of providers for residential provision
Identify options for challenging behaviour provision
Collaborating working across HIOW
80% of CHC eligibility decision made by the CCG within 28 days
Less than 15 Percent of Decision Support Tools (DST's) completed in an acute setting
Cost avoidance (package negotiation)
Choice & Equity Policy
26 Maternity and Children’s Programme
The following pages set out the Maternity and Children’s programme of work for 20/21, showing:
• The major areas of the programme and their underpinning projects • The deliverables from the programme, highlighting: • the key outcomes and benefits • the oversight framework metrics that will be impacted on as a result of the programme • the national standards to which the programme will support delivery • A high level description of the projects within the programme, alongside any associated impact on finance, activity and performance 27 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
MATERNITY AND CHILDREN’S (for Plans see Appendix 1)
Acute Paeds Spacer (ICP) Review Mental Neuro Community Mental Health Acute Maternity Paediatric Medical Pathways - Transformation Children's special Health Developmental Service in ED Community Advice & CAMHS school Support pathway for Service (CPMS) (ICP) working with (Better Births) Guidance transformation – (ICP PHT (ICP - (STP/LMS Nursing nursing Teams in Children & Integration - (ICP) service Schools Families - Portsmouth leading) FGSEH Programme) leading) (ICP)
To create clearer mobilisation Working with pathways of service Advice and Solent to identifying inter- guidance support local dependencies outpatients To integrate and national with community, - To reduce Solent NHS developments primary care, Paediatric Trust’s COAST education and outpatient and CCN social care. follow ups. A teams into review of one to create Explore Digital Web Options the advice a team that To identify and has the gaps in service guidance shared skills referral and Review of CAMHs Learning provision for process. knowledge to Disability Offer children with a range of manage the complex joint caseload disabilities and and to undertake a Eating Disorder Review healthcare needs. role in the Paediatric Emergency Department
28 Benefits & Outcomes – Maternity & Children’s The projects within this programme will deliver:
Key Programme Quality and Performance Outcomes and Benefits
• Deliver improvements in maternal and neonatal safety • Deliver improvements to children’s ED and outpatient pathways and patient experience • Reduction in non-elective admissions • Reduced Urgent Care activity in both Primary & Secondary Care • Reduced number of respiratory related admissions • Reduction of referrals into hospital • 51% of women receive continuity of person caring for them by 2021 • Reduce still births, neonatal deaths, maternal deaths by 20% and 50% in 2025 • By March 2021, at least 95% of children and young people with an eating disorder should be seen within one week of an urgent referral • By March 2021, at least 95% of children and young people with an eating disorder should be seen within one week of a routine referral
Oversights Framework
Metric PCCG England Value 102a Percentage of children aged 10-11 classified as overweight or obese 35.8% 34.2% 125a Neonatal mortality and stillbirths 3.45 Null 125b Women’s experience of maternity services 83.2 82.7 125c Choices in maternity services 66.7 60.4 125d Maternal smoking at delivery 12.5% 10.5%
Lowest Performing Quartile Interquartile Range Highest Performing Quartile
Performance Metrics Deliverable Target Reduce ED attendances TBC Reduce referrals into CAMHS TBC Reduce CAU admissions TBC Reduce NEL admissions TBC
29 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
MATERNITY AND CHILDREN’S (for Plans see Appendix 1) Planned Start Activity Financial Project Name Brief Description Lead Org POD Performance Impact Date Impact Impact
The aim of the project is to have sustainable Acute Paediatric Mental Reduction of To reduce the number of Health Service working within PHT which will comprise of ED and Ward Admissions from ED hospital admissions due ICP- Acute Paediatric based.The service will be provided by Solent NHS Trust and will offer 01/06/2020 for Mental Health to self-harm for 0-18 year Mental Health Service CCG psychiatric support to children and young people up to the age of 17 (Mobilisation) conditions 0-18 olds in ED and Wards presenting at the Paediatric Emergency Department, whilst also 20/21 -528 offering ward based support. FYE -528 The aim of this project is to have a spacer available in every Reduction in A&E To reduce the number of community space that families have contact with so in the event of an attendances hospital admissions and asthma attack both health professionals and parents will have access (Asthma) ED attendances to a spacer where 10 puffs will be offered to the affected child to help 20/21 -22 them quickly and efficiently and thus reduce pressure at Pediatrics FYE -27 ICP- Spacer 01/06/2020 CCG A&E at Portsmouth Hospital Trust (PHT). Reduction in NEL Admissions (Asthma) 20/21 -4 FYE -5 A review of the advice and guidance referral process so can be used in Reduction in Reduction in Outpatient paediatrics. Advice and Guidance allows one clinician to seek advice Outpatient First Appts from another. Unlike creating a booking request, where a number of Appointments providers can be selected, Advice and Guidance is a communication 20/21 Reduction In Follow up ICP - Advice & between two clinicians: the “requesting” clinician and the provider of FYE - 1575 appointments 01/09/2020 CCG Guidance a service (the “responding” clinician) - 2513 Reduction in Follow up Appointments 20/21 - 817 FYE: -1292 The project aims to review the CPMS to provide a high quality, Reduction in Waiting Reduction in first accessible community based Paediatric Medical Service for children list times Adoption assesment waiting times and young people aged between 0-19 which ensures the early for Adoption, Child identification, assessment, treatment and support for children and Reduction in Waiting Protection EHCP & LAC. their parents, who have special needs and or disabilities. list times Child ICP- CPMS CCG/ Protection TBC Transformation Solent Reduction in Waiting list times EHCP
Reduction in Waiting Awaiting list times LAC Data To integrate Solent NHS Trust’s COAST and CCN teams into one to Reduction in Paeds NEL create an integrated team that has the shared skills and knowledge to admissions manage the joint caseload in both current separate teams and to undertake a role in the Paediatric Emergency Department in Queen Alexandra Hospital, Portsmouth, working with ED Dept. colleagues to CCG/ ICP- iCCN manage the appropriate treatment of children attending there. Already started Solent
Phase 2 of the project will start from 1st of April 2020, this will ensure completion of all training required for nursing staff to work across the acute and community system. This will then lead into a phased approach ensuring that staff are working across the system. 30 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
MATERNITY AND CHILDREN’S (for Plans see Appendix 1) Planned Start Activity Financial Project Name Brief Description Lead Org POD Performance Impact Date Impact Impact
Under this programme is all the maternity projects and work that is Safer care, Better happening locally within PHT and also regionally from an LMS postnatal and perinatal ICP - Maternity perspective Already started CCG mental health care, Personalised care,
The project will look at the journey of the child from when they are Reduction in Outpatient referred into acute services to when they are transitioned to adults or Appts discharged. It will also show when the child is handed off to other services or pathways. ICP Acute Pathway The children who will enter these services are likely to have complex Already Started CCG Review and/or long term health conditions. The purpose of reviewing the paediatric medical pathway is to ensure services are aligned to the needs of the child, to identify duplication or gaps and to provide Reduction in recommendations to improve pathways for the child Outpatient Appts TBC TBC This project is currently a scoping exercise to look at the existing Special School Nursing provision of Special School Nursing in the city and its potential future 01/04/2020 CCG Review delivery.
This project aims to test new approaches to assessment and diagnosis of Children Young People experiencing Neuro Diverse conditions through the introduction of a 'profile of need'. The profile tool will be Neuro Development used by all key professionals. Approaches to the education of 01/04/2020 CCG Pathway stakeholders working with and for children with ND conditions and explore new approaches to provision and intervention will also be trialled. This work is being done on behalf of the STP to explore how the wider system may change. Portsmouth have recently been announced as one of the next areas to benefit from Mental Health Support Teams (MHSTs). Established by NHS England and jointly delivered with the Department for Education, MHSTs will provide early intervention on mild to moderate mental health issues, such as anxiety, low mood or behavioural difficulties, as Mental Health Support well as providing help to staff within a school and college setting to CCG Teams In Schools support their children and young people. The teams will act as a link with local children and young people’s mental health services and be supervised by NHS staff. They will also support the development of whole school approaches to improve mental health. Portsmouth is in wave 2 and will have MHSTs by the end of 2020. 31 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
MATERNITY AND CHILDREN’S (for Plans see Appendix 1)
Planned Start Activity Financial Project Name Brief Description Lead Org POD Performance Impact Date Impact Impact
There is a need to review and revise the overall CAMHS service Review of CAMHS specification and streamline the monitoring arrangements across both Learning Disability 01/04/2020 CCG the CCG and the Local Authority who hold a number of different inter offer related contracts. To help reduce the pressure on CAMHS and provide more Explore Digital Web preventative early intervention type support for mental health and based options wellbeing issues we have started exploring web-based options that providing preventative are available through a range of providers that are commissioned by 01/04/2020 CCG early intervention other areas across the country. type support Review
Now that we have a better sense of actual demand we now need to understand the services capacity to meet that demand and whether Eating Disorders the funding we provide is adequate. 01/04/2020 CCG Review A review of the service will take place as there is a further need to fully understand how our Eating Disorder offer aligns with NICE and national Eating Disorder guidance.
32 Primary Care Programme
The following pages set out the Primary Care programme of work for 20/21, showing:
• The major areas of the programme and their underpinning projects • The deliverables from the programme, highlighting: • the key outcomes and benefits • the oversight framework metrics that will be impacted on as a result of the programme • the national standards to which the programme will support delivery • A high level description of the projects within the programme, alongside any associated impact on finance, activity and performance
33 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
PRIMARY CARE (for Plans see Appendix 1)
Digital First Care navigation Strategic estates Workforce Primary Care and social plan development prescribing
Axe the fax To support the We will current Work is ongoing to produce and primary care ensure that deliver a workforce to NHS App practice based Primary Care work in active signposting estates plan, different ways is linked in closely which and to develop to the social prioritises area skill-mix both prescribing offer of greatest in, and and to maximise concern wrapped opportunities to and/or need around, exploit a non but works to general medical approach address practice in to supporting estates issues order to create Portsmouth across the capacity and patients (or in whole city. provide addition to efficacious medical care management) to meet their holistic needs.
34 Benefits & Outcomes – Primary Care The projects within this programme will deliver: Key Programme Quality and Performance Outcomes and Benefits – Primary Care
• Earlier intervention • Maximise choice and control • Reduction in non-elective hospital admissions • Reduction in touches with the health and social care service • Case managed approach to patient care • Build patient confidence to self-manage • Focus on care planning and goal setting • Faster healing rates for leg ulcers
Oversights Framework Primary Care
Metric PCCG England Value 128b Patient experience of GP services 81.4% - 128d Primary care workforce - 128f Patient experience of getting an appropriate GP appointment - 132a Evidence that sepsis awareness raising amongst healthcare professionals has been prioritised by the CCG Green
Lowest Performing Quartile Interquartile Range Highest Performing Quartile
Performance Metrics
Deliverable Target Reduction in NEL admissions TBC Reduction in ED attendances 50 per day
35 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
PRIMARY CARE (for Plans see Appendix 1)
Planned Activity Financial Project Name Brief Description Lead Org POD Performance Impact Start Date Impact Impact
Care Navigation - Across Portsmouth, we are working hard to ensure that when people need to see a GP, they have access to one quickly and in a way that suits them, be that in person, over the phone or using the online Care Navigation consultation service. It allows front line staff to provide patients with more Apr-20 CCG information about local health and wellbeing services, both within and outside of primary care, in a safe, effective way. It is about offering patients choice and help to access the most appropriate service first.
From 31st March 2020 all fax machines will be banned across the NHS under plans to overhaul outdated technology and IT systems, from this date all NHS organisations will be required to use modern communication methods such as secure email, to improve patient safety and cyber security. A national campaign ‘Axe the Fax’ has been created in order to support this Axe The Fax Apr-20 CCG initiative.
The CCG Primary Care team have been working with practices and services to review current working processes and ensure alternative secure communication methods are put in place.
We will produce & deliver a Primary care estates plan which will prioritise Strategic Estates Plan area of greatest concern/and/or need but works to address estates issues Apr-20 CCG accros the whole city To support the current primary care workforce to work in different ways and WorkForce to develop skill mix both in and wrapped around general practice in order to Apr-20 CCG Development create capacity and provide efficacious care
36 MCP Programme
The following pages set out the Primary Care programme of work for 20/21, showing:
• The major areas of the programme and their underpinning projects • The deliverables from the programme, highlighting: • the key outcomes and benefits • the oversight framework metrics that will be impacted on as a result of the programme • the national standards to which the programme will support delivery • A high level description of the projects within the programme, alongside any associated impact on finance, activity and performance
37 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
PORTSMOUTH MCP (for Plans see Appendix 1)
Outpatient and Elective LTC Hub Pathways (links to ICP Planned Care Programme)
Roll-out of Gastroenterology further LTCs Strategy (Community based)
Chronic Pain Transformation
38 Benefits & Outcomes – MCP The projects within this programme will deliver: Key Programme Quality and Performance Outcomes and Benefits – Primary Care
. Reduction in ambulance conveyances . Reduction in A&E attendances . Reduction in NEL admissions . Patients able to access a variety of same day services in response to their health needs in primary, community and acute care
Oversights Framework Primary Care
Metric PCCG England Value Diabetes patients that have achieved all the NICE recommended treatment targets: three (HbA1c, cholesterol and blood pressure) for 39.9% 38.7% 103a adults and one (HbA1c) for children 103b People with diabetes diagnosed less than a year who attend a structured education course 3.77% 8.54%
Lowest Performing Quartile Interquartile Range Highest Performing Quartile
Performance Metrics
Deliverable Target Reduction in ambulance conveyances TBC Reduction in ED attendances 50 per day Reduction in NEL admissions TBC
39 Planning 2020/21 PCCG OPERATING PLAN 2020/21 – PROGRAMMES AND PROJECTS
PORTSMOUTH MCP (for Plans see Appendix 1)
Planned Start Activity Financial Project Name Brief Description Lead Org POD Performance Impact Date Impact Impact
LTC Hubs will provide generic care provision for a range of LTC - Improved patient activation conditions whilst also providing more specialised and - Reduction in admissions individualised care for patients with certain conditions; initially it is - Reduction in fragmentation and variation LTC Hubs proposed the LTC Hubs focus on the following conditions: Jan-20 MCP - Upskilling of primary care workforce - Chronic Respiratory Disease and high risk / unstable asthma - Reduced clinical risk through all staff accessing full - Diabetes medical records - Heart Failure A pilot that establishes a Leg Ulcer Hub for a period of 36 weeks, - Improved healing timeframes seeing a maximum 144 patients. For the purposes of the pilot, - Improved access to specialist care referrals that meet set criteria will be accepted from Solent’s - Improved facilities for bariatric patients Leg Ulcers Central Portsmouth Community Team and the GP Practices. Jan-20 MCP - Delivery of holistic care – detection/prevention/treatment/advice and guidance - Improved outcomes – reduction in deterioration and hospital admissions, reduction of reoccurrence The project aims to improve care for patients with gastro - Reducing the number of appointments per conditions by the development of 3 elements; procedure/episode - A community-based gastroenterology strategy - Reduction in inappropriate referrals - To bring together local gastroenterology pathways within a single - Reduction in wait times including cancer Gastro Strategy framework to support primary care in both primary and community Oct-19 CCG based delivery. - To propose new approaches to delivering gastroenterology that will reduce conveyance to and dependence on secondary care through a vertically integrated system. To provide service delivery that develops a consistent care - Increased patient activation in self- management of pathway for people affected by chronic pain to improve patient chronic pain symptoms with potential range of Chronic Pain outcomes and service effectiveness and to whilst making the best Jul-19 CCG treatment options. use of sum of resources available ensure long term sustainability of - Potential to reduce volume and usage of prescribed the service. drugs.
40
GOVERNING BOARD
Date of Meeting 18 March 2020 Agenda Item No 10
Title Financial Strategy and Budget Setting 2020/21
To update the Governing Board on development of the 2020/21 financial strategy and budgets.
Purpose of Paper
Recommendations/ The Governing Board is asked to approve the 2020/21 financial Actions requested strategy and accept the initial draft 20/21 budgets.
Engagement Activities – Clinical, Stakeholder and N/A Public/Patient
The Governing Board accepted the STP LTP assumptions contained within the briefing presented 15th January 2020. This report includes Item previously updates following the release of the NHS operational planning and considered at contracting guidance 2020/21 released by NHS England 31st January 2020.
Potential Conflicts of Interests for Board N/A Members
Author Nicola Burnett, Deputy Chief Finance Officer
Sponsoring member Michelle Spandley, Chief Finance Officer
Date of Paper 6 March 2020
Planning/Budget Setting 20/21
5th March 2020
Prepared 6th March 2020
ImprovingImprovingImproving health healthhealth services… services...services… LTP Submission: Assumptions
• In agreement with partners across HIOW 2 scenarios were modelled using a consistent set of assumptions around cost inflation, activity growth and the potential impact of demand management or other actions to control or avoid growth in activity • These were a “do nothing” scenario projecting the growth in costs that would apply with no action and a “do something” set of assumed reductions and additional productivity improvements
Improving health services… LTP Submission: Cost Inflation Assumptions
• A standard set of assumptions for the effects of cost inflation were agreed across all HIOW partners • These are set out below
19/20 20/21 21/22 22/23 23/24 AFC pay deal 0.0% 2.9% 0.7% Pax & mix effect - AFC 1.6% 2.1% 2.1% 2.1% Pay & mix - Other HCHS workforces 1.6% 2.1% 2.1% 2.1% 2.1% Drugs 4.1% 0.6% 0.6% 0.6% 0.6% Revenue consequences of capital 1.8% 1.8% 1.9% 2.0% 2.0%
Inflation Other operating costs 1.8% 1.8% 1.9% 2.0% 2.0% CNST contributions 10.5% 10.5% 10.5% 10.5% 10.5% Primary Care Prescribing 4.1% 0.5% 0.5% 0.5% 0.5% CHC 3.8% 1.4% 1.3% 1.0% 1.1% - - - - - Productivity 1.10% 1.10% 1.10% 1.10% 1.10% Change in service standards Workforce Expenditure 1% 1% 1% 1% 1% Capital to Opex impact % capex added to opex 6% 6% 6% 6% 6% Non STP Contract tariff uplift 1.30% 1.30% 0.90% 0.90%
Improving health services… LTP Submission: NHS Portsmouth CCG
• The CCG has produced a draft financial plan modelling the overall STP assumptions supplemented with local intelligence. The LTP plan submitted indicated the CCG is able to meet its financial trajectories set by NHS England. The overall STP position however was £52m off plan.
• Following assurance discussions with NHS England & Improvement the STP leadership collectively committed to improving the financial position by £34.6m, £1.5m surplus in 20/21 and 21/22 represents Portsmouth CCG’s notional share.
2019/20 2020/21 2021/22 2022/23 2023/24
In-year surplus (£000'S) 0 1500 1500 641 830
• 20/21 STP modelling will be used as a starting point for the 20/21 Operational Planning exercise which was due for initial submission 5rd March 2020
• Final 20/21 plans and budgets are to be submitted to NHS England 29th April 2021
Improving health services…
20/21 Operational Planning: Changes from LTP
• Financial Improvement Trajectory (FIT) updated to include impact of technical adjustments
• Tariff for 20/21 confirmed as 2.5% less 1.1% (1.4% net), LTP assumed 2.4% less 1.1% (1.3% net)
• Confirmation of business rules: • Minimum 0.5% contingency (current plan for 0%)
• Revised Financial Recovery Fund rules • minimum 50% system allocation • £1 for £1 loss up to maximum • Equal phasing across Qtrs (25%) in advance • Clawback via allocation (CCG) or through repayment or financing (provider)
• Non Recurring 0.5% reward payment for providers that breakeven or deliver surplus
• Potential write-off of historic CCG overspend >4% of allocation
• New performance standard of 92% bed occupancy
Improving health services… 20/21 Operational Planning: FIT
• The CCG’s FIT for 20/21 has been revised from a break even expectation to a surplus of £30k due to a technical adjustment related to the national impact of Market Forces Factors (MFF) in 20/21
Improving health services… 20/21 Operational Planning: STP
• On the 5th March all NHS organisations across the STP submitted initial draft 20/21 operating plans to regulators.
• The aggregated positions submitted were broadly inline with expectations. 2 organisations posted minor variances to the anticipated plan to be potentially removed through the next set of submissions.
• The current distance from FIT across the STP is £17.3m, is inline with the expectation of regional regulators.
0K1 10L 10J 10R 10V 10X 11A HHFT IOWT PHT Solent SHFT UHS SCAS STP Total Surplus / (Deficit) excluding FRF & MRET (4,231) (2,631) (3,998) 1,530 (4,136) 1,500 (12,886) (7,679) (19,521) (22,057) (140) (11,355) 1,694 (903) (84,813) MRET 5,018 4,516 7,290 16,824 Surplus / (Deficit) excluding FRF (4,231) (2,631) (3,998) 1,530 (4,136) 1,500 (12,886) (2,661) (19,521) (17,541) (140) (11,355) 8,984 (903) (67,989)
Reconcilliation to expectation (excluding FRF) 0 0 0 0 0 0 0 0 0 0 0 4 0 403 407 STP Distance from FIT (Excluuding FRF) 1,500 1,500 (4,000) 1,500 1,500 1,534 (12,850) (8,543) 1,500 1,500 1,500 (5,796) 1,500 403 (17,252)
Improving health services… 20/21 Operational Planning: CCG Headlines
• The CCG has submitted a plan to achieve a surplus of £1.53m surplus in 20/21.
• Expenditure in Mental Health has been planned to meet the Mental Health Investment Standard (MHIS) of 5.5% in 20/21. An increase of £2.2m between financial years.
• Contractual envelopes with the CCGs major providers have been maintained at LTP submission levels.
• The CCG has not built a contingency of 0.5% in keeping with the agreed STP LTP assumptions.
• The financial plan has funded the current outturn pressures within prescribing (£1.1m) and Extra Contractual Referrals (ECR’s) (£1.5m)
• Application of STP planning assumptions, MHIS and outturn pressures has reduced the level of reserve available for new investments in 20/21.
• Plans do not include the impact of STP Transformational funding anticipated in 20/21
Improving health services… 20/21 Operational Planning: CCG Detail
POSITION AT MONTH 9 - 1920 2019/2020 2020/2021 Annual Forecast Outturn Plan Budget £000s £000s £000s Acute Commissioning: 154,595 155,948 158,262 Mental Health Commissioning : 39,719 41,200 43,196 Community Services Commissioning : 33,705 33,721 34,811 Primary Care Commissioning : 67,770 68,647 72,000 Continuing Care: 18,463 18,807 19,646 Other Commissioning: 11,010 9,684 9,335 Running Costs: 4,176 4,172 4,124 Reserves : 7,506 4,763 1,399 Total Expenditure 336,943 336,943 342,772
Allocation Available 336,943 336,943 344,302
In Year Surplus/(Deficit) 0 0 1,530
Improving health services… 20/21 Operational Planning: CCG Detail
19/20 Forecast Outturn 20/21 Plan
1% 2% 1% 0%
3% 3% 6% 6%
20% 21% 46% 46%
10% 10%
12% 13%
Improving health services… 20/21 Operational Planning: CCG Detail
POSITION AT MONTH 9 - 1920 2019/2020 2020/2021 Annual Budget Forecast Outturn Plan £000s £000s £000s Acute Commissioning: Portsmouth Hospitals NHS Trust 128,784 128,784 132,662 University Hospital Southampton FT 3,278 3,471 3,516 Western Sussex Hospitals NHS FT 629 624 637 London Providers 1,446 1,315 1,342 Spire Healthcare 1,320 1,310 1,337 South Central Ambulance Service 8,813 9,118 9,098 St Marys Treatment Centre 6,666 7,200 7,059 NCAs / OATs 2,148 2,610 1,332 Other Acute Commissioning 1,512 1,517 1,279
Mental Health Commissioning : Solent NHS Trust (Mental Health) 29,332 29,332 29,180 Southern Healthcare FT (Mental Health) 634 634 653 Other Mental Health Commissioning 9,753 11,234 13,363
Community Services Commissioning : Solent NHS Trust (Community) 29,466 29,500 30,825 Southern Healthcare FT (Community) 543 543 562 Joint Equipment Store 1,215 1,194 1,226 Wheelchair Service 897 897 615 Carers & Hospices 240 240 248 Other Community Commissioning 1,345 1,348 1,336
Primary Care Commissioning : Practice Primary Care Prescribing 32,009 33,085 33,645 Primary Care IT 908 920 920 Local Commissioning Schemes 4,276 4,102 4,123 Delegated Commissioning 28,226 28,132 32,327 Primary Care Transformation 1,425 1,417 0 111 Service 926 991 985
Continuing Care: CHC Adult Fully Funded 15,350 15,595 16,289 CHC Children 928 950 993 Funded Nursing Care 2,185 2,262 2,364
Other Commissioning: Recharges NHS Property Services Ltd 845 845 785 Childrens ECRs and S56/S257 476 406 420 Other Commissioning 1,779 511 -6 BCF 7,910 7,922 8,136
Running Costs: HQ / Directorates, Agency & Assurance 2,658 2,663 2,627 CSU Charges 1,230 1,236 1,224 Estates and Facilities 287 273 273
Reserves : Non Recurrent Reserve 1,664 1,664 0 Commissioning Reserve 5,841 3,099 1,399 Improving health services… Total NHS Portsmouth CCG in Year Totals 336,943 336,943 342,772 20/21 Operational Planning: CCG Savings
• To deliver the financial plan the CCG must make savings of £11.9m in 20/21, 3.5% of expenditure
• The majority of the savings have been identified within the budgets set, and have been applied to the contractual envelopes in negotiation with our major providers.
2020/2021 2020/2021 2020/2021 Plan Identified Unidentified £000s £000s £000s Acute Commissioning: 4,558 4,558 0 Mental Health Commissioning : 814 580 234 Community Services Commissioning : 599 599 0 Primary Care Commissioning : 1,203 1,203 0 Continuing Care: 257 257 0 Other Commissioning: 1,862 0 1,862 Running Costs: 37 37 0 Reserves : 2,553 2,553 0 Total Expenditure 11,883 9,787 2,096
Improving health services… 20/21 Operational Planning: Next Steps
• The board is requested to accept the CCG planning strategy and resultant draft 20/21 budgets
• STP assurance meeting with NHS England & Improvement 23rd March 2020
• Deadline for 2020/21 contract signature 27th March 2020
• 2nd draft 20/21 operating plan submission 9th April 2020
• Final 20/21 operating plan submission 29th April 2020
Improving health services…
GOVERNING BOARD
Date of Meeting 18 March 2020 Agenda Item No 11
Title Full Register of Interests (all staff) In line with NHS England Guidance, the CCG has developed two separate declaration of interests registers.
Committee Register of Interests The Committee Register details all individuals working for, with or on behalf of the CCG who sit on a decision-making committee (as detailed within the CCG’s Scheme of Delegation). This includes members, regular attendees and administrative support i.e. those who could be considered as influencing committee decisions. This Register is a standing agenda item on all decision-making
committees and is reviewed at every meeting. Purpose of Paper
Staff Register of Interests Along with the Committee Register of Interests, remaining staff who work for, with or on behalf of the CCG are requested twice a year, to complete and submit a declaration of interest form for inclusion on the staff register.
The Governing Board are required to undertake an annual review of the CCG’s Register of Interests as detailed within the NHS England Guidance.
Recommendations/ The Governing Board are asked to review the attached Staff Register Actions requested of Interest.
Engagement Activities – Clinical, Stakeholder and N/A Public/Patient
Item previously N/A considered at
Potential Conflicts of Interests for Board None Members
Author Justina Jeffs, Head of Governance
Sponsoring member Dr Elizabeth Fellows, CCG Chair
Date of Paper 10 March 2020
NHS Portsmouth Clinical Commissioning Group Register of Interests - Other CCG staff - UPDATED March 2020
Date of Interest Type of Interest From To
Current position (s) held- i.e. Governing Body, Declared Interest- (Name of the Name Is the interest Nature of Interest Action taken to mitigate risk Member practice, organisation and nature of business) direct or Employee or other indirect?
Interests
Non-Financial Non-Financial
Financial Interests Financial
Professional Interests Professional
Non-Financial Personal Non-Financial Ben Abubaker Performance Lead Solent NHS Trust P Direct Registered to work as Bank 2017 Current Manage in line with CCG policy Staff Nurse Emma Aldred Transformation Manager Portsmouth Hospitals Trust P Indirect Family members employed 2016 Current Manage in line with CCG policy by PHT; Brother, Sister in- law and Sister
Emma Aldred Transformation Manager Stamshaw Infant School, Portsmouth P Direct Governor 2015 Current Manage in line with CCG policy Victoria Allison HR Practitioner Nil Hiba Alqas Prescribing Support Nil Pharmacist Fiona Armstrong HR Advisor, PCC Nil Jo Atkinson Commissioning Project Nil Officer Debbie Bishop Planning Manager Nil Kirstie Bradfield Commissioning and Nil Contracts Officer Trainee (PCC) Janet Brooks Quality Improvement Nil Left 20 October 2019 Officer Robert Brownsmith Medicines Optimisation GSK P Indirect Holds shares in an ISA 2015 Current Manage in line with CCG policy Pharmacist Jules Bryan Commissioning Contracts Nil Officer (PCC) Veryan Burcham Chair of Practice Managers East Shore Partnership P Direct Primary employment as Feb-12 Current Left 30 November 2019 Forum Practice Manager Caroline Curtis CHC Commissioning Nil Manager, ICS Sarah Darracott-Hawkins Planning and Performance Autism Service P Indirect Family member accesses Sep-18 Current Left 3 November 2019 Officer CCG commissioned services
Sarah Darracott-Hawkins Planning and Performance Autism Magazine P Direct Editor Sep-18 Current Left 3 November 2019 Officer Sarah Darracott-Hawkins Planning and Performance Self Employed P Direct Secondary employment as Current Left 3 November 2019 Officer photographer Danielle Day Administration Assistant, Nil Continuing Healthcare Team Dr Charlotte Day Named GP Safe Guarding Drayton Surgery P Direct GP Partner 2015 Current Manage in line with CCG policy
Dr Charlotte Day Named GP Safe Guarding Fareham & Gosport Primary Care Alliance P Direct Member 2002 Current Manage in line with CCG policy
1 of 5 Date of Interest Type of Interest From To
Current position (s) held- i.e. Governing Body, Declared Interest- (Name of the Name Is the interest Nature of Interest Action taken to mitigate risk Member practice, organisation and nature of business) direct or Employee or other indirect?
Interests
Non-Financial Non-Financial
Financial Interests Financial
Professional Interests Professional
Non-Financial Personal Non-Financial Dr Charlotte Day Named GP Safe Guarding Portsmouth Primary Care Alliance P Direct Member 2002 Current Manage in line with CCG policy
Dr Charlotte Day Named GP Safe Guarding University of Southampton P Direct Teaches Medical Students 2018 Current Manage in line with CCG policy
Dominic Dew Commissioning Manager Nil within HCPC Pascale Dewane Performance & Planning Self Employed P Direct Secondary employment - Sep-17 Current Manage in line with CCG policy Officer cleaning business Andrea Edgson Senior Finance Manager Limited Company providing staffing support P Direct Sole Director - Company is Current Manage in line with CCG policy to NHS finance departments not currently seeking any new work and existing contracts have now ceased. Andrea Edgson Senior Finance Manager Chartered Institute of Public Finance and P Direct Member Current Manage in line with CCG policy Accountancy (CIPFA) Andrea Edgson Senior Finance Manager HFMA P Direct Member Current Manage in line with CCG policy Andrea Edgson Senior Finance Manager Friends of St Mary's Hospital Charity, Isle of P Direct Trustee Current Manage in line with CCG policy Wight Andrea Edgson Senior Finance Manager Isle of Wight NHS Trust P Indirect Husband is Deputy Director Current Manage in line with CCG policy of Finance Morwenna Fenner Medicines Management Portsmouth Hospitals Trust P Direct Secondary employment Current Manage in line with CCG policy Technician Aimee Flintoft Planning Officer NIL Bradley Flowerday Transformation Support Portsmouth Hospitals Trust P Indirect Sister is Orthopaedic Current Manage in line with CCG policy - no Officer Operating Department direct conflict of interest Practitioner Linda Foster Executive Assistant NHS Portsmouth CCG P Indirect Sister in Law works in CHC Current Manage in line with CCG policy Team Matthew Fowkes Project Support/Evaluation Nil and Data Acquisition Lead (HCPC)
Ben Gallagher Planning & Innovation Redbarn Preschool P Direct Committee Member Current Manage in line with CCG policy Officer Ben Gallagher Planning & Innovation Kadampa Meditation Centre, Southampton P Direct Trustee Current Manage in line with CCG policy Officer Ben Gallagher Planning & Innovation Meditation Classes P Direct Teach Meditation Classes on Current Manage in line with CCG policy Officer a voluntary basis Louise Gallop Nurse Assessor CHC Aquarius Nursing Home P Direct Bank Nursing Shifts Current Manage in line with CCG policy Tracey Garvey Business Assistant Nil Bianca Glavin (nee Davies) Prescribing Support Centre for Pharmacy Postgraduate P Direct Trainer 2012 Current Manage in line with CCG policy. On Pharmacy Technician Education (CPPE) Maternity Leave. Gemma Gray HR Pay and Policy Officer - Nil PCC Graham Groves Finance Manager CIPFA P Direct Member Current Manage in line with CCG policy Stuart Harris Performance Manager Portsmouth Hospitals Trust P Indirect Wife is on bank staff Feb-18 Current Manage in line with CCG policy Lucy Higginson CHC Nurse Assessor Nil
2 of 5 Date of Interest Type of Interest From To
Current position (s) held- i.e. Governing Body, Declared Interest- (Name of the Name Is the interest Nature of Interest Action taken to mitigate risk Member practice, organisation and nature of business) direct or Employee or other indirect?
Interests
Non-Financial Non-Financial
Financial Interests Financial
Professional Interests Professional
Non-Financial Personal Non-Financial Karen Hutton Finance Assistant Nil Dawn Jordan Commissioning Business Nil Officer, HCPC Violeta Kazak Finance Assistant Nil Jeanette Keyte Commissioning Nil Left 06/03/20 Programme Manager Anne Knight Senior Finance Manager CIMA P Direct Member 19/12/2016 Current None required Anne Knight Senior Finance Manager HFMA P Direct Member 19/12/2016 Current None required Sylwia Kurec Management Accountant CIMA P Direct Member Current None Ann Leworthy Financial Accountant Nil Steph Luke CHC Nurse Assessor Local Nursing Home P Direct Occasional Bank RGN shifts Current Manage in line with CCG policy undertaken Victoria Macfarlane Commissioning Project Nil Manager Pamela Macpherson Prescribing Support Nil Pharmacy Technician Carlie Madgwick Quality Improvement Portsmouth Hospitals NHS Trust P Direct Bank work as RGN 03/02/2020 Current Manage in line with CCG policy Officer Olivia Marsh Commissioning Project Nil Manager Andrea Maynard Management Accountant Nil Patrick McCullagh Commissioning Manager Nil Catherine Mead Associate Designated Nil Left 17 November 2019 Nurse for Safeguarding Adults Charlotte Mellis Administration Assistant Nil Stacey Munro IFR Representative BMA P Direct Member 1989 Current None Stacey Munro IFR Representative Sunnyside Medical Centre P Direct Salaried GP Current Declare conflict of interest at IFR meeting when relevant Emma Newell HR Advisor, PCC Nil Quadri Olaniyan Medicines Optimisation Community Pharmacy P Direct Locum Pharmacist Current Manage in line with CCG policy Pharmacist Quadri Olaniyan Medicines Optimisation PHL P Direct Bank Pharmacist Current Manage in line with CCG policy Pharmacist David O'Neill HR Partner, PCC Nil Opeoluwa Owoso Lead Medicines PHL P Direct Secondary employment for 24/01/2019 Current Manage in line with CCG policy Optimisation Pharmacist out of hours service as pharmacist Tim Pattinson Personal Health Budget Nil Support Worker Kerry Pearson Senior Commissioning Solent NHS Trust P Direct Secondment to Solent NHS Apr-17 Current Secondment arrangement explained Programme Manager Trust at beginning of every meeting to disclose dual position. Rosie Penlington Commissioning Project Nil Manager Denise Perry Senior Programme Trafalgar Medical Group Practice P Indirect Boyfriend is salaried GP at Apr-19 Current Manage in line with CCG policy Manager practice
3 of 5 Date of Interest Type of Interest From To
Current position (s) held- i.e. Governing Body, Declared Interest- (Name of the Name Is the interest Nature of Interest Action taken to mitigate risk Member practice, organisation and nature of business) direct or Employee or other indirect?
Interests
Non-Financial Non-Financial
Financial Interests Financial
Professional Interests Professional
Non-Financial Personal Non-Financial Denise Perry Senior Programme NHS Portsmouth Primary Care Group P Indirect Boyfriend is an elected Jun-19 Current Manage in line with CCG policy Manager Clinical Executive Caroline Pillans HR Advisor, PCC Nil Sarah Pitts Lead Medicines Nil Optimisation Pharmacy Technician Dr Jonathan Price Clinical Commissioning Trafalgar Medical Group P Direct Partner 1991 Current Manage in line with CCG policy Lead Dr Jonathan Price Clinical Commissioning Portsmouth Primary Care Alliance Ltd P Direct Practice is a Member Current Manage in line with CCG policy Lead (PPCA) Dr Jonathan Price Clinical Commissioning Healthcare P Direct Parent of Autistic Adult 1991 Current Manage in line with CCG policy Lead Sarah Prodger Specialist Safeguarding Nil Nurse Samantha Reilly Medicines Optimisation CPPE P Direct Clinical Demonstrator 2019 Current Manage in line with CCG policy Pharmacist Andrea Rice Project Officer Nil Rebecca Robson Clinical Lead Nil Gareth Rowe Finance Manager CIMA P Direct Member Current Manage in line with CCG policy Soraya Saeed Senior Project Manager, Nil ICS Tracey Salter HR Advisor, PCC Nil Patricia Smith Assistant Finance Manager Nil
Victoria Smyth Primary Care Nil Commissioning Officer Leonie Snell Continuing Care Nurse Nil Assessor Andrew Spencer Commissioning Project Solent NHS Trust P Direct Secondment to Solent NHS Mar-19 Current Manage in line with CCG policy Manager HCPC Trust Leigh Spurling Primary Care Nil Commissioning Officer Sarah Stevens Quality & Safeguarding Nil Support Officer Shirley Stout Commissioning Project Nil Officer Pragna Thakrar Medicine Optimisation Nil Prescribing Support Pharmacy Technician Dr Kevin Vernon Clinical Commissioning Lake Road Practice P Direct Partner Oct-02 Present Declare an interest in items relating to Lead Primary Care and not voting in these matters. Dr Kevin Vernon Clinical Commissioning Portsmouth Primary Care Alliance Ltd P Direct Sessional work Dec-16 Present Declare an interest in items relating to Lead (PPCA) Primary Care and not voting in these matters. Richard Webb Finance Manager, PCC Nil Joshua Wallace Planning & Performance Nil Analyst
4 of 5 Date of Interest Type of Interest From To
Current position (s) held- i.e. Governing Body, Declared Interest- (Name of the Name Is the interest Nature of Interest Action taken to mitigate risk Member practice, organisation and nature of business) direct or Employee or other indirect?
Interests
Non-Financial Non-Financial
Financial Interests Financial
Professional Interests Professional
Non-Financial Personal Non-Financial Joanne Williams Acting Director of Portsmouth Hospitals Trust/ South Eastern P Direct Interface post working across 01/04/2018 Current Manage in line with CCG policy Medicines Optimisation & Hampshire CCG and Fareham Gosport SEH CCG, F&G CCG and Interface Formulary CCG PHT Pharmacist Joanne Williams Acting Director of South Eastern Hampshire CCG P Indirect Husband is employed by Oct-19 Current Manage in line with CCG policy Medicines Optimisation & CCG Interface & Formulary Pharmacist Tina Windebank Continuing Care Team NHS Portsmouth Clinical Commissioning P Indirect Sister in Law works for NHS Current Manage in line with CCG policy Secretary Group Portsmouth CCG Blanka Wood Project Manager, New Nil Models of Care Jacob Woodford Management Accountant CIMA P Direct Member Current Manage in line with CCG policy. On secondment to Isle of Wight CCG Muhammad Zaman Senior Planning & Nil Performance Analyst
5 of 5
GOVERNING BOARD
Date of Meeting 18 March 2020 Agenda Item No 12
Verbal Report from Committee Chairs and Title Minutes
Audit Committee Verbal update.
Health and Wellbeing Board Verbal update and minutes from 25 September 2019 and 8 January 2020.
Purpose of Paper Primary Care Commissioning Committee Verbal update and minutes from 29 October 2019.
Quality and Safeguarding Committee Verbal update.
Clinical Advisory Group Verbal update
Recommendations/ Accept Actions requested
Engagement Activities – Clinical, Stakeholder and N/A Public/Patient
Item previously N/A considered at Potential Conflicts of Interests for Board N/A Members
Author Various
Sponsoring member Dr Elizabeth Fellows, Chair of Governing Board
Date of Paper 11 March 2020
HEALTH AND WELLBEING BOARD
MINUTES OF THE MEETING of the Health and Wellbeing Board held on Wednesday, 25 September 2019 at 10.00 am in Conference Room A, Civic Offices, Portsmouth.
Present
Councillor Matthew Winnington (in the Chair)
Councillor Gerald Vernon-Jackson CBE Councillor Rob Wood Councillor Judith Smyth (co-opted) Dr Linda Collie, CCG Dr Nick Moore, CCG Dr Jason Horsley, Director of Public Health Sue Harriman, Solent NHS Alison Jeffery Director of Children's Services Siobhain McCurrach Healthwatch Portsmouth Jackie Powell CCG Lay Member Steven Labedz, Portsmouth Education Partnership Frances Mullen, Portsmouth College Supt. Steve Burridge
David Williams PCC Chief Executive Kelly Nash PCC
22. Welcome, Apologies and Introductions (AI 1)
Councillor Winnington, chairing the meeting, welcomed everyone and introductions were made of those present.
Apologies for absence had been received from Innes Richens, Mark Cubbon and Dianne Sherlock.
23. Declarations of Members' Interests (AI 2)
There were no declarations of members' interests.
24. Minutes of Previous Meeting - 19 June 2019 (AI 3)
Councillor Smyth had previously raised the need for more outcome focussed work by the board; Kelly Nash confirmed that an item would be brought to the November meeting to take up this point.
Dr Moore raised a couple of typographical errors on page 3 of the minutes which should refer to GPs being "interested" in receiving information
1 (regarding exclusions), and also the use of expertise of partner organisations and the need for a "joined up" approach.
Subject to the above, the minutes of the previous meeting held on 19 June 2019 were approved as a correct record.
25. Dental Provision (AI 4)
Julia Booth presented the submitted report on behalf of NHS England. The report outlined their response to the termination of 3 contracts (where there had been under-performing) within 3 months, which had left a gap. Therefore 2 pieces of work were underway to firstly make interim arrangements for dental provision and secondly to procure new longer term contracts. 3 separate providers had agreed to undertake extra activity, prioritising cases of urgency. There was now a temporary 1 year contract with Portsmouth Dental Academy. NHS England was working closely with all 3 providers and there would be an overlap from the temporary to permanent providers in the city.
Elected member representatives on the HWB Board were concerned that there were gaps in areas of significant deprivation and wanted to ensure that dentists were present in Portsea and Paulsgrove. Julia Booth responded that this provision would be asked for within the tender but it was for the providers to say where they will cover. It was confirmed that NHS England property department was being consulted regarding the possible expansion to the Lake Road surgery in Buckland. Members stressed the importance of this provision in deprived area and the possible impact on hospital services, so the public should be made aware of the progress of plans. NHS England had written to Colosseum patients regarding alternative provision and a briefing had taken place with Healthwatch Portsmouth (who had put information on their website).
Ms Booth reported that the procurement survey had been published within the last 2 weeks, and she would feedback the comments raised by HWB Board members to their procurement group and noted the comments made regarding the way news had broken, with a better process of communication needed. Stakeholder letters had also been sent out via the CCG and HWB. They would continue to work with the local authority to promote good oral health for children and enhanced services for under 5s had been piloted over the wider region as well as the national Starting Well campaign. Dr Horsley offered assistance in similar promotion in more deprived areas.
The Chair thanked Julia Booth for attending and asked that updates be communicated to HWB Board Members
26. Safeguarding Issue - HWB response to PSAB Review (AI 5)
Councillor Winnington, as Chair, reminded members not to discuss the individual details of the case but focus on the 2 wider recommendations which had been brought to the attention of the Health & Wellbeing Board.
2
Rich Johns, the Independent Chair of the Portsmouth Safeguarding Children Board (PSCB), was in attendance to present the item on behalf of the PSCB and the Portsmouth Safeguarding Adults Board, also stressing the need for anonymity for 'Mr D' and recommendations had come from the independent reviewer and had been through the PSAB sub group, with these 2 recommendations being identified as having broader implications and which had therefore been referred to HWB. Recommendation 13 relates to accessibility of services and equipment designed to assist in cases of obesity and recommendation 18 relates to health outcomes for those with learning disabilities. The PSAB was therefore asking for assurances that these areas are being addressed. The PSAB wanted to see progress on providing services for all, which is not always easy in these specialist fields, and noted that the other recommendations were being considered by other bodies. Alison Jeffery also referred to lessons being learnt from the case of Child G.
It was agreed that a clear response report be brought to the November meeting of HWB regarding the lessons learnt from this case regarding specialist provision in response to the independent reviewer's recommendations 13 and 18.
27. Director of Public Health's Annual Report (AI 6)
Dr Jason Horsley presented his annual report "Harm from illicit drugs and how to prevent it " accompanied by Adam Holland who had undertaken research incorporated within it. The main conclusion was that a lot of this harm was not just physical but the wider social and mental harm to individuals and their families and the links to organised crime.
Dr Horsley raised areas of debate such as a national ban proving ineffectual; prices of drugs had not risen and the enforcement agencies could not stop a supply coming into the country (or being present in prisons). He asked if there should be a continuation of the same, a more draconian approach or a move to partially legalise or decriminalise drugs? It was hard to know the level of usage of illegal substances. It was however known that a small proportion of users were completely dependent, with links to mental illness, deprivation and adverse childhood experiences (neglect and abuse). It was thought that nationally drug use has decreased over the last decade, but there has been a slight increase in the proportion of young people (16-24 year olds) reporting recent drug use. There has also been a rise in those using opiates and crack cocaine. Most deaths nationally and locally are from opiates (due to higher potency), at a time of central cuts to associated services.
Most harm to individuals is to their life opportunities, as they are in the penal system there are restrictions to their education and employment and more vulnerability to organised crime and homelessness, with impacts on their children and at great public cost. Therefore the risk versus legislative changes needed further consideration, and the presentation slides showed experiences in different countries, with links between decriminalisation and lower death rates.
3
Section 7 set out the Director of Public Health's conclusions, including the need to review the legislation and lobby government which should treat this as a health issue (currently overseen by the Home Office). Dr Horsley also raised areas for future exploration, such as drugs consumption rooms, festival drug checking, more education in schools regarding the harm and giving strategies for children to resist taking drugs and work with the local universities to understand the scale of risks. The final version of the report was being designed and was due to be published in October.
It was reported that the link to this report on the agenda was wrong and needed to be rectified. The HWB Safety Advisory Group was investigating festival safety issues further. Supt. Steve Burridge responded that the police had to act with impartiality and they were also involved in cross agency work to address vulnerability and county lines work. Festivals were the subject of a national debate.
The Chair and HWB members welcomed the report, which would be further disseminated, and the further issues arising from it would continue to be discussed here and at other forums.
28. Health & Care Portsmouth Operating Model : progress report (AI 7)
Dr Linda Collie and David Williams presented this further update report; progress had been reported to the PCCG Board and PCC's Cabinet, with Solent NHS and Portsmouth Hospitals being involved in the process of delivering successful integration across health and care services in the city. Section 4 of the report detailed progress from the Blueprint plans and Section 6 detailed the first phase of the health and care operating model with the launch of new services and extension of joint leadership roles and joint commissioning.
Dr Collie explained how this would be delivered in parallel with the National Health's long term plan with 5 primary care networks in Portsmouth, with work now taking place on how these would work with the clusters. Section 10 of the report set out further proposals to increase integration between PCCG and PCC, with the extended leadership team to include the Accountable Officer functions, with delegated defined functions (and sub committee of HWB) and creating a joint finance role CCG/PCC.
David Williams reported that discussions had taken place with partner organisations and there continued to be the need for close engagement with providers for this to succeed, especially as there remained some peculiarities of boundaries with Hampshire and the Isle of Wight, with the need to look at Portsmouth City geography. Dr Collie stressed that work was taking place at all levels. Sue Harriman added her support on behalf of Solent NHS and reported that the NHS 10 year plan is also looking at tailoring services for people rather than organisational boundaries. Jackie Powell and Siobhan McCurrach both commented on public engagement and the need to make the process as clear as possible in communications. Dr Collie clarified that NHS England needs to approve the accountable officer role.
4
RESOLVED that the Health and Wellbeing Board:
i) Noted the progress so far on the integration of PCC and PCCG functions in support of the Health and Care Portsmouth operating model. ii) Noted and endorsed the progress on the proposals for further integration, including the preferred option for integrating of PCCG Accountable Officer and PCC Chief Executive functions. iii) Noted that further work now needs to take place to develop the voice and relationship with local providers in the work, and to articulate the link with the developing NHS architecture and consider where there might be practical opportunities to develop this.
29. Proposal for a pilot superzone to tackle childhood obesity and create a healthier environment (AI 8)
Dominique Le Touze presented the Director of Public Health's report. In Portsmouth 1 in 4 Reception Class children were classified as obese, above the national average. Whilst a lot of work was already taking place with children and families there had not been a significant impact so a new approach was being considered for a 1 year pilot "superzone". This would extend the idea of playstreets used elsewhere and seek to reduce the expansion of fast food outlets and their offers (encouraging healthier options and portions). This would need a co-ordinated approach between the Council, health sector and parents. The pupils at Arundel Court Primary School, in Charles Dickens ward, had been asked their views and experiences of what they liked and disliked in their environment; they were concerned by litter, dog fouling and safety concerns that prevented them using open spaces. Table 1 in the report detailed the workstreams.
There would also been wider implementation of initiatives such as the playstreets and the Pompey Monster scheme which encouraged walking to school (this was being copyrited for sale to other councils). There would also be use of community warden presence to promote safety. It was noted that the school which had expressed interest in participating had then made a presentation by the children on their views, and this direct feedback from children was welcomed by the Board. Steve Labedz commented that having sought their views the children would need to see something happen as a result of this exercise.
The Health and Wellbeing Board approved the proposal to implement a pilot superzone around a Portsmouth primary school (Arundel Court Primary School) with the aim of creating a healthier environment.
30. Economic Development Strategy & City Vision (AI 9)
David Williams presented this report; the far reaching Economic Development Strategy incorporated health and wellbeing and a joint approach would help in bids for funding for the broader health economy. This was for the
5
development of a City Vision not just a PCC vision, with engagement of partners and communities. Councillor Winnington welcomed the broader definition of key workers for the city, to include care workers and teaching assistants. It was noted that the list of key stakeholders had not been stated in the report.
This information report was noted.
31. Responding to Climate Change (AI 10)
Kelly Nash reported that since the Council had stated a Climate Change Emergency in March and the Cabinet had approved actions, a multi-agency board had been established, chaired by the University of Portsmouth, with a wide membership. The first meeting of the board had taken place the previous week and further updates would be given.
The information report was noted.
32. Dates of future meetings (for information) (AI 11)
The next meetings would take place on Wednesdays at 10am:
27 November 2019 (post meeting: this was rescheduled to 8 January) 5 February 2020
The meeting concluded at 12.07 pm.
Councillor Matthew Winnington (Joint Chair)
6
HEALTH AND WELLBEING BOARD
MINUTES OF THE MEETING of the Health and Wellbeing Board held on Wednesday, 8 January 2020 at 10.00 am in the Executive Meeting Room, Guildhall, Portsmouth.
Present
Councillor Matthew Winnington (in the Chair)
Councillor Gerald Vernon-Jackson CBE Councillor Luke Stubbs Councillor Rob Wood Councillor Judith Smyth
Innes Richens, CCG/PCC Alison Jeffery PCC Frances Mullen, Portsmouth College Sarah Beattie, Probation Suptd. Steve Burridge Roger Batterbury, Healthwatch Portsmouth Prof. Gordon Blunn (co-opt) Claire Currie (Deputy DPH) Penny Emerit (PHT)
Officers Present David Williams Kelly Nash Matthew Gummerson
1. Chair's welcome and introductions (AI 1)
Councillor Winnington opened the meeting by welcoming everyone, especially new members to the Board, and introductions were made.
2. Apologies for absence (AI 2)
These had been received from Dr Linda Collie (Joint Chair), Sue Harriman (represented by Suzannah Rosenberg), Dianne Sherlock, Mark Cubbon (represented by Penny Emerit), Steve Labedz and Jackie Powell.
3. Declarations of Interest (AI 3)
There were no declarations of interest.
4. Minutes of Previous Meeting - 25 September 2019 and matters arising (AI 4)
1 Matters Arising - Minute 25 - Dental Provision
Councillor Vernon-Jackson reported that whilst the discussion at the last board meeting had made clear that Paulsgrove and Portsea should be addressed as areas of high deprivation he had been told that this had not been part of the bid document offered to dentists to reprovide in the city, with 2 general bids, one for the North and one for the South being procured by NHS England. Members also cited the availability of buildings for practices in these precise locations and wished NHS England to be reminded of this request.
It was therefore AGREED: (i)that a letter signed by both Joint Chairs of the Portsmouth Health & Wellbeing Board be send to reiterate the Board's expectation that dental reprovision is made in both Paulsgrove and Portsea and that this be reflected in the continued procurement exercise, recognising the physical premises available in these 2 areas of high deprivation which had lost access to dentists. (ii) that an explanation and update by NHS England be brought to the February meeting of HWB.
RESOLVED that the minutes of the Health and Wellbeing Board held on 25 September 2019 be agreed as a correct record.
5. Membership Update - Additional Member of Health and Wellbeing Board - University of Portsmouth (AI 5)
RESOLVED that the Health and Wellbeing Board agree to co-opt Professor Gordon Blunn, representing the University of Portsmouth, as a member of the Board with immediate effect.
Professor Blunn was then invited to join members at the table.
6. Adult Safeguarding Board Annual Report 2018-19 (AI 6)
Andy Biddle, Assistant Director for Adult Social Care, presented the annual report on behalf of the Portsmouth Adult Safeguarding Board (PSAB), and ran through the 7 priorities and actions and multi-agency work being taken associated with these (as detailed in the report). The report also referred to 2 Safeguarding Adult Review referrals, one of which formed the basis of the next report on the agenda, with lessons being learnt from these.
Members welcomed the thorough report and comments included:
The transitioning process needed to be "improved" rather than "focussed on" for young adults to provide lifelong care and safeguarding for those 19+ - Alison Jeffery reported that the had been 6 instances of trafficking with young adults being vulnerable to being caught up in county lines activities. Page 15 of the annual report recorded Hampshire Constabulary statistics and it was asked if other risks should be included (such as
2
stabbings); the data collected related to those young adults with support needs.
The PSAB annual report was accepted.
7. Update on Safeguarding Reviews - Adult Mr D and Child G Learning Review (information report) (AI 7)
Andy Biddle, Assistant Director for Adult Services, presented the information report of the Portsmouth Safeguarding Adults Board Manager, which had been requested by the Health & Wellbeing Board. Due to the similarities in the cases a joint action plan had been produced and monthly multi-agency meetings had taken place. 2 page executive summaries had been useful for staff training sessions (237 staff). Mr Biddle outlined the 'Family Approach' taken pan Hampshire, work with GP practices to request reviewing their systems, examination of health check processes for those with learning disabilities and looking at supervision. There would need to be additional training when legal changes to mental capacity were implemented in October 2020.
Questions were raised regarding the 'training opportunities' with regular training continuing as well as monthly staff briefings and there is an audit of supervision practice through line management. Alison Jeffery reported that another theme raised in the report was of the need for escalation and a new protocol to ensure effective reporting of concerns. She reported that in December 2019 there had been an inspection of mental health for children; this had found that the protocol needed to be used more often especially when multi-agency work is involved (the final report back on the inspection would be published on 31 January 2020).
The information report was noted.
8. Domestic Violence and Abuse Strategic Review 2019-2023 (AI 8)
A deputation was made by Kirsty Mellor, as a community activist against domestic abuse, who referred to the national and local picture (causing 15 times as many killings as terrorism). Her points included:
Primary Care staff should spot the signals and make appropriate referrals with staff receiving training More joined up work between agencies of health, social care, housing, education and the emergency services Pressures on local authority budgets with cuts to funding Welcoming this strategy with the need for protection to be in place for victims.
The Chair thanked Kirsty for her deputation before Lisa Wills, PCC Strategy and Partnership Manager and Bruce Marr, Head Harm and Exploitation presented their report. Lisa Wills reported that further crime statistics (as referred to in the PSAB report) would be coming to the next meeting and she outlined the work with colleagues in Hampshire Constabulary and Probation.
3
Bruce Marr referred to the inconsistent funding streams (paragraph 5.3 of the report) and future funding uncertainty for local authorities should it become a legal requirement for them to provide refuge provision. There had been some success in income generation. It was also noted that different agencies had different funding streams had different governance arrangements. He was concerned by the threat to funding for work with perpetrators.
Questions and comments from members included:
The availability of updated information on the funding position and if the Police & Crime Commissioner's funding would be renewed? The difficulty being experienced in running services when bids/grants were on a yearly basis rather than 3 yearly; it was thought that the P&CC's office made grants on an annual basis for transparency and equality of access. David Williams as PCC Chief Executive had made representations on the subject of fragmented funding and suggested that the HWB make representation via the Joint Chairs to the Home Office and Police & Crime Commissioner to allow the continuity of specialist providers and to ensure efficient spending of public money. Public Health supported the Strategy and emphasis on prevention. Cllr Stubbs felt that the proportion of male victims needed to be reflected. Alison Jeffery emphasised the impact of Domestic Abuse on children's life chances and reported that the City Council had invested in 4 additional workers and preventative work took place through the Early Help Service as there should not just be reliance on the voluntary sector. Links to mental health services to assist in prevention. Work with Hampshire, Southampton and the Isle of Wight and the possible extension of commissioning on a regional basis and within the STP system.
Bruce Marr responded on the issue of fragmented funding, and the lack of join up between government departments in this respect, with funding streams being accessible by different agencies for different departments. Innes Richens, Chief Operating Officer CCG, also reported that conversations were taking place regarding the referrals from GPs and it was noted the numbers of referrals had dipped. This could be due to pressures on GPs and there was an increase in the cost to support GPs via the IRIS model.
Councillor Smyth suggested that recommendation 2 be expanded to reflect the need to ensure a sustainable funding model to support these services.
Superintendent Steve Burridge also suggested that an update be brought back to monitor the strategy's implementation and thereafter on a regular basis.
4
Suzannah Rosenberg referred to the 'Positive Minds' project run by Solent NHS to give increased psychological help to victims which also needed to be well equipped to help with trauma and undertook to further consider commissioned provision ability to identify and respond to disclosures.
Officers confirmed that bids would be submitted to meet the various deadlines. The Chair reported that Councillor Hunt, as Cabinet Member for Community Safety, had hoped to attend due to his interest in this subject but was unwell.
RESOLVED (1) the Health and Wellbeing Board approved the updated 3 year Domestic Violence and Abuse Strategy (as set out in Appendix A of the report) and agreed to review and refresh the action plan annually. (2) In considering the sufficiency of local investment to respond to domestic abuse the Board asked that the Joint Chairs make representation to the Home Office, Ministry of Housing, Communities and Local Government and the Police & Crime Commissioner regarding the fragmented nature of the funding arrangements which makes services run by agencies and the voluntary sector hard to run and sustain. Also that the HWB Joint Commissioning Group review options for drawing on local resources to provide more sustainable support (3) Monitoring of the Action Plan be delegated to the Domestic Abuse Steering Group (with membership outlined in Appendix C) to report back annually to the Health & Wellbeing Board.
9. Health and Wellbeing Strategy - Progress and Future Plans (AI 9)
Matt Gummerson, Strategic Lead for Intelligence for Public Health, presented the joint report and circulated a larger version of the coloured monitoring framework appendix. With the expanded membership of the Health and Wellbeing Board the strategy needed to reflect this in the updated strategy and there was the need to discuss future priorities. The Joint Strategic Needs Assessment (JSNA) also needed refreshing - the slides displayed would be made available to all members which showed areas of key concern. These included male life expectancy, obese and overweight Reception Class children. There were also areas of good progress such as the commended SEND inspection result.
RESOLVED the Health and Wellbeing Board (1) Noted the progress against the indicators agreed for the Health and Wellbeing Strategy as set out in the report (Section 4 and Appendix A); (2) Would consider areas where further work is required, with a separate session to take place on the afternoon of 5th February (3) Agreed the outline proposal for future development of the JSNA that will underpin the next Health & Wellbeing Strategy, with a report to be brought back later in the year.
5
10. Social, Emotional and Mental Health Strategy (Information report with links to Local Transformation Plan) (AI 10)
Alison Jeffery, Director of Children, Families and Education, presented the information report; this outlined the positive feedback to the strong statistical approach taken in examining settings, and provision of specialist schools. There was however more work needed to give stronger support for 18-25 year olds. Important work was taking place on attachment and relationships, which linked to the Domestic Abuse agenda.
The Chair welcomed the Strategy and positive results which would be set out in full when the Inspector's report was published on 31 January 2020.
The information report was noted.
11. Dates of future meetings (AI 11)
The proposed dates were agreed for Wednesdays at 10am for 2020:
5th February 17th June 23rd September 25th November
At the conclusion of the meeting the Chair announced the need for the press and public to leave to enable him to give information about a confidential sub group to take place later that day requested by Hampshire Constabulary to see if a Domestic Homicide Review meeting involving members of HWB was needed; if so terms of reference and appointment of an independent chair would be needed and a report back to HWB within 6 months.
The meeting concluded at 12.20 pm.
Councillor Matthew Winnington Chair
6
APPROVED
Minutes of the Primary Care Commissioning Committee meeting held on Tuesday 29 October 2019 at 10.30am – 12.30 pm in Committee Meeting Room, CCG HQ, Portsmouth
Summary of Actions
Agenda Action Who By Item 5. GP Patient Survey results
Will set up a Task and Finish group to look at the S McInnes January results, particularly in relation to access.
Engage with other local CCGs to share intelligence and discuss findings.
6. Personal Medical Services (PMS) Reinvestment – Commissioning Intentions
Share specific specifications outside of this T Russell Ongoing Committee with group members as they become available
7. Care Navigation update
Work and support practices around areas of C Horan March improvement.
Look at ways of increasing utilisation of the locally developed SystmOne Care Navigation template.
Provide training and develop a close working relationship with practices, one of the options would be individual practice visits.
Liaise with Care Navigators and discuss how Primary Care can support them.
Look at ways of embedding Care Navigators into practices.
Identify super users in practices.
Bring back an update every six months.
8. Primary Care Finance M06 2019/20
Will clarify the current Primary Care financial R Spandley January position at the next meeting.
1
9. Ear Irrigation within Primary Care
Will consult with the Local Medical Committee S McInnes See item 6 further regarding tariffs and prepare the above specification.
10. Review of Practice Merger
Will share the results of the patient survey and S McInnes January provide an update at a future meeting.
Present: Margaret Geary - Lay Member (Chair) Mark Compton - Deputy Director of Transformation Dr Elizabeth Fellows - Chair of Governing Board (GP) Jackie Powell - Lay Member Terri Russell - Deputy Director of Primary Care David Scarborough - Practice Manager Representative Dr Clare Sieber - Local Medical Committees Medical Director (GP) Jo York - Director (New Models of Care)
Apologies: Simon Cooper - Director of Medicines Optimisation Jason Eastman - Associate Director of IM&T Lisa Harding - Local Medical Committee Representative Dr Jason Horsley - Director of Public Health, Portsmouth City Council Andy Silvester - Lay Member Michelle Spandley - Chief Finance Officer Rebecca Spandley - Assistant Finance Manager
In Attendance: Roger Batterbury - Healthwatch Representative Christine Horan - Primary Care Improvement Manager Justina Jeffs - Head of Governance Steve McInnes - Primary Care Relationship Manager Stephen Orobio - Clinical Quality Manager Lisa Stray - Business Assistant Jo Williams - Acting Director of Medicines Optimisation
1. Apologies and Welcome
Margaret Geary welcomed members to the meeting, noted the apologies as above and reminded those present of the following:
• The meeting is not a public meeting and therefore no participation from members of the audience would be allowed during the formal business of the Committee. • The CCG undertakes Primary Care Co-commissioning under delegated powers from NHS England • In order to support the management of any conflicts of interests, the Chair is a lay member of the CCG. • The Chair will determine action to be taken where members declare a conflict in line with the CCG’s policies.
2
2. Declarations/Conflicts of Interest
Members working in General Practice declared a conflict of interest with agenda items 6, 9 and 10. Margaret Geary, as the Chair, agreed that the conflicted member could participate in the discussion but not in any decision-making.
Justina Jeffs reported that the Register of Interests – Governing Board/Committee Members document will be updated accordingly with the following change:
Delete ‘Dr Nigel Watson, Wessex Local Medical Committee Ltd (GP)’ and replace with ‘Dr Clare Sieber, Local Medical Committees Medical Director (GP)’
3. Minutes of Previous Meeting
The minutes of the Primary Care Commissioning Committee meeting held on Tuesday 27 August 2019 were approved as an accurate record.
An update on actions from the previous meeting was provided as follows:
Agenda Action Progress Item 7. Hampshire and Isle of Wight (HIOW) Primary Care Strategy
Agreed Actions:
• Take comments back to NHS England and will All Actions have been provide an update as appropriate. Completed
• Share any additional comments back to Terri Russell.
• Share with the board as a now a public meeting.
• Share with members of the Primary Care Board circulation list.
8. Any Other Business
• A straw poll will be conducted with Committee Completed members to ascertain the most suitable day that all members can to attend future Primary Care Commissioning Committee and Primary Care Commissioning Committee Part II meetings.
4. Risks
There were no new risks to report.
The Primary Care Commissioning Committee noted the update.
3
5. GP Patient Survey results
Members were informed of the latest GP Patient Survey (GPPS) results. The report reflected that results were generally lower than both national and comparative CCG areas, and were declining against previous results. The range across practices was also noted and it was advocated that any learning points should be shared. The data had previously been shared at the CCG’s Quality and Safety Executive Committee where it was agreed that the Primary Care Team will work collaboratively to identify and try to address specific issues that may be relative to access. Results relating to perception of care were positive and the Committee agreed this reflected well on the Health Care Professionals.
Members raised the following:
• Educate patients on how to make use of available resources and allow them time to adjust to such changes within the practice. • Review the results in more detail and discuss with practices to better understand the issues.
Steve McInnes will set up a Task and Finish group to look at the results, particularly in relation to access. Steve will also engage with other local CCGs to share intelligence and discuss findings. Action: S McInnes The Primary Care Commissioning Committee noted the report.
6. Personal Medical Services (PMS) Reinvestment – Commissioning Intentions
David Scarborough the Practice Manager Representative working within Primary Care and Dr Elizabeth Fellows, Chair of Governing Board and GP of the Committee, declared an indirect conflict of interest with information contained with the paper. Margaret Geary, as the Chair, agreed that David Scarborough and Dr Elizabeth Fellows could participate in the discussion but not in any decision-making.
Terri Russell spoke to the PMS Reinvestment – Commissioning Intentions paper that included previously approved principles for reinvestment and additional proposed schemes. The additional proposed schemes would make use of further reinvestment monies both in this financial year and recurrently going forward. Members were provided with an explanation of the origins of each new scheme and the estimated funding requirements.
Additional schemes in 2019/2020
• Long action reversible contraception (LARC) for non-contraceptive reasons Local Commissioned Service - £40k • Safeguarding Local Commissioned Service - £60k • Ear irrigation Local Commissioned Service - £90k
Agreed Actions:
• Share specification outside of this Committee with group members • Work out where practices have not been claiming and share with the group.
Action: T Russell
Committee members were asked to approve the outlined Commissioning Intentions.
4
The Primary Care Commissioning Committee will approve the final scheme outside of the meeting.
7. Care Navigation update
Chris Horan provided an overview of the Care Navigation Programme which supports Care Navigators in identifying and actively signposting patients and carers to the most relevant healthcare service for them at that time.
Members raised the following:
• Roger Batterbury raised a concern that practices should be allowed adequate time to adjust to changes. • Chris Horan highlighted that the data indicated that not all practices were using the locally developed SystmOne Care Navigation template; this did not mean that practices were not Care Navigating. • Jo York said that this is a good opportunity to take to non-clinical TARGET. • Terri Russell suggested that to help embed Care Navigation into practice it is integral that practice management is involved in supporting their staff in the development of new processes and ways of working within practices. • Dr Elizabeth Fellows commented that it would be useful for The Lighthouse Group Practice who has the highest users of the template to share what they are doing with other practices, to help other staff members to understand the system and the process they have embedded. • Further to a question by Jackie Powell, Chris Horan confirmed that You Trust is part of the Social Prescribing.
The following Actions were agreed:
• Work and support practices around areas of improvement. • Look at ways of increasing utilisation of the locally developed SystmOne Care Navigation template. • Provide training and develop a close working relationship with practices, one of the options would be individual practice visits. • Liaise with Care Navigators and discuss how Primary Care can support them. • Look at ways of embedding Care Navigators into practices. • Identify super users in practices. • Bring back an update every six months. Action: C Horan
Committee members were asked to receive the information provided in the report.
The Primary Care Commissioning Committee received the report
8. Primary Care Finance M06 2019/20
Dr Clare Sieber raised a question around the tracked spending figure on the Primary Care Finance 2019/20 report. Rebecca Spandley will clarify the current Primary Care financial position at the next meeting. Action: R Spandley
The Primary Care Commissioning Committee agreed that the Finance report will be carried forward to the next meeting.
5
9. Ear Irrigation within Primary Care
David Scarborough the Practice Manager Representative working within Primary Care and Dr Elizabeth Fellows, Chair of Governing Board and GP of the Committee, declared an indirect conflict of interest with information contained with the paper. Margaret Geary, as the Chair, agreed that David Scarborough and Dr Elizabeth Fellows could participate in the discussion but not in any decision-making.
Committee members worked through the proposed Locally Commissioned Service (LCS) i for the removal of ear wax within Primary Care. The proposal considered a new LCS or adding to an existing Basket LCS with an estimated finance around £90k. In both cases, Personal Medical Services Re-investment monies could be utilised to secure recurrent funding.
Steve McInnes reported that a recent survey of GP practices recognised that 9 practices in Portsmouth are currently providing a service, with 5 practices referring patients elsewhere. Due to difficulties in maintaining competencies and keeping equipment in good working order, there is at least 2 practices strongly considering withdrawing from this service in the near future.
Members raised the following:
• Dr Elizabeth Fellows raised a concern regarding the on-going costs of replacing insufficient quality equipment on a yearly basis. • Dr Clare Sieber suggested a buddy arrangement should be considered to enable practices to share equipment. • Julia O’Mara highlighted an inequality for patients across the city that are currently unable to access this service, and explained that not enough nurses are adequately trained to inspect the ear. • Julia O’Mara asked if the new LCS will cover house bound patients. It was advised this would be a community care responsibility. • Steve McInnes said that he felt the new service would make good use of PMS reinvestment funds in Primary Care.
Steve McInnes will consult with the Local Medical Committee further regarding tariffs.
Action: S McInnes
The Primary Care Commissioning Committee agreed the proposal in principle.
10. Review of Practice Merger
David Scarborough the Practice Manager Representative working within Primary Care and Dr Elizabeth Fellows, Chair of Governing Board and GP of the Committee, declared an indirect conflict of interest with information contained with the paper. Margaret Geary, as the Chair, agreed that David Scarborough and Dr Elizabeth Fellows could participate in the discussion but not in any decision-making.
Steve McInnes provided an update on the recent Practice Merger between The Devonshire Practice and Southsea Medical Centre, now known as The Lighthouse Group Practice.
The merger had helped ensure services were sustained for patients and both the practice and the CCG felt the merger had been very positive. The timing had co-incided with some new initiatives and changes to the workforce, which had a positive impact on services. Steve thanked Andrew Clarke, Practice Manager, for leading the merger and for his considerable
6
hard work and effort during the process. All of the staff had worked tirelessly to ensure the merger went as smoothly as possible.
The practice will undertake a patient survey in November, in order to gauge patient’s opinions around the merger and the new processes in place.
Steve McInnes will share the results of the patient survey and provide an update at a future meeting.
Action: S McInnes Committee members were asked to receive the report.
The Primary Care Commissioning Committee noted the report.
11. Any Other Business
The CCG offices will be completely closed on the 27 December 2019. All GP practices have their individual continuity plan and aware of CCG on-call arrangements.
12. Date of Next Meeting
The next Primary Care Commissioning Committee meeting to be held in public will take place on Thursday 30 January 2020.
Apr Jun Aug Oct Dec Jan Member Name 2019 2019 2019 2019 2019 2020 Margaret Geary Mark Compton A A Simon Cooper A A Jason Eastman A Dr Jason Horsley A A A A Jackie Powell Suzannah Rosenberg Terri Russell David Scarborough A Dr Clare Sieber Andy Silvester A A Michelle Spandley A A A A Dr Nigel Watson A A Jo York A
- Present A – Apologies
7