Meeting in Public of the BSW CCG Governing Body Thursday 18 March 2021, 10:30Hrs

Use the Adobe bookmarks tool to easily access the agenda item reports

Meeting in Public of the BSW CCG Governing Body Thursday 18 March 2021, 10:30hrs

- Virtual meeting via Zoom -

Timing No Item title Lead Action Paper ref.

Opening Business 10:30 1 Welcome and Apologies Chair Note Verbal

2 Declarations of Interests Chair Note Verbal

10:35 3 Questions from the public Chair Note Verbal

10:40 4 Minutes from the BSW CCG Governing Chair Approve GB/20-21/138 Body Meeting held on 25 February 2021

5 Action Tracker Chair Review GB/20-21/139

10:45 6 BSW Clinical Chair’s Report Chair, Note Verbal (incl. reports from the Locality Clinical Dr Bryn Bird, Leads) Dr Amanda Webb, Dr Edward Rendell 10:55 7 BSW Chief Executive’s Report Tracey Cox Note GB/20-21/140

11:00 8 Medical Directors Quarterly Report Dr Ruth Grabham Note GB/20-21/141

Business items 11:05 9 COVID-19 Incident Response and Chair, Note Verbal Vaccination Programme Update Tracey Cox

11:15 10 BSW Performance, Quality and Finance Richard Smale, Note GB/20-21/142 Report Caroline Gregory

11:25 11 Urgent and Emergency Care – Current Al Sheward, Approve GB/20-21/143 State and Future Direction Emma Smith, and Karen Baker Note 11:50 - Short break – 10 mins 12:00 12 BSW Academy Sheridan Flavin Endorse GB/20-21/144

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 1 of 2 Page 1 of 210

Timing No Item title Lead Action Paper ref.

12:20 13 BSW CCG 2020 NHS Staff Survey Sheridan Flavin Endorse GB/20-21/145 Results 12:35 14 Planning for 2021-22 Julie-Anne Wales, Note GB/20-21/146 Caroline Gregory 12:50 15 Governance Peter Lucas Verbal a. BSW CCG Audit Committee Terms of Note Reference b. External Audit Services Note

12:55 16 Risk Management Julie-Anne Wales Note GB/20-21/147

13:05 17 Integrated Care System Developments - Tracey Cox, Note GB/20-21/148 White Paper Briefing and Update on BSW Richard Smale Position Items for information Items in this section will be taken as read and not discussed unless members raise specific points

13:20 18 Summary Report from Governing Body Chair Note GB/20-21/149 Committees

Closing Business 13:20 19 Any other business Chair

Next meeting: Thursday 20 May 2021

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 2 of 2 Page 2 of 210

DRAFT Minutes of the BSW CCG Extraordinary Governing Body – Meeting in Public

Thursday 25 February 2021, 13:15hrs Virtual meeting held via Zoom

Present Statutory Members Name Clinical Chair - Chair of Governing Body Dr Andrew Girdher AG Chief Executive Tracey Cox TC Chief Financial Officer Caroline Gregory CG Registered Nurse Maggie Arnold MA Secondary Care Specialist Dr Paul Kennedy PK Lay Member Audit and Governance (joined the meeting from 9:21hrs) Peter Lucas PL Lay Member Patient and Public Engagement (PPE) Julian Kirby JK Additional Members Lay Member Finance Ian James IJ Lay Member Primary Care Commissioning and Deputy Chair Suzannah Power SP Locality Clinical Lead (BaNES) Dr Bryn Bird BB Locality Clinical Lead (Swindon) Dr Amanda Webb AW Locality Clinical Lead (Wiltshire) Dr Edward Rendell ER Locality Healthcare Professional (BaNES) Dr Tim Sephton TS Locality Healthcare Professional (Wiltshire) (from 14:55hrs) Dr Catrinel Wright CW Locality Healthcare Professional (Wiltshire) Dr Nick Ware NW Locality Healthcare Professional (Wiltshire) Dr Sam Dominey SD Medical Director Dr Ruth Grabham RG Director of Nursing and Quality Gill May GM Director of Strategy and Transformation Richard Smale RS Attendees Interim BSW Executive Director for People and OD (from 9:00hrs) Sheridan Flavin SF Director of Corporate Affairs Julie-Anne Wales JAW BaNES Chief Operating Officer Corinne Edwards CE Swindon Chief Operating Officer David Freeman DF Wiltshire Chief Operating Officer Elizabeth Disney ED B&NES Director of Public Health Bruce Laurence BL Swindon Director of Adult Social Services Sue Wald SWa Wiltshire Director of Children’s Services Lucy Townsend LT Assistant Director of Corporate Affairs Anett Loescher AL Deputy Director of Communications and Engagement Tamsin May TM Board Secretary Sharon Woolley SW Director of Planning and Transformational Programmes Lucy Baker LB (for items 3 & 4) BSW Local Maternity System Midwife (for item 4) Sandy Richards SR

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 1 of 12 Page 3 of 210

BSW Programme Lead for Transition (for item 15 ) Catherine Phillips CP Clinical GP Lead for Mental Health (for item 3) Dr Sarah Blaikley SB

Apologies

Interim BSW Executive Director for People and OD Alison Kingscott Locality Healthcare Professional (Swindon) Dr Francis Campbell

1 Welcome and Apologies

1.1 The Chair welcomed members and officers to the meeting, and noted apologies.

1.2 The meeting was declared quorate.

1.3 To enable Governing Body meetings to continue as much as possible during these unprecedented times, Zoom was being utilised where possible. The Standing Orders allow for this provision.

1.4 Only those questions raised through the normal submission process of three working days in advance of the meeting would be acknowledged during the meeting.

1.5 The Chair advised Members that the order of the agenda would be amended as follows to enable Catherine Phillips to join the meeting after 15:20hrs; item 13 BSW CCG Inclusion Charter would be taken after item 15 Disciplinary Policy.

2 Declaration of Interests

2.1 The CCG holds a register of interests for all staff, Governing Body and committee members. None of the interests registered were deemed to be relevant for the meeting business. There were no other interests declared regarding items on the meeting agenda.

3 Update on All Age Mental Health

3.1 LB, Director of Planning and Transformational Programme and SB, Clinical GP Lead for Mental Health, were in attendance to present an update on all age mental health and emotional wellbeing challenges, solutions and transformation across BSW. The three year transformation plan would commence from 1 April 2021.

3.2 SB and LB talked through the comprehensive presentation, sharing the CCGs understanding of the mental health crisis, the services in place with providers and within secondary care, and highlighted the following to the Board: • Mental health referrals were now starting to return to pre-COVID levels. There had been a short temporary pause of the referral waiting list in January 2021 due to the third pandemic peak and the redeployment of some staff, but this had reopened as quickly as possible with prioritisation work now underway and escalation processes being reviewed. • The transformation plan had been co-created with the main mental health providers across BSW; Avon and Wiltshire Mental Health Partnership (AWP) and Oxford Health, and third sector support organisations. The additional £3.5m of funding will support this in year, at pace whole-scale transformation. • There was a known national shortage of Psychiatric Intensive Care Units (PICU) and children and young people (CYP) beds, however, AWP had commissioned

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 2 of 12

Page 4 of 210

additional beds for BSW where possible, and alternative solutions were being looked into. • The performance data indicated challenges surrounding the Improving Access to Psychological Therapy (IAPT) services and CYP access. Deep dives would be undertaken on performance measures across localities with the providers to understand the actual waiting times. • Weekly meetings are held with third sector, secondary care providers, and localities to review actions and positions; but it was recognised that a long journey of transition was ahead. • Themes from recent engagement and listening activities have been used to inform the transformation programme. • The demand for future mental health support needs to be better understood at system and locality level to plan and prioritise services. The ‘CReST’ (Children and Young People's Mental Health Referral System Management Tool) demand and capacity model was being used to develop scenarios. • A mental health Operational Pressures Escalation Levels (OPEL) dashboard had been developed, signalling those early warning triggers and pressure points to enable the teams to be proactive and plan for the future. • A co-designed BSW Staff Wellbeing Hub model would be going live in April as a response to the national request to an enhanced psychological offer, providing dedicated support for our health and social care staff. • A multi-agency BSW Suicide Prevention Working Group has been established, to develop targets and universal support and actions. Suspected suicide, suicide rates and trends were being monitored through this group. • The community mental health framework would build further on this multi-agency working – which would see an instant change in the referral process for GPs through the Primary Care Liaison Service (PCLS) to a community support triage officer to one of the three pilots (eating disorders, 16-25 pathway and personality disorders) to support workers placed within the five third sector partners. Holistic management and support would then be provided, not just mental health, and signpost patients to existing support areas. If referrals required IAPT support, these will be directed to psychologists and consultant clinical phycologists as to enable patients to meet the IAPT and therapy goals within eight to ten months. Support would continue through the community multi-disciplinary teams (MDTs) and all services, and at three, six and twelve months support for those discharged would be through the community network programme. The recovery and secondary care teams will be further utilised. A complete 360 narrative change for the mental health pathway. • The new model would bring a person centred approach to emotional, wellbeing and mental health support. Seven primary care networks (PCNs) would work closely with the new framework, implementation had commenced. • It was acknowledged there was still significant work to do to improve access and waiting times. The focus on enhanced advice and guidance would see the new community framework replacing historic referrals and removing thresholds. • A third sector support line had now been established within each locality to provide that early intervention and prevention support. • Mental health would be included in the new BSW advice and guidance offer, better connecting clinicians. This was being worked through with AWP to ensure they had the ability to support this. It was not just about psychiatrists, but the mental health pharmacists and the shared care model package that AWP was signed up to. • Third sector partners had been successful in securing £1.6m for a three year enhanced crisis response, that would go live in quarter one of 2021.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 3 of 12

Page 5 of 210

• The Mental Health Investment Standard is a key measure and a responsibility of the CCG to increase its spend on mental health services. The CCG had met this requirement for 2019/20. • The strategic priorities have been refreshed and there would be a restart of the BSW all age mental health Thrive programme.

3.3 In response to questions, the Board further noted: • Daily conversations were in place with the principal provider, AWP, to manage performance and to ensure a collaborative approach, particularly as part of the Integrated Care System (ICS) journey. Cultural change would be the biggest challenge for AWP, but the model would bring that new way of working that AWP and its staff needed to be part of. Although workforce would remain an issue, this new model brought a different type of workforce and its utilisation. • Demand modelling could be drilled down to locality and geographical level, and local impacts and variations could be built in. • It was acknowledged that there were also considerable waiting times around access to ADHD and autism diagnosis and support services. • The Quality, Performance and Assurance Committee (QPAC) would look to monitor the impact on the patients and staff concerning the further use of the Positive Behaviour Support training. • PCNs were to employ their own mental health first contact practitioners, which would bring an opportunity for AWP training programmes to empower the training process. • The PCN model trial would be include a six-month evaluation process before considering a roll out further across BSW. Audits would be undertaken at three, six and 12 month intervals. This new model would eventually renounce the need for the PCLS. AWP would not be able to operate two models – so a full roll out would be expected at the start of year two of this transformation, although it was hoped this may be sooner as the programme evolves. • The biggest new resource requirement for year one was third sector support workers, although the team were confident those people could be secured and attracted to work across BSW. • It was expected that the biggest notable change as a consequence of this transformation programme would be the reduction of patients presenting in primary care and visiting their GPs as they would have been dealt effectively and completely by the new pathway for their mental health problem. Primary Care would be invited to attend monthly MDTs and become involved where desired. A 360 package was to be offered to patients to build resilience and enable them to manage on their own. ACTION: Further all age mental health update to be brought to the July Governing Body meeting.

3.4 There had been a suggestion of offering a Board-to-Board discussion with AWP; the Chair acknowledged this and wished for this offer to be made and followed up with AWP.

3.5 The Governing Body noted the report, the progress made to date and next steps.

4 BSW Local Maternity and Neonatal System Response to National Ockenden Recommendations

4.1 SR, BSW Local Maternity System Midwife and LB presented the BSW response to the national Ockenden report, including the initial Immediate and Essential Actions (IEA). The report published in December 2020 followed a request from the NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 4 of 12

Page 6 of 210

Government Health Secretary to NHS England to conduct a review. The Board noted the following: • There were seven key areas of IEA’s which were to be implemented, 12 urgent clinical priorities were to be followed to by 21 December 2020. The BSW Local Maternity and Neonatal System (LMNS) undertook a rapid review and gap analysis as part of the initial submission, with further evidence submitted on 15 February, and then further in March to the national portal. The summary of assurance indicated largely a green rating against each of the IEAs. Trusts have action plans in place to ensure full compliance is met. Regular updates would be presented to QPAC to ensure oversight on progress against the actions. • The Clinical Negligence Scheme for Trusts (CNST) Maternity Incentive Scheme had now gained commitment from all three Trusts. • A named non-executive director as the Maternity Safety Champion was also now in place upon each Trust Board. BSW also has a well-established Maternity Voices Partnership. • BSW was in the process of implementing the Better Birth recommendations and Maternity and Neonatal Safety Improvement to drive maternity transformation. A 50% reduction in the rate of stillbirths, neonatal death and brain injuries occurring during or soon after birth was to be achieved by 2025. BSW had achieved the 2020 target of a 20% reduction. • Next steps included the completion of the full assurance template by Trusts, revising the LMNS dashboard, formalising the sharing of Trust-level intelligence and the implementation of the Perinatal Quality Surveillance Model and its five principles. • Resourcing and staffing remained a challenge, particularly to ensure the recommendations were implemented. • The move towards the ICS would see the LMNS building upon the existing model and further integration with other groups, such as the BSW ICS Quality Surveillance Group (QSG), to ensure planned and co-ordinated action and to inform quality improvement and transformation. BSW was in a strong place with the QSG already established, membership included provider representatives, Health Education England, Healthwatch and NHS England, bringing that system oversight and sharing of intelligence to identify those early warning signs and to reduce the silo working. The QSG would soon present to ICS Executive Board on its momentum and its output, and how it formulates with the ICS governance structure. • CNST funding was to be confirmed against achievements. Each Trust was currently working on data submissions. Face to face, multi-disciplinary training was a challenge due to COVID, but was now starting to resume. • Fetal heart rate monitoring was intermittent auscultation; this would use non- electronic means rather than telemetry. • The rotation of midwifes across the model and services was key to ensure continued learning and training. The continuity of care model was being established, but it was recognised a culture change would be needed.

4.2 The Governing Body noted the update, the progress made against the recommendations and next steps.

(14:19hrs – LB and SR left the meeting)

5 Questions from the Public

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 5 of 12

Page 7 of 210

5.1 A number of questions were received from the public ahead of this meeting. The Chair read out each question, followed by the CCGs response. This would also be made available upon the CCGs website following the meeting.

5.2 The questions and full response can be found on our website here: https://bswccg.nhs.uk/docs-reports/meeting-agendas-and-papers/bsw-ccg- governing-body-meetings/thursday-25-february-2021/1757-bsw-ccg-governing- body-250221-questions-from-the-public-and-responses/file

6 Minutes from the BSW CCG Governing Body Meeting held on 19 November 2020

6.1 The minutes of the meeting held on 19 November 2020 were approved as an accurate record of the meeting.

7 Action Tracker

7.1 The one action noted on the tracker concerned the request for a mental health service update, which was an earlier agenda item, and therefore marked as CLOSED.

8 Patient Focus

8.1 GM talked through a number of slides, providing the Board with an update concerning the COVID-19 Vaccination Programme. Good feedback concerning the roll out of the programme was being received. To date, 262,000 vaccinations of the first dose had been administered across BSW.

8.2 BSW had achieved cohorts one to four within the required timeframe, national letters to those within cohorts five to six were now being sent out. Vaccinations were being offered to all health are care staff that were in an at risk situation, the CCG was working closely with local authority partners to ensure care staff were vaccinated.

8.3 Significant engagement and communications work continued to be undertaken through social media, radio and PCNs to support equality of access and to ensure the sharing of correct information, particularly amongst the seldom heard groups. Utilisation of those community champions and leaders would support this further. £100,000 has been made available to all systems including BSW, to further support the roll out to seldom heard groups. An Opening Doors panel event was being held on 4 March 2021, particularly aimed at the Black, Asian and Minority Ethnic (BAME) community, but all were encouraged to join the virtual question and answer session. Information concerning the vaccination and programme was available in a range of languages. Learning from previous flu campaigns was being incorporated into this programme.

8.4 GM referred to an interview with Nirmalaben D Patel and her son following her vaccination. This interview would be shared wider on the CCG website and social media channels to raise further awareness amongst the BAME communities, along with videos being created for other BSW communities.

8.5 BSW was doing incredibly well, with targeted work to reach all our communities and all our residents to take up the vaccination offer, to achieve full adult coverage by the end of July and delivery of the second vaccine by the end of September. NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 6 of 12

Page 8 of 210

8.6 Thanking all the clinical and non-clinical staff involved in the roll out of the programme was to be considered to acknowledge their vital input in making it such a success. The Chair advised that a letter from TC and himself had been sent to the majority of staff involved to share their thanks. SWa also advised that thank you messages had also been sent to volunteers, local community leaders and clinical staff in the Swindon area. One suggestion made was to create a ‘thank you’ screen saver to display upon CCG staff screens. It was acknowledged that so many had become involved in the roll out in various supporting roles, recognition for all these was needed.

9 BSW Clinical Chair’s Report (incl. reports from the Locality Clinical Leads)

9.1 The Chair gave a verbal report, incorporating updates as provided by each of the Locality Clinical Leads. The Board noted: • COVID cases continued to fall across BSW, but remained at a high number keeping the area in a delicate position. The road to relaxing lockdown restrictions was to be slow and gradual as outlined by the Government.

Swindon locality: • Integrated Care Alliance (ICA) workstreams had restarted, focussing on inequalities, service improvements and recovery. • Pathway support had seen a sustained reduction in patient flow through the GWH and length of stay patients, which reflected the whole system response. • The vaccination programme roll out at the Swindon Steam Museum in particular was going remarkably well, having one of the highest numbers across the South West. • Population health data was being used in a pilot project to target the most vulnerable, high-risk members of our communities, enabling the system to provide that targeted vaccination support. • GWH had recently appointed a Director of Partnerships and Improvement • The serious mental health register was being used to ensure patients could access their annual health reviews at the Junction in Swindon from the beginning of March. This would then be extended across BSW following an initial launch in Swindon.

Wiltshire locality: • A more intense ICA development period was to begin, linking in with a number of partners. • The Trowbridge, Paulton and Chippenham minor injury units had now reopened, these had been temporarily closed to allow staff to be redeployed to support the pandemic response across others areas of the system.

BaNES locality: • Phase 2 of the Health Infrastructure Plans (HIP2) hospital project was to now commence, moving into seven priority clinical workstreams.

9.2 Following the cancellation of the Governing Body meeting in public for 21 January 2021, a number of papers were circulated in an out of meeting pack to Board members for information and assurance. A meeting pack, containing reports such as the EU Exit Assurance, the Annual Emergency Preparedness Resilience & Response (EPRR) Assurance Report and the BSW CCG Merger Benefits Report, were received and noted by the Board on 14 January 2021.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 7 of 12

Page 9 of 210 9.3 The business of the Governing Body Private Session held on 21 January 2021 included the approval of the following governance items: • BSW CCG Quality and Performance Assurance Committee Terms of Reference • BSW CCG Finance Committee Terms of Reference • Swindon Locality Commissioning Group Terms of Reference • BSW CCG Updated Scheme of Reservation and Delegation (which has now been uploaded to our website) And reviewed and noted: • Meeting Schedule 2021-22 • BSW CCG Conflicts of Interests for Governing Body Members (which has now been uploaded to our website)

9.4 The Primary Care Commissioning Committee signed off the final allocation of the GP COVID Capacity Expansion Fund for BSW practices, in recognition of the continuing demands on practices and PCNs in delivering the COVID vaccination programme. These funds were ring-fenced exclusively for use in general practice.

9.5 The Chair wished to note his thanks to all system providers and key workers for their support and commitment during this challenging time.

10 BSW Chief Executive’s Report

10.1 The Governing Body received and noted the Chief Executives report.

11 COVID-19 Incident Response and Vaccination Programme Update

11.1 A separate vaccination programme update was not given; this had been covered sufficiently as part of proceeding items.

12 BSW Performance, Quality and Finance Report

12.1 The Board received the BSW Performance, Quality and Finance Report, and noted in particular: • This was an evolving report, becoming a system wide resource for all system partners, with work ongoing with local authority and community partners to further develop it. • The report indicated the challenges and pressures faced by the system during the third peak of the pandemic, but was now gradually reflecting an improving picture, although recognising the journey ahead to get back on track with planned care activity, waiting lists and long waiters. Collaborative working would help address this significant challenge. • Specific work was underway to reduce ambulance handover delays, the time patients were waiting in an ambulance on arrival at ED and that compassionate care, privacy and dignity • The Quality and Safety Sub Group and the Elective Group, would be reviewing the 52 week waiter list, and in particular the impact on children and young people. • Although the system financial view had been included in the report, the CCG still had its statutory obligation to report on the CCG position. This would return for the March report. • The unusual system financial regime managed nationally was reflected and the work to date to improve the system position.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 8 of 12

Page 10 of 210

• It was noted that for the Swindon locality update on page 73 of the report, should state ‘low referrals’ as discharge figures had improved.

12.2 The CCGs Business Intelligence Team were preparing forward modelling data to further inform system priorities and objectives. The Team were engaged in all areas of work to provide that oversight. The 2021-22 plan had not yet been developed, but background work was being undertaken to better understand trajectories and baseline of activity. It was hoped this modelling would enable the system to be more proactive and plan for the longer term.

12.3 The Governing Body noted the contents of the BSW Performance, Quality and Finance Report.

13 Update on CCG People Strategy and Action Plan

13.1 SF presented an update to the Board against the CCG People Strategy and its action plan. The Board recollected that the Strategy had three main areas of focus, with six sub themes and 47 actions. The progress against each of these actions was noted from page 130 of the paper pack. Pace against some of these actions had been impacted by the pandemic response and colleague redeployment during surge activity.

13.2 The CCG had taken part in the NHS Staff Survey, but the results from this had been nationally embargoed until 11 March 2021. These would be shared at the March meeting. It would be ensure that the CCGs People Strategy aligned to the results from the survey.

13.3 Significant work had been undertaken on colleague engagement and communications as part of the health and wellbeing agenda. Implementation of a number of learning and development actions had been delayed due to colleagues being unable to attend planned sessions. A trial programme was underway with managers and their teams to support new ways of working and agile working.

13.4 Values and behaviours had been developed for the CCG, but there was further work to do in this culture and inclusion area. A colleague recognition scheme was being developed and had received support from the Colleague Partnership Forum (CPF); this was to be presented to the Executive Team on 1 March 2021. The CCG Inclusion Charter (later on the agenda) further supported the CCGs action around the equality and diversity agenda.

13.5 In response to questions, SF recognised that although implementation of actions may be complete, the surrounding work with colleagues and managers needed to continue to ensure full achievement, particularly in reference to appraisals to enable an overall picture of data and trends, and demand forecast of training requirements. Regular health and wellbeing conversations had been encouraged between managers and their teams. Agile and flexible working was being embraced, but core working hours needed to be confirmed.

13.6 The People Team capacity was noted as a risk to the delivery of the identified Strategy actions in the timescales stated. SF recognised that funding was limited, and advised that resources were being reviewed to best utilise what was available.

13.7 Page 126 of the paper pack referenced the BSW Academy, bringing significant improvements to system development and future ways of working. The BSW ICS

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 9 of 12

Page 11 of 210

System Capability Group was developing the outline business case for the Academy, an exciting venture that would consider leadership, learning on the inclusion agenda and a quality and improvement approach for all organisations across the BSW system. This would collectively use resources and leadership, training and development monies for the benefit of all. The business case was currently being considered by system partners. The CCG fully supported this proposal and would strongly lead by example by putting monies into this venture to expand development opportunities. Further details would be shared with Members to ensure they were kept informed of developments. ACTION: TC to share the BSW Academy outline business case with Governing Body members.

13.8 The Governing Body noted progress of the CCG People Strategy.

14 BSW CCG Disciplinary Policy

14.1 SF presented the updated BSW CCG Disciplinary Policy, that had been reviewed and updated to take account of the recommendations made in 2019 by Prerana Issar - NHS Chief People Officer, and Baroness Dido Harding - Chair, NHS Improvement, and the recommendations in a letter from Prerana Issar on 1 December 2020.

14.2 The recommendations concerned an event that happened in May 2019 when a nurse was subjected to a suspension and disciplinary process in a London Trust. In December 2020 Prerana wrote;

‘In May 2019 we shared with you an important piece of work in response to a tragic event that occurred at Imperial College Healthcare NHS Trust (ICHT) four years ago. Sadly, Amin Abdullah, a nurse who at the time was the subject of an investigation and disciplinary procedure, tragically took his own life.

The shared learning from Amin’s experience has demonstrated the need for us to work continuously and collaboratively, to ensure that our people practices are inclusive, compassionate and person-centred, with an overriding objective as to the safety and wellbeing of our people.

I urge NHS organisations to commit to tangible and timely action to review on a yearly basis and by the end of this financial year, all disciplinary procedures against the recommendations and that these are formally discussed / minuted at a Public Board or equivalent. I would also like to suggest your policy is made available on your organisation’s public website by the end of the financial year.’

14.3 The CCG reviewed in detail the recommendations made as a result of this sad event and has worked with CSU Human Resources team to amend the Disciplinary Policy, to implement all of the recommendations made. The updated policy has also been reviewed and discussed at the CPF and by the Executive Team, and all proposed changes received full support.

14.4 In addition to the recommendations outlined nationally, the CCG amended the policy to include a “Mutually Agreed Outcome” clause to further support the wellbeing of our colleagues. This was also approved by the CPF and Executive Team.

14.5 The Governing Body;

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 10 of 12

Page 12 of 210 a. recognised the references to how the CCG would support colleagues who are subject to this policy, to support their mental health and wellbeing b. noted the content of the Disciplinary Policy c. noted that this policy would be published on the CCG website d. noted that this policy would be reviewed on an annual basis

15 BSW CCG Inclusion Charter

15.1 CP, BSW Programme Lead for Transition was in attendance to present, with MA, the BSW CCG Inclusion Charter. A number of recent conversation workshops held with colleagues, as part of the work the CCG was doing to support the diversity, equality and inclusion agenda, had brought out the action of developing an Inclusion Charter. MA and CP had facilitated these discussions and supported the joint development of the Charter.

15.2 The CCG already worked in way in support of the Charter, but this was now a formalised visual tool for the CCG to use for team and self-reflection and a reminder of what the CCG wishes to achieve, bringing good etiquette and basic humanity to the organisation, building on the strong foundations of work already in place.

15.3 The Charter was an evolving document led by constant feedback and engagement, and it was recognised that there was surrounding work to do and robust conversations to be held.

15.4 Consideration had been given to making this a system level Inclusion Charter, but it had been agreed that this would currently remain at CCG level as significant work had already been undertaken to gather CCG colleague views and thoughts, and development should not be delayed. The would maintain the CCG focus as we moved into an ICS.

15.5 CP was also working closely with the BSW Equality and Diversity Inclusion Lead, Rex Webb to progress system level equality and diversity work and increase the diversity of the workforce through the Equality and Diversity Inclusion Network. Solent NHS Trust were also sharing their learning from their targeted work, which BSW would consider to increase the diversity of the workforce pool.

15.6 The Governing Body approved the BSW CCG Inclusion Charter.

(15:40hrs – CP left the meeting)

16 Communications and Engagement Activity

16.1 The communications and engagement activity report for October to December 2020 was received and noted. Quarterly reports would be brought to the Board as an action of the Communications and Engagement Strategy, ensuring the Board were kept informed of activity and ambitions.

17 Summary Report from Governing Body Committees and Other Committees

17.1 The Governing Body noted the report on recent Governing Body committee meetings.

17.2 As Chair of QPAC, JK informed the Board that an extraordinary meeting of QPAC had been held on 18 February 2021 to consider proposals to commence a four-

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 11 of 12

Page 13 of 210

month pilot for interim support of the Attention Deficit Hyperactivity Disorder (ADHD) and Autism waiting lists with AWP, whilst assessment and diagnosis appointments were arranged.

18 Any Other Business

18.1 The next CCG Governing Body meeting in public was scheduled for Thursday 18 March 2021.

18.2 There being no other business, the Chair closed the meeting at 15:44hrs.

Signed as a true record and as approved by the BSW CCG Governing Body at the meeting held on 18 March 2021:

Name:

Role:

Signature:

Date:

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 12 of 12

Page 14 of 210 BSW CCG Governing Body - Public Session Action Log - 2020-21

Updated following meeting held on 25/02/2021

OPEN actions

Meeting Date Item Action Responsible Progress/update Status 25/02/2021 3. Update on All Age Mental Health Further all age mental health update to be brought to Item added to the forward planner for July 2021. the July Governing Body meeting. Lucy Baker CLOSED

25/02/2021 13. Update on CCG People Strategy and Tracey Cox to share the BSW Academy outline Item upon the March Governing Body agenda Action Plan business case with Governing Body members. Tracey Cox CLOSED

Page 15 of 210

Meeting of the BSW CCG Governing Body Report Summary Sheet

Report Title Chief Executive’s Report to the CCG Agenda item 7 Governing Body Date 18 March 2021

Purpose Approve Discuss Inform x Assure

Author Tracey Cox, BSW Chief Executive

This report BSW x BaNES Swindon Wiltshire concerns CCG locality locality locality Executive summary The CEO regularly reports to the Governing Body on sector developments that are expected to impact the CCG, and on key issues relating to the CCG’s plans, operations and performance.

Recommendation(s) The Governing Body is invited to note the contents of this report.

1. National and Regional Developments

1.1 20/21 Q3 SW Regional & National MH and LD & Autism Deep Dive meeting

On 19th February a Quarter 3 Deep Dive Regional meeting was held with Clare Murdoch, National Senior Responsible Officer for the Mental Health and Learning Disabilities Transformation programme. The purpose of the meeting was to provide a forum for ICS/STP leads to update on 2020/21 performance, to provide an opportunity to learn from other areas, share best practice, issues, concerns and to highlight any support required from Regional & National colleagues.

The meeting highlighted the ongoing imperative to recover and transform services in response to increasing demand for mental health support and the ongoing national commitment to ensuring parity between physical and mental health. Future priorities will be to support the recovery of Long Term Plan trajectories, a focus on health inequalities and repatriation of people in Inpatient settings. The new all age Autism Strategy is due to are published this spring.

1.2 HSE COVID-19 Spot Check Inspections

HSE have been supporting the national effort to tackle coronavirus in a number of ways, including through a COVID-19 spot inspection programme.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 1 of 3

Page 16 of 210

As part of the programme, 17 acute hospitals were inspected across Great Britain during December and January. The outcomes were carefully analysed to provide an opportunity to share learning and enable trusts to swiftly identify any common areas that may need improvement. The themes identified may also be applicable across a variety of other health and social care settings and services. A summary of the recommendations are:

1) Review of risk management arrangements and their coordination across the teams 2) Ensure compliance with legal obligations to consult with trade unions and employee representatives 3) Review all non-patient facing areas to ensure a suitable and sufficient risk assessment has been carried out 4) Review the provision of lockers and welfare facilities 5) Establish routine monitoring and supervision arrangements 6) Review arrangements regularly to ensure they remain valid and act on any findings

1.3 NICE Launch 5 Year Strategy

NICE (the National Institute for Health and Care Excellence) is launching an ambitious new 5-year strategy at a webinar on 19th April to discuss how the organisation will be more dynamic and responsive and develop its products, processes and partnerships in the coming years. To register please click here.

1.4 Update on ICS Legislative Changes

A briefing on the White Paper proposals, its implications for how we work as a system and the BSW ICS Development Programme is covered as a separate item on the Governing Body agenda.

2. BSW Developments

2.1 Changing Futures Programme

Partners across BSW have been allocated £15k development grant as a system to progress the next stage of a bidding process for the Changing Future Programme. This is a pot of national funding to work with complex individuals with funding available from the Ministry of Local Government, Communities and Housing. The proposal we are working on is aimed at rough sleepers and the homeless and vulnerable females, working in a ‘test and learn process’ and then developing the models to support to deliver whole system transformation and change.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 2 of 3 Page 17 of 210

The proposals we are developing involve 21 partners. Only a maximum of 15 areas will be chosen nationally but grants of £1.5m to £4m are available over 2 years. A bid will be submitted by end of April.

2.2 BSW Mass COVID Vaccination programme

The latest position as at 8th March on Covid vaccinations is set out below. Invitations for cohort 8 going on w/c 8th March and cohort 9 w/c 15th March. We will be upscaling from 40,000 to 70,000 vaccinations per week over the next 8-12 weeks.

2.3 CQC Provider collaboration reviews – cancer services

We have been by CQC that provider collaboration reviews (PCR) of Cancer services will recommence shortly. These were originally due to take place in January but due to escalating pressures in the system a decision was taken to pause the fieldwork.

The focus of this PCR is to consider how providers are working together to ensure the provision of cancer services in light of COVID-19. CQC will carry out this work remotely, interviewing senior leaders and those involved in the provision of services across the system. CQC are also working with Choice Support, to obtain the views and understand the experiences of people have used, or are using, cancer care services and pathways.

The fieldwork in our system will begin during the week of 22 March 2021.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 3 of 3 Page 18 of 210

Meeting of the BSW CCG Governing Body Report Summary Sheet

Report Title Medical Directors Quarterly Report Agenda item 8

Date 18 March 2021

Purpose Approve Discuss Inform x Assure

Authors Dr Ruth Grabham, Medical Director

Appendices None

This report BSW x BaNES Swindon Wiltshire concerns CCG locality locality locality Executive summary The BSW CCG Medical Director regularly reports to the Governing Body, for information, about key developments surrounding the integration of providers across health and care settings, clinical pathways and clinical leadership and engagement.

Recommendation(s) The Governing Body is asked to note the report.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 1 of 4

Page 19 of 210

Medical Director’s Report for Governing Body 18/03/2021

Dr Ruth Grabham

November 2020 – February 2021

Following my last report to the Governing Body at the end of October 2020, we have had another wave of Covid 19, more severe than the preceding episodes, peaking in mid- January which has influenced the focus of work and engagement during this period.

Once again clinicians and colleagues across BSW have come together in a truly collaborative way, to look after our patients in the best way possible, while also supporting a new vaccination campaign across our area. Firstly, all clinical colleagues working for the CCG had their work programme reviewed and if it was not critical to the management of the pandemic were redeployed to work in their CCG time, at their practice, or for the vaccination programme.

Covid Virtual Ward and Covid Oximetry @Home.

A National SOP was issued by NHS E/I on 13/1/2021, for a Covid Virtual Ward, to support early discharge of appropriate patients from the acute hospitals, to relieve pressure on inpatient beds. We were able to stand up the BSW Covid Virtual Ward by 15/1/2021, by using a blended model of our existing Covid Oximetry @Home service, with increased support from secondary care. Each acute trust has a named Clinical Lead who completes a virtual weekly ward round with the Covid Virtual ward Clinical Lead for the patients they have discharged. We have taken nearly 100 patients through the ward since it became operational, one of the busiest in the South West, with very positive patient feedback.

The Covid oximetry @Home service continues to take referrals, including those patients aged between ages 40 and 50 and has managed over 350 patients to date, monitoring for silent hypoxia.

Long Covid Service

In November, in response to the growing numbers of patients reporting symptoms of Long Covid a SOP was issued by NHS E/I to set up a new service.

We have created a multi-agency and multi-disciplinary assessment and treatment pathway to support people with long Covid. The team has received127 referrals from across our footprint with an age range of 15 to 83 since the model was launched in December 2020. The assessment process was co- designed across our ICS and includes a virtual MDT with respiratory, cardiology, chronic fatigue, psychology, occupational health, GP, physio and community team expertise drawn in from across our provider partners. Patient feedback continues to be very positive.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 2 of 4 Page 20 of 210

Clinical Leadership and Engagement

A considerable part of my role includes facilitating joint working across BSW which the examples above demonstrate. As we went into the third wave of Covid we stood back up our Clinical Reference Group, with lead clinicians from across all BSW providers, where we share any operational issues and clinical concerns .This is co-chaired by our Director of Nursing and Quality, Gill May and myself. Clinical advice and support was also provided for example, in discussions on Critical Care Mutual Aid across the acute providers, assurance of our large vaccination site and PCN sites, a referral pathway for vaccination of patients with history of allergy and in the South West Ethical Reference Group.

Medicines Optimisation

The Director of Medicines Optimisation(MO) and Clinical Policies is now working full time supporting the vaccination programme, apart from Clinical Policies, so work programmes have been revised to take account of this ,with our associate Directors of Medicines Optimisation leading on our business as usual. Other colleagues in the team are also supporting the roll out of the vaccination programme operationally.

Given the redeployment of a number of the team, to assure ourselves that we were still going to deliver on savings set against our budget, we reviewed the data. Overall, the MO team is able to deliver the planned savings for 20/21 with a potential shortfall of £17K on £2.8m. The MO team is prioritising business as usual through our Prescription Ordering Direct service, and in savings delivered by the pharmacy technicians in spite of the various challenges in the current climate. In reality, our capacity to over deliver on QIPP as in previous years is what is more limited and our limitations are directly COVID related.

Operationally, the MO team has been able to use GP forward view funding to recruit additional call handlers to enable the Prescription Ordering Direct service to support more practices and care homes in BaNES and Wiltshire. It has also recruited additional dietitians and seconded a stoma nurse from SFT to support practices in the review and optimisation of prescribing of foods and stoma products across BSW. Discussions are also underway with both SFT and RUH to rotate their band 6 pharmacists through the CCG medicines optimisation team following the model already in place with GWH. The aim is to have both rotations in place by August.

The CCG Medicines Optimisation Group has a remit of providing advice and guidance to the CCG and encourage and develop PCN engagement in Medicines Optimisation. Its meetings have been paused to enable clinicians to support the Covid response but now discussion is ongoing to determine if they have capacity to resume meetings. Responses so far suggest the meeting will be able to recommence shortly.

System wide, our work on Integrating Pharmacy and Medicines Optimisation (IPMO), has recommenced. We are expecting specific reference to the IPMO requirements, in the near future ICS planning guidance, by the end of April from the national group. Our BSW Chief

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 3 of 4 Page 21 of 210

Pharmacists are meeting fortnightly to identify plans for key pieces of work to achieve MO at scale to improve patient outcomes and value for money.

Population Health and Care Group

Our system wide meeting tasked with looking at how to use Population Health Analytics in developing a new model of care for BSW, was stood down during the third wave given the clinical roles of the committee members and reconvenes this month.

However, BSW will be participating in a national programme which aims to support the adoption of Population Health Management (PHM) approaches. This is a 20 week externally supported action learning programme which works to link local data, build analytical skills, design and deliver new models of care, risk stratify the elective backlog and explore alternative models, develop new population based blended payment models and evaluate impact of interventions. We are working with the National Programme Team to establish the required information governance arrangements and will be receiving an update from a clinical lead in Dorset, who has been participating in an earlier phase of the programme. We are also in the process of recruiting some Primary Care Networks to take part.

On March 25th we are holding the first of a series of meetings, looking at a potential new care model for BSW, informed by population health management and learning from work being undertaken in localities to date. The first session aims,

• To reflect on what has made other systems successful in delivering significant change in the way population health is delivered. • To share the current thinking on how population health will be delivered (Integrated input from Localities, Provider Collaboratives, LTP Programmes). • To identify the actions we will take together to deliver the change.

The desired outcomes of the session are:

• A shared understanding of how we intend to make Population Health real. • A shared understanding of the implications on how we need to change our way of working and behaviours to make it happen. • An agreed set of actions for how we are going to take it forwards.

The first session includes clinical and professional colleagues with BSW transformational leads, who will then work to deliver some first thoughts to share more widely across the system, in a series of meetings over the next 6 months.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 4 of 4 Page 22 of 210

Meeting of the BSW CCG Governing Body Report Summary Sheet

Report Title BSW Performance, Quality and Finance Agenda item 10 Report Date of meeting 18 March 2021

Purpose Approve Discuss Inform X Assure

Executive lead, Richard Smale – Executive Director Strategy and Transformation contact for enquiries Gill May - Executive Director of Nursing and Quality, Caroline Gregory- Director of Finance Contact: relevant team for specific queries, report production: Danielle Harris/ Fiona Newton This report concerns BSW X BaNES Swindon Wiltshire CCG locality locality locality This report was BSW Partnership Executive group received the full BSW reviewed by Performance report at the 12 March 2021 meeting. QPAC received the Performance and Quality section at the 11 March 2021 meeting. Executive summary COVID – Prevalence in our communities is showing a decrease in all localities resulting in a reduction in hospital admissions and deaths at all 3 acutes. However, Swindon currently has the highest case rate for the South West. As at 2nd March 2021 there are 14 patients across BSW who require Level 3 ITU Care. For the same time period, there are 100 inpatients who are Covid positive.

Planned care - Waiting list size and long waits continue to grow however, activity levels have improved compared to December and January with improvement in the latter half of February. Work continues in all three trusts to reduce 62d and 104d breaches back to or below historic levels, and is now close to being achieved at GWH and RUH. Diagnostic activity in CT and MRI has also been impacted but endoscopy continues to perform well.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 1 of 4 Page 23 of 210

Report Title BSW Performance, Quality and Finance Agenda item 10 Report Updated BSW Think 111 communication plan being developed. Initial Winter Debrief event being planned for May ahead of 21/22 Winter planning. SHREWD - Review of each of the resilience dial segments with subject matter experts have commenced and reporting back to oversight group. Self assessment of the Hospital Discharge policy completed for the acutes and localities, focus on completing community assessments and the development of system gap and improvement action plan. 111 provider in national contingency during February due to covid outbreak in call centre, and a between 30-50% of calls diverted to other providers at times. Key risks - Ambulance Handovers – system quality improvement event in March to identify leadership, incident response, escalation as a result of Ambulance delays and incidents. Increase in non criteria to reside patients, increased acuity and lack of physical capacity in department contributing to handover delays.

Mental Health – Routine referrals into AWP have restarted with a reminder of advice and guidance options to support alternatives. Shared care and ARRS collaborative events planned for March with AWP and Primary Care to continue to build relationships. We have seen during end of February and early March a further increase in activity and acuity particularly in relation to section 136. We are developing a system wide proactive comms messaging supporting self help and early intervention. We have confirmed funding for our three community wellbeing houses to continue for 21/22 from the national team along with securing revenue costs for our fourth community facility.

Primary Care – Continued pressure in primary care with impact of Covid on workforce and throughput. Hot hubs continuing at four sites. Vaccination programme underway and all Primary Care Network (PCN) areas are live with circa 250,000 vaccinations delivered to date. Significant challenge expected during March and April as 2nd doses need to be delivered in parallel with continued 1st dose delivery. Oximetry at home has now launched across the patch and is being supported by Medvivo with 8000 oximeters available. 270 patients have accessed this service to date. Think 111 programme continues; latest enhanced MCAS validation data indicates approximately 84% of patients are downgraded to an alternative service other than ED or UTC or directed to self care. Current provider has experienced outbreak in call centre which has seen between 30-50% of calls diverted nationally to be answered during February.

Finance – NHS BSW System

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 2 of 4 Page 24 of 210

Report Title BSW Performance, Quality and Finance Agenda item 10 Report At month 10 our YTD plan is £15.6m deficit, we are reporting a deficit position of £9.4m a positive variance of £6.2m. Of this £5.4m relates to the CCG, £1.3m relates to SFT and £0.5m relates to GWH. RUH are reporting a YTD adverse variance of £1m. Included in the position is £3.9m income relating to the hospital discharge scheme which is expected to be reimbursed. Our year end forecast is £17.6m deficit a positive variance of £7.5m, this mainly relates to the CCG improving its forecast outturn by £8m. SFT is also improving it’s forecast position by £1.2m as a result of genetics income. GWH and RUH forecasting to overspend against their plans, GWH by £0.8m and RUH by £1m this is mainly due to increased annual leave accruals as a result of staff being unable to take leave.

Equality Impact BSW CCG is committed to working to better understand the equality Assessment and diversity issues that exist and how we can use our approach to performance and quality to improve our response on issues of equality and diversity. Our approach to performance and quality will enable us to measure our success in addressing this, and demonstrating this through our performance reporting. We have included supporting detail in the report on inequalities and will continue to expand and develop this further as a priority.

Public and patient N/A engagement Recommendation(s) Governing Body is invited to note the contents of the BSW Performance, Quality and Finance Report. Link to Board • BSW04 – Ambulance Response Assurance • BSW26 – Covid- 19 2nd wave Framework • BSW22 – Workforce or High-level Risk(s) • BSW06 – Provider Elective Performance • BSW29 / BSW30 – Financial Risks & Covid-19 • BSW23 – Mental Health Performance Targets • BSW44 – Winter pressures demand (Urgent Care Performance)

Risk (associated with High Medium Low N/A X the proposal / recommendation) Key risks N/A

Impact on quality Quality impacts linked to the performance of the organisation are detailed within the report.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 3 of 4 Page 25 of 210

Report Title BSW Performance, Quality and Finance Agenda item 10 Report Impact on finance Financial impacts linked to performance of the organisation are identified in the Finance and Activity reporting. Finance sign-off: Caroline Gregory x

Conflicts of interest N/A

This report supports ☒ BSW approach to resetting the system the delivery of the ☐ Realising the benefits of merger following CCG’s ☒ Improving patient quality and safety strategic objectives: ☒ Ensuring financial sustainability ☐ Preparing to become a strategic commissioner This report supports ☒ Improving the Health and Wellbeing of Our Population the delivery of the ☒ Developing Sustainable Communities following BSW ☒ Sustainable Secondary Care Services System Priorities: ☐ Transforming Care Across BSW ☐ Creating Strong Networks of Health and Care Professionals to Deliver the NHS Long Term Plan and BSW’s Operational Plan

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 4 of 4 Page 26 of 210 BSW Performance, Quality and Finance Report

BSW CCG Governing Body March 2021

Page 27 of 210 Aim- To produce a BSW system wide integrated performance, quality and finance pack, which is not just a vehicle to share data but a report which combines analysis with narrative, focussing on highlighting and reviewing the key pressures, patient safety and quality issues in the system by exception, and reporting on what matters to BSW in an agile way - not just constitutional performance.

• High level system wide measures and indicators which underpin and determine the pathway summaries. • Working towards being automated so that we have an at a glance dashboard view of all of our BSW metrics and traffic light system to show where there may be issues and also where things are going well. Performance • Mixture of constitutional measures and what's important to the system and our population, and highlights areas of pressure. Performance Framework • Accessible to all system partners, with regular analytical review and ratification of data outputs. and Quality report • System performance and quality overview for Urgent Care (by Locality) Covid-19, Planned Care (inc recovery) Mental Health, Primary Care, Finance and Workforce. Framework System overview Presented as a “donut” diagram where appropriate, similar to SHREWD presentation. summaries • Represents a overall position on a page using a rag rating and executive narrative to Report give a summary view.

• Second tier of indicators from a repository of system wide data to enable further analysis, providing more information for stakeholders to understand the drivers of performance and quality to support transformation and improvement across BSW. Secondary Indicators • Indicators agreed with localities and boards with input from all partners across the system. Self service routine reporting available. • Supports exception reporting and detailed locality review

• Performance, BI and quality team will provide initial narrative and points of interest, working with nominated sponsor to agree what should be analysed further and presented to relevant boards for further review and tell the story, including focus By exception reporting/deep dives on patient safety and experience. • Exception reporting to be supported (and owned) by all partner organisations. • Build on using population health approach to support.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 28 of 210 Contents

• BSW System Status 4-5 Timing of information in this report: Please note the information used in • Performance Framework 6 this report is the latest available information from each source at the • Urgent Care Focus 7-9 point the report was collated. This can mean similar data from • Locality Focus 10 different sources will not be from the same period. Managing the pandemic has driven • COVID-19 Focus 11-13 the creation of new local data sources for some data but we will • Planned Care Focus 14-18 also use the national validated data sources for more detailed reporting • Phase 3 Activity Focus 19 where available. Over the coming months the CCG and all BSW partners will be working • Mental Health Focus 20-25 together to develop data flows to support the development of the new • Primary Care Focus 26-28 performance framework. • Finance 29-32 • Data Sources 33

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 29 of 210 BSW System Status

Urgent Care – System wide escalation plan still under review. Capacity and Demand planning continuing to review current capacity and demands with a focus on Easter planning in March and potential impact of lockdown restrictions roadmap to be understood. Updated BSW Think 111 communication plan being developed. Initial Winter Debrief event being planned for May ahead of 21/22 Winter planning. SHREWD - Review of each of the resilience dial segments with subject matter experts have commenced and reporting back to oversight group. Self assessment of the Hospital Discharge policy completed for the acutes and localities, focus on completing community assessments and the development of system gap and improvement action plan. 111 provider in national contingency during February due to covid outbreak in call centre, and a between 30-50% of calls diverted to other providers at times. Key risks - Ambulance Handovers – system quality improvement event in March to identify leadership, incident response, escalation as a result of Ambulance delays and incidents. Increase in non criteria to reside patients, increased acuity and lack of physical capacity in department contributing to handover delays.

COVID – Prevalence in our communities is showing a decrease in all localities resulting in a reduction in hospital admissions and deaths at all 3 acutes. However, Swindon currently has the highest case rate for the South West. As at 2nd March 2021 there are 14 patients across BSW who require Level 3 ITU Care. For the same time period, there are 100 inpatients who are Covid positive.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 30 of 210 BSW System Status

Finance – NHS BSW System -At month 10 our YTD plan is £15.6m deficit, we are reporting a deficit position of £9.4m a positive variance of £6.2m. Of this £5.4m relates to the CCG, £1.3m relates to SFT and £0.5m relates to GWH. RUH are reporting a YTD adverse variance of £1m. Included in the position is £3.9m income relating to the hospital discharge scheme which is expected to be reimbursed. -Our year end forecast is £17.6m deficit a positive variance of £7.5m, this mainly relates to the CCG improving its forecast outturn by £8m. SFT is also improving it’s forecast position by £1.2m as a result of genetics income. GWH and RUH forecasting to overspend against their plans, GWH by £0.8m and RUH by £1m this is mainly due to increased annual leave accruals as a result of staff being unable to take leave.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 31 of 210 Performance Framework

Quality Metrics

17 Serious Incidents – Main types being pressure ulcers and treatment delay 12 CCG formal complaints – main theme access to services 179 CCG PALS enquiries - top theme for February was access to COVID-19 vaccinations for housebound patients

RAGs: Achieving standard = Green; Below standard = Red; Standard to be defined = Grey.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 32 of 210 Urgent Care Focus- Ambulance Delays Data Source: Urgent Care & Flow Report • Reduction in the number of Ambulance Handover delays seen in February. Most delays occur in the out of hours period where there is limited escalation. • Ambulance risk has been reviewed with updated mitigating actions captured on the corporate risk register • South West regional ambulance transformation plan has been paused and a reprioritisation exercise is being undertaken to prioritise a reduction in activity and an improvement in ambulance call cycle time • Two serious incidents investigations in progress where ambulance handover delays contributed. Emerging themes of pre-alert process and risk assessment of patients queuing. • Moderate harm incidents reported with themes of pain management, falls risk and deteriorating patient • Deep dive of 3 patients who experienced long handover delays of over three hours in progress to analyse potential alternative pathways, suitability of conveyance and potential harm. • Retrospective review of serious incidents undertaken to understand implication of ambulance handovers on resource allocation delays and call stack. Five incidents identified, further analysis of handover delay implication needed.

BSW - Handovers Taking > 60 minutes (3 Acutes)

700

600

500

400

300

200 Handovers > Taking 60 - minutes (3 Acutes) (3 minutes 100 BSW 0 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov- 20 Dec-20 Ja n-21 Feb-21 BSW - Handovers Taking > 60 minutes (3 Acutes) Mean Lower CL Upper CL

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 33 of 210 Urgent Care Focus- Criteria to Reside Data Source: Urgent Care & Flow Report • Standardised approach to presenting Criteria to Reside at Locality and System level implemented. • Data on Oximetry Project in Jan 2021 now included in daily thresholds dashboard. • Virtual frailty ward pilot commenced. • Discharge workshop with NHSE colleagues planned for Feb. • Revised trajectories (NHSE Letter Dec 23rd 2020) built into daily report on Admissions, Discharges and demand. • Discharge dataset built in SHREWD for live use in Feb 2021. • Review local improvement plans to identify delays in patients leaving the Trust on the same day before 17:00pm. • National Discharge Policy self assessment underway.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 34 of 210 Urgent Care Focus- Care Home Capacity B&NES Locality – as part of surge capacity spot purchased a further 16 D2A beds. However, on-going concern about the impact of Covid on residents and staff with a number of homes closed to placements and visitors (14 as of 5th February), except health & care practitioners. Council and CCG working together to provide IP&C support. RUH undertaking a RCA of a number of individuals discharged to care homes who later tested positive recognising there are challenges in mitigating all risks. However, designated setting beds have worked well and considering the need for these into 2021/22 Wiltshire Locality – The system continues to support care home providers with the Local Authority leading on this, with advice from the Wiltshire Care Home Advisory Group. Care Home closures continue to be a concern and are closely monitored. Provider Forums continue to be held. Designated beds across Wiltshire are under review currently. The Designated Unit in a Care Home will be supported to swing capacity back to IR and D2A beds by the end of March 2021. Swindon Locality – Notice has been given on the ten designated setting beds in place known as Poppy Unit and this contact will cease at the end of March. There are currently no patients in this setting and work is underway to utilise the beds for D2A for the duration of March. Vaccinations – 91% of residents, 75% of employed staff and 44% of agency staff have received the first vaccination dose. The Swindon Care Services Cell has met in its new form and will be looking at all projects linked to the care sector. Some funding has been allocated to provide workshops to start developing Swindon’s care home and PCN MDT and this is in the planning stages. .

Data extracted: 3rd March 2021 Care Home Indicators BaNES Swindon Wiltshire BSW Occupancy Rate - Nursing Homes: 80% 76% 83% 80% Occupancy Rate - Residential Homes: 78% 89% 79% 81% Occupancy Rate - Other*: 0% 54% 84% 69% Occupancy Rate - Total: 79% 83% 80% 80% Residential Home occupancy per 100,000 population aged 18+: 299 322 424 373 Nursing Home occupancy per 100,000 population aged 18+: 285 218 186 215

NHS Bath and North East Somerset, Swindon and Wiltshire CCGData Source: February Urgent Care & Flow Report and Care home capacity tracker as at 04/02/2021 Page 35 of 210 Urgent Care Focus- Locality Updates B&NES Swindon Wiltshire

• Hospital at Home pilot (formerly known as virtual • 4hr performance has improved at GWH to 95% and • Locality are working to review the plan to deescalate the frailty ward) commenced at the beginning of over. extended community capacity opened in January January led by the RUH. 10 patients have now • GWH patients with a LOS >21 days are below 40, • SFT recovery sustained in February been discharged to this service. the lowest compared to SFT and RUH. • Discharge Service Standards gap analysis completed, • Paulton MIU re-opened 22/2 with opening hours • Home First pilot started with Trauma ward reviewing next steps with this work 8-8pm 7 days. • Low Partner discharges across Swindon, Wiltshire • Working with partners to plan for Q1 cessation of HDP • Additional surge capacity commissioned to and Out of Area. Now focussing on amber funding and developing mitigations th support discharge and flow given pressures in referrals. –Retain domiciliary care until 13 May 2021 reablement, including D2A beds and home care • Virtual ward pilot continues to run successfully. –designated unit care home beds and South Newton capacity until end of March 2021 • Additional therapy capacity (2.6 WTE) Now has designated project support. • SFT, GWH and RUH sustaining reduction achieved in commissioned to support reablement teams • Frailty at the Front Door project underway. the number of Wiltshire patients with no-criteria to reside • Staffing to open 12 additional beds in • Notice has been given on designated setting beds – looking to use as D2A capacity until end of March. • Rapid response case – recruitment almost complete – community hospitals to support flow implementation group in-place from February and joint • Continued focus on patients not meeting the • Review and re-design of Care Home reporting from GWH which will support the Trusted Assessor health and social care model to start in April 2021 criteria to reside with improved reporting model. • Home first expansion – Recruitment in progress and • Additional metrics added to Virgin Care Sit rep • Awaiting update on the SHREWD discharge dial to some new staff have started in-post, mapping the to give greater oversight of flow across the taken in to account C2R/NC2R data staffing profile from May 2021. community • Virtual frailty – Care Home support working well and expanding (17 homes) • Two MIUs have re-opened SHREWD Position as at 02-Mar:

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 36 of 210 COVID19 Focus Cases and prevalence overall for BSW CCG continued to reduce steadily during February in-line with trends nationally. However, Swindon’s case rate has been more changeable – rising slightly from mid February for around 5 days before starting to fall again. Swindon now has the highest rate per 100,000 in the South West.

Page 37 of 210 Page 38 of 210 Page 39 of 210 Planned Care Focus- P2 Capacity

P1 & P2 activity has been maintained, with a small volume of P2 activity agreed as planned transfers to independent sector providers. Weekly assurance is reported to NHSE and no requests for mutual aid have been required.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 40 of 210 Planned Care Focus- Long Waiters • Independent Sector (IS) continue to provide support to longest waiters across NHS and IS waiting lists as well as clinically priority patients suitable for transfer to their clinical settings. • Quality metrics for independent sector providers do not identify any safety or experience concerns. However, reporting has not been received for all providers due to the contracting arrangements in 20-21. • ClearPTL (North-East CSU developed tool) available and elective care board reviewing it’s use as it does not include independent sector waiting list information. • Quality and Safety sub group of elective care board has collated information on clinical harm review processes and risks for discussion at next Elective Care Board. An update is provided as part of the QPAC Agenda this month. • Planning process focusing on recovery and modelling activity for Q1 as well as Q2 onwards (for formal operational plan submission).

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 41 of 210 Planned Care Focus- Cancer • Further deterioration in breast symptomatic 2 week waits to 7.7% (lowest of 2020/21), accompanied by an increase in breaches for suspected breast cancer, mostly due to inadequate Outpatient capacity at GWH and SFT. • Slight improvement in 2ww overall, but Outpatient capacity issues remain for breast and Lower GI. Skin breaches have reduced significantly. • The Quality Team have not seen an increase in cancer related serious incidents or complaints. • 62 Day Performance well above England average of 75.2% and GWH achieved 62 Day target for Q3 (Oct-Nov-Dec) at 86.3%.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 42 of 210 Planned Care Focus- Cancer Inequalities

• Cancer cases have higher prevalence in wealthy populations • White British and Irish appear to have the highest percentage • Among the total population of 901,534, there are 41,567 (4.61%) cancer patients, 22702 (54.6%) female and 18,865 (45.4%) male • f cancer cases

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 43 of 210 Quality Overview • 21 Serious Incidents were logged across all BSW providers in January 2021. The top reported category of incident was treatment delay and maternity/obstetric (still born births). A new identified theme relates to the handover of ambulances at A&E with two SIs relating to patient death, investigations are underway. Quality leads are in discussion with providers concerning themes and implementing actions from learning. Acute Care themes continue in: – COVID outbreaks and nosocomial infections – Monitoring of the deteriorating patient: • Use/Calculation of NEWS2 • Clinical ownership • Requesting and following up of test results • Following clinical pathways/guidelines, including how temporary staffs are supported to do this. • Escalation in line with protocol. – Use of the World Health Organisation (WHO) Surgical Safety checklist in theatres – ED management of head injuries. – Out of Hours Service protocols for non-mobile children and treatment of unexplained injury.

• Pressure Ulcers and Inpatient Falls remain a regular incident trend across both community and acute services. Providers have in place improvement plans to address learning and identified themes from incident investigations.

• Complaint themes for providers in Q3 have identified Clinical care, communication and staff behaviour.

• Concerns have been expressed about the quality and safety of patient discharges, with GWH identifying this as a theme from quality intelligence. A quality improvement work stream is underway with a focus on end of life discharges. Anecdotal examples from across the BSW system have also been given, e.g. patients going home without their house keys, medication not provided completely, and communication issues with families. The Wiltshire Discharge Service Catch Up Group (multi-stakeholder discharge leads) have requested clarification processes for LA and care homes to report potential incidents to providers. The Wiltshire Quality Lead is engaged in discussions to provide this and support quantifying themes or trends. The Quality Lead for Urgent Care will also raise this at the Urgent Care and Flow Board for discussion.

• The Elective Care Clinical Harm Review Task and Finish Group is progressing to explore potential harm to patients as a result of long wait lists. A specific query has been highlighted regarding risk of harm on paediatric wait lists and the longer term impact on developmental outcomes. This is in the process of being explored as a standalone issue for which learning will also be fed into the wider task and finish group under the Elective Care Board. At this stage no trust has identified any paediatric risks through their internal reviews.

• Mortality levels at SFT and GWH remain in expected tolerances, with RUH HSMR being higher. RUH are aware and are taking steps to address this, it is believed a coding issue is contributing to this increased HSMR. The Quality Lead will be attending the RUH Mortality Surveillance Group going forward. Providers are undertaking mortality reviews/SJR’s for COVID deaths. The findings will be shared with Quality once completed.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 44 of 210 Phase 3 Activity Focus • Most recent weekly (unvalidated) data shows a sustained dip in performance versus phase 3 plans for elective activity. However this does not reflect the activity taking place in the independent sector which is supporting the overall elective capacity. There remains variance in recovery between specialities which is the subject of further review within Trusts. Further GIRFT (Getting It Right First Time) work is underway for orthopaedics and ophthalmology. • BSW CCG are low in the South West region for virtual appointments – outpatient transformation group will be discussing actions to respond to this information.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 45 of 210 Mental Health Focus

BSW Community Transformation Framework Proposal

Our collaborative response to the national community mental health framework was submitted on March 3rd 2021as per the revised national deadline. We await feedback from the national and regional team with plans to commence our seven BSW PCN pilot sites from April 1st 2021.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 46 of 210 Mental Health – Performance Measures

Metric Target / Q 1 Q 1 Q 2 Plan Q 2 Q3 Q3 Ambition Plan Actual 20/21 Actual Plan Actual 20/21 20/21 20/21 20/21 20/21 E.H.9 CYPMH 35% 5,285 5,055 5,414 4,825 5,519 - (rolling 12 months) Access 32.18% 30.80% 32.96% 29.38% 33.6% 28.6% Nov 20 A deep dive is being planned for CYP access for April 2021 – linking to regional work. This is to understand end to end pathway waits and links to proactive demand and capacity work being undertaken

E.A.3 IAPT 25% 2,165 2,315 3,274 2,885 4,210 - IAPT deep dive to be reported March 2021 to develop clear Roll out (6.25% Q4) 2.31% 2.47% 3.50% 3.08% 4.50% actions in relation to waiting times and access

E.H.13 SMI 60% 1,220 1,220 1,400 1,063 1,600 1,113 New holistic model has gone live in Swindon to improve uptake Annual Health 19.12% 19.12% 23.03% 16.84% 26.3% 17.04% and quality of SMI AHCs. Rapid role out to Wiltshire and BaNEs Checks being planned. Exploring links to covid vaccination work to create one stop facility for this population and to address heath inequalities.

E.H.17 SMI Continued 297 299 315 353 333 316 As per LTP plan Individual Improvem From Richmond Fellowship Quarterly monitoring return. Qtr 3 Placement & ent drop in new referrals. Support

E.K.1a Adults Continued 17 17 22 22 19 21 Plans based on actual at Q1 and Q2 >18 LD reduction Now at 20 – mini MADE event across BSW for all MH/LD/ASD Inpatients placements being held on 18th March 2021.

E.K.1c Continued 5 5 5 5 5 8 Q4 Plan = 4 children’s <18 reduction Mini MADE event across BSW for all MH/LD/ASD placements LD inpatients being held on 18th March 2021.

E.K.3 LD 75% 80 79 315 326 942 - Agreed to move to update full year plan to 60% moving in line Annual Health 1.7% 1.7% 6.7% 6.9% 20% with SW CCGs. CCG local position at Q3 1,317 (27.9%) and Checks (YTD) (YTD) (YTD) 1,866 (39.6%) as at 8th Feb 2021. New model to support clearing backlog commencing 8/03 in Chippenham – 135 pts in first cohort. Will include covid vaccinations where possible. NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 47 of 210 BSW CCG - Oxford Health Month 10 2020-21 Children Eating Disorder service lines Source: Oxford Health reporting App

The number of referrals and attendances for Eating Disorders has been increasing during 2020-21 and is an increase on the 2019-20 levels. The first to follow-up appointment ratio is approximately 1:16.

This is impacting the National target of seeing 95% of Urgent referrals within 1 week and 95% of Routine referrals within 4 weeks. The charts on the next page show the Nationally reported rolling 12 month performance, and the locally reported monthly performance. BSW is performing better than England, but following the same trend.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 48 of 210 BSW CCG - Oxford Health Month 10 2020-21 Children Eating Disorder service lines

source: NHS England Statistics Urgent cases: % ED Referrals assessed within 1 week (National Routine cases: % ED Referrals assessed within 4 weeks (National Target 95%; Phase 3 Plan 86.8%) Target 95%; Phase 3 Plan 92.1%)

Source: Oxford Health reporting App

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 49 of 210 Mental Health Focus- SMI Physical Health Checks The BaNES locality has the highest recorded percentage of all 6 health checks being carried out. 16% of BSW’s most deprived population have had all 6 health checks, Alcohol status was the least recorded health check for this group of our population. However there is no statistical correlation between deprivation and the likelihood of having all 6 health checks. This is also true for Ethnicity, however Ethnicity recording needs to be improved with 1,188 records on the SMI register without Ethnicity populated.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 50 of 210 Mental Health - Quality AWP Safeguarding Deep Dive – Feb 2021 QA Meeting • AWP, BSW and BNSSG CCG’s completed a focused deep dive conversation on Safeguarding provision across the Trust after recognising themed learning from investigations, CQC findings and risks associated with team capacity. It was also recognized that the pandemic and increased service demand has impacted the Trust’s ability to move forward on the quality improvement programme. • Recruitment is underway for 6 additional posts within the safeguarding team to provide additional operational capacity. • The CCG’s committed to working collaboratively with AWP and the wider system to support collaborative learning and quality improvement aligned to the safeguarding workstreams.

AWP CQC Report • Two unannounced focused inspections of AWP core services were completed in December 2020. Reports published on 10 February 2021. CQC visited Swindon recovery team, North Wiltshire CMHT, Swindon intensive service, North Wiltshire intensive service, BNSSG and BSW community perinatal services. CQC team also visited the forensic/ secure services. • Inspection findings were broadly positive. Issues identified by the CQC were already known to AWP. Only one requirement notice was issued for Regulation 12 Safe Care and Treatment “The trust must ensure that risk assessments and risk management plans are updated in response to new or changing risks”. • Two recommendations were made - “Trust should ensure that initiatives to increase recruitment in teams with vacancies are continued and that there is enough suitably qualified and skilled staff to meet patient needs” and “The trust should continue to implement, and monitor progress with, their action to improve safeguarding processes”. • Core service ratings remain unchanged. Updated CQC action plan will be shared by AWP to be discussed via AWP Quality Assurance Meeting.

Huntercombe Hospital (Maidenhead) CQC Report • 60 bed independent hospital in Berkshire offering CAMHS PICU, Eating Disorder and GAU beds has been rated inadequate by CQC. Report published on 17 February 2021. • Concerns centred on two PICU wards Severn and Thames. Issues identified with risk assessment, risk management, care planning, medicines management , consent to treatment, parental involvement, staff training, governance, and oversight by senior leaders. • Five BSW patients at hospital, reviews completed by Oxford Health to provide assurance of safety and discussed at BSW MADE event. x3 case managers from the provider collaborative have been embedded for quality oversight of all wards. Currently patient transfers not mandated by NHSE/CQC but this will be monitored, including sourcing family/carer views..

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 51 of 210 Primary Care Focus- GP Appointments

Historically, Primary Care's main mode for appointments was face to face. This changed dramatically during the peak of the COVID pandemic as practices were asked to adopt a Total Triage system.

Practice activity increased in January and February, whilst this was initially attributed to Flu Clinics (just over 100,000 appointments booked week ending 4th Oct – returning to the numbers seen in February pre COVID), current activity can potentially be attributed The contact mode (face to face, telephone or DNA) is ascertained by using a combination of 'appointment flags, rota name and appointment status. to the COVID vaccination Some practices only identify the mode at slot level and therefore this detail is not available. Swindon sitrep data does not include the appointments programme. delivered via the Success (Medvivo) model – these are reported separately.

Number of Video Consultations by Week

BaNES Locality Swindon Locality Wiltshire Locality 400 700 2000 1800 350 600 1600 300 500 1400 250 400 1200 200 1000 300 150 800 200 600 100 100 400 50 200 0 0 0 21/04/20 17/05/20 31/05/20 14/06/20 28/06/20 12/07/20 26/07/20 17/08/20 02/09/20 16/09/20 02/10/20 16/10/20 30/10/20 13/11/20 04/12/20 18/12/20 25/01/21 21/04/20 17/05/20 31/05/20 14/06/20 28/06/20 12/07/20 26/07/20 17/08/20 09/09/20 23/09/20 09/10/20 23/10/20 06/11/20 20/11/20 11/12/20 04/01/21 18/02/21 21/04/2020 17/05/2020 31/05/2020 14/06/2020 28/06/2020 12/07/2020 26/07/2020 17/08/2020 02/09/2020 16/10/2020 30/10/2020 13/11/2020 04/12/2020 18/12/2020 25/01/2021 16/09/2020 02/10/2020

The figures here show the number of video consultations made by locality - these figures are a subset of the telephone appointments in the above chart. At the height of the pandemic, approximately 3% of telephone consultations contained a video consultation element. This has now dropped to 1% and continues to drop as practices are able to offer more face-to-face appointments with the Flu Clinics now in decline and being overtaken by the COVID vaccination programme.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 52 of 210 Primary Care Focus- Flu Vaccinations As at w/e 31st January 2021, BSW’s Flu vaccination rates are generally equal to or above national levels. The 50-to-64-year-old group is the clear outlier in terms of BSW’s gap to achieving the national ambition. Flu data for the winter season has now ended so this is our final position.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 53 of 210 Primary Care Quality Priorities and Actions Serious Incidents Reported by Locality Patient Experience 4 50 40 3 30 20 2 10 0 1 Staff… 0 Waiting…

2017/18 2018/19 2019/20 2020/21 and… Care and… Care Accessto… Accessto… Discharge… Financial/Po… Information… Accessand… Communica… Communica… Managemen… Environment Swindon Wiltshire ClinicalCare ClinicalPolicy Update Priorities BaNES Swindon • The Quality Team continues to offer ongoing support • Due to the current pandemic pressures the timeline for to all practices across BSW the Governance Toolkit, incident training and flow chart • All practices are supported by the CCG to investigate for raising Safeguarding alerts, NRLS Incidents, Patient Serious Incidents when they occur. There is variation Complaints and GP Feedback has been revised. This between the three localities in the use and rate of continues to be a high priority for the team to implement reporting mechanisms. There has been a reduction in and will be carried out as soon as practicable. incident reporting due to the pandemic • Ongoing support to practices responding to CQC • There have been 111 PALS contacts, with the main inspection outcomes. concern received related to access to services. The • Establishing the first Quality and Risk Review Group main theme for the contacts related to the Covid across BSW. vaccination programme. The team are working with all • Continued development of the Primary Care dashboard providers to improve outcomes. • Support for strengthened governance models across • Nine formal complaints were received and 4 practices. compliments were received of which 3 are relating to • Promoting Freedom to Speak Up and positive safety the vaccine programme culture. • The Quality team continue to support Care Homes with the use of pulse oximetry and Restore 2

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 54 of 210 Financial Targets (M10) M1-M12 / £'m YTD / £'m Target Forecast RAG Target Actual RAG Revenue expenditure not to exceed allocations 1,480.1 1,500.9 R 1,229.7 1,238.2 R Capital expenditure not to exceed allocations 0 0 G 0 0 G Administration costs not to exceed the allocation 18.5 17.5 G 15.6 14.6 G Better payment practice code % of NHS invoices paid within target (value) 95% 99.6% G 95% 99.6% G Better payment practice code % of NHS invoices paid within target (number) 95% 91.3% A 95% 91.3% A Better payment practice code % of non NHS invoices paid within target (value) 95% 98.1% G 95% 98.1% G Better payment practice code % of non NHS invoices paid within target (number) 95% 97.1% G 95% 97.1% G Operate within cash resources G G QIPP % achieved 85% n/a G 85% n/a G Delivery of cumulative surplus 0 0 G 0 0 G Delivery of in year surplus requirement (15.0) (20.8) R (10.0) (8.5) R MHIS spend requirement to meet target (non-core and core service spend) 124.8 128.2 G 104 105.9 G

At M10 the CCG was forecasting a deficit of £20.8m and had a year-to-date deficit of £8.5m. With anticipated reimbursement for costs associated with the hospital discharge scheme, the deficits reduce to £7m for the year and £4.6m year-to-date. The full year deficit has reduced by £6m in month and is now £8m better than plan.

During M11 the CCG has received additional funding which will enable further improvements and we expect to report a breakeven or small surplus position at M12. At M11 the two red rated metrics will become green.

Performance against invoice payment terms has improved but remains below target in terms of number of NHS invoices paid. We are achieving all targets by value.

MHIS target spending for 20/21 is £124.8m and we are currently forecasting to exceed this.

Page 55 of 210 Adjusted Forecast (M10) Forecast /£’m

Adjust Adjusted Plan HDP* Plan Forecast +/(-) ALLOCATIONS (1,480.1) (13.8) (1,493.9) (1,493.9) -

EXPENDITURE ACUTE 736.1 736.1 736.4 0.3 MENTAL HEALTH 130.7 130.7 131.5 0.8 COMMUNITY HEALTH SERVICES 113.7 0.4 114.1 114.5 0.4 CONTINUING CARE 82.1 3.0 85.1 86.7 1.6 OTHER 87.6 10.4 98.0 92.1 (5.9) PRIMARY CARE 326.5 326.5 322.4 (4.1) CORPORATE 18.5 18.5 17.5 (1.0) 1,495.1 - 1,503.9 1,500.9 (8.0)

DEFICIT/(SURPLUS) 15.0 - 15.0 7.0 (8.0) • Overspend on MH placements from higher caseload • Overspend on CHC & FNC placements due to price and complexity of patients. • Corporate underspend reflects release of accruals from vacant posts • Other variances are where reserves have been released net of COVID budgets.

*HDP (Hospital Discharge Programme) costs are reimbursed 1-2 months in arrears by NHSE

NHS Bath and North East Somerset, Swindon and Wiltshire CCG 30 Page 56 of 210 Community Health Continuing COVID Spend (M10) Care 5% 2%

£42.8m Primary YTD Care services 31%

• £24.5m spent on the Hospital Hospital Discharge Discharge Programme (HDP) YTD. Scheme 62% • On top of this the CCG is passing

through £3.1m a month to NHS acute Benchmarking - £ per head providers. In M1-M6 this was paid to (M9) £100.00 NHS providers directly. £80.00 £60.00 £40.00 £20.00 • Both COVID spend and HDP spend £- have been below regional average. COVID HDP BSW South West COVID spend reflects the lower allocation received.

NHS Bath and North East Somerset, Swindon and Wiltshire CCG 31 Page 57 of 210 Mass Vaccinations (M10) Vaccination Centres • A draft national contract has now been released providing contractual 20/21 Projected cover for the costs of the costs vaccination programmes but no final £’m version for signature yet. Staffing 1.9 Premises 0.9 • BSW system has an internal governance mechanism whereby Other 0.2 any cost deviations of >£50k must be authorised by GWH as the lead 3.0 provider. PCN • Current projections are for £7.6m of 20/21 Projected spend in 20/21. costs £’m • Payments for delivery of vaccines Service Fees 4.4 are made directly to the PCN by Premises 0.1 NHSEI. Vaccine Centres are led by GWH. Other 0.1 4.6

NHS Bath and North East Somerset, Swindon and Wiltshire CCG 32 Page 58 of 210 Data Sources

Urgent Care Urgent Care & Flow Board ..\..\..\..\Urgent Care\Routine reports\Urgent Care and Flow Board Report Monthly\Final Slides SHREWD https://e-shrewd.com/resilience/

Planned Care Elective Care Board ..\..\..\Routine Reports\Final Reports\Weekly Activity Report\Acute Reports RTT K:\Analytics\Planned Care\Performance\RTT\2020-21 Diagnostics K:\Analytics\Planned Care\Performance\DM01\2020-21 Cancer K:\Analytics\Planned Care\Performance\Cancer Wait Times\2020-21

COVID K:\Analytics\COVID-19\Slides - COVID SITREP K:\Analytics\COVID-19\Triggers and Thresholds Report\Slides

Mental Health Opal status dashboard K:\Analytics\Ad Hoc Requests\AH195 - MH OPEL Status Dashboard\MH OPEL Status Dashboard Draft v2.xlsx

Primary Care Flu Vaccination K:\Analytics\Primary Care\Routine Reports\Flu Vaccinations\Published Reports Primary Care Appointments K:\Analytics\Primary Care\Routine Reports\Weekly Summary Report\BSW PDF

NHS Bath and North East Somerset, Swindon and Wiltshire CCG Page 59 of 210 Meeting of the BSW CCG Governing Body Report Summary Sheet

Report Title Urgent and Emergency Care – current Agenda item 11 configuration and future direction Date of meeting 18 March 2021

Purpose Approve x Discuss x Inform Assure

Executive lead, Richard Smale, Director of Strategy and Transformation contact for enquiries This report concerns BSW x BaNES Swindon Wiltshire CCG locality locality locality This report was Shared with Chair and key members of the Think 111 First reviewed by Programme Board. To be discussed and signed off at the Board on 11/03/21 Executive summary The purpose of this presentation is to:

• Inform the Governing Body of the current configuration of services delivering Urgent and Emergency Care across BSW. • Inform the GB of the progress with Think 111 First and future developments • Discuss and seek approval for the approach and timeframe for the development of the BSW Urgent and Emergency Care Strategy

Equality Impact Will be carried out as part of the development of the strategy Assessment Public and patient Will be carried out during the formulation of the strategy engagement Recommendation(s) 1. The Governing Body is asked to approve the approach and timeline for the development of the Urgent Care Strategy 2. The Governing Body is asked to note the report and the progress made to date on implementing Think 111 First

Link to Board It links to the Board Assurance Framework in the following Assurance categories: Framework • BSW approach to resetting the system or High-level Risk(s)

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 1 of 2 Page 60 of 210

Report Title Urgent and Emergency Care – current Agenda item 11 configuration and future direction • Improving patient quality and safety and moving towards a system approach • Ensuring Financial Sustainability There are also two specific urgent and emergency care risks on the corporate risk register (Winter pressures and Ambulance Response Delays and ED handovers) that impact on urgent and emergency care activity. Risk (associated with High Medium Low x N/A the proposal / recommendation) Key risks Failure to produce an Urgent and Emergency Care Strategy for BSW Impact on quality The implementation of an Urgent and Emergency Care Strategy will ensure that people are treated in the right place at the right time. Impact on finance Transformation funding has been used for the Think 111 First enhanced clinical validation programme. We are in discussion with NHSE/I to identify funding for backfill of the time clinicians will need to spend on the development of the strategy. Finance sign-off: N/A

Conflicts of interest None identified

This report supports ☒ BSW approach to resetting the system the delivery of the ☒ Realising the benefits of merger following CCG’s ☒ Improving patient quality and safety strategic objectives: ☐ Ensuring financial sustainability ☒ Preparing to become a strategic commissioner This report supports ☐ Improving the Health and Wellbeing of Our Population the delivery of the ☐ Developing Sustainable Communities following BSW ☐ Sustainable Secondary Care Services System Priorities: ☒ Transforming Care Across BSW ☐ Creating Strong Networks of Health and Care Professionals to Deliver the NHS Long Term Plan and BSW’s Operational Plan

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 2 of 2 Page 61 of 210 Integrated Care System Urgent and Emergency Care: Current configuration of services and future direction in BSW

BSW CCG Governing Body: March 2021

Al Sheward – Winter Director Emma Smith – Head of Urgent Care Karen Baker – Think 111 Programme Manager

Page 62 of 210 Purpose • To reflect on current position within BSW – Existing Urgent and Emergency Care (UEC) standards and strategy – Programme governance – Current configuration of services • Future direction of travel – UEC Strategy and transformation – Work that has already started (Think 111 first) – What do we need to next and key priorities

NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care System Page 63 of 210 Urgent and Emergency Care: Current standards, strategy and transformation

June 2018 2004 2013 2017 Prime Minister asked Emergency Care Standards Review of the Transformation Ambulance Response National Medical Director to Introduced including the of Urgent and Emergency Programme (ARP) New undertake a review of the 4hour emergency care Care Services leading to 111 Operating Model core set of NHS Access standard. on-line, NHS 111. 5year Forward View (UTCs) Standards.

Jan 2019 December 2020 March 2019 March 2021 NHS Long Term Plan Transformation of Urgent Interim report of the Update on elective and published highlighting need and Emergency Care: Clinically-Led Review of NHS Mental Health Pathways to for Urgent & Emergency models for care and Access Standards (CRS) be published Care Transformation measurement

NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care System Page 64 of 210 Current urgent and emergency care offer in BSW

3 Emergency Departments 2 co-located Urgent treatment centres 3 Minor Injury Units 1 walk in centre service 1 Integrated Urgent Care service (NHS 111, clinical assessment service and out of hours primary care) 1 Ambulance 999 service

NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care System Page 65 of 210 BSW UEC Governance of Performance and Improvements

3 x Local Accident and Emergency Delivery Boards with system partners focusing on each of the acute hospitals

1 x Urgent Care and Flow board with all system partners

The Board is part of the BSW Oversight and Delivery Framework.

Purpose: • Focus entirely on urgent care and patient flow by supporting the operational delivery and planning activities of the Locality alliances • Main purpose to provide strategic oversight of operational delivery, including winter and COVID-19 planning

NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care System Page 66 of 210 The principles of UEC model and design

1. People with urgent care needs should get the right advice in the right place, first time 2. We must provide highly responsive, bookable, urgent care services that support reduced avoidable attendance at, or time in an ED, and resultant admissions. 3. We must ensure that those people with more serious or life-threatening emergency care needs receive treatment in centres with the right facilities and expertise to maximise chances of survival and a good recovery 4. We must ensure that no patient stays in the emergency department or in hospital longer than is clinically necessary

NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care System Page 67 of 210 Think 111 First: Accessing Urgent Care Services • National requirement for all systems to implement by 1st December 2020 to support with the recommendations from the Royal College of Emergency Medicine on:‘COVID-19: Resetting Emergency Department Care’ to ensure: 1. Emergency Departments must not become reservoirs of nosocomial infection for patients

2. Emergency Departments must not become crowded ever again

3. Hospitals must not become crowded again

4. Emergency care must be designed to look after vulnerable patients safely

5. Emergency Departments must be safe workplaces for staff

• The national ask is too directly book patients into Emergency Departments and Same day emergency care services

NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care System Page 68 of 210 BSW Think 111 First approach • BSW Programme established – clinically lead

• Focused on enhanced clinical validation using ED clinical staff to perform additional triage (validation)

• National assurance of system readiness for go- live 12th November 20

• Prioritised booking into ED for 1st December, with SDEC prioritised for Jan – Mar 21

• UTC and MIU services also operating with booking ahead approach via NHS 111

NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care System Page 69 of 210 BSW Think 111 First Model (1st December – 31st March) What we have done: Progress so far: • Enhanced Clinical assessment service consistently • Rolled out Emergency Department Direct interface delivers 84% patients signposted into an alternative (EDDI) at GWH ED and UTC, RUH ED and SFT ED service or self-management from UTC and ED to enable booking into timed slots • General feedback has been positive from patients and staff for booked slots; patients really like • Enhanced clinical assessment shifts with ED clinical speaking to (and seeing) an ED consultant, avoiding staff (Fri / Sat / Sun /Mon) having to go anywhere

• Video consultations Next steps / work underway

• Same day emergency care booking arrangements • Clinical huddles review daily process and issues but • Finalise evaluation and cost benefit analysis now reduced to fortnightly unless there are • Refresh local communications plan ahead of Easter exceptions • Secure long term funding to sustain model

• Think 111 First baseline survey (Nov –Dec)

NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care System Page 70 of 210 Roadmap 111/ IUC: National IUC ambitions for 21/22

• Direct booking into SDEC implemented across all regions

• Access from 111 into 2hr Rapid Response services, service to be profiled on DOS (by end March 21)

• Improved data collection (Apr 21)

• Increased direct booking into ED (trajectory TBC but likely 50-70% by Sept 21)

• Access/Direct booking from 111 into Mental Health Crisis (by Sept 21)

• Rollout of video consultations across integrated urgent care services post national procurement

NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care System Page 71 of 210 What is next for BSW? – A UEC strategy

• Co-design a BSW strategy: – Where we are against the 4 key principles and how close we are to achieving them – Look at all UEC services (including UTC / 999 / Flow / Hospital Occupancy) – Consider how our current service offer for UEC fits with the BSW long term vision – What is right for our population – Ensure we have resilient and sustainable services

NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care System Page 72 of 210 Next steps: Proposed timeframe

Oct 21 Phase 1 Jun 21- Jul 21 Improvement UEC strategy plans ahead of May 21 – Jun 21 approved, Winter 21/22 Draft final UEC improvement May 21 Strategy for programme consultation developed BSW Winter Mar 21 – May 21 Debrief event Consultation and Engagement exercise

NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care System Page 73 of 210 Meeting of the BSW CCG Governing Body Report Summary Sheet

Report Title CCG Support to BSW Academy Proposal Agenda item 12

Date of meeting 18 March 2021

Purpose Approve Discuss X Inform X Assure

Executive lead, contact Tracey Cox, Chief Executive Officer for enquiries Clinical lead Sarah Jane Peffers

Author Alison Kingscott and Sheridan Flavin, Interim Directors for People and Organisational Development Appendices BSW Academy Business Case

This report concerns BSW X BaNES Swindon Wiltshire CCG locality locality locality This report was Tracey Cox, Chief Executive Officer reviewed by Executive summary • At the Governing Body meeting on 25th February a verbal briefing was provided by the CEO on the plans for the BSW Academy. • Governing body members gave their support to the concept of the BSW Academy. • The full outline business case is shared with governing body members for information. • In order to support and fulfil the requirements of a BSW Academy all system partners are being asked to consider how system and local resources can be repurposed in a way that delivers the ambitions of the BSW Academy • Recommendations on how the CCG might respond to this request and support the development of the Academy are set out below. Recommendation(s) Action or decision required by the Governing Body: 1. The Governing Body is asked to note the BSW Academy outline business case. 2. The Governing Body is asked to support the intent of the CCG to support the creation of BSW Academy and to

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 1 of 4 Page 74 of 210 Report Title CCG Support to BSW Academy Proposal Agenda item 12

repurpose appropriate resources to support the delivery of the academy aspirations. This could include for example the alignment of some existing CCG staff to support the development of the Academy. 3. The CCG should assign a proportion of its 2021/22 Training and Development budget for staff into supporting the Academy. This is proposed to be £25,000.

Link to Board Assurance Framework or High-level Risk(s) Risk (associated with High Medium Low X N/A the proposal / recommendation) Key risks Key risk would be lost opportunities for working at scale across the system for activities related to academy pillars, e.g. Learning and Leadership. Impact on quality Improving access for academy activities across BSW will drive up quality for service delivery and patients. Impact on finance Ongoing conversations within the CCG will identify resources that are determined to support the delivery of the Academy aspirations and will be repurposed or aligned as appropriate.

Finance sign-off: Caroline Gregory, Director of Finance X

Conflicts of interest 1. None

This report supports the ☒ BSW approach to resetting the system delivery of the following ☐ Realising the benefits of merger CCG’s strategic ☒ Improving patient quality and safety objectives: ☐ Ensuring financial sustainability ☐ Preparing to become a strategic commissioner

This report supports ☒ Improving the Health and Wellbeing of Our Population the delivery of the ☐ Developing Sustainable Communities following BSW System ☐ Sustainable Secondary Care Services Priorities: ☒ Transforming Care Across BSW ☒ Creating Strong Networks of Health and Care Professionals to Deliver the NHS Long Term Plan and BSW’s Operational Plan

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 2 of 4 Page 75 of 210 BSW CCG Support to the Creation of a BSW Academy

1. Summary

The outline business case (OBC) for the creation of BSW Academy (Appendix 1), has been developed by the ICS System Capability Group, and was shared with the ICS Executive Group on 12th February. It gained overall support to progress the business case.

All partners were asked to share the detail of the OBC with key stakeholders within their organisations, and to feedback at the next ICS Executive meeting in March, to enable the business case to proceed.

Tracey Cox, CEO BSW CCG and SRO ICS, and Kevin McNamara, Chief Executive, Great Western Hospital, and System Capability and People Group sponsor, wrote to all BSW organisations on 22nd February 2021 to share the outline business case for the creation of a BSW Academy.

At the BSW Governing Body meeting on 25th February 2021, Tracey Cox outlined the main components of the Academy to governing body members, and this was received positively.

The comprehensive outline business case is attached at Appendix 1 for information. This sets out the vision, benefits and some assumptions about how the Academy could work.

Some of the potential benefits of an Academy outlined in the OBC include: • The development of system wide approach to sharing of the apprenticeship levy, maximising utilisation of the levy • The development of a consistent and inclusive talent management model • Creating a system wide intelligent leadership offer to support all leaders across the system • The provision of an on line training platform so that training can be offered to more staff and reducing the number of unfilled places • Creating the environment for consistent improvement in workforce metrics and especially highlighting the integration of Black, Asian and Minority Ethnic groups

All partners are being asked to consider how they can support the Academy through consideration of a funding model that utilises both the system wide funding available (for example through Health Education England) and the repurposing of local resources for the benefit of the system (for example Quality Improvement/Training and Development funds).

Support to the business case from partners will indicate that consideration is being given to how we can repurpose resources across the system to support the Academy aspirations. This is likely to result in the movement of staff across BSW, either temporarily (as an Associate leading on a project) or permanently (as one of the project leads or

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 3 of 4 Page 76 of 210 academy infrastructure). The detail on this is yet to be worked through but partners are being asked to give this consideration in order to make the Academy a success.

The CCG as a partner to the Academy is keen to support the implementation, and is having active conversations about resources that could be repurposed to support the academy. This includes a review of training and development funds and any relevant roles or activity.

2. Recommendations

2.1 The Governing Body is asked to note the BSW Academy outline business case.

2.2 The Governing Body is asked to support the intent of the CCG to support the creation of BSW Academy and will repurpose appropriate resources to support the delivery of the academy aspirations.

2.3 The Governing Body is asked to endorse the recommendation that BSW CCG will assign up to 25% from its non-committed 2021/22 Training and Development budget for staff into supporting the Academy. This equates to circa £25,000 at the time of writing this paper.

3. Next Steps

3.1 Once support has been confirmed from all BSW partners further activity on developing the full business case will take place and an implementation plan created through the System Capability and People Group. Further detail will be shared with Governing Body members as it develops.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 4 of 4 Page 77 of 210 Page 78 of 210

Document Governance

Document Location T:\Business_Development\55. System Capability\BSW Outline Business Case [GWH NHS FT, Shared Drive] Authors Chris Trow (CT), Associate Director of Strategy, Great Western Hospitals NHS Foundation Trust.

Sarah-Jane Peffers (SJP), Associate Director of Patient Safety and Quality, NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group.

Samson Agboola (SA), NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group. SRO Kevin McNamara – System Capability SRO Version 0.11

Status Draft

Approvals By 12/02/21: BSW Exec Board (Draft Outline Business Case) – 1st Review

Document Change Control Date of Version Lead for Revisions Type of Description of Revision Version Number Revision

Various 0.00 - 0.02 SA / Base information populated to case. 24/01/21 0.03 SJP Major Updates to base information, changes to priorities and proposed benefits. 29/01/2021 0.04 CT Major Document restructured and additional sections added. Updated with multiple updates throughout document. 02/02/2021 0.05 CT / Version released to Kevin McNamara (SRO) for review. 03/02/2021 0.06 SJP Minor Updates to resource section and updates to Appendix 1. 04/02/2021 0.07 CT Minor Updates to KPIs, minor amends throughout. Version circulated to System Capability Group. 04/02/2021 0.08 CT Minor Adjustments throughout to narrative, addition of Venn diagram, inclusion of financial appraisal build and cost summary plus cost build assumptions and caveats. 08/02/2021 0.09 – 0.10 CT Major Updates to exec summary, all diagrams, further additions to local drivers, revised year one objectives, revised resource chart, multiple minor edits throughout following review. 09/02/2021 0.11 CT Minor Corrected error to resource chart.

Page 1 of 27

Page 79 of 210 Contents

Executive Summary 03 The Case for Change 04 - Local Drivers 04 - National Drivers 05 BSW Academy Delivery Model 07 - Our priorities for each pillar 07 - Making a difference 08 The Operating Model 10 - The Transformation & Change Centre 10 Population Health & Care Models 12 BSW Academy Governance Structure 13 - Existing academies in the system 13 Establishing the BSW Academy and the five-year plan 14 - A thriving system driven through the BSW Academy 15 Measuring Success 16 Investment Required for the BSW Academy 16 - Resource 16 - IT 18 - Estate / Space 18 - Communications & Marketing 18 - Financial appraisal build & cost summary 19 Funding Model 20 Risk 21

Appendix 1: Relationship management matrix 23 Appendix 2: Resource requirements – outline description of roles 26

Diagrams

A: A snapshot of BSW 04 B: Delivery model overview 07 C: How the pillars work together 08 D: BSW Academy Operating Model 10 E: Drivers of the Transformation & Change Centre 11 F: System contacts from Learning Disabilities (LD) population. 12 G: BSW Academy governance structure 13 H: BSW Academy phasing 14 I: BSW Academy – organisational structure 17 J: Potential funding model arrangement 21

Tables

1: Current approach v what the BSW Academy could offer 09 2: Key benefits and outputs of the Transformation & Change Centre. 12 3: Year one objectives 16 4: Key performance indicators 16 5: Resource summary 17 6: Assumptions and caveats within the cost build 19 7: Identified risks 21

Page 2 of 27

Page 80 of 210

Executive Summary

This business case sets out the proposal for a BSW Academy to support the whole workforce to deliver outstanding care to our communities across the Integrated Care System (ICS).

The BSW Academy will introduce new ways of working, drive innovation and improvement, lead the way in workforce development and be a beacon for inclusion.

The System Capability Group has worked with internal and external stakeholders to develop the Academy, which is underpinned by five pillars; leadership, learning, innovation, improvement and inclusion (see right).

With a highly-skilled team and engagement with BSW stakeholders the Academy will create an environment where these pillars are at the heart of the way the ICS works to benefit its workforce and communities.

The Transformation & Change Centre forms part of the BSW Academy and will take the lead in driving forward transformative improvement projects across the ICS, taking direction from the priorities of the BSW Academy but also directly from the three system workstreams (System Capability, Population Health and Care, System Architecture) and from a place level (the localities that make up our ICS, Bath and North East Somerset, Swindon and Wiltshire). The detail on the Transformation & Change Centre (including associated costs form part of a separate business case).

The establishment of a BSW Academy marks an exciting opportunity to make a step change in the way we work together as we move towards a formal ICS. We already work hard to address similar objectives, this allows us to come together and support our workforce in a consistent and more powerful way to deliver outstanding care. Removing duplication, encouraging ideas and innovation, driving improvement all in an inclusive way under a united leadership.

Importantly we want to ensure that we work much more closely with our communities and our workforce, listening to their feedback and ideas, understanding their concerns and circumstances and involving them in the solutions, actively co-designing improvements and services fit for the future.

The BSW Academy and the wider System Capability workstream will be the change engine for our ICS, helping develop our collective capability so that we are better placed to serve our partnership and respond to tomorrow’s challenges.

Page 3 of 27

Page 81 of 210

The Case for Change

Local Drivers

Our ICS vision is to ‘empower people to live their best life’ and help the system to support broader social and economic development.

This will be achieved through the delivery of five key ambitions:

. To improve the health and wellbeing of our population . Reduce health and care inequalities . Improve the quality and experience of care for those receiving and those delivering it . Ensure workforce development and wellbeing . Make the best use of resources

Our three ICS work programmes; System Architecture, Population Health and Care Models and System Capability work in collaboration to achieve these aims. System Capability focusses on developing our culture to create capacity and capability we need to make change happen.

Diagram A: A snapshot of BSW

Page 4 of 27

Page 82 of 210

National Drivers

The Long-Term Plan (January 2019) made a commitment to invest in the workforce:

. Ensure we have enough people with the right skills and experience, so that staff have the time they need to care for patients well. . Ensure our people have rewarding jobs, work in a positive culture with opportunities to develop their skills and use state of the art equipment and have support to manage the complex and often stressful nature of delivering healthcare. . Strengthen and support good, compassionate, and diverse leadership at all levels- managerial and clinical to meet the complex, practical, financial, and cultural challenges.

These commitments have been further emphasised in the People Plan 2020/2021 and the NHS People Promise which also recognises the significant impact of Covid-19 on staff and how the health service has and continually needs to react and adapt to the Covid-19 pandemic.

The plan focuses on:

. Looking after our people . Belonging to the NHS . New ways of working and delivering care. . Growing for the future.

The NHS People Promise explicitly pledges:

. We are a team . We work flexibly . We are always learning . We are safe and healthy . We each have a voice that counts . We are recognised and rewarded . We are compassionate and Inclusive.

The recently published consultation document from NHSE/I; Integrating Care - Next Steps to building strong and effective Integrated Care Systems across England (November 2020), builds on previous publications that set out proposals for legislative reform and is primarily focused on the operational direction of travel. It opens a discussion with the NHS and its partners about how ICSs could be embedded in legislation or future guidance. Within the document there are multiple references to workforce capability, the BSW system capability workstream needs to be ready to reflect these priorities:

. Workforce planning, commissioning, and development to ensure that our people and teams are supported and able to lead fulfilling and balanced lives. . Coordination by providers at scale can support, better workforce planning, and more effective use of resources including clinical support and cooperate services. . Systems will continue to play an increasingly important role in developing multi-disciplinary leadership and talent, coordinating approaches to recruiting, retaining, and looking after staff, developing an agile workforce, and making the best use of individual staff skills, experience, and contribution. . Valuing diversity and developing the workforce and leadership which is representative of the population it serves. . Enabling employees to have rewarding career pathways that span the entire system, by creating employment models, workforce sharing arrangements and passporting or accreditation systems that enable their workforce to be deployed at different sites and organisations across the system and sharing practical tools to support agile and flexible working. . NHSEI will support systems to adopt improvement methodologies and approaches which enable them to improve services for patients, tackle unwarranted variation and develop cultures of continuous improvement.

Page 5 of 27

Page 83 of 210

In June 2020 ADASS, Skills for Care, and the Local Government Association (LGA) agreed to work collaboratively on five strategic workforce priority areas:

1. Strategic workforce planning 2. Growing and developing the workforce to meet future needs 3. Enhance the use of technology 4. Supporting well-being and positive mental health 5. Building and enhancing social justice, equality, diversity, and inclusion in the workforce.

By establishing a BSW Academy centred on five pillars of leadership, Learning, Innovation, Improvement, and Inclusion, we will support the system, place based partnerships, and provider collaboratives to lead the way in workforce development to allow BSW workforce to deliver outstanding care to our communities, and support the BSW ICS to fully realise both local and national workforce priorities. The BSW Academy working alongside all partners can unlock potential and inspire ambition in all colleagues, creating a culture where everyone can thrive, deliver better life outcomes for everyone living across the footprint and empower them to live their best lives.

The continued efforts of system working has now been recognised through the designation of BSW as an ICS and this ambition will continue with even greater collaboration within all health and care partners as we move to become a formal ICS body, likely by April 2022. The significance of the partnership and its support, adaptability, agility, talent, tenacity, and willingness has been further exemplified during the current Covid-19 pandemic. It is important that the progress that has been seen during this period has a firm platform to continue, the BSW Academy will be one vehicle to achieving this. The workforce is our most valuable asset, and we need to ensure there are programmes and initiatives to continue to unlock potential and inspire ambition and create a culture where everybody thrives. The academy has a five-year ambition to secure a thriving centre of excellence and deliver tangible benefits:

. Consistent and continuous improvement practice . Learning and developing together . Maximising learning opportunities . Cultivating ideas and research . Collaborative practice . Consistent benefits evaluation . Everyone has a voice . Celebrating success.

Engagement with ICS trailblazers (West Birmingham and the Black Country, Surrey Heartlands and West Yorkshire and Harrogate) BSW System Capability has had the opportunity to understand the benefits and challenges of establishing an academy. The key learning recognises the need for:

. Clear and lean governance structures to maintain direction and ensure pace of delivery . Consistent funding flows to deliver the agreed objectives and develop at scale . Leadership support from Clinicians and Professionals . A substantive workforce model to support delivery, this needs to include substantive roles within the academy pillars and associate roles to support programmes and individual development . Innovation can be realised by working alongside other industries and networks e.g. AHSNs and to bid for innovation projects . Close alignment with Population Health and care models . Established SMART measures of success from the start . Provide support at all levels, Primary Care Networks (PCNs), place based partnerships, provider collaboratives and system.

Page 6 of 27

Page 84 of 210

BSW Academy Delivery Model Diagram B: Delivery model overview

BSW Academy will be centred around 5 pillars of Leadership, Learning, Innovation, Improvement, and Inclusion. We will lead the way in workforce development to allow our workforce to deliver outstanding care to our communities

Our priorities for each pillar

Leadership

. Development of a system intelligent leadership offer, supporting leaders across the system at

all levels with the tools they need to operate effectively at a team, organisation, place and

system level

. Accessible and comprehensive leadership development

. Establish key messaging and leadership principles to keep our approach consistent

. Establish talent management, from providing an accessible path for aspiring leaders to

succession planning, ensuring that our leaders are representative of our workforce and the

communities they work for

. Ensure networking and collaboration opportunities are utilised to their full potential in support

of system working

Learning

. Maximising the apprenticeship levy spend as a system

. Increasing learners across the system (T-Levels, TNA’s, RTP, higher apprenticeships) and

improved accessibility from under-represented groups.

. Statutory and mandatory passporting

. Care certificate passporting this will significantly impact care homes and domiciliary care

providers

. System wide Training Needs Analysis (TNA) to drive commissioning and programme

development – commissioning CPD together, assisting smaller providers

. Placements as part of continuum of learning – recruit for potential, this will provide

opportunities for learners to try alternative roles and organisations

. Building system-wide placement allocation capacity for all learners, creating opportunity from

the system to support more learners

. Equalising student capacity and providing a better student experience

. Procuring a digital platform to shared learning opportunities

. One e-learning platform across the system

. Using the learning estate more effectively considering more virtual delivery

. Joint learning and development of policies

. System-wide careers advice – improving the links with Careers and Enterprise Company

(CEC). Creating cornerstone employers (at ICA level)

Innovation

. Foster ideas and identify innovations from both within and outside BSW, learning from

forerunners

. Share our innovations and learning across our partnerships, neighbourhoods, communities

and between organisations, encouraging adoption and spread

Page 7 of 27

Page 85 of 210

. Identify and respond to funding opportunities in-line with BSW priorities . Develop the BSW academy as multi-agency centre of excellence for innovation along with BSW partners and the AHSN, universities and research councils . Evaluate the impact of our innovations to evidence benefit to population health

Improvement

. Improve our capability to continually improve by providing education, training and support for

our workforce and wider community in continuous improvement approaches

. Provide hands-on coaching and support, particularly at a place level, to reduce unwarranted

variation and unmet need

. Develop the BSW Academy as a multi-agency centre of excellence for continuous

improvement along with BSW partners and the AHSN, universities and research councils

. Horizon scan for best practice both within and beyond BSW, ensuring learning and best

practice is spread between both internal partners and external organisations

Inclusion

. Ensuring that the principles of equality, diversity and inclusion are embedded within our

approach to change, improvement and skills

. Undertake an equality, diversity and inclusion diagnostic exercise across the system

. Build networks and connect people – we will support the development and implementation of

thriving staff networks

. Develop and implement system-wide talent management and succession planning by the

delivery of a stepping up programme

. Support the implementation of a consistent approach to the delivery of policies, procedures

and mandatory training

. Ensure the right people are actively engaged in all transformation programmes

. Build and deliver a broad development programme to include the development of NEDS and governors

Diagram C: How our pillars work together

Making a Difference

The BSW Academy will make our ICS a place where leadership, Learning, Innovation, Improvement, and Inclusion are at the heart of the way we work together for the benefit of our local communities and our workforce. The Academy operating model will enable support for the System and for Primary Care Networks (PCN’s), place-based partnerships and provider collaboratives.

Page 8 of 27

Page 86 of 210

Table 1: Current approach v what the BSW Academy could offer

Current model BSW Academy offer 1. Inconsistent approach to system intelligent Development of a system intelligent leadership leadership which can lead to opportunities not offer, supporting leaders across the system at being realised. all levels with the tools they need to operate effectively at a team, organisation, place, and system level. 2. BSW System does not have a coherent talent The Academy will support the system to management approach. Covid-19 has seen many develop a consistent and inclusive talent individuals showing significant system leadership management model and provide a central potential which needs to be developed further as repository to support individuals to become we learn from the impact of Covid-19 and start to system leaders and support system change develop new ways of working. programmes. The academy will also support effective succession planning through system- wide workforce planning and the development of appropriate and bespoke learning and development programmes. 3. Currently there is a significant amount of By offering a system-wide approach to the apprenticeship levy sunsetting each month across sharing of apprenticeship levy. Reducing multiple BSW organisations. sunsetting and maximising apprenticeship learning opportunities.

4. Under-utilising of local training programmes. By the development of an on-line training platform, local training can be offered to more people and therefore maximising learning opportunities and reducing the number of unfilled places. 5. Need for a Training Needs Analysis to align with This will ensure there is a coherent approach system workforce planning to influence HEE, HEI’s that maximises opportunities for all across and other educational providers. health and care and whether somebody works for a large or small, independent or LA or NHS provider. 6. Organisations are unable to offer statutory and Through a system-wide approach across all mandatory passporting increasing the healthcare providers on-boarding of staff will supernumerary time of new starters. become more effective and efficient, reducing duplication of training for individuals, and offering costs-savings to organisations 7. There is currently inconsistent approach to student By adopting a consistent approach there is the allocation and support across providers. opportunity to support more students and offer greater variety of placement. 8. Lack of a system understanding of: BSW system diagnostic to align and develop - The needs of Black, Asian and Minority greater opportunities. Ethic workforce groups as well as other Creating of system-wide staff networks to under-represented or hard to reach groups create a greater voice and influence across the and their specific support, learning and system. development needs. - The link of deprivation and differing levels of educational attainment within the footprint to health and life outcomes. 9. Unwarranted variation in practice. Lead the challenging of variations through co- developed protocols and delivery of consistent clinical and managerial standards across the BSW system

Page 9 of 27

Page 87 of 210

10. Lack of coherent evaluation and monitoring of BSW To provide consistency to BSW projects and projects. reduce risks to delivery, whilst evaluating the impact of BSW innovations to evidence benefit to population health.

11. Need for increased transparency across A highly skilled ‘centre of excellence’ to foster workstreams to: ideas and identify innovations from both within . Identify interdependencies earlier in project and outside BSW, as well as share innovations development and learning across partnerships, . Initiate larger scale improvement projects that neighbourhoods, communities and between impact entire system as opposed to individual organisations. workstreams. 12. Disgruntled and fatigued staff who feel Using system coverage resource to ensure the undervalued, overworked and ignored in innovation right people are actively engaged in all and transformation projects. transformation programmes and supporting the development and implementation of thriving staff networks. 13. Greater resourcing capabilities required to support Provision of education, training, and skillset changing and complex programmes of work. masterclasses to develop BSW workforce and empower staff to take on a greater range of projects. This will be a key role of the Transformation & Change Centre.

The Operating Model

Diagram D: BSW Academy Operating Model

The BSW Academy will have a cohesive and interdependent relationship with the Transformation and Change Centre. The Academy priorities will also be aligned to the needs of BSW’s Population Health and Care and System Architecture work programmes.

The Transformation & Change Centre

The Transformation & Change Centre has been developed to provide practical support and advice to change projects across our ICS. Our aim is to assist projects in every stage of their ‘life cycle’ from initiation and design, through to delivery and evaluation.

By adopting a flexible and agile approach to project delivery, the Transformation & Change Centre will support initiatives at organisational, locality (Place) and ICS (system). Operating through a hub and

Page 10 of 27

Page 88 of 210

spoke model with local teams, it will coordinate access to resources for programme and project support and provide a co-ordination function for system wide transformational programmes.

Working with the BSW Academy in developing the improvement methodologies and skilled resources needed across footprint. Work will be driven not only from within the BSW Academy but also from the three system workstreams (System Capability, Population Health & Care and System Architecture) and from a place level depending on the requirement and priority.

The Transformation & Change Centre will provide our ICS with:

. A mechanism for testing project and programme initiation requests against agreed system priorities to support system focus and delivery of transformation . A framework for allocating change resources in line with approved transformation initiatives . A central log for all transformation projects across the system to improve alignment, share learning, prevent duplication and avoid repetition of work . A mechanism for the effective management of transformation risks and issues across BSW . Development of easy-to-use methodologies, documents and templates to support project initiation and delivery . Progress reports to improve system visibility of delivery and impact of interventions. . In conjunction with the Academy, an educational function providing skills development in improvement methodologies.

Diagram E: Drivers of the Transformation & Change Centre

Page 11 of 27

Page 89 of 210

Table 2: Key benefits and outputs of the Transformation & Change Centre.

Driver Key activities Key Benefits / Outputs . Developing project governance . Uninformed ICS templates, including documents and supporting project highlight report and RAID log leads to complete . Improved PIDs and project scoping across . Sharing approved PIDs and BSW business cases with leads, and . Clear definition of intended project Design highlighting winning themes for outcomes and timescales. consideration . Testing, challenging and commenting on draft documents to support project leads . Identifying interdependencies with . Scheduled TCC meetings with workstream other projects in programme and leads flagging risks . Winning themes for PIDs and business . Ensuring regular and consistent cases reporting of progress and outputs . Amendments to TCC process Align from projects and programmes . Regularly contacting workstream leads to review TCC support offer to create flexible and listening approach . Providing access to specialist . Efficient and effective project delivery. support, advice and capacity to . Lessons learnt on all projects delivered. support delivery. . Project evaluation documents to . Monitoring milestones and understand outcomes and inform future escalating ‘at risk’ projects via project development Deliver appropriate ICS structures . Supporting delivered projects to move into ‘usual business’. . Supporting the capturing of lessons learnt to inform future initiatives.

Population Health and Care Models

To increase its benefit and value to the system, the BSW Academy will work closely with Business Intelligence and the Population Health and Care workstream. Priorities for programme input will be defined as this workstream sets out its own priorities and the outcomes it is seeking to achieve.

One of the early focus areas for 2021/22, which has already been set, will be Learning Disabilities.

Diagram F: System contacts from Learning Disabilities (LD) population.

Page 12 of 27

Page 90 of 210

The latest Population Health update shows:

. Patients with LD have higher rates of primary care contacts and secondary care activity compared to patients without LD . People with LD in BSW have an average of ~3 long term conditions compared to less than 2 for the rest of the population.

LD patients and people have a greater reliance on primary and secondary care than other patient cohorts, and further improvements to care provision must be made to help control attendances and manage care in the best setting. The Academy pillars will enable these improvements through the delivery of education, training and support for workforce, as well as increasing learners across the system to better manage patients with LD:

. Education and training - the Academy will work with primary and secondary care clinicians to identify up-skilling requirements to create new LD pathways, including digital follow ups and remote monitoring solutions to allow patients to receive care from their homes . Maximising levy spend - in maximising the levy spends the Academy will offer increased opportunities to new Nurses and HCAs apprentices. Apprenticeships will focus on providing increased resource and capacity in the system to reduce pressure on current workforce.

BSW Academy Governance Structure

The structure outlined in the diagram below identifies the governance arrangements for BSW System Capability. The System Capability and People Group (SCPG) will provide strategic direction and oversight of the ICS System Capability programme. This will involve commissioning BSW Academy to deliver specific programmes relating to the purpose of the Academy and the function of the 5 pillars and will provide the necessary oversight to ensure successful delivery. The SCPG will report directly to the ICS Executive Board and to the Regional People Board.

Diagram G: BSW Academy governance structure

The BSW Academy will need to be ‘hosted’ by one of the system organisations until the ICS is formally established in organisational form. The hosting organisation has not yet been agreed.

Existing academies in the system

Many of the larger organisations within the ICS already have well-established learning and development academies to support the staff within their own organisations. These establishments have their own experienced staff and can provide multi-professional training in equipped education facilities including clinical skills labs, telemedicine, simulation, videoconferencing, extensive IT and multi-professional libraries.

Page 13 of 27

Page 91 of 210

There are clear synergies with the function of BSW Academy and organisational academies. There are potential opportunities to work collaboratively to share the functions and facilities, as well as the knowledge and skills of the staff who could fulfil an Associate role within the BSW Academy. The role and function of both will evolve over time to recognise the efficiencies, the greater opportunities to work at scale, to tackle some of the more challenging problems, where it is clearly best practice to do so, where we can create better and equal opportunities for our combined workforce and become more ambitious in thinking and planning.

There are several other organisations that will support and enhance the delivery of the Academy, these are listed in Appendix 1. It is essential that effective relationships are built with all partners to maximise the offer to staff at place and system level.

Establishing the BSW Academy and the five-year plan

Diagram H: BSW Academy phasing

Page 14 of 27

Page 92 of 210

A thriving system driven through the BSW Academy

Ultimately, across BSW, we want to become a thriving ICS. The BSW Academy will play a significant role in this. Becoming a thriving ICS will take time and commitment from all involved.

What thriving looks like for the BSW Academy:

. Known population needs and a developed workforce delivering / working towards outstanding care. . Robust workforce planning that develops and evolves the right workforce at the right time. . Accessible eLearning platform to maximise system learning opportunities. . We will spend every available pound of our apprenticeship levy. . Delivering sought after apprenticeships and graduate placements. . Increased learning opportunities and access into health and care for school leavers. . Good retention rates across the system with active learning. . An inclusive workforce that reflects the population across BSW. . We will manage talent effectively, so everybody can develop and aspire to lead. . We will prepare people for future leadership roles through dynamic succession planning and support programmes. . Successful system intelligent leadership programmes at all levels, and multiple tools to enable people to operate as a team, organisation, place and system. . Increased opportunities and flexibility for creative careers throughout the system. . Flourishing staff forums and local people will have a real voice in the system. . Continuous improvement will be an embedded part of our culture, we will actively engage and encourage our communities and workforce to co-design services, develop ideas and be part of our future. . We will have established links with universities, research councils, the AHSN and be an active participant in improvement collaboratives and research programmes. . We will have agreed methodology to measure the impacts on our communities. . Consistent improvements in workforce metrics especially highlighting the integration and development of Black, Asian, and Minority Ethnic groups and representative of our community. . Recognised for our innovation and our ability to share best practice and experiences, acting as a model for other systems to follow. . A proven track record to horizon scan and convert opportunities into working projects to improve our communities and workforce. . Well linked to local business and industry, working collaboratively to tackle large scale social issues that impact on the health and care of our people. . A successful system coaching and mentor programme to support people to develop.

Page 15 of 27

Page 93 of 210

Measuring Success

Table 3: Year one objectives

Table 4: Key performance indicators

Investment Required for the BSW Academy

Resource

The workforce model will consist of substantive roles employed by the ICS and system support and development roles. This will achieve:

. System leadership with focused and consistent strategic delivery . Consistent knowledge, expertise, and strategic leadership for all pillars of the Academy

Page 16 of 27

Page 94 of 210

. Senior operational leadership to lead stakeholder management, communicate the vision, ensure the delivery of all objectives and work alongside the Director of OD and People to readily lead and develop the BSW workforce strategy . Maximising the opportunity to actively engage with internal and external stakeholders to realise further benefits to the Academy . Real opportunities to develop staff and build a system wide talent management structure that has the ability and agility to respond to the demands of the system.

The substantive roles required to support our journey to becoming a thriving Academy are listed in the table below:

Table 5: Resource summary

Role Band WTE Academy Director 9 1 Project Manager* 8b 1 Pillar Leads 8a 5 Bid Manager 7 1 Comms and Engagement 6 1 Project Support 5 3 Administrator 4 1 *funding for 8a already secured 13

The success of the Academy delivery model will be predicated on the synergy between substantive posts, system-wide sponsors, associate roles, and system advisory roles. The function of the roles is outlined in Appendix 2.

The organisation structure (detailed below) includes all core roles that will enable its successful set-up and add value across the whole system.

Many of these roles already exist within the system, some of them are complimentary roles and some are not WTEs. New posts are highlighted in green boxes.

A next step action will be to work with the CCG to assess any redeployment opportunity.

Diagram I: BSW Academy – organisational structure

Page 17 of 27

Page 95 of 210

Points to note: . Project Manager is 12 months fixed term with a review at the end of this term to assess the future requirement of this role. The initial requirement will be focussed on the mobilisation and transition periods and supporting the initial programmes of work initiated by the pillars. . Pillar Leads could support more than one pillar depending on priorities . HEE are a system enabler and resource, therefore can offer roles and functions to support the delivery of the Academy. HEE could therefore substitute / compliment some of the roles outlined above . Some of the roles could align to roles that already exist in the system and therefore roles and responsibilities could align to the Academy . It is essential that Clinical and Professional advisory roles are available to support the Academy . The Transformation & Change Centre sits within the BSW Academy and will work collaboratively with pillar leads on some projects. Priorities will be set from one of the ICS workstreams (System Capability, Population Health & Care, System Architecture) or from a place level depending on need – i.e. not all work will flow from the BSW Academy directly.

All costs associated with the Transformation & Change Centre are not included within this case.

This case does not include any request for investment for an IT platform as this is being procured under the System Architecture workstream. For the purposes of this case it is assumed that this platform will provide the following as a minimum: . Some form of landing page for the Academy . Academy information – including a searchable directory of learning opportunities and courses available centrally and ideally across the system . An online learning function or link to one . A scheduling tool to allow online booking for on-line or place based learning . Information and updates about key projects being undertaken in the Transformation & Change Centre . Key contacts page

IT costs for each post, e.g. laptops/screens are included.

Estate / Space

This case does not propose any form of additional estate with the exception of a small space requirement for the core team, including:

. The Academy Director x1 . Project Manager x1 . Admin x1 . Communications & Engagement x1 . Bid Manager x 1 . Flexible working / hot-desks x 5

This space is not required in a set location and could be flexible dependant on the recruitment process but would be most effective placed in one building.

Where possible flexible working would be encouraged.

Communications and Marketing

This will be a new approach to working together as one system. To ensure its success will require a careful launch that reaches all parts of the system which sets the tone for what the Academy will achieve moving forward.

A good communications and engagement plan will be key to this and the Communications & Engagement Lead will oversee this process working closely with the full time post.

Page 18 of 27

Page 96 of 210

This will ensure: . We make the most of every opportunity, sharing working underway, good news, best practice and learning . We raise our profile across England and the UK . We reach our staff and communities within our system to share our key messages . We work hard to reach those groups who have traditionally been hard to reach . We encourage engagement and participation . We maintain a sense of momentum and positive change – highlighting the value that the Academy is bringing.

Costs have been included for: . Marketing the Academy across the system – including the development of the branding / collateral . Set-up and on-going support for social media channels . A print budget – emphasis will always be digital first but noting that some hard copy materials will be required.

Financial appraisal build & cost summary

2021/22 2022/23 2023/24 2024/25 2025/26 BSW OBC Cost Build £ £ £ £ £ 04 Feb 2021 v001.xlsx Pay Costs 704,284 645,865 655,553 665,386 675,367 Non-Pay Costs 45,777 16,072 16,313 16,557 16,806 Total 750,061 661,936 671,865 681,943 692,172

Table 6: Assumptions and caveats within the cost build

1. Pay costs based on NHS bandings noted in the OBC. Job evaluation required to confirm. 2. The Project Manager 8b role is assumed to be 1 year fixed term for the purposes of the cost build and is not forecast in future years. 3. Based on a start date of 1st April 2021 - i.e. / full year costs in the first financial year. This is likely to need amendment to reflect a more realistic inception timetable. 4. No costs attached to releasing any PA's / time of medical and clinical staffing to support, neither has the cost of the Associate roles, noting that these may also flex in number depending of the requirement. This would need review and inclusion in a full budget comparison. 5. Existing budget comparison, across all BSW organisations to be incorporated under the ICS, against a full costing for the new academy model has at this time not been undertaken. 6. TUPE costs have not been considered for the wider structure that may redeploy staff from the existing organisations within the ICS. 7. Project inception costs of support from corporate functions has not yet been considered in this outline costing, including HR, Legal, Finance, Procurement, Payroll, IT etc. 8. Only costs attached to direct kit for the new posts are included in the above. Full ICT costs have not been included in the above analysis. 9. The estate cost applied is a per-person generic costing of desk space. More detail would be required on this to identify what the costs of any base location. 10. No variance / sensitivity attached to risks, this is not currently included in these outline costs. 11. Travel costs have not been considered in this outline costing - while it is anticipated that much of the coordination could be done in an agile manner there would likely be some travel attached to the BSW Academy. 12. Site cost is assumed to reflect the need for a desk per WTE on the basis of 1 person per WTE at a unit cost of £1,000. But the requirement has been lowered to 10 desks in total after allowing for flexible / agile working. 13. There is no R&M requirement for space/kit, stationery, DSE expenditure, training costs attached to these particular staff, subscriptions etc. at present in these figures. 14. Pay costs are not assumed to require enhancements / uplifts for unsociable hours or shift patterns. 15. This does not include any consideration of capital requirement, for example if work is required to a site to redesign for this use, and assumes ICT costs are revenue in nature - this may not be the case.

Page 19 of 27

Page 97 of 210

16. If academy and learning funding (HEE & Other) finance is to be combined under this umbrella going forward then additional financial resource may be required due to the complexity of the funding arrangements. 17. Annual uplift has been factored in at a flat 1.5% to incorporate inflation (both Pay and Non-Pay). 18. Posts have been costed at median increment level, there is risk that this could over / under estimate the staff cost marginally based on the actual increment at appointment. 19. At present the costing does not incorporate an increment increase on pay. 20. Pay costs are based on the pay costing tool before corporate overheads etc. 21. Pay costs are based on the pay costing tool before absence cover on the assumption that with these roles not being patient facing cover arrangements would not be required for A/L etc. 22. IT cost is assumed to reflect the need for 1 laptop per WTE on the basis of 1 person per WTE at a unit cost of £1,500. If headcount is higher this may need to be increased. 23. There is not at present any assumed costs for replacement of ICT after x years. 24. The £ figures in the table do not consider the time value of money. 25. Annual print budget is included at £2,000. 26. Ongoing coms and promotion is included annually at £2,500. 27. Annual license costs for comms platforms is included at £1,100. 28. No cost is included for eLearning platform, assumed that these costs and budget are elsewhere. 29. No cost is included for website or intranet, assumed that these costs and budget are held elsewhere.

Funding Model

Research and discussion with other systems has underlined the need to agree a long term funding agreement up-front. Without this building block in place all other systems have faced significant challenges to make meaningful impact or even to ensure continued survival.

With the current national economy backdrop, the likely continued or even increased pressures to public spending and the current BSW financial pressures it is even more critical that if we are to realise the potential benefits identified in this case we must agree funding for the BSW Academy for at least the next five years.

The proposed funding model suggests a base level agreed financial contribution per head (driven by organisation headcount), this could potentially be weighted so that larger system partners burden a slightly larger contribution over smaller ones. It is anticipated that some roles will be fulfilled by existing roles within the system, with some being funded by their home organisation (Resource section – page 16 onwards). A next step action will be to work with the CCG to assess any redeployment opportunity.

Further contributions would be expected from external sources, such as Health Education England (HEE), and from horizon scanning / bid opportunities – although it is noted that exact levels cannot be guaranteed and that overall costs would need to be underwritten by the ICS partners. It is also anticipated that, through the work of the BSW Academy, there will be off-setting of costs from elsewhere within the system and economies of scale, agreement will need to be reached on how best to capture this benefit but it would also contribute to the funding arrangement.

Any potential surplus achieved (funds secured over and above expected from external sources for example) would be used to invest in new opportunities in the BSW Academy to ensure that its impact and ability continues to evolve and improve over time – noting that external funding is usually tied to specific resources or spend on identified activity.

Page 20 of 27

Page 98 of 210

Diagram J: Potential funding model arrangement

Risk

Table 7: Identified risks

Risk Likelihood Severity Risk Mitigation Owner # H/M/L H/M/L 001 Place v system Oversight and scrutiny by Projects / programmes of work will System Capability SRO need to work in the best interests and BSW Exec Board. of the people and workforce within SRO BSW, specific placed based Delivery of priorities and Medium Medium issues should not be overlooked if KPIs set and agreed. Academy there are clear benefits BSW Academy workforce Director model that is available to work at all levels in the system

002 Lack of buy-in from all parts of the The System Capability system will lead to inability to Group has membership secure long term funding. from a large proportion of organisations within the system, this has meant the Academy operating model, Purpose and success measures have been collectively agreed Medium High SRO and the outline business proposal has also been agreed by all members of the programme. Continued communication through an effective communication and engagement strategy will ensure active socialisation

Page 21 of 27

Page 99 of 210

Risk Likelihood Severity Risk Mitigation Owner # H/M/L H/M/L of BSW Academy and the delivery model.

003 Over-reach: The BSW Academy needs to keep within its set remit and work Clear priorities set with collaboratively with system agreed KPIs. Oversight partners, noting that there will be Low Low and scrutiny by System SRO specialist training requirements Capability SRO and BSW from some providers and that Exec Board. these may be better delivered locally.

004 Inability to demonstrate value Joint development of principles and priorities. SRO

Pillar leads to set clear success factors and Low Medium measurable benefits at

outset of projects. Comms Academy & Eng to share key Director messages and raise profile.

005 Inability to work across the system BSW Academy Director – the Academy is about more than will ensure that a balance just health. is made to the support Academy and resources made Director available across the footprint. All All partners to partners Medium Medium demonstrate buy-in and SRO approve business case. Ensure that priorities are BSW Exec key focus. Board Overview and scrutiny by System Capability SRO and BSW Exec Board.

006 Inability to secure national Appointment of Bid funding. Given the financial Manager to focus on backdrop of the system, an horizon scanning and inability to realise this may impact building compelling bids. of the scale and pace of activity, The Academy will build Academy ultimately will determine the ability Medium Medium effective links with HEE Director to reach thriving status. and NHSEI to maximise the resources available. Likely to be a lead time before this income stream is realised.

Page 22 of 27

Page 100 of 210

Appendix 1

Relationship management matrix.

Team / Organisation Description of function Link / Knowledge base / Role Academic Health All AHSN’s have an agenda to drive . Expertise and knowledge on innovation Science Network adoption and spread of innovation across and spread (AHSN) all areas of healthcare provision and . Key links with local universities population health, each AHSN also has . Opportunity to gain financial support for the remit to bring together the resources BSW innovation programmes and assets In their geography to create a . Experience of working with external synergy between researchers in partners outside of health and social universities, industry and entrepreneurs, care and the local NHS to identify, exploit and commercialise innovations that will have national and international significance HEE Supports the delivery of excellent . Expertise and knowledge on workforce healthcare and health improvement to the and development patients and public of England by . Ability to utilise the workforce resource ensuring that the workforce of today and within HEE tomorrow has the right numbers, skills, . Opportunity to influence regional values, and behaviours, at the right time spending on the needs of BSW and in the right place workforce . assistance and influence HEI’s to support BSW requirements BSW Primary and Training Hubs are funded by HEE and . Predominant focus on primary Community Care are involved with: education and training Training Hubs . Retention and training of staff . Established relationships with HEI’s . Ensuring staff have access to training . Established links with PCN’s . The development and support of news . Effective links with the communities roles and schools to promote primary care . The introduction of new ways of and community as a career choice working . Leadership Operational People The OPDG is responsible for the delivery . Synergies is work programmes Delivery Group of an effective workforce programme . Shared resource to support BSW (OPDG) aligned to the strategic direction of the Academy e.g., System workforce ICS System Capability programme, planning supporting the delivery of the BSW and . Established links with HEE and NHSEI NHS People Plan. Within this remit, the OPDG shall cover the following areas, reporting to the SCPG, as appropriate Strategic Clinical Strategic Clinical Networks focus on . Expert clinical advice and guidance Networks priority service areas to bring about . Leading the way in development of improvement in the quality and equity of clinical pathways in key areas: care and outcomes of their population, Cardiovascular, cancer, mental health, both now and in the future. They bring and maternity together all those who use, provide and commission the service to make improvements. Strategic Clinical Networks aim to: . Reduce unwarranted variation in health and well-being services . Encourage innovation in how services are provided now and, in the future . Provide Clinical advice and leadership to support their decision making and strategic planning Primary Care PCN’s build on the core current primary . Network’s (PCN’s) care services and enable greater . Integral to Place Based Partnerships provision of proactive, personalised, . Key role in the employment and coordinated and more integrated health development of new roles in primary and social care. PCN’s are based on GP care registered lists, typically serving natural . Collaborative working between health communities of around d 30,000-50,000. and care

Page 23 of 27

Page 101 of 210

They are small enough to provide the personal care valued by both patients and GP’s but large enough to have impact and economies of scale through better collaboration between practices and others in the local health and care system NHS Leadership To work with partners to deliver excellent . Expertise and knowledge in leadership Academy leadership across the NHS to have a and talent management direct impact on patient care. Offering a . Resource to support bespoke range of tools, models, programmes and development for BSW expertise to support individuals, . Established leadership programmes for organisations and local partners to all levels develop leaders, celebrating and sharing . Diagnostic tools and models of delivery where outstanding leadership makes a that can be utilised by BSW Academy real difference Association Directors Provides a national and regional voice . Expert advice and guidance in adult of Adult Social and leadership for adult social care. It is social services Services at a regional level where directors form . Potential to provide a check and and agree their regional support and challenge to BSW workforce strategy improvement programmes based on local priorities. Nursing/ AHP forums . Enable mutual AHP/ . Professional leadership and expert Nursing/Professional support and clinical/ Professional knowledge leadership . Active participants to check and . Provide timely intelligence on challenge strategy and work workforce supply, challenges, and programmes solutions to a range of stakeholders . Active participants in the delivery of . Support and advise on strategic Academy work programmes workforce planning and service redesign . Share and support local service improvement, innovations, and developments Trade Unions Represent the professional interests of . Shared Learning and development staff groups working in the public, private Opportunities and voluntary sectors. . Advice and Guidance offer members free, confidential advice . Active participants in the development and support on employment matters, of the Academy strategy career development, immigration, welfare . Sponsorship of programmes and more. lobby governments and other bodies across the UK to develop, influence and implement policy that improves the quality of patient care. promote and engage in research, recognising that high quality research has the power to transform patient care Organisations Many organisation have physical . The BSW Academy and the Academy/ Education buildings where they are able to provide organisations individual academies/ and Training centres multi-professional training, in state-of-the- Education centres have a common art education facilities including clinical purpose skills labs, telemedicine, simulation, video . Share training opportunities to a wider conferencing, extensive IT and multi- audience professional libraries. The Centre’s also . Provide efficiency savings to the provide staff who can support staff to system by procuring and providing learning and progress in their roles CPD at scale through coaching, training, mentoring and . Share best practice development.

Page 24 of 27

Page 102 of 210

Professional Bodies Public Body that maintains registers of . Shared learning and development clinicians and professional who meet the opportunities registration requirements. . Advice and Guidance set the requirements of the professional education that supports people to develop the knowledge, skills and behaviours required for entry to, or annotation on, professional registers. We shape the practice of the professionals on registers by developing and promoting standards including Professional Codes and promoting lifelong learning through revalidation. Where serious concerns are raised about a professional’s fitness to practise, Professional bodies can investigate and, if needed, take action.

Community Groups Created and functions for a specific . Ability to offer advice and guidance on purpose and can support advancement of subject areas a particular cause or interest . Act as a critical friend . Provide voluntary support to projects

Page 25 of 27

Page 103 of 210

Appendix 2

Resource requirements – outline description of roles.

Role Description Academy The Academy Director is accountable to the SRO and is responsible for: Director . Working closely with the Director of People and OD, to ensure strategic development and delivery of the workforce strategy and delivery . Defining and communicating the vision and objectives in line with the strategy . Ensuring the Academy objectives across all the pillars are being met and where necessary, alongside the pillar sponsors and the SRO consider mitigations and assure ongoing viability . Engaging key stakeholders – see Appendix 1 – Relationship management matrix. . Providing the Academy team with leadership, decisions, and direction . Reporting to the System Capability and People Group on the key deliverables and achievements in line with the BSW Workforce Strategy Pillar Sponsor These roles are senior system / strategic level roles and will have knowledge and expertise to design the objectives and support and coach the operational leads to fulfil the objectives. The sponsor will be a member of the System Capability and People Group and take a key role in the design of the workforce strategy and the commissioning of its delivery. Pillar Lead . Ensuring that the pillar objectives/ projects are effectively carried out on a day-to-day basis . Collaborative with organisation/ PCN/ Place based partnerships and Provider collaboratives leads to ensure consistency of approach throughout BSW system and recognise where support or development opportunities are required . Network and collaborative with external organisations to seek new opportunities to help support the delivery of the BSW Workforce strategy . Monitoring performance . Addressing and issues/risks and working with the sponsor to identify mitigations as appropriate . Supporting the associate roles and project support roles to learn and develop.

Associate(s) The role will be a development opportunity for individuals from all organisations who seek the opportunity and development to influence and deliver system-wide programmes of work. Individuals will divide their time between their current role and the needs of specific academy programmes of work and will usually provide 1-2 days for 6-12 months (maximum). The development opportunities for individuals will be clearly articulated through their Personal Development Plans and time will be given to support: . Coaching/ shadowing . Academic study (pro rota) . System-wide networking The main purpose of the role will be: . Planning and managing specific projects in close collaboration with the Pillar lead and Academy Director. . Stakeholder engagement and management . Managing projects using systematic approaches and tools from beginning to end . Delivering in accordance with quality improvement frameworks . Understanding and collating key metrics to support monitoring and assessing innovation as well embedding these with the wider system. . Contributing to the development of education and learning, engaging with stakeholders to identify needs, co-designing of workshops (online & face to face), as required. . Developing or facilitating training packages as required . Carrying out scoping, horizon scanning and collaboration with our team and other teams as required. . Supporting the delivery of the BSW Academy communications plan and liaising with a wide range of stakeholders as required. . Supporting projects working with a range of stakeholders . Developing outputs which will facilitate the spread and adoption of practice . Maintaining a portfolio of activity which supports the key objectives of the programme. Project Manager To support the mobilisation and transition of the BSW Academy. Project Support The post holder will provide support for individual projects or programmes and assist in project planning and preparing project communications as appropriate. Accountability for the delegated project and its associated elements would remain with the Pillar and/or associate Assist the Pillar Lead and wider team in supporting project scoping requirements and evidencing and in the preparation of other core project documentation. This post could be suitable for a Graduate Trainee or Apprentice.

Page 26 of 27

Page 104 of 210

Clinical and The advisory roles will provide: Professional . Expert advice and guidance Advisory roles . The required level of check and challenge to the strategy, programme objectives and any new initiatives being considered. . Provide clinical/ professional leadership and support the voice of professional networks in the delivery of the Academy’s programme of work. . Provide the Academy Director and Pillar Leads with the most up to date clinical and Professional evidence to support delivery. . Connect with the clinical and professional networks as appropriate and ensure there is synergy between the work of the BSW Academy of the wider networks. These roles will be ½ day (1 X PA) and will be sponsored by their employer organisations. These roles could be considered as part of a person’s leadership development. The roles could rotate between individuals on a 6–12-month rotation and candidates could be nominated from their own professional networks. Communications . To provide communications advice and support with a strong focus on explaining internally & Engagement and externally the work of BSW Academy to improve quality and outcomes of healthcare Lead . To lead the development and delivery of Academy and programme communications and engagement strategies that are aligned The workforce strategy priorities, designed to achieve the best communication outcomes and support achievement of business objectives and the improvement in patient care and experience . Ensure that the profile of the BSW Academy is raised across the footprint and nationally. Communications . To develop and deliver communications, marketing and engagement strategies based on & Engagement rigorous insight, evidence and evaluation, in order to continuously improve the Partner effectiveness of the work of the team and organisation . Ensure that the profile of the BSW Academy is raised across the footprint and nationally. . To use evidence and insight into the use and effectiveness of different communication channels in order to improve those channels owned by BSW ICS and support the effective identification of channels for audiences . To use research and evaluation in order to shape communications campaigns, evaluate impact, and to track progress of the communications activities of NHS England over time . To maintain a very good understanding of emerging communication channels and technologies Bid Manager Horizon scanning and bid management. The post holder would proactively seek funding opportunities that align with the BSW Academy priorities. Working with Pillar Leads, Sponsors and the BSW Academy Director as appropriate to build compelling bids and a library of information to aid the development of future bid opportunities. The post holder will need to work at pace to deliver bids to demanding timelines and be able to build a compelling and viable proposal, taking this through an approval process ahead of submission. Any review or feedback to the awarding authority would also be owned. Admin Administrative and PA support to the BSW Academy Director

Page 27 of 27

Page 105 of 210

Meeting of the BSW CCG Governing Body Report Summary Sheet

Report Title BSW CCG 2020 NHS Staff Survey Results Agenda item 13

Date of meeting 18 March 2021

Purpose Approve x Discuss x Inform Assure

Executive lead, contact Sheridan Flavin and Alison Kingscott – Directors for People and for enquiries OD (DPOD)

Clinical lead N/A

Author Sheridan Flavin and Alison Kingscott – Directors for People and OD (DPOD) Appendices N/A

This report concerns BSW x BaNES Swindon Wiltshire CCG locality locality locality This report was BSW Executive Team, Senior Leadership Team and Colleague reviewed by Partnership Forum

Executive summary The attached report outlines the results from the 2020 NHS Staff Survey [the survey] that BSW CCG took part in from 12 October 2020 to 27 November 2020. The CCG achieved a response rate of 72% (280 colleagues responded) which is a slightly lower response rate than all CCG’s at 79%, however we launched the survey two weeks later than the otter CCG’s who participated. The report shares a high level overview of how the CCG responded as a whole organisation and further how each Directorate responded to the questions within the survey. It draws to the attention of the reader the positive areas and areas of concern for the CCG overall and identifies10 top priorities as identified by the executive team and further actions to be considered at directorate and team level so that localised actions plans can be developed to be delivered over the next 6 months from April 20201 – end of September 2021.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 1 of 2 Page 106 of 210

Report Title BSW CCG 2020 NHS Staff Survey Results Agenda item 13

Managers will be discussing the results with their teams and creating local action plans that will be monitored through SLT and shared with exec team for assurance. Recommendation(s) The Governing Body is asked to;

1. To note the contents of the report and the results from the survey 2. To support the 10 priority actions as identified by the executive team 3. To support the approach of localised action plans being development by managers

Link to Board None Assurance Framework or High-level Risk(s) Risk (associated with High Medium Low N/A the proposal / x recommendation) Key risks There is a risk that not all of the actions identified will be able to be delivered in the short timescale available.

Impact on quality The actions will have will have a positive impact on the experience and mental health and wellbeing of colleagues who work in the CCG. Impact on finance N/A

Finance sign-off: [N/A]

Conflicts of interest None

This report supports the ☐ BSW approach to resetting the system delivery of the following ☐ Realising the benefits of merger CCG’s strategic ☐ Improving patient quality and safety objectives: ☐ Ensuring financial sustainability ☐ Preparing to become a strategic commissioner

This report supports ☐ Improving the Health and Wellbeing of Our Population the delivery of the ☐ Developing Sustainable Communities following BSW System ☐ Sustainable Secondary Care Services Priorities: ☐ Transforming Care Across BSW ☐ Creating Strong Networks of Health and Care Professionals to Deliver the NHS Long Term Plan and BSW’s Operational Plan

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 2 of 2 Page 107 of 210

BaNES, Swindon and Wiltshire NHS Staff Survey 2020 Results Report and Action Plan

February 2021

Alison Kingscott and Sheridan Flavin, Interim Directors for People and OD Jude Champion, HR Business Partner, CSU

NHS Staff Survey Results 1 February 2021

Page 108 of 210

Contents

Section Description Page Number

Section 1 Introduction 3 National 10 theme comparison 4 Top 10 positive scores 6 Top 10 negative scores 7 Key Themes 9 Next Steps 11 Summary 11

Section 2 Appendix 1 13 Results by Directorate 13 Your Job 14 Your Managers 18 Your Health, Wellbeing and Safety 20 at Work Your Organisation 25 Background Information 27 Covid-19 Questions 28

Section 3 Appendix 2 31 Top 10 actions identified by 31 executive management team

Section 4 Appendix 3 35 Actions to consider by directorate 35

Section 5 Appendix 4 44 CSU HR Actions 44

NHS Staff Survey Results 2 February 2021

Page 109 of 210

SECTION 1

Purpose The purpose of this report is to present the results of the 2020 NHS Staff Survey (the survey) and share a high level overview of how each Directorate answered the questions within the survey. This report highlights positive areas and areas of concern for the CCG overall and identifies a resulting action plan for focus in the next 6 months.

The information presented in the report provides a basis for discussion and action planning. A set of suggested actions for consideration by each directorate is included at Appendix 3 in relation to each of the results section presented by Picker1.

It is anticipated that the suggested actions will be reviewed and developed further in partnership with all colleagues and through the CCG Colleague Partnership Forum, Senior Leadership Team and Executive Team.

Process The following process was followed:

• The questionnaire used for the NHS Staff Survey 2020 was developed by the NHS Staff Survey Coordination Centre together with the Advisory Board. • BSW CCG used Picker as the survey provider. • The questionnaire contained 78 nationally mandated questions • Two questions were included in the survey to specifically address colleague experience of covid 19 • 388 colleagues were invited to complete the survey. • 280 colleagues completed the survey. • The CCG achieved a response rate of 72%. • The survey was launched the week commencing 12 October 2020 and closed on 27th November 2020. • Completing the survey was not mandated, but colleagues were strongly encouraged to complete it. • Reminders to complete the survey were sent out to colleagues the week commencing 16 October and via an intranet article. Colleagues were also encouraged to complete the survey at most colleague briefings that took place during the window that the survey was open. Picker also sent reminders to complete the survey direct to CCG colleagues. • Picker provides the results for each question where the minimum of 11 colleagues have responded. This number is set nationally. • The questions asked fall under the following categories; Your Job, Your Managers, Your Health, Well-Being and Safety at Work, Your Organisation and Background Information. • This report and action plan have been written and developed following these five categories. • The results via this report were shared with the CCG Executive Team on 8th February and the Colleague Partnership Forum on 19th February and Senior Leadership Team on 2nd t March 2021. Feedback received from these forums will be reviewed and action plan updated accordingly. • The final report is now shared with the CCG Governing Body on 18th March 2021.

1 Picker – are the provider commissioned by the CCG to run the survey

NHS Staff Survey Results 3 February 2021

Page 110 of 210

• The action plan that is developed and agreed will be taken forward within the CCG and through the identified leads. • The National NHS Staff Survey results are due to be published on 11th March 2021. These reports are available on the NHS Staff Survey Co-ordination Centre.

Reporting

The National NHS Staff Survey is managed centrally via the survey co-ordination centre (SCC) and only two providers work with the SCC; Picker and Quality Health. BSW CCG commissioned Picker to support us as they are working with a large cohort of other CCG’s and they can therefore report BSW CCG against a large comparator group.

Picker report the survey findings under five headings to reflect the survey structure; Your Job, Your Manager, Your Health, Well-Being and Safety at Work, Your Organisation and Background Information. However the SCC report across 10 themes; Equality & Diversity, Health & Wellbeing, Immediate Managers, Morale, Quality of care, Safe Environment – Bullying & Harassment, Safe Environment – Violence, Safety Culture, Staff Engagement & Team Working.

For the purposes of this report, the BSW CCG survey findings are presented under the five headings.

To provide a summary of how BSW CCG compares to the benchmark group (other CCG’s); we have included the table below from the SCC which is displayed over 10 themes.

The table below from the SCC demonstrates that we compare as “average” on nearly all indicators which puts BSW CCG in the middle of the pack.

NHS Staff Survey Results 4 February 2021

Page 111 of 210

2020 NHS Staff Survey Results > Theme results > Overview

Equality, Health & Immediate Morale Quality of care Safe Safe Safety culture Staff Team working diversity & wellbeing managers environment environment engagement inclusion - Bullying & - Violence harassment 10

6 10)

- (0 5

Score 4

0 Best 10.0 8.8 8.3 8.0 7.8 9.8 10.0 8.7 8.2 8.2 Your org 9.5 6.6 7.4 6.3 7.0 8.8 10.0 6.9 7.0 6.6 Average 9.5 6.9 7.6 6.4 7.0 8.9 10.0 7.1 7.2 7.0 Worst 8.5 5.7 6.9 5.6 6.1 8.2 9.9 6.4 6.3 6.1 Responses 274 276 276 271 172 263 275 273 278 277 NHS Staff Survey Results 5 February 2021

Page 112 of 210

Response Rate 388 colleagues were invited to complete the survey. 280 colleagues responded to the survey with a response rate of 72%. 105 colleagues did not respond to the survey and the survey was unable to be delivered to 3 colleagues.

BSW CCG response rate at 72% is slightly lower than the overall response rate for the other 42 CCGs that participated within the Picker cohort, where the average response rate was 79%. For the national survey results there was 51 CCGs within the cohort and the average (median) was 80%. However, it should be noted that BSW CCG launched the NHS Staff Survey two weeks later than the other CCGs who participated.

Results Summary Picker reporting on the staff survey results uses the concept of “positive scores” as a summary measure to show how organisations compare to the average score for all “Picker” organisations. The positive score shows the percentage of respondents who gave a favourable response to applicable questions. The answers provided as agree or strongly agree are combined to create an overall positive score for each applicable question.

The table below shows the top 10 responses based on all the responses provided to the survey from BSW CCG colleagues. The Picker average has also been included for comparison purposes and the table rag rated based on whether the BSW score is above the Picker average (green), the same as the Picker average (amber) or below the Picker average (clear).

A) Top 10 positive scores based on BSW colleagues’ responses

BSW Picker No. Question Area of report Percentage average 100% 99% - Q12 a- Not experienced physical violence Your Health, 100% c from patients/service users/their Wellbeing and relatives or other members of the Safety at work public, from managers or from (part 2 of 4) other colleagues

99% 99% Q15a Not experienced discrimination Your Health, from patients/service users, their Wellbeing and relatives or other members of the Safety at work public (part 3 of 4) 96% 94% Q15b Not experienced discrimination Your Health, from manager/team leader or Wellbeing and other colleagues Safety at work (part 3 of 4) 93% 94% Q10b Don’t work any additional paid Your Health, hours per week for the CCG, over Wellbeing and and above contracted hours Safety at work (part 1 of 4) 93% 94% Q17a Know how to report unsafe clinical Your Health, practice Wellbeing and Safety at work (part 4 of 4)

NHS Staff Survey Results 6 February 2021

Page 113 of 210

BSW Picker No. Question Area of report Percentage average 89% 91% Q13a Not experience harassment, Your Health, bullying or abuse from Wellbeing and patients/service users, their Safety at work relatives or members of the public (part 2 of 4) 88% 89% Q18e Feel safe in my work Your organisation 87% 87% Q3b Feel trusted to do my job Your job (part 1 of 4) 83% 83% Q5c Satisfied with support from Your job (part 2 colleagues of 4) 82% 90% Q9a I know who senior managers are Your Health, Wellbeing and Safety at work (part 1 of 4)

The table below shows the least positive 10 responses based on all the responses provided to the survey from BSW CCG colleagues. The Picker average has also been included and the table rag rated based on whether the BSW score is above the Picker average (green), the same as the Picker average (amber) or below the Picker average (clear).

B) Top 10 negative scores based on BSW colleagues’ responses

BSW Picker No. Question Area of What does this Percentage average report mean 5% 4% Q11g Not put myself under Your Health, This means 95% pressure to come to wellbeing put themselves work when not feeling and safety at under pressure well enough work (part 2 of 4) 27% 26% Q10c Don’t work any Your Health, So 73% do work additional unpaid wellbeing extra hours hours per week for this and safety at organisation, over and work (part 1 above contracted of 4) hours 35% 24% Q6a I have realistic time Your job 65% don’t have pressures (part 3 of 4) realistic time pressures 37% 47% Q11a Organisation definitely Your Health, 65% said we takes positive action wellbeing don’t take on health, wellbeing and safety at positive steps and safety at work work (part 1 of 4) 37% 45% Q13d Last experience of Your Health, 37% of those harassment/bullying/ wellbeing who abuse reported and safety at experienced work (part 3 h/b/a did not of 4) report it 45% 57% Q9b Communication Your Health, 55% said not between senior wellbeing effective

NHS Staff Survey Results 7 February 2021

Page 114 of 210

BSW Picker No. Question Area of What does this Percentage average report mean managers and staff is and safety at effective work (part 1 of 4) 45% 45% Q4g Enough staff at the Your job 55% said not CCG to do my job (part 2 of 4) enough properly 45% 51% Q9c Senior managers try to Your Health, 55% said they involve staff in wellbeing don’t try to important decisions and safety at involve staff work (part 1 of 4) 46% 50% Q9d Senior managers act Your Health, 54% said they on staff feedback wellbeing don’t act on and safety at feedback work (part 1 of 4) 48% 49% Q19a I don’t often think Your 52% said they about leaving this organisation DO think about organisation leaving

The results above are discussed in greater detail in the directorate results section of this report at Appendix 1.

It should also be noted that due to the size of some of the directorates, one negative response in a small directorate will have a greater impact on the % score than one negative response in a bigger directorate. Skew2 in % results should be considered when reviewing directorate % scores

2 Skew - distorted in a way that is regarded as inaccurate, unfair, or misleading.

NHS Staff Survey Results 8 February 2021

Page 115 of 210

Acting on NHS Staff Survey Results Prior to the NHS Staff Survey being completed significant work had been undertaken by the CCG in relation to developing our Workforce Race Equality Standard (WRES) action plan following the national requirement to submit a WRES report to NHS England. A number of actions detailed in the WRES action plan will support the improvements required to address the findings of the survey.

The four year CCG People Strategy was agreed in October 2020 and identified a number of actions to support the NHS People Plan and focuses on three themes; colleague experience and development, engagement and culture and leadership at all levels.

In order to ensure that we are responding to colleagues feedback through the survey, we will continue to cross reference the WRES and People Strategy actions to the survey findings. It is vital that we demonstrate to colleagues that we have listened and heard their feedback and that we turn that into actions

Details of the NHS People Plan, CCG People Strategy and WRES action plan are available through the website or on the intranet.

Key Themes The results from this survey provide a baseline position of staff’s views and experiences of working for BSW CCG. This baseline will provide a reference point for measuring progress in the future when the NHS staff survey is repeated in October 2021.

The overall response rate of 72% was good considering the survey for BSW commenced two weeks later than the other 42 CCGs surveyed through Picker, and the average response rate was 79% (and across the NHS for all CCGs it was 80%).

This section highlights some key themes that have emerged from the staff survey results that have informed further discussion, review and action planning. A number of suggested actions are detailed on the action plan in Appendix 3.

The themes provided below should be considered in the context of the BSW vision of “working together to empower people to live their best life” and the BSW CCG values of “caring, innovative, inclusive, accountable and collaborative.”

It is considered that the areas which need to be focused on to improve the working lives and experiences of colleagues and that are supported by the proposed actions detailed in the action plan are:

1. Support for colleagues and managers 83% of colleagues reported being satisfied with support from colleagues however this was slightly lower regarding support from immediate manager at 79%. It was reported that 69% of colleagues are satisfied with the opportunities to use their skills and 35% reported having realistic time pressures.

65% of colleagues reported that their immediate manager asks for their opinion before making decisions that affect their work.

Work needs to be undertaken to increase the support available to colleagues and to managers in terms of addressing the areas of concern that have been raised as a result of the survey. Further details regarding the proposed actions to be taken are detailed in the action plan.

NHS Staff Survey Results 9 February 2021

Page 116 of 210

2. Recognition of colleagues work and commitment to the CCG 57% of colleagues reported being satisfied with the extent the organisation values their work, 79% of colleagues reported that their immediate manager encourages them at work and 81% of colleagues reported that their manager values their work.

Since the survey was carried out work has been underway to implement a colleague recognition scheme which should help highlight to colleagues that their work is recognised and valued by the CCG and their immediate manager.

3. Colleagues health and wellbeing 35% of colleagues reported that they have realistic time pressures and 37% of colleagues reported that the organisation definitely takes positive action on health and wellbeing.

95% of colleagues have put themselves under pressure to come to work when not feeling well enough and 63% of colleagues have also reported that they have felt unwell due to work related stress and 55% of colleagues in the last 3 months (prior to the survey) have come to work when not feeling well enough to perform their duties.

This highlights that further work needs to be carried out in this area to support and improve the health and wellbeing of BSW colleagues. A number of actions have been identified to help improve the health and wellbeing of colleagues and these are detailed in the action plan and it is anticipated that the Health and Wellbeing group assist to shape these actions further.

4. Working relationships including bullying, harassment and/or abuse It is positive that 89% of colleagues have reported that they have not experienced harassment, bullying or abuse from patients/service user, their relatives or members of the public. This highlights that 11% of colleagues have experienced harassment, bullying or abuse but only 37% of colleagues have reported their last experience of harassment, bullying or abuse.

88% of colleagues have reported not experiencing harassment bullying or abuse from managers, which highlights 12% of colleagues have and 87% of colleagues have reported not experiencing harassment, bullying or abuse from other colleagues, which highlights 13% of colleagues have. The CCG has a zero tolerance approach to any form of bullying, harassment or abuse.

The results signify that significant further work is required in this area. The action plan details a set of actions that seek to address the concerns raised in relation to bullying and harassment.

5. CCG Communications It is reported that 45% of colleagues think that the communication between senior managers and colleagues is effective and 46% of colleagues reported that senior managers act on colleague feedback. It was also reported that 45% of colleagues feel that senior managers try to involve staff in important decisions.

Within the free text boxes, it was also raised that there is not enough visibility of the Executive team and senior managers.

Action needs to be taken to improve the communication across the organisation between senior managers and colleagues and the visibility of senior managers and the Executive team needs to be increased.

NHS Staff Survey Results 10 February 2021

Page 117 of 210

6. Addressing and reporting of unsafe clinical practice 64% of colleagues would feel confident that the CCG would address concerns about unsafe clinical practice and 74% of colleagues would feel secure raising concerns about unsafe clinical practice. 55% of colleague reported that they were given feedback about changes made in response to reported errors/near misses/incidents.

These results highlight that the CCG needs to reflect on how concerns are addressed and feedback provided to colleagues regarding changes that have been made. Work also needs to be undertaken to make colleagues feel secure about raising unsafe clinical practice.

Next Steps BSW CCG is committed to improving the working lives, experiences and wellbeing of its workforce and the participation in the survey provides the CCG with valuable information on areas to focus on to “make this a great place to work”.

The CCG will continue to invest time, money and resources to implementing the actions detailed in the action plan and will commit to undertaking the national NHS staff survey on a regular basis to be able to measure progress from this year’s staff survey results and therefore continually improve the overall work environment for colleagues.

Results by Directorate are contained in Appendix 1 and are being used to develop local action plans within each Directorate. A list of the 10 top priorities has been developed by executive team and are at Appendix 2. There is a detailed list of suggested actions at Appendix 3 that directorates and managers can review/use to inform and create local action plans, and CSU HR actions at Appendix 4 to address areas of concern that have been highlighted through the 2020 national NHS staff survey.

The top 10 priority actions identified by the Executive Directors are highlighted orange in Appendix 3 and 4 to enable ease of cross reference.

The CCG will build on the positive responses that have been highlighted through the results of the survey alongside the action plans for the CCG People Strategy, BSW People Plan and WRES.

Steps will be taken to have shared ownership of the actions identified by Directorates, the Colleague Partnership Forum, the Senior Leadership Team and the Executive Team.

Summary The survey results offer many opportunities to respond to colleagues feedback, however the areas of focus will vary department by department and some areas of feedback may be best addressed by CSU HR as they refer to policy and procedure issues. It is clear that any actions created should be delivered within the time available before the next annual NHS Staff Survey that will be circulated in October 2021. This means that the CCG has 6 months to demonstrate to colleagues that we have heard, listened and acted on their feedback by demonstrating progress on feedback between April and September 2021.

It would be too easy to produce a long list of actions for the whole organisation but this is not considered to be the correct approach and instead we have taken the approach of creating a top ten priority actions for the whole organisation, with a directorate by directorate action plan to be

NHS Staff Survey Results 11 February 2021

Page 118 of 210

developed at a local level with directorate and department teams, as well as a CSU HR action plan to address policy and procedure issues.

As a result, the Executive Team has identified the top 10 priority actions (Appendix 2) from a long list of potential actions (Appendix 3 & 4) as the main focus for the CCG for the period April to August 2021. These priority areas will be tested further with the Senior Leadership Team, Colleague Partnership Forum and all colleagues through a number of colleague forums/focus groups. However this work will not delay actions from being progressed as appropriate.

Directors and senior leaders have been provided with a copy of the staff survey results for the whole organisation and a breakdown of results for their own area. It is important that each directorate share their results with their teams and formulate a local action plan to address specific areas of concern as reported in the survey results. It is envisaged that each directorate will have local meetings to explore the survey findings in more detail to gain more information and co-create the actions to address areas of concerns.

It is proposed that directorate actions plans are monitored via SLT on a regular basis and progress and areas of good practice can be shared. It will also provide an opportunity for collaboration between directorates who are working on similar survey results.

Appendix 3 of this paper outlines actions that have been developed by the People Directorate and CSU HR as areas of work that each directorate may consider appropriate to utilise to address areas of concerns in their part of the organisation as they reflect on the results in Appendix 1.

Appendix 4 of this paper outlined the actions that CSU HR has agreed to address and delivery dates will be priorities through April – September 2021

NHS Staff Survey Results 12 February 2021

Page 119 of 210

SECTION 2

Appendix 1 - Results by question for each Directorate

The following tables detail the direct findings from Picker for all the questions asked of colleagues in the survey that was issued in October 2020. The highlights from the results are detailed below and also areas that the CCG will need to focus on based on the findings. The tables detail the percentage of positive responses for each Directorate if there were more than 11 colleagues answering the question.

The answers have been rag rated for each Directorate based on how it compares to the overall score for the question for the whole organisation; 3% above (green), below (red) or in between (amber) the Where a * is used in the table of results this indicates that there were 11 of less answers and the information has been withheld to protect respondent confidentiality.

Information is also provided to highlight areas of concern based on overall responses from Directorates within the CCG.

Within the tables below a positive score is the percentage of respondents to whom the question applies, who gave a favourable response to each question. Only questions that can be positively scored have been included.

If less than 11 colleagues answered a question the results were not analysed by Picker, as this number falls below the required minimum for analysis. These results are also not included within the report due to respondent confidentiality.

Some questions are routed meaning that they are designed to make sure that respondents respond only to questions which are relevant to their experience. For example, Q11d: “In the last three months have you ever come to work despite not feeling well enough to perform your duties.” Colleagues who answered yes were directed to Q11e, Q11f and Q11g, to answer further questions about where staff felt pressure from. For colleagues who answered no to Q11d they were directed to Q12. This does mean that where colleagues may have been routed to Q11e, Q11f and Q11g to gather further information about their experiences, the results may not have been analysed due to the number of colleagues answering this question being less than 11.

The tables detail the overall positive response score for the whole organisation (comparator organisation overall) and following this the positive response score for each Directorate.

The survey was broken down into five areas and the tables below reflect this. The areas are: Your Job, Your Managers, Your Health, Well-Being and Safety at Work, Your Organisation and Background Information.

NHS Staff Survey Results 13 February 2021

Page 120 of 210

Table 1 - Your Job

Often/always Q2a look forward to 56% 55% 73% 62% 53% 61% going to work Often/always Q2b enthusiastic 67% 59% 73% 70% 66% 71% about my job Time often / always passes Q2c 76% 73% 82% 81% 72% 80% quickly when I am working Always know what work Q3a 70% 68% 100% 62% 71% 75% responsibilities are Feel trusted to Q3b 87% 68% 100% 94% 87% 92% do my job Able to do my job to a Q3c 81% 77% 73% 91% 81% 83% standard I am pleased with Opportunities to show Q4a initiative 70% 59% 100% 70% 69% 69% frequently in my role Able to make suggestions to Q4b improve the 79% 73% 100% 83% 74% 86% work of my team/dept Involved in deciding Q4c 56% 50% 91% 57% 56% 53% changes that affect work Able to make improvements Q4d 61% 50% 91% 74% 55% 59% happen in my area of work Able to meet conflicting Q4e 51% 32% 55% 55% 48% 59% demands on my time at work Have adequate Q4f materials, 73% 77% 91% 83% 67% 78% supplies and

NHS Staff Survey Results 14 February 2021

Page 121 of 210

Corporate Nursing & Comparator Executive Finance Strategy & T Services Quality (BSW CCG Directorate Directorate Directorate Directorate Directorate Overall) (BSW) (BSW) (BSW) (BSW) (BSW) equipment to do my work Enough staff at organisation to Q4g 45% 23% 64% 62% 37% 56% do my job properly Team members have a set of Q4h 62% 64% 91% 64% 63% 64% shared objectives Team members often meet to Q4i discuss the 72% 86% 82% 72% 69% 78% team's effectiveness I receive the respect I Q4j deserve from 76% 68% 100% 77% 73% 80% my colleagues at work Satisfied with Q5a recognition for 64% 50% 91% 64% 64% 66% good work Satisfied with support from Q5b 79% 77% 91% 74% 78% 83% immediate manager Satisfied with Q5c support from 83% 90% 91% 83% 83% 78% colleagues Satisfied with amount of Q5d 76% 73% 91% 74% 77% 78% responsibility given Satisfied with Q5e opportunities to 69% 50% 91% 74% 71% 64% use skills Satisfied with extent Q5f 57% 41% 82% 60% 57% 56% organisation values my work Satisfied with Q5g 50% 36% 91% 55% 43% 58% level of pay Satisfied with opportunities Q5h for flexible 75% 73% 100% 91% 68% 78% working patterns I have realistic Q6a 35% 18% 9% 36% 39% 42% time pressures

NHS Staff Survey Results 15 February 2021

Page 122 of 210

Corporate Nursing & Comparator Executive Finance Strategy & T Services Quality (BSW CCG Directorate Directorate Directorate Directorate Directorate Overall) (BSW) (BSW) (BSW) (BSW) (BSW) I have a choice Q6b in deciding how 69% 64% 91% 87% 63% 64% to do my work Relationships at Q6c work are 52% 41% 45% 64% 48% 59% unstrained Satisfied with quality of care I Q7a give to 70% * * 77% 70% 74% patients/service users Feel my role makes a Q7b difference to 78% * 82% 79% 78% 80% patients/service users Able to provide Q7c the care I aspire 54% * * * 60% 54% to

Positive highlights

• 56% of colleagues often/always look forward to going to work (Q2a). • 87% of colleagues feel trusted to do their job (Q3b). • 81% of colleagues feel able to their job to a standard they are pleased with (Q3c). • 79% of respondents confirmed they are satisfied with support from their immediate manager (Q5b). • 76% of respondents confirmed they are satisfied with the amount of responsibility given (Q5d). • 73% of respondents confirmed they have adequate materials, supplies and equipment to do their work (Q4f). • 78% of respondents confirmed they feel their role makes a different to patients/service users (Q7b).

Potential Areas to focus on and influence action plan

• 70% of respondents confirmed they had opportunities to show initiative frequently in their role (Q4a). • 56% of respondents confirmed they are involved in deciding changes that affect their work (Q4c). • 61% of the respondents confirmed they are able to make improvements happen in their area of work (Q4d). • 51% of respondents confirmed they are able to meet conflicting demands on their time at work (Q4e). • 62% of respondents confirmed they have a set of shared objectives (Q4h).

NHS Staff Survey Results 16 February 2021

Page 123 of 210

• 64% of respondents confirmed they are satisfied with recognition for good work (Q5a). • 52% of respondents confirmed relationships at work are unstrained (Q6c).

NHS Staff Survey Results 17 February 2021

Page 124 of 210

Table 2 - Your Managers

My immediate manager Q8a 79% 82% 91% 74% 82% 81% encourages me at work Immediate manager can Q8b be counted on 78% 77% 100% 68% 79% 88% to help with difficult tasks Immediate manager gives Q8c 74% 68% 91% 68% 76% 75% clear feedback on my work Immediate manager asks for my opinion Q8d before making 65% 55% 91% 68% 65% 69% decisions that affect my work Immediate manager Q8e 79% 82% 91% 77% 78% 82% supportive in personal crisis Immediate manager takes a positive Q8f 81% 82% 91% 79% 79% 86% interest in my health & wellbeing Immediate manager Q8g 81% 86% 91% 85% 81% 86% values my work I know who Q9a senior 82% 91% 100% 83% 81% 73% managers are Comms between senior Q9b 45% 41% 82% 45% 46% 39% management and staff is effective Senior managers try Q9c involve staff in 45% 36% 100% 53% 40% 44% important decisions

NHS Staff Survey Results 18 February 2021

Page 125 of 210

Positive highlights

• 74% of respondents confirmed their immediate manager gives them clear feedback on their work (Q8c). • 81% of respondents confirmed their immediate manager takes a positive interest in their health and wellbeing (Q8f). • 81% of respondents confirmed their immediate manager values their work (Q8g).

• Potential Areas to focus on and influence action plan 65% of respondents have confirmed that their immediate manager asks for their opinion before making decisions that affect my work (Q8d). • 79% of respondents stated their immediate manager is supportive in a personal crisis (Q8e). • 45% of respondents stated that communication between senior management and staff is effective (Q9b). • 45% of respondents stated that senior managers try to involve staff in important decisions (Q9c). 46% of respondents stated that senior managers act on staff feedback (Q9d)

NHS Staff Survey Results 19 February 2021

Page 126 of 210

Table 3 - Your Health, Wellbeing and Safety at Work

Don't work any additional paid hours per week for this Q10 organisation, 93% 100% * 94% 92% 97% b over and above contracted hours Don't work any additional unpaid hours per week for Q10 this 27% 18% 0% 30% 28% 37% c organisation, over and above contracted hours Organisation definitely Q11 takes positive 37% 32% * 50% 29% 43% a action on health and well-being In last 12 months, have not experienced Q11 musculoskelet 74% 59% 82% 79% 75% 71% b al (MSK) problems as a result of work activities In last 12 months, have Q11 not felt unwell 63% 41% 64% 72% 61% 71% c due to work related stress In last 3 months, have not come to Q11 work when 55% 41% 73% 62% 46% 68% d not feeling well enough to perform duties

NHS Staff Survey Results 20 February 2021

Page 127 of 210

Corporate Nursing & Comparator Executive Finance Strategy & T Services Quality (BSW CCG Directorate Directorate Directorate Directorate Directorate Overall) (BSW) (BSW) (BSW) (BSW) (BSW) Not felt pressure from manager to Q11 come to work 83% 69% * 89% 85% 84% e when not feeling well enough Not felt pressure from colleagues to Q11 come to work 85% 77% * 78% 87% 84% f when not feeling well enough Not put myself under pressure to Q11 come to work 5% 0% * 6% 7% 5% g when not feeling well enough Not experienced physical violence from Q12 patients/servi 100% 100% 100% 100% 99% 100% a ce users, their relatives or other members of the public Not experienced Q12 physical 100% 100% 100% 100% 100% 100% b violence from managers Not experienced Q12 physical 100% 100% 100% 100% 99% 100% c violence from other colleagues Last experience of Q12 physical * * * * * * d violence reported Not experienced Q13 harassment, 89% 100% * 100% 79% 91% a bullying or abuse from

NHS Staff Survey Results 21 February 2021

Page 128 of 210

Corporate Nursing & Comparator Executive Finance Strategy & T Services Quality (BSW CCG Directorate Directorate Directorate Directorate Directorate Overall) (BSW) (BSW) (BSW) (BSW) (BSW) patients/servi ce users, their relatives or members of the public Not experienced Q13 harassment, 88% 75% * 91% 86% 98% b bullying or abuse from managers Not experienced harassment, Q13 bullying or 87% 79% * 98% 86% 89% c abuse from other colleagues Last experience of Q13 harassment/b 37% * * * 40% * d ullying/abuse reported Organisation acts fairly: Q14 87% 83% * 93% 87% 95% career progression Not experienced discrimination from Q15 patients/servi 99% 100% 100% 100% 97% 98% a ce users, their relatives or other members of the public Not experienced discrimination Q15 from 96% 95% 100% 96% 96% 98% b manager/tea m leader or other colleagues Organisation treats staff Q16 involved in 66% 63% * 65% 65% 70% a errors/near misses/incide nts fairly

NHS Staff Survey Results 22 February 2021

Page 129 of 210

Corporate Nursing & Comparator Executive Finance Strategy & T Services Quality (BSW CCG Directorate Directorate Directorate Directorate Directorate Overall) (BSW) (BSW) (BSW) (BSW) (BSW) Organisation encourages Q16 reporting of 84% 85% * 75% 86% 88% b errors/near misses/incide nts Organisation takes action to ensure Q16 errors/near 75% 84% * 63% 77% 79% c misses/incide nts are not repeated Staff given feedback about changes made in Q16 response to 55% 65% * 41% 62% 56% d reported errors/near misses/incide nts Know how to Q17 report unsafe 93% 76% 100% 83% 95% 100% a clinical practice Would feel secure raising Q17 concerns 74% 71% 100% 57% 73% 86% b about unsafe clinical practice Would feel confident that organisation Q17 would address 64% 67% 100% 54% 60% 78% c concerns about unsafe clinical practice

Positive highlights

• 74% of respondents in the last 12 months confirmed they have not experienced MSK problems as a result of work activities (Q11b). • 93% of respondents confirmed they do not work any additional paid hours per week over and above contracted hours (Q10b). • 100% of respondents confirmed they have not experienced physical violence from patients/service users, their relatives, or other members of the public (Q12a).

NHS Staff Survey Results 23 February 2021

Page 130 of 210

• 100% of respondents have not experienced physical violence from Managers or colleagues (Q12b and Q12c). • 87% of respondents stated the CCG acts fairly in terms of career progression (Q14). • 99% of respondents confirmed they had not experienced discrimination form patients/service users, their relatives, or other members of the public (Q15a). • 96% of respondents confirmed they have not experienced discrimination from manager/team leader or other colleagues (Q15b). • 93% of respondents stated they would know how to report unsafe clinical practice (Q17a). • 45% of respondents confirmed that communication between the senior management team and colleagues is effective (Q9b). • 37% of respondents feel the organisation definitely takes positive action on health and wellbeing (Q11a). • 88% of respondents confirmed they have not experienced harassment, bullying or abuse from Managers (Q13b). • 87% of respondents confirmed they have not experienced harassment, bullying or abuse from other colleagues (Q13c). • 5% of respondents confirmed they have not put themselves under pressure to come to work when not feeling well enough (Q11g). • 37% of respondents confirmed the last experience of harassment/ bullying / abuse was reported (Q13d). • 66% of respondents confirmed the CCG treats staff involved in errors/ near misses/ incidents fairly (Q16a). • 55% of respondents confirmed staff have given feedback about changes made in response to reported errors/near misses/incidents (Q16d). • 64% of respondents would feel confident that the organisation would address concerns about unsafe clinical practice (Q17c). • 74% of respondents reported they would feel secure raising concerns about unsafe clinical practice (Q17b).

Potential Areas to focus on and influence action plan • 5% of respondents stated that they had not put myself under pressure to come to work when not feeling well enough (Q11g). • 37% of respondents have confirmed that they reported their last experience of harassment / bullying / abuse (Q13b). • 66% of respondents stated that the organisation treats staff involved in errors/ near misses / incidents fairly (Q16a) • 75% of respondents stated that the organisation takes action to ensure in errors/ near misses / incidents are not repeated (Q16c) • 55% of respondents stated that the organisation give staff feedback about changes made in response to reports errors/ near misses / incidents (Q16d) • 74% of respondents stated that they would feel secure raising concerns about unsafe clinical practice (Q17b) • 64% of respondents stated that they would feel confident that organisation would address concerns about unsafe clinical practice (Q17c)

NHS Staff Survey Results 24 February 2021

Page 131 of 210

Table 4 - Your Organisation

Care of patients / Q18a service users 75% 81% 91% 67% 78% 79% is org’s top priority Organisation acts on Q18 concerns 80% 90% 100% 72% 82% 81% b raised by patients / service users Would recommend Q18 organisation 69% 52% 91% 74% 69% 78% c as place to work If friend / relative needed treatment Q18 would be 61% 57% * 54% 64% 69% d happy with standard of care provided by org. Q18 Feel safe in 88% 90% 100% 93% 84% 92% e my work. Feel safe to speak up Q18 about 69% 52% 91% 74% 63% 80% f anything that concerns me in this org. I don’t often Q19 think about 48% 43% 73% 61% 46% 49% a leaving this organisation I am unlikely to look for a Q19 job at a new 51% 48% 73% 59% 51% 54% b organisation in the next 12 months I am not Q19 planning on 62% 62% 82% 65% 63% 66% c leaving this organisation.

NHS Staff Survey Results 25 February 2021

Page 132 of 210

Positive highlights

• 80% of respondents reported the CCG acts on concerns raised by patients/service users (Q18b). • 88% of respondents confirmed they feel safe in their work (Q18e). • 62% of respondents confirmed they are not planning on leaving the CCG (Q19c). • 51% of respondents confirmed they are unlikely to look for a job at a new organisation in the next 12 months (Q19b). • 69% of respondents confirmed they feel safe to speak up about anything that concerns them in the organisation (Q18f).

Potential Areas to focus on and influence action plan • 69% of respondents would recommend organisation as a place to work (Q18c) • 61% of respondents have confirmed that if friend / relative needed treatment would be happy with standard of care provided by org. (Q18d) • 69% of respondents Feel safe to speak up about anything that concerns me in this org. (Q18f) • 48% of respondents I don’t often think about leaving this organisation (Q19a) • 51% of respondents are unlikely to look for a job at a new organisation in the next 12 months-(Q19b) • 62% of respondents are not planning on leaving this organisation (Q19c)

NHS Staff Survey Results 26 February 2021

Page 133 of 210

Table 5 - Background Information

Corporate Nursing & Strategy Comparator Executive Finance Services Quality & T (BSW CCG Directorate Directorate Directorate Directorate Directora Overall) (BSW) (BSW) (BSW) (BSW) te (BSW) Q Description n = 22 n = 11 n = 47 n = 118 n = 59

Disability: organisation made Q2 adequate 81% * * * 73% * 6b adjustment(s) to enable me to carry out work

• 81% of respondents report that the organisation made adequate adjustment(s) to enable me to carry out work (Q26b).

NHS Staff Survey Results 27 February 2021

Page 134 of 210

NHS Staff Survey questions relating to Covid-19 pandemic Two additional questions were asked this year regarding colleagues experiences of working during Covid-19 pandemic. The responses to the two questions were free text and have therefore been grouped into themes.

Q21a – Thinking about your experience of working through the Covid-19 pandemic, what lessons should be learned from this time?

The table below provides a brief overview of the main themes that were provided in resonse to Q21a. In total 159 colleagues provided a free text response to this question.

- IT is a challenge at times but new technology is being embraced. - Not necessary to print out documents - IT systems need to be more robust and hardware and software updated. - Poor IT infrastructue for some providers across the system which is reducing effectiveness of responses. - Better training on new IT systems External feedback

- Pressure, demands and priorities from NHSE/I have continued and need reviewing - Better communication from central Government - Public sector pay to be reviewed and uplifted - The NHS needs more funding - Conflicting guidance around patients in care homes - GP’s left to muddle through. - Clearer national messaging Health and Wellbeing

- Contact needs to be maintained on a regular basis on a personal and professional basis and open two way consistent communication. - It has been very stressful - Executive Team should be more visible and Directors to do a monthly Q&A sesson on teams to aid visability. - More assistance and support required from HR - Team working is paramount and greater things can be achieved as a team, including work with other organisations. - Workloads need to be reviewed and discipline aroud working hours/breaks. - Able to be flexible and adaptable in approach to ensure the best care can be offered. - More support required for staff when working from home. - Lack of trust to do job, however this is improving. - Not to undertake organisational change at the same time as dealing with a pandemic. - Colleagues who arent performing can continue to do so from home any attempt to manage the will be seen as bullying and harassment. - People feel out of the loop, morale is low, staff are all on their knees, allow them some breathing space. - Do not need meetings about meetings, need to review if all meetings are needed.

NHS Staff Survey Results 28 February 2021

Page 135 of 210

- The flexibility of where colleagues work and when they work their hours is not detrimental to the CCG. - DSE assessments need to be done on a regular basis. Working environment

- PPE must be available at all times - Often unable to take breaks from desk due to back to back meetings, feel unable to escape work environment due to home working. Agreed etiquette around when you are available for calls/meetings would be helpful. - Home working environments are not ideal when you don’t have a dedicated office space. - Colleagues should be supplied with equipment to work safely from home, £100 is not enough. - The CCG should reimburse colleagues for the extra use of utilities at home due to the financial impact this is putting on colleagues. - Missing the communication that comes from working in an office enviroment. - Managers need to have training on managing a team working remotely. - Meeting arrnagements to be changed to allow gaps between meetings. - Having cameras on in team meetings can feel intimidated but expectation is camera will be on. - Due to working from home there is often no break from the screen. Governance

- Need to ensure good governance even when decisions are made at speed. - A SOP should be produced regarding the infrastructure needed to manage any future pandemics.

Q21b – What worked well during Covid-19 and should be continued?

The table below provides a brief overview of the main themes that were provided in resonse to Q21b. In total 154 colleagues provided a free text response to this question.

Internal focused feedback

- Embracing technology - Working from home - Saving money on commuting - Improved and regular communication with line managers/team and increased morale - Using MS Teams – more efficient and less costly to the organisation - Better work life balance, higher levels of productivity, colleagues trusted more - Manager support has been invaluable - Better and increased communication internally and externally - Reduced paperwork and silo working - Working together - Efficient decision making and slicker processes External focused feedback

- Joined up working with other organisations and responses at a local system level have been incredible - Quicker decision making, speed of change to get projects started, lighter touch governance, lighter touch CQC inspection process, less NHSE/I assurance required

NHS Staff Survey Results 29 February 2021

Page 136 of 210

- Collaborative working with the Local Authority and STP/ICS footprint and the removal of organisational boundaries. Actions that may be considered appropriate to address areas of concern raised under Q21a and Q21b

• The Executive Team to acknowledge the positive and negative impact home working and the pandemic has had on colleagues mental health and wellbeing. • The Health and Wellbeing Group to review what further actions can be taken to support colleagues mental health and wellbeing based on the experiences of people to date. • Clear boundaries to be reiterated to all colleagues around the expectations of working hours, factoring in regular breaks throughout the date and ensuring all colleagues have a good work life balance. • Guidance to be reissued about trying to avoid having back to back meetings. • Acknowledgement and recognition from the Executive Team regarding colleagues ongoing and high level of commitment during an exteremely challenging time. • Continue to embrace technology, specifically MS teams and allow colleagues to continue to work in an agile manner and have the choice to continue working from home, when there is an option to return to an office.

NHS Staff Survey Results 30 February 2021

Page 137 of 210

SECTION 3

Appendix 2 - Top 10 Priorities identified by Executive Management Team

Area of Focus Order Action Measure of success Link to other Target Lead of strategies/plans/CCG completion priority initiatives/policies date 1 A survey or drop in sessions Colleagues will feel able to WRES action plan: section on CSU HR / to be held to understand speak up about their bullying and harassment COMMS / further the harassment, experiences and know that MGR bullying or abuse colleagues action will be taken. People Plan: Looking after our have experienced from People managers and why experiences of bullying, CCG People Strategy (Culture and inclusion) harassment and/or abuse is not being reported. Your Health, Following this appropriate Wellbeing and action can be taken. Safety at 2 A CCG Director/FTSU Colleagues will feel WRES action plan: section on CSU HR / Work Guardian to explore with listened to and bullying and harassment COMMS /

teams/individuals their appropriate action can be FTSU / experience of harassment, taken with the aim to People Plan: Looking after our H&WG bullying and/or abuse from reduce the experience of People managers. The two teams bullying, harassment who reported the highest and/or abuse experienced CCG People Strategy (Culture and by colleagues from inclusion) experiences of this to be met managers. with first. Following this appropriate action can be taken.

NHS Staff Survey Results 31 February 2021

Page 138 of 210

Area of Focus Order Action Measure of success Link to other Target Lead of strategies/plans/CCG completion priority initiatives/policies date 3 A written communication or Colleagues aware that WRES action plan: section on CSU HR/ colleague briefing to be action will be taken if any bullying and harassment COMMS organised to highlight to incidences of bullying, colleagues that the CCG has harassment and/or abuse People Plan: Looking after our a zero tolerance approach are raised. People towards bullying, harassment and/or abuse CCG People Strategy (Culture and inclusion) and that the CCG wants all experiences of bullying, harassment and/or abuse to be reported. 4 A recording by Tracey Cox Colleagues understand WRES action plan: section on COMMS and FTSU guardian to be that the AO and FTSU bullying and harassment placed in a prominent place guardian will take action on the CCG intranet site regarding any form of People Plan: Looking after our regarding how the CCG bullying, harassment or People addresses any incidences of abuse once they are aware bullying, harassment and/or of the issue. CCG People Strategy (Culture and Inclusion) abuse. 5 Drop in sessions with HR The strain on working CSU HR offered to all staff to help relationships is reduced. identify why working Your Job relationships are stained and what can be done to address it. Following this appropriate action can be taken.

NHS Staff Survey Results 32 February 2021

Page 139 of 210

Area of Focus Order Action Measure of success Link to other Target Lead of strategies/plans/CCG completion priority initiatives/policies date 6 Organisational Change Policy Colleagues feel more BSW Organisational Change CPF to be reviewed to ensure it is involved in decision Policy clear that where appropriate making regarding changes managers should involve that affect their area of colleagues as early as work. possible in discussing and deciding changes that affect their area of work. 7 Teams to review and discuss A greater understanding of CCG People Strategy MGRs the team/directorate the team’s objectives and (Engagement) objectives at a team meeting how working as a team will and for individuals to reflect achieve the overall on how their own objectives objectives. will help achieve the team objectives. Your Health, 8 Training to be offered about Colleagues would feel CCG People Strategy (Learning MGRs Wellbeing and supporting colleagues and better equip with and development) Safety at teams remotely to help managing and supporting Work improve communication teams remotely. between managers and colleagues. 9 The 1:1 template to be Colleagues will feel CSU HR updated to include questions involved in the decision regarding any decisions line making and that their Your managers are considering views have been taken on Managers that impact colleagues work board. and have a constructive conversation regarding this

NHS Staff Survey Results 33 February 2021

Page 140 of 210

Area of Focus Order Action Measure of success Link to other Target Lead of strategies/plans/CCG completion priority initiatives/policies date prior to decisions being made. 10 Organise Senior Manager Improved, COMMS/ Forums to discuss and communications EXECS improve good team throughout, good communications and share leadership and effective best practice team work

NHS Staff Survey Results 34 February 2021

Page 141 of 210

SECTION 4 Appendix 3 - Actions to consider by directorate

The following actions have been developed by the People Directorate and CSU HR as areas of work that each directorate may consider appropriate to implement in their departments. The “order of priority” column related to the top 10 actions identified by the executive team. *ICW – In Collaboration With

*ICW – In Collaboration With

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date Your Job 7 Teams to review and discuss A greater understanding CCG People Strategy (Engagement) MGR the team/directorate of the team’s objectives objectives at a team and how working as a meeting and for individuals team will achieve the to reflect on how their own overall objectives. objectives will help achieve the team objectives. Managers to reflect on a Colleagues feel valued CCG Recognition Scheme MGR regular basis of good work and morale is increased. carried out by members of their teams and to feed this back to the individuals in a timely manner. Managers to discuss with All colleagues have a job 23.02.21 MGR / CSU colleagues if their job description that reflects HR descriptions need reviewing the work they are being and updating. If so, this asked to undertake. action to be taken by the manager and colleague and shared with HR to establish

NHS Staff Survey Results 35 February 2021

Page 142 of 210

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date if the changes are significant. The Executive Team to Colleagues would feel CSU HR / consider if an exercise needs they are being treated DPOD to be carried out to ensure and paid fairly if a robust parity across the whole CCG review of roles and pay is between comparable jobs undertaken. following the merger. CCG pulse survey to be The strain on working CCG People Strategy (Engagement) COMMS / issued asking specific relationships is reduced. CPF / SLT questions about working relationships and actions When a further CCG pulse that can be taken to address survey is carried out it is this, to help inform the reported that working action that can be taken. relationships are less strained. Your A communication to be sent Colleagues are aware of BSW Other Leave Policy COMMS / Managers to all staff about the the support available to CSU HR emergency leave that is them in terms of leave in available to all colleagues a crisis. when dealing with a personal crisis. Coaching/mentoring to be Managers feel confident CCG People Strategy (Learning and MGR explored with all managers and able to have development) during 121 or appraisal challenging conversations (whichever comes first) with and feel able to coach regards to the management their direct reports rather of colleagues and their own than provide the answers. development.

NHS Staff Survey Results 36 February 2021

Page 143 of 210

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date 10 Organise Senior Manager Improved, COMMS / Forums to discuss and communications EXEC improve good team throughout, good communications, what do leadership and effective these look like? share best team work practice Your Health, 8 Directorate and department Colleagues would feel CCG People Strategy (Learning and MGRS Wellbeing review of communications better equip with development) and Safety at to colleagues to improve managing and supporting Work communication between teams remotely. managers and colleagues. Senior Managers/Directors Colleagues will have the CCG People Strategy (Engagement) EXEC / SLT to attend team meetings on chance to raise any a regular basis to improve concerns directly with the two way communication Director/Senior Manager and visibility. and Directors will be able to share any messages directly with the teams within their directorate.

Who’s who pages to be Colleagues will know developed for the intranet who’s who within the COMMS site to help colleagues organisation from band understand who the leaders 8a and above. of the organisation and senior managers are. Information from the SLT Colleagues feel they are CCG People Strategy (Engagement) SLT meeting to be shared either kept up to date with via a written communication matters being discussed or via the colleague briefing within the CCG.

NHS Staff Survey Results 37 February 2021

Page 144 of 210

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date to ensure colleagues are informed of matters being discussed within the CCG. A CCG pulse survey to be The CCG will have up to CCG People Strategy (Engagement COMMS issued to understand what date data of the current and colleague wellbeing) further action the CCG could feelings within the CCG take to support and improve and suggested actions the health and wellbeing of that can be taken. colleagues and how the CCG can support colleagues who are feeling isolated. Managers with support of CPF members aware of CCG People Strategy (Engagement) MGR / CPF directorate CPF member to the issue’s colleagues are explore within their facing in relation to Directorates what further health and wellbeing and action can be taken to able to drive forward support and improve the changes in relation to this health and wellbeing of area. colleagues. Health and wellbeing H&W GROUP Health and Wellbeing Team team aware of what to review what further actions can support action can be taken to colleagues moving support colleague’s mental forward. health and wellbeing based on experiences to date. Future initiatives are H&W GROUP based on qualitative Lessons learnt exercise to be feedback direct from carried out by health and colleagues. wellbeing team to inform

NHS Staff Survey Results 38 February 2021

Page 145 of 210

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date future health and wellbeing initiatives.

A monthly/quarterly health Colleagues will be kept up CCG People Strategy (Engagement) H&W GROUP and wellbeing newsletter to to date on health and / COMMS be developed by the health wellbeing initiatives and and wellbeing group will be able to find all the detailing initiatives that are information in one place in place and support and it will include clear available. signposting to other available support. DSE assessment to be Colleagues do not suffer ALL carried out by all colleagues physical issues as a result COLLEAGUES and shared with their line of their office set up at managers. Any necessary home. action as a result of the DSE assessment to be taken. MGR Audit to be carried out to All colleagues have the establish if all colleagues right equipment to carry have the right equipment at out their roles. home to enable them to carry out their roles. 1 A survey or drop in sessions Colleagues will feel able WRES action plan: section on CSU HR / to be held to understand to speak up about their bullying and harassment COMMS / further the harassment, experiences and know MGR bullying or abuse colleagues that action will be taken. People Plan: Looking after our have experienced from People managers and why experiences of bullying,

NHS Staff Survey Results 39 February 2021

Page 146 of 210

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date harassment and/or abuse is CCG People Strategy (Culture and not being reported. inclusion) Following this appropriate action can be taken. 2 A CCG Director/FTSU Colleagues will feel WRES action plan: section on CSU HR / Guardian to explore with listened to and bullying and harassment COMMS / teams/individuals their appropriate action can be FTSU / experience of harassment, taken with the aim to People Plan: Looking after our H&WG bullying and/or abuse from reduce the experience of People managers. The two teams bullying, harassment who reported the highest and/or abuse CCG People Strategy (Culture and experiences of this to be experienced by inclusion) met with first. Following colleagues from this appropriate action can managers. be taken. 4 A recording by Tracey Cox Colleagues understand WRES action plan: section on COMMS and FTSU guardian to be that the AO and FTSU bullying and harassment placed in a prominent place guardian will take action on the CCG intranet site regarding any form of People Plan: Looking after our regarding how the CCG bullying, harassment or People addresses any incidences of abuse once they are bullying, harassment and/or aware of the issue. CCG People Strategy (Culture and abuse. Inclusion) A separate Colleagues will fully CCG People Strategy (Engagement) QI TEAM workshop/webinar type understand the steps session could be held for they need to take to directorates within the CCG report unsafe clinical that have a clinical practice and the action workforce who may witness that the CCG will take. unsafe clinical practice.

NHS Staff Survey Results 40 February 2021

Page 147 of 210

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date

You said/we did approach to be taken to highlight and promote the actions that have been taken when errors/near misses/incidents have been reported. This approach Colleagues are assured could be promoted on a that action is being taken quarterly basis via a when incidences are colleague briefing. reported.

Your Discussions to be had by the Colleagues will feel People Plan: Looking after our EXEC / CSU Organisation Executive Team about the valued and have a clear people, new ways of working and HR introduction of a talent path regarding their delivering care and Growing for the management programme talent that is being future and/or succession planning nurtured and if possible, to help retain and develop a plan for their next WRES: Recruitment and Retention talent within the CCG. career moves within the CCG. CCG People Strategy (Leadership at all levels) To explore training and Colleagues will feel People Plan: New ways of working MGR / CSU development opportunities valued by the CCG and and delivering care and Growing HR for all colleagues to increase the action will support for the future job satisfaction. continuous learning. WRES: Recruitment and Retention

NHS Staff Survey Results 41 February 2021

Page 148 of 210

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date CCG People Strategy (Leadership at all levels, culture and inclusion, Learning and Development)

All vacancies are advertised The CCG will be able to MGR / CSU internally first to help retain retain talent (measured HR and develop colleagues. through lower turnover rates and internal promotions/secondments ) within the CCG and develop colleagues. Background All managers to have 121 Colleagues with a CCG Managing Sickness Absence MGR Information meetings with every disability know that Policy and Procedure colleague to have a health reasonable adjustments and wellbeing conversation will be considered. and to establish those colleagues who have a disability and ensure that relevant and reasonable adjustments they require to carry out their work have been considered. COVID-19 Executive and SLT team to Colleagues will know that EXEC / SLT / related acknowledge the positive the Executive Team are COMMS actions and negative impact home aware of the difficulties working and the pandemic they have faced including has had on colleague’s the positive and negative mental health and impact working from wellbeing. home has caused.

NHS Staff Survey Results 42 February 2021

Page 149 of 210

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date

Agile Working Protocol to be Colleagues will achieve a Ways of Working Policy (including AGILE completed and tested with good work life balance agile working). WORKING CPF to outline the through knowing the CCG GROUP expectations of working does not expect them to Agile Working Protocol hours, the importance of work any hours above breaks, the need to avoid their contracted hours, CCG People Strategy (Workforce back to back meetings and encourages colleagues to planning and transition) the importance of having a take breaks and avoid good work life balance and back to back meetings. that the CCG strongly encourages this. Executive Team and SLT to Colleagues will continue Colleague Recognition scheme EXEC / SLT acknowledge and recognise to feel valued by the colleagues ongoing and high Executives within the level of commitment during CCG. extremely challenging times. Concerns raised regarding Colleagues will be People Plan: Belonging in the NHS GOV. TEAM Governance through the assured that there are NHS Staff Survey to be good governance explored further by the processes in place even Governance Team during a time of crisis.

NHS Staff Survey Results 43 February 2021

Page 150 of 210

SECTION 5 Appendix 4 – CSU HR Actions

*ICW – In Collaboration With

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date Your Job A template for 1:1s to be 1:1 template is being CPF / MGR developed to include used by all managers and prompts for discussing: aiding open and transparent - Areas where colleagues conversations regarding; feel improvements can areas where colleagues be made in their area of feel improvement can be made in their work area, work. where initiative and - Where colleagues can autonomy can be use their initiative and increased. share ideas, they have for improving areas of work. - Colleagues and Managers to discuss if there are areas where colleagues can have a greater level of autonomy. - Managers to discuss during 1:1’s any Colleagues feel better conflicting demands equip to manage colleagues may have on conflicting demands on their time and unrealistic their time and unrealistic time pressures. time pressures and

NHS Staff Survey Results 44 February 2021

Page 151 of 210

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date discuss what action can be taken to reduce the conflicting demands and unrealistic time pressures. 6 Organisational Change Colleagues feel more BSW Organisational Change Policy CPF Policy to be reviewed to involved in decision ensure it is clear that where making regarding changes appropriate managers that affect their area of should involve colleagues as work. early as possible in discussing and deciding changes that affect their area of work. Performance review A greater understanding Appraisal/performance review CPF paperwork to be updated to of the team’s objectives paperwork detail the team objectives and how these link with alongside colleagues’ individual objectives. individual objectives to clear demonstrate how individual objectives support the achievement of the team objectives. 5 Drop in sessions with HR The strain on working CSU HR offered to all staff to help relationships is reduced. identify why working relationships are stained and what can be done to

NHS Staff Survey Results 45 February 2021

Page 152 of 210

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date address it. Following this appropriate action can be taken. Your 9 The 1:1 template to be Colleagues will feel CSU HR Managers updated to include involved in the decision questions regarding any making and that their decisions line managers are views have been taken on considering that impact board. colleagues work and have a constructive conversation regarding this prior to decisions being made. A communication to be sent Colleagues are aware of BSW Other Leave Policy COMMS to all staff about the the support available to emergency leave that is them in terms of leave in available to all colleagues a crisis. when dealing with a personal crisis. Your Health, Explore specific training on Colleagues will have CCG People Strategy (Learning and CSU OD Wellbeing and managing stress including training and tips on how Development) Safety at conflicting priorities, to manage stress and Work workload and work life ensure good work life balance to be balance. commissioned. 3 A written communication or Colleagues aware that WRES action plan: section on CSU HR/ colleague briefing to be action will be taken if any bullying and harassment COMMS organised to highlight to incidences of bullying, colleagues that the CCG has harassment and/or abuse People Plan: Looking after our a zero tolerance approach are raised. People towards bullying,

NHS Staff Survey Results 46 February 2021

Page 153 of 210

Area of Focus Order Action Measure of success Link to other strategies/plans/CCG Target ICW* of initiatives/policies completion priority date harassment and/or abuse CCG People Strategy (Culture and and that the CCG wants all inclusion) experiences of bullying, harassment and/or abuse to be reported. Your To explore training and Colleagues will feel People Plan: New ways of working CSU OD Organisation development opportunities valued by the CCG and and delivering care and Growing for all colleagues to increase the action will support for the future job satisfaction. continuous learning. WRES: Recruitment and Retention

CCG People Strategy (Leadership at all levels, culture and inclusion, Learning and Development)

NHS Staff Survey Results 47 February 2021

Page 154 of 210

Meeting of the BSW CCG Governing Body Report Summary Sheet

Report Title Planning for 2021/22 Agenda item 14

Date of meeting 18 March 2021

Purpose Approve Discuss Inform √ Assure

Executive lead, Julie-Anne Wales, Director of Corporate Affairs and Caroline contact for enquiries Gregory, Chief Financial Officer This report concerns BSW √ BaNES Swindon Wiltshire CCG locality locality locality This report was The proposed approach to planning in 2021/22 has been discussed reviewed by by the BSW Partnership Executive and the BSW Oversight and Delivery Board Executive summary These slides set out our approach to planning in 2021/22 against a backdrop of constrained resources. We anticipate there will be very limited recurring funding except for targeted amounts with a clear purpose such as for Mental Health Transformation and Elective Care Recovery.

We are therefore proposing to focus on how we are spending the £1.5bn budget we have in BSW and take a risk based approach regarding our highest patient safety and quality risks and focus on outcomes and improvements to the health of the populations we serve.

This work will be led by our developing Integrated Care Systems; and other groups such as the Elective Care Board; Urgent Care and Flow Board; Acute Alliance; MH Thrive Programme Board; LD/ASD Programme Board and the BSW Local Maternity and Neonatal System Programme Board with a view to developing a BSW System Plan. Equality Impact The groups developing elements of the plan will be assessing the Assessment positive impacts of their priorities on inequalities in our health and care system. Public and patient Not planned at this stage. engagement

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 1 of 2 Page 155 of 210

Report Title Planning for 2021/22 Agenda item 14

Recommendation(s) 1. The Governing Body is asked to note the proposed approach to the development of our BSW System Plan for 2021/22, noting national guidance is expected on 25 March 2021.

Link to Board In developing the plan, we are taking a risk based approach and aim Assurance to address the highest patient quality and safety risks highlighted on Framework our risk register. or High-level Risk(s) Please click this link to view the latest BAF and Risk Register - https://intranet.bswccg.nhs.uk/tools-and-resources/resource- library/governance

Risk (associated with High Medium Low N/A the proposal / recommendation) Key risks The key risk is that BSW does not make the most of the opportunity to utilise short term funding and national targeted funds to transform the way services are designed and delivered in 2021/22. If we are unable to make progress we will also continue to spend above our financial allocation as a system. Impact on quality Our approach will be risk based and focus priorities to address quality and safety and improving the health of our population. Impact on finance The BSW System Plan will include a single BSW Financial Plan for 2021/22. Not required at this stage

Conflicts of interest No conflicts of interest have been identified at this stage. The process to approve the plan involves system wide governance arrangements which will mitigate any particular interests. This report supports ☒ BSW approach to resetting the system the delivery of the ☒ Realising the benefits of merger following CCG’s ☒ Improving patient quality and safety strategic objectives: ☒ Ensuring financial sustainability ☒ Preparing to become a strategic commissioner This report supports ☒ Improving the Health and Wellbeing of Our Population the delivery of the ☒ Developing Sustainable Communities following BSW ☒ Sustainable Secondary Care Services System Priorities: ☒ Transforming Care Across BSW ☒ Creating Strong Networks of Health and Care Professionals to Deliver the NHS Long Term Plan and BSW’s Operational Plan

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 2 of 2 Page 156 of 210 Planning for 2021/22 Update for the Governing Body 18th March 2021

Bath & North East Somerset ● PageSwindon 157 of 210 ● Wiltshire ● Working together Context • We are currently spending £1.07 for every £1 we receive in BSW

• There will be no additional recurring funding for 2021/22 except targeted amounts with a clear purpose such as for Mental Health transformation and the Elective Recovery Fund

• What non recurrent funding we receive must be used for transformational change otherwise we perpetuate and increase our debt

• With the rolling over of the financial regime from 20/21 into Q1 of 21/22 we have some time to reconsider our approach, and

• Set the prototype for a new way of working in the future as system partners relating to how we together are spending our resources

• National Planning guidance due 25th March

Bath & North East Somerset ● PageSwindon 158 of 210 ● Wiltshire ● Working together 2 A New Way We are proposing a new approach and to:

 Have an honest conversation about restricted budgets

 Change the focus from bidding for new monies towards reviewing how we are spending our current £1.5bn budget

 Take a longer term view – where do we want to get to? What do we want to achieve? What would help us deliver our priorities?

 Take a risk based approach – what are our highest patient safety and quality risks?

 Focus on Outcomes and confirm the highest priorities for action – what are we going to work on together over the next 12 months and beyond?

 How might we move resources from one part of our system to another to address these risks?

Bath & North East Somerset ● PageSwindon 159 of 210 ● Wiltshire ● Working together 3 Opportunities

• For a mindset change – from ‘we have no money’ to ‘we have £1.5bn available’ – how do we use our allocation to best effect?

• Opportunity for a new narrative, new conversation and new relationships

• Rebrand away from a bidding competition towards a transformation approach

• Agree the collective risks and take a system view

• Focus on outcomes and take a QI approach

• Use our workforce differently with more flexibility and across old boundaries

• Capitalise on digital innovations

• Practice a new way of working together in support of sustainability across our ICS

Bath & North East Somerset ● PageSwindon 160 of 210 ● Wiltshire ● Working together 4 BSW Design Principles Through the listening activities that were undertaken as part of the reflection on our response to COVID-19, we have identified a set of design principles which will inform the ongoing development of our approach to population health and care design. These design criteria are intended to be adopted in a flexible manner, providing a guide to the way population health and care is developed across BSW.

Bath & North East Somerset ● PageSwindon 161 of 210 ● Wiltshire ● Working together The Task • To commence a series of conversations regarding our priorities in anticipation of the national guidance setting out funding allocations and the requirements of the planning round for 21/22

• Focused approach by system groups within a matrix to create a coherent whole

• Initiating connections with others groups on areas of joint interest

• Ensuring clinical and professional voices in discussions

• Overarching system wide set of processes to deliver:

– A Single comprehensive Demand and Capacity Plan – Quality Impact Assessments to support groups and inform decision making – An overview of Impact on Inequalities – A Single BSW Financial Plan – A Single BSW System Plan – Single Digital Strategy, Estates Strategy and Workforce Plan

Bath & North East Somerset ● PageSwindon 162 of 210 ● Wiltshire ● Working together 6 Outline Framework – areas for consideration

Criteria Detail

Pressures and gaps Identify specific service pressures (including quality and access issues) or a gap in service provision within BSW Disinvestment Given the backdrop of very limited and targeted investment funds, consider which services are not providing VFM and/or good outcomes and where we recommend disinvestment Recovery backlog Consider the requirements for service recovery associated with the Covid pandemic Improve productivity Identify opportunities for improvement in productivity and the potential for cost releasing savings Changes/alignment of clinical Identify unwarranted variation in clinical pathways across pathways BSW, or between BSW and other systems Developing our care model to Develop vision for ‘future state’ care model within your support transformation, improve area (e.g. overall system design, implementing LTP outcomes and enable people to priorities, integrated operating models, focussing on lead their best lives prevention and early intervention, and reducing inequality)

Bath & North East Somerset ● PageSwindon 163 of 210 ● Wiltshire ● Working together 7 Expected Outputs for Decision Making 1. Prioritised work programmes for: • Each locality • The Acute Hospital Alliance • Urgent Care • Elective Care Recovery • Mental Health/LD/ASD • Maternity and Neonatal Transformation • Financial Recovery

2. Identifying impacts on inequalities and quality outcomes for our population

3. An accompanying resource plan, outlining requests for short term transformational funding and national targeted funding

4. A Risk Register to capture what we are unable to progress including commentary on our mitigations and including Quality Impact Assessments

5. Ascertain the impact for enabling support functions such as Digital, Workforce and Estates

Bath & North East Somerset ● PageSwindon 164 of 210 ● Wiltshire ● Working together 8 Matrix Working Approach

Bath & North East Somerset ● PageSwindon 165 of 210 ● Wiltshire ● Working together 9 Planning & Prioritisation Critical Path

Guidance and support offer plus comms to the system 05/03/21

Process bringing QIA inc Sense check EQIA and Group discussions together outputs BSW Partnership Exec final System Plan vs DPIA DOFs/DDOFs – likely to need 2 of discussions decisions on Planning and Planning 03/05/21 ODG meetings per group 19/04/21 – Investment Priorities Guidance – End May 08/03/21 – mid 17/05/21 11/06/21 Early April Enablers: 17/05/21 April Workforce Meds Optimisation Digital

Risks Finance Recovery Income guidance D&C

Bath & North East Somerset ● PageSwindon 166 of 210 ● Wiltshire ● Working together Governance and Decision Making

• System Leadership embedded in process and Planning Programme Board established to oversee the Planning Process

• ICAs; Urgent Care and Flow Board; Elective Care Board; Acute Alliance; MH Thrive Programme; LD/ASD Programme and Maternity and Neonatal System Programme develop work programmes, resources plans and risk register. System Planning leads supporting

• System level groups pull together system wide picture for demand and capacity; quality impact; inequalities; finance and key enablers

• Recommendations to Oversight and Delivery Board who make recommendations to BSW Partnership Exec

• Members of BSW Partnership Executive report outcomes to through their internal governance structures

• CCG Governing Body asked to endorse decisions

Bath & North East Somerset ● PageSwindon 167 of 210 ● Wiltshire ● Working together 11

Meeting of the BSW CCG Governing Body Report Summary Sheet

Report Title Risk Management Agenda item 16

Date of meeting 18 March 2021

Purpose Approve Discuss x Inform x Assure x

Executive lead, Julie-Anne Wales, Director of Corporate Affairs contact for enquiries This report concerns BSW x BaNES Swindon Wiltshire CCG locality locality locality This report was The Corporate Risk Register, Risk Map and Board Assurance reviewed by Framework are reviewed by the Executive Team, the Senior Leadership Team, the Risk Management Panel and the Audit Committee.

Executive summary The purpose of this paper is to present the risks on the CCG’s Corporate Risk Register and Board Assurance Framework for comment and for the Audit Committee’s assurance that risk management remains integral to its current work.

Equality Impact N/A Assessment Public and patient N/A engagement Recommendation(s) The Governing Body is asked to note the report and to make any comments or suggestions regarding the nature of the risks identified; the content or format of the report.

Link to Board Please click this link to view the latest BAF and Risk Register - Assurance https://intranet.bswccg.nhs.uk/tools-and-resources/resource- Framework library/governance or High-level Risk(s) Risk (associated with High Medium Low N/A x the proposal / recommendation) Key risks This paper identifies the key risks that face the CCG.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 1 of 4 Page 168 of 210 Report Title Risk Management Agenda item 16

Impact on quality This risk management process includes the management of quality risks.

Impact on finance This risk management process includes the management of financial risks.

Finance sign-off: N/A

Conflicts of interest None identified.

This report supports ☒ BSW approach to resetting the system the delivery of the ☒ Realising the benefits of merger following CCG’s ☒ Improving patient quality and safety strategic objectives: ☒ Ensuring financial sustainability ☒ Preparing to become a strategic commissioner This report supports ☒ Improving the Health and Wellbeing of Our Population the delivery of the ☐ Developing Sustainable Communities following BSW ☒ Sustainable Secondary Care Services System Priorities: ☒ Transforming Care Across BSW ☒ Creating Strong Networks of Health and Care Professionals to Deliver the NHS Long Term Plan and BSW’s Operational Plan

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 2 of 4 Page 169 of 210

Risk Management

1. Executive Summary

1.1 The purpose of this paper is to present the risks on the CCG’s Corporate Risk Register and Board Assurance Framework for comment and for the Governing Body’s assurance that risk management remains integral to its current work.

2. Recommendation(s)

2.1 The Governing Body is asked to note the report and to make any comments or suggestions regarding the nature of the risks identified; the content or format of the report.

3. Background

3.1 Corporate Risk Register and Risk Map There are currently 33 risks on the Corporate Risk Register (CRR), with 10 risks scoring as High / Red having a current score of 16 or over. A further 20 risks are scored as Moderate / Amber, with scores between 9 and 15. Three risks have had their current risk scores decreased but have remained on the risk register until they can be officially closed at the next Risk Management Panel, as per process.

The risk category that has the highest number of High / Red risks is that of ‘Public, Patient and Staff Safety including Clinical Harm’, with 6 risks.

One new risk has been added to the CRR by February’s Risk Management Panel (RMP) and it relates to a merger of the two previous Ambulance risks around queuing and call stacking and response delays.

The new risk (BSW 47) acknowledges that there is a risk that patients could have a poor experience and are at risk of deterioration as a result of delays in receiving the appropriate and timely 999 ambulance response and handover delays. The new arrangements to reduce the risk of spread of COVID-19 in ED has restricted the volume of patients that can be safely accommodated, and when there is a surge in patients and ambulances attending ED this can result in ambulance handover delays. The initial and current score for this risk stands at 16 (Likelihood 4 x Impact 4).

3.2 Board Assurance Framework The Board Assurance Framework (BAF) for 2020 / 2021 sets out the risks to the CCG achieving its identified Strategic Objectives.

The five objectives that have been identified are as follows: 1. BSW Approach to resetting the System; 2. Realising the benefits of our merger;

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 3 of 4 Page 170 of 210

3. Improving Patient Quality and Safety and moving towards a system approach; 4. Ensuring Financial Sustainability; and 5. Preparing to become a Strategic Commissioner in the context of the developing ICS.

Each objective has an Executive owner of the risk and an overall risk rating. The risks to delivering the objective are identified as well as actions to mitigate the risk and to fill any identified gaps in the controls and assurances.

4. Other Options Considered

4.1 None.

5. Resource Implications

5.1 None.

6. Consultation

6.1 The Corporate Risk Register is reviewed by the Executive Team, the Senior Leadership Team and the Risk Management Panel.

7. Risk Management

7.1 This paper identifies the key risks that face the CCG.

8. Next Steps

8.1 None.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 4 of 4 Page 171 of 210 Corporate Risk Register Feb-21

Movement in score Risk Date risk RAG on Risk Owner Risk Latest Target delivery Person (from previous Risk Category Risk Brief entered Risk Proposed action progress Director Manager review Description of risk including event, cause and consequences Existing controls and assurances date for each delivering each Commentary on progress against action plans updates since July no. (for risk Appetite descriptor on Treatment (number each action) against Accountable Responsible date action action 2019 or date of risk map) register actions2 entry on register) Current impact Current Target risk score Current likelihood Current risk score risk Current Original risk score BSW Public, Low Preparations for 15-Feb-21 Gill May, Alan Sheward, 12-Feb-21 20 12 Treat There is a risk that the preparations we have made for winter, are insufficient to We have undertaken demand and capacity planning as a system for these 1. Review Demand, Flow and Capacity plans by "place" 1. Complete, plans 1. Locality COOs Previous actions removed from plan as delivered. On target 4416 44 patient and Winter Director of Winter Director cope with the impact of a resurgence of COVID-19; a high incidence of Flu in the scenarios and have put in place programmes of work to increase beds and non (locality) to assess current and future Demand, Flow and being enacted Review of demand, flow and capacity as part of System Pressures response staff safety Nursing & population; and the usual impact that colder weather has on a range of health bedded capacity; crisis response services and rehabilitation support for Capacity. including Quality conditions and further impacts on drugs, supplies and equipment as a result of discharges. clinical harm EU Exit. These may result in plans for recovery of elective and cancer services We have planned Flu vaccination clincs. 2. Test escalation plans with partners as a whole system. 2..March 2021 2. Head of EPRR being impacted negatively. The new operating models to support social isolation Implementation of a new NHS111 First Service to support Emergency are impacting arrangements previously adopted to manage peaks in demand and Departments with enhanced clinical assessments for patients with an ED these may lead to patients having to be held in ambulances prior to admission disposition. 3. Review and undertake self assessment against 3. February 2021 3. Winter Director (BSW 47) and it may become increasingly difficult to maintain the Infection Infection, Prevention and Control leads have worked together to ensure a Discharge Policy with Acute and Community Providers. Prevention and Control measures in green zones leading to outbreaks and bed consistent approach across BSW. closures. A Winter Director has been appointed for the system taking up post in 4. Complete review and commence measures 4. APRIL 2021 4. Head of Urgent November 2021 surrounding Transformation of Urgent and Emergency Care & Wilter There is a Critical Care mutual aid agreement in place for BSW between Care: Models of Care and Management Director providers. A Triggers and Thresholds report is updated daily to provide a common 5.Plans tested in anger Jan 2021. Review of Jan ICS 5. Feb 2021 5. Director of understanding of system pressures and incidence of COVID by area. This is Significant Incident outcomes underway. Corporate Affaris Review taken to System Executives 12 February 2021 being extended to include community partners. SHREWD, an operational management system is being rolled out across BSW 6. Undertake a Capacity & Demand review alighed to 6. March 2021 6. Winter Director to enable a detailed system wide view of pressures of as they impact different lICA escalation. services within our system. e.g. Ambulance, ED; admissions and discharges; community services.In addition to more responsive and operational appraoch 7. Undertake a Winter Debrief of the ICS - SCOPE 7. April 2021 7. TBC the Wnter Director is leading a strategic piece of work focused on an Urgent Development Care and Flow improvmeent plan. BSW Finance Moderate Financial 17/05/2020 Caroline Joss Convey, 17-Feb-21 Treat Financial pressures and lack of policy alignment across health and social care Contract review meetings in place to monitor the situation. Regional Finance Directors meetings being organised to 30/03/2021 Caroline Gregory, Phase 3 letter published for the NHS, but still waiting policy guidance for social care. Hospital Discharge Programme arrangements now Potentially Off 4416 31 Pressures Gregory Financial may lead to decisions to make changes to service provision which could have an STP discussions regarding the financial position in BSW and ongoing discuss the pressure to health. Tracey Cox & confirmed nationally and agreement reach across the 3 localities on the additional services which will be put in place. Results of the target Chief Finance Recovery adverse impact on the CCG and patient flow. sustainability and also across the SW through the FD network with Locality hubs in place to discuss and review policy. COOs. Wiltshire BCF review shared with the Governing Body and BaNES actively being considered through the Joint Commissioning Officer benchmarking work being undertake to determine level of financial risk. Further funding has been made available to Social Care Committee. Schedules for the BCF being produced to share with Governing Body in the next couple of months. Risk now that funding Locality discussions to review policy as it emerges though they recognise this will not be sufficient to will not continue beyond 31/3 for HDP has been raised to BSW Execs and through to the BSW Partnership Board with agreement that address their in year pressures. Work going on across an urgent action needs to be taken to discuss the impact of ceasing these schemes on the system; which ones should continue and how the three localities to review better care fund to ensure they will be funded. value for money and alignment with current service priorities. Ongoing discussions about how we can support over second COVID-19 surge and through winter with the national Hospital Discharge Programme. National decision taken recently not to extend funding for the HDP scheme beyond 31/3 so discussions taking palce with all system partners through Localities on what schemes should continue and how this will be funded

BSW Public, Low COVID-19 17-Feb-20 Julie-Anne Louise Cadle, 12-Feb-21 12 12 Treat COVID-19 thrives on cold, slightly damp environments lasting longer in the air and A robust 24/7 incident management and on-call structure is in place to manage The situation is fast moving and we are adapting our Ongoing Louise Cadle is co- Response and surveillance is underway with public health monitoring any further outbreaks and impacts on health and social care. The On target 4416 26 patient and Second Peak of Wales, EPPR Manager on surfaces therefore as we head towards the winter months there is a real risk of the CCG's business continuity and supporting the system's response. BSW has response as required on a daily basis in response to the ordinating. Many various test and trace work strands are being implemented as directed. staff safety Infections Director of a second wave. Seasonal influenza with other coughs, colds and sneezes may established command and co-ordination arrangements to work with NHSEI, intelligence and national directions. members of the Further work is underway to review ICC arrangements as the response escalates and also to incorporate EU Exit and Winter escalation. including Corporate Affairs confuse individuals as to whether they have a cold or COVID-19 which could Public Health England, local councils and NHS providers to plan for current and wider team are Capacity to resource the ICC is an issue as staff attempt to return to BAU in response to Phase 3. clinical harm increase risk of transmission if individuals do not get tested or follow isolation future requirements. A weekly tactical call takes place across the BSW system participating in our rules. Evidence from Scientific Advisory Group for Emergencies SAGE is that led by BSW CCG providing a touchpoint across health and social care to response. being indoors, potentially crowded/close proximity with limited air flow for monitor impacts and provide a shared situational awareness. AEO/Head of prolonged periods of time, noisy environments where people are coughing, EPRR participate in local planning calls with Local Resilience Forums. shouting does increase more droplet transmission. Increase in testing for positive cases with subsequent contact tracing follow-up The current trend is that the symptoms are milder than previously with less arrangements is helping to reduce transmission (although limited to the public hospitalisation with many people unaware they are infected and are continuing life adhering to isolation and social distancing). This does mean that any without isolating thus increasing community transmission and clusters of subsequent wave will be slower to grow than the first wave, giving more time for outbreaks in areas. There is also evidence that the public having been lockdown response and standing up of services. for months and new found freedom are not adhering to social distancing. If flu immunisation uptake is strong this year, the general increase in social Relaxation of lockdown in social activities and with schools reopening in distancing should mean we could expect a better flu and other respiratory virus September could increase numbers of positive cases. season than would have occurred without these changes. However, season to The first wave focussed very much on acute care and we saw far more season variations in circulating flu strains means it could still be a bad flu admissions than currently, if this continues this will impact other pathways of care season. such primary care.

BSW Public, Low Mental Health 29/04/2020 Lucy Baker, Georgina 15-Feb-21 Treat Emotional wellbeing and mental health of the population may be impacted during 24/7 helplines continue with AWP and OHFT - this will be merged into a new 1. Planning for continued public messaging 1. End March 2021 1. LB/GR/Comms Actions on track and monitored via weekly multia agency BSW MH Covid meeting and monthly MH recovery and restoration forum On target 4416 32 patient and Director of Ruddle, the Covid -19 period. General service need is anticipated to increase, with the THINK FIRST 111 offer in q4 20/21 in line with LTP. 2. Request via BSW weekly multiagency MH Covid group 2. update requested at team staff safety Transformational Assistant requirement potentially spanning 5+ years, this includes a continued increase in BSW system MH demand and capacity modelling continues. IAPT and CAMHS for each locality to review work of vulnerable people's next MH recovery meet 2. Localities including Programmes Director Mental rates of crisis and suicide rates complete - being reviewed and linked to best practice modelling ( mersey care ) cells/ compassionate community hubs to review reach Jan 2021 3. GR clinical harm Health Third sector support lines continue in each locality - funding for continuation in out models. Bath MIND linking with other localities to 3. In progress 21/22 has been secured. BSW multiagency suicide prevention working group share model including material for people who may be in place with key actions - line suspected suicide surveillance in place across digitally excluded - confirmation that triangulation of risk both force areas stratified lists is being undertaken in each locality 3. CCG MH investment schemes [sumitted through CCG investment prioritisation process] have been informed by the anticipated need [covid-19 imapct]. BSW Capacity and Moderate Workforce 19-Dec-19 Lucy Baker, Georgina 15-Feb-21 16 12 Treat There is a risk that service improvement work and business as usual activities will Co-created BSW response to community MH framework submitted Nov 2020 - Pilot of new roles underway including peer support Mental Health Numerous Mental Health risks with a view to amalgamate and/or streamline the risks. Potentially Off 4416 22 Capability Director of Ruddle, be impacted by workforce challenges across all age mental health and LD/ASD next submission 20/01/21. System work force sub group developed to map workers. Proactive work with Primary Care Networks to Workforce Group Collaboratively designed community model being socialised across all PCNS and with partners for next submission - Jan 20th 2021 Target Transformational Assistant services. At present pressures have been escalated by providers and are evident current workforce against espoused model mitigate risk. meetings ongoing. Programmes Director Mental through waiting lists and caseloads, CCG led needs analysis and service scoping Health is underway to qualify the workforce gap comparatively to population need; to be completed by Q3 and responsive actions set in Q4.

BSW Public, Low Estate 19-Dec-19 Lucy Baker, Georgina 15-Feb-21 16 12 Treat There is a risk that AWP MH inpatient & Community services are not being There is a dedicated AWP bed base service reconfiguration steering group in Work plan in place as part of steering group governance. Steering group meetings Lucy Baker Potentially Off 4416 25 patient and Director of Ruddle, delivered from safe and effective buildings; estates review and responsive place which is following the NHSE seven step model. Successful bid to Demand and capacity modelling for 18+ MH bedbase on-going. Dormitory eradication capital bid submitted and approved Target staff safety Transformational Assistant investigation to incidents have identified low roofs, ongoing antilig work is eradicate dorm accommodation in AWP bed base ( BaNES) confirmed complete Estates capital transformation bid submitted to NHS E. including Programmes Director Mental required to maintain safety on inpatient wards in particular. Significant financial clinical harm Health, outlay required, with associated impact being a rolling closure of 2 beds whilst anti- Broad issues remain and are of significant concern. Safety work commenced in areas of the footprint and knock on effect in Simon Yeo, lig improvements are made. This does not improve the quality of the wider relation to access to PICU beds being monitored weekly via BSW MH multiagency meeting Assistant environment. Director of Estates geographical location has proven a challenge to recruitment owing to Estates poor transport links and minimal local employment draw BSW Capacity and Moderate Demands on 03-Dec-19 Jo Cullen, Tracey 19-Feb-21 16 6 Treat Increased demands on GP practices and primary medical services with impact on Confirmation of BSW Covid response primary care offer to confirm funding 1. Current discussions of opportunities for non-recurrent 1. Ongoing discussions 1. Jo Cullen Ongoing discussion with NHSE; local discussions with PCN about submissions due 31.10.20 Potentially Off 4416 11 capability Primary Care / Director of Strachan, the ability to maintain clinical safety and service standards. streams to ensure focus on clinical priorities. Delivery of Network Contract DES funding and specific additional ad hoc schemes / 2. Development of 2. Jo Cullen / Development in progress due 31.10.20 target GP Practices Primary Care Deputy Director Evidence of primary care activity impacted by different ways of working (triage and and Additional Roles Reimbursement Scheme for additional specified roles. services / roles to support recovery whilst recognising the dashboard Emma Higgins Process in place. of Primary Care face to face) and increasing demand. National GP Workload Tool has been shared with all practices. Practices as need to preserve integrity of nationally-negotiated ARRS 3. Ongoing review 3. Di Walsh Need to link actions 2, 3, and 4 to the Primary Care Strategy. National Standard Operating Procedures for General Practices set out 3 key providers and CCG as commissioners have contractual responsibility for quality scheme. 2. Development of Covid-19 response primary quarterly 4. Sam Wheeler PCN development and workforce plans being drawn up. priorities: Ensuring that primary care can respond to continuing presence of Covid- assurance of services. CCGs review practice list size on a monthly or quarterly care offer 20/21: outcomes measures into one primary 4. Follow up with 5. Jo Cullen 19, including ability to respond to potential additional waves as well as winter basis. Primary Care Operational Groups receive monthly reports of operational care dashboard (one set of metrics which will fulfil the practices. 6. Jo Cullen pressures ; ensuring that routine demand can be met safely and effectively; and issues within practices and reports to Primary Care Commissioning Committee requirements under the PCO and QI QOF) focussing on 5. Ongoing 7. Jo Cullen rapid implementation of integrated out of hospital care model across the in Common - Covid impact being worked through and additional reporting in the more vulnerable and those disproportionately 6. Ongoing Localities/PCNs place. GP reporting log in place and support from Quality Team available. Daily affected by Covid-19. 7. Ongoing As of week commencing 14th December - delivery of PCN designated sites for patient level report of activity in acute hospital sent to GP practices. Daily 3. GP retention programme for BSW being further Covid Vaccination programme through priority groups - under national Enhanced practice sitreps for staffing in place. BSW Primary Care Strategy includes GP developed through training hubs and other schemes for Service. retention programme development. Some practices undertaking risk mentoring, supervision and CPD for existing and new BSW Public, Low Inequality 11/04/2020 David Freeman / Local Authories, 09-Feb-20 Treat 100%Risk of iharm to non-COVIDBSW population groups with known / unknown health Usualt tifi methods ti / of communicating ti di ti with k our J ipopulation t ki regarding ith M d health i t issues id 1. lRaising the issue through press and social media, in On-going 1. Comms Team 1. There are series of actions for the restart of Acute care, Community and Out of Hospital Care, Management of Referrals and Mental On target 4416 35 patient and Elizabeth Disney Public Health needs and vulnerable groups as a result of the extended pandemic leading to and how to seek help. particular encouraging parents/carers to seek urgent 2. Vaccination Health - complete staff safety / Corinne England, increased inequality. Health Inequality was addressed in the Phase 3 submission and associated treatment for children. team, PCNs, 2. National and local publicity campaigns to encourage update of vaccine. Targeted work to ensure housebound patients vaccinated as including Edwards, Acute Trusts Risk of greater impact on those members of our population already action plan with each locality completing a health inequality assessment, but as 2. Ensuring the most vulnerable and hard to reach community a priority group with arrangements for outreach/roving models to vaccinate homeless, boaters, gypsies & travellers, etc clinical harm Chief Operating disadvantaged such as: we come out of the third wave of the pandemic and move into recovery into groups in our localities have access to the covid vaccine providers Officers increased risk of contracting COVID; 2021/22, HIA's will need to be reviewed. Suggest this risk is now closed as this related to the first wave of the pandemic and the system risk register now adquately BAME community; covers this. BSW Public, Low Delivery of 01/12/2020 Gill May, Emma Higgins, 01-Dec-20 16 9 Treat The risk is that enough of the BSW population do not get vaccinated for COVID, A BSW Governance structure has been designed to support this programme of 1. Additional support to be provided to the workforce All to be in place during Complex delivery Most significant risk and potential cause of delay is the workforce element. On target 4416 45 patient and COVID vaccine Director of Head of Quality when the vaccine become available to facilitate a reduction in the circulation of work with a quality and clinical focus; operational and financial focus. Not all team to support recruitment and training demands. December in time for arrangements for staff safety to the Nursing & Improvement the COVID virus reducing the likelihood of harm to vulnerable individuals and elements are currently in place and are being rolled out. the arrival of the first BSW detailed in our The Governance arrangements are being implemented and legal agreements in the process of being drafted. including population of Quality ensuring NHS services can meet the demands made on them. BSW Executive Assurance Group - reporting to individual organisational 2. Incident reporting process to sit alongside the vaccine. MOU and Contract clinical harm BSW There are risks associated with: Governing Bodies. governance arrangements - will link into national with GWH as Lead Operational plans are well developed. No date has been set for implementation yet. Workforce - having enough appropriately trained staff to deliver the vaccine to Quality review group and clinical safety huddle - to enable response to a reporting requirements. Further deadlines to Provider and the population. rapid and evolving situation. stand up PCN delivery monitored Population take up to accept the vaccine - some people are concerned about Operational Group - overseeing delivery. 3. Minimal performance KPIs have been set nationally. at a later date, still to be the risks of having this vaccine and may choose not to be vaccinated. This will BSW is developing a reporting suite to support agreed. impact the efficacy for the whole population. assurance. PCNs - there will be delays in the standing up of community based vaccination programmes due the transportation and storage requirements of one the first 4. Quality visits by all partners to the vaccination centres vaccines likely to be available. and local sites are planned. Estates delays - appropriate facilities have been identified in Bath and Salisbury. Heads of Terms have yet to be agreed and complex support for traffic 5. Salisbury site to be established first as less complex management; signage; parking waste management; security etc. set up. Finance - the CCG will be underwriting the costs for the system and the lead provider, GWH and although an allocation has been made, we are not clear if it 6. COVID Vaccination Leads from all partners in BSW will be adequate to cover all our costs. being identified. Operational sustainability - information about the requirements is changing rapidly and this a fast moving programme. It is likely that the vaccination 7. MOU detailing the responsivities and commitment of all Page 172 of 210 BSW Capacity, Low Ambulance 01/12/2020 Gill May, Emma Smith, 12-Feb-21 16 6 Treat (Updated February 2021 - Merged BSW 04 and BSW 43 risks) 1. Review of current performance and activity demands reported in monthly 1. Ambulance handover delays and ambulance response 1. March 2021 1.Urgent Care and 1. Work progression, new metrics should be included for March board 4416 47 Capility, Response Director of Head of Urgent * There is a risk that patients have a poor experience and are at risk of reports and discussed at the joint SWAST and South West CCGs Finance, time metrics to be reviewed as part ot Urgent care and Flow Board / BI NEW Quality and Delays and ED Nursing & Care deterioration as a result of delays in receiving the appropriate and timely 999 Information and contracting sub-committee flow board on a monthly basis; and shadow reporting of 2. April 2021 2. Shrewd oversight board meeting monthly Patient handovers Quality Helen Harris, ambulance response and handover delays following a conveyance. This is likely proposed new urgent and emergency care standards to 2. (Shrewd group) 04 / 43 Experience Urgent Care to occur when an ambulance resource could not be dispatched to them (waiting 2. Live data flows: SWAST BSW data reported via Shrewd to show ambulance identify flow barriers in departments. 3. Feb / March 2021 3. South West wide meetings in Febuary 2021 Merged Quality Lead within 999 call stack), from increasing demand on existing resources and or, as a handover delays and activity at each 3 acute trusts at 10 minute intervals; south 3. Emma Smith, result of a crew's ability to offload patient requiring treatment in an emergency west wide ambulance call stack data (reported every 3 hours) 2. Update BSW Shrewd flows to capture ambulances in 4. April 2021 BSW Locality 4. Updated project plans and propsals waited for Medvivo department within 15 minutes of arrival to respond to the next incident. The new bound to acutes, current BSW incidents within live call COOs / Alliances, arrangements to reduce the risk of spread in covid-19 in ED has restricted the 3. South West Ambulance Transformation plan to look at transformational within stack, and complete review of RAG of triggers. 5. Ongoing Lucy Baker 5. volume of patients that can be safely accommodated, and when there is a surge ambulance response and activity reductions ot mitigate growth; agreed at joint in patients and ambulances attending ED this can result in ambulance handover SWAST and South West CCG Transformation implementation group 3. Refinement of SWAST transformation plan to put in 6. June 2021 - part of 4. Emma Smith / 6. Requested at Feb FICSC, SWAST refining business cases. Discusion at March FICSC delays. here are also patient and staff welfare issues if they have to stay in the place schemes which will impact the greatest on SWAST contract planning Medvivo ambulance, for some staff at the end of a shift in cold or hot weather without the 4. NHS 111 validation of category 3 and 4 dispositions to reduce inappropriate demand and response times locally with clear time 7. TO be discussed as part of risk summit (2nd March - TBC) ability to leave the patient for rest, comfort or food. referrals into 999 frames for delivery. Areas included are: access to urgent 7. March 2021 5. Helen Harris community response including fall services, access to 8. Provisional date identified; attendee list and invite to be sent out with agenda. BI team producing BSW information pack. SWAST to 5. Monthly joint SWAST and South West CCGs Quality Assurance and specialist clinical advice (e.g. Virtual care home pilot), 8. April 2021 6. Emma Smith / be contacted re resourcing overruns Surveillance Sub-committee to review quality indicators, incidents relating to access to mental health specialist advice, same day Steve Collins patient harm emergency care, NHS 111 think first 9. April 2021 (work 9. To be addressed via Think 111 programme plan post lockdown delayed to due covid 7. Al Sheward, 6. Hospital Liaison officers (HALO) in place at RUH and GWH until the end of 4. Transition the validation nhs 111 category 3 and 4 response) Emma Smith, Helen March 2021 to act as communicators between hospital crews and the ED ambulance dispositions from NHS pathways clinicians to Harris appropriately qualified clinicians within IUC CAS that able 10. End of Feb 21 7. Acute hospital escalation plans to identify triggers for action to work off pathways. (RUH / SFT); GWH 8. Emma Smith, phase 1 (Oct 21) Helen Robertson 8. Access to welfare facilities at the acutes for patients and paramedic staff 5.QI monitoring of low and medium harm of any BSW Public, Low Diabetes 01-Apr-13 Mark Harris, Brian Leitch, 17-Feb-21 25 6 Treat Patients with diabetes in BSW, particularly those in BAME or deprived BSW diabetes work programme being developed along with implementation 1.BSW exec to determine governance and support 1. End of Jan 21 1. BSW Exec Risk and actions updated to reflect understanding of poorly controlled diabetes and actions proposed to resolve. Potentially off 3515 01 patient and Director of Commissioning communities or those learning disabilities or mental health difficulties, do not plan. Steering group overseeing programme, supported by CCG Clinical Lead in arrangements including staffing structure for diabetes in target staff safety Commissioning Manager receive consistently good support, leading to poorly controlled diabetes, causing Diabetes. BSW including complications which shorten life or severly curtail socio-economic engagement. 2. New commissioning manager in post, along with education coordinator TUPE'd from Council to CCG. Leading creation of work clinical harm Poorly controlled diabetes costs almost 10% of the NHS budget, mostly through Transformation funding will support process development and training with some 2. Work programme will specify actions to achieve 2. End of Mar 21 2. Brian Leitch programme. Some posts already filled. complications. of the highest priority practices. GP Champions in post to lead and other posts in Transformation funding objectives and wider process of being recruited (Diabetes Pharmacist, Diabetes Nurses, opportunities in diabetes NHSE National Diabetes Transformation Programme has allocated c£230k p.a. to Coordinator). Planning underway for practice engagement from May 21. 3. Recruitment to commence March 21, to enable primary care support to start from May 2021. diabetes priority areas of work each year until 2024. Delays in funding, along with 3. Primary care support plan being developed and team 3. End of April 21 3. Nima Satish COVID vaccinations limting primary care engagement, have delayed recruitment Other Transformation funding activities and funded in process of being recruited expanded (Clinical Lead) & and implementation. There is a risk that updated spending plans are not accepted or commissioned Brian Leitch Overall progress has reduced likelihood from 4 to 3. by NHSE, which could endanger a portion of funds in subsequent years. 4. BSW exec to provide clarity on equitable funding for 4. End of Feb 21 4. BSW Exec Patient self management key to diabetes control, supported though diabetes diabetes education across BSW including Wiltshire education which is a NICE recommendation for all newly diagnosed people. resolution Funding for Type 2 education in Wiltshire limits access to approx 10% of the newly diagnosed population and limited Type 1 education places. This is an inequitable position, as Swindon and BaNES have funding for a larger proportion of their population. BSW Public, Moderate Provider 29-Nov-19 Mark Harris, Andy Jennings 24-Dec-20 15 9 Treat Waiting list size and number of long waiters will exceed plan and trajectory. 1) Elective Care Steering Boards at each provider monthly. 1) Visibility of gap between pre-Covid and current 1) Now BAU 1) Mark Harris 1) Elective Care Board meeting monthly to collate existing information held in each provider as BAU activity. Development of SHREWD Potentially Off 5315 06 patient and Elective Director of (SFT), Lucie Causal factors include pre-Covid demand and capacity mismatches; pausing of 2) BSW Elective Care Board commencing July 20. capacity. 2) Now BAU 2) Tom Rhodes for elective to support live information. target staff safety Performance Commissioning Owens (RUH), elective activity during Covid; and restarted activity operating below pre-Covid 3) Weekly activity reporting from providers. 2) Maximise use of independent sector capacity and 3) Ongoing until Sept 21 3) Mark Harris 2) Shared waiting list meetings in place between independent sector and acute providers. Progress reviewed weekly as BAU activity including Anna Field levels. The impact will be a waiting list size that exceeds our agreed plan with 4) Shared waiting list reviews between acute and independent sector providers restrict new referrals to independent sector to avoid 4) Sept 2020 4) Anna Field alongside activity transfers from NHS to IS providers. clinical harm (GWH) - Senior NHSE and a large number of long waiters, including very significant numbers of weekly. disparity in access time for patients. 5) Now BAU 5) Mark Harris 3) National validation and prioritisation exercise completed. Commissioning over 52 week waits. 5) Quality team review of harm from long waiters 3) Develop actions for reviewing existing waiting list 6) Jan 21 6) Ashley 4) Increased use of A&G and PIFU observed. BSW wide agreement to procure single digital solution. Managers 6) Harm review initiated by Electiev Care Board patients and validating need to remain on list. Windebank-Brooks 5) Programmes detailed and live. Current position shows BSW exceeding Phase 3 plans in all 5 areas and in top 3 of region for all 4) Expand advice and guidance coverage and Patient areas. Initiated Follow Ups through Outpatient Transformation 6) T&F group established. Scope set out using QI methodology. Board. 5) Complete Adopt and Adapt work programmes across Risk likelihood remains 5 as Phase 3 plans were set below 100% of normal run rate. This will be reviewed in Phase 4 planning which will 5 domains. focus further on both recovery and backlog clearance including GIRFT for orthopaedics and ophthalmology supported by NHSE 6) E t bli h T&F t l t H R i Ri lt BSW Finance Moderate Delay in 14/07/2020 Mark Harris, Anna Field, 11/02/2021 15 6 Treat Investment proposal of £200k put forward for 20/21 funding but not yet approved. GWH and SFT are referring Rheumatology patients to Ophthalmology for eye 1. Request that the cost for this eye monitoring to be put 1. Mark Harris QPAC had a discussion regarding this risk in it's September meeting. Potentially off 3515 41 commissioning Director of Deputy Director It is estimated that at least 1400 patients a year require eye screening due to screening as they attend their annual check-ups in rheumatology - it is estimated forward as investment for 2021/22 as the cost needs to target decision in Commissioning of taking Hydroxochloroquine. Without regular eye screening with specialist that within a year these hospitals will have screened all patients but as eye be built into future contracts. QPAC view - The cost pressure that arises from initiating an eye screening service within secondary care is to be taken forward to BSW relation to Commissioning equipment these patients will not have any early changes to their eye sight screening requirements are ongoing the screening capacity will be needed on Senior Leadership team (SLT) during October as an example of an area that would, pre-Covid and under tariff based contracts, have commissioning detected, and the opportunity to change their treatment will be missed resulting in an on-going basis. been considered for investment by BSW. There are many such issues that we need to find a way forward with. decision re irreversible deterioration in sight. HCQ eye GWH and SFT are displacing routine referrals to accommodate the necessary The overall view of the group is that all acutes should be offering the necessary eye screening when prescribing HCQ. monitoring Screening for HCQ toxicity is recommended by the RCOphth as standard of care capacity for screening. RUH eye department are not accepting such referrals as therefore exposing BSW to litigation if an unscreened patient suffers loss of sight there is no capacity. (litigation has now been successful in other areas of the country). Discussions at BSW QPAC and SLT in October - agreed that all acutes should be offering the necessary eye screening when prescribing HCQ. this view has been communicated with all acutes.

BSW Quality and Moderate BSW Local 09-Jun-20 Lucy Baker, Sandra 12-Feb-21 12 3 Treat There is a risk that BSW Local Maternity system will not meet the national target Maternity Transformation money allocated to provide Birth rate plus workforce 1)'Scrutiny via LMS programme board 01-Oct-21 Sandra Richards, 1) LMS programme board monitoring+S16 with monthly highlights report to NHSE. Off target 5315 09 Patient Maternity Director of Richards, for most women to booked on a continuity of carer pathway ( target originally analysis and acuity tools to ensure robust data to support large scale maternity 2)Additional training and engagement sessions with staff LMS Project 2)Additional training and engagement events with staff across all 3 providers. Experience system will not Transformational LMS Project more than 51% of women by March 21 now nationally revised deliverable to be model changes. to involve planning models of care Midwife Offer sent to Trusts for additional UWE training April, May and June 2020. meet the target Programmes Midwife 35% by March 21 and most women by March 2022). This is due to service Monitoring via LMS programme boards 3)Requires Trust Board level engagement and support 3) Maternity Incentive Scheme published Dec 2020 includes Continuity of carer and requires action plan with trust board monitoring for women redesign for provision alongside birth units and staff reluctance to work in new RUH have designated as a quality improvement project with additional support . for large scale model change. monthly. booked on to a models of care. The extension of the model plan in each provider from 20% to 4)Review of birth rate plus workforce modelling of current 4)Birth rate plus data collection completed for each Trust and draft reports received by each Maternity provider. Red RAG rating due to continuity of >51%% \( to include 75% BAME) require additional scrutiny and assurance and maternity services undertaken requirement for SFT to undertake maternity staff full consultation on proposed model delaying rollout of proposed model. GWH delayed carer pathway potentially funding. The impact will be non - achievement of National Maternity 5)Models for each provider area for large scale change to recruitment of midwifery staff due to RAP approvals process and business case for model for Continuity of Carer not yet completed but Transformation targets and associated risks of not achieving improved outcomes achieve >51% % target and for most women to receive is in progress. RUH continues to rollout CoC teams and are aiming to reach 35% target. Electronic data collection from Maternity for mothers and neonates and reduction of inequalities in care. Continuity pathway by 2022 to be completed by information systems are not compliant with Maternity records standards for each provider and required data submission for NHSE in 30.12.2019- Revised date to 01.08.2020 March will require both manual and electronic data to be collected and validated. 6)Birth rate plus workforce modelling on proposed 09.06.2020 Risk updated to reflect new target of most women ( > 51% women with over 75% BAME) to on CoC pathway by 01.03 2021. models to be completed by 30.12.2019. Now revised to COC models continue to be rolled out in Bath area. Swindon and Salisbury have paused plans to rollout due to staffing issues related to September 2020 Covid pandemic. Revised date for CoC business plan for 01.08.2020. 7)Rollout of CoC teams to begin by Feb 2020 in each 7) 10.08.2020 Rollout of Continuity of Carer teams in RUH area including Frome, Shepton Mallet, Chippenham and Paulton as planned. provider area to achieve 35% ambition in March- now GWH and SFT teams rollout paused due to Covid - 19 pandemic challenges. amended to >51% by march 2021 to include 75% BAME 8)15.12.2020 Staff consultation regarding contract chaneges underway at SFT. New Interim Head of Midwifery aware of risk and working women within Division supported by Director of Midwifery from Southampton to progress plan for implementation. Unlikely to reach 35% target at 8) Resumption of work on business plans and Staff SFT. RUH are on target to meet 35% target. GWH business plan drafted and recruitment plans in place but unlikely to meet target by consultations on contract changes planned. Mar 2021. 9) RUH continuing to roll out CoC teams now achieving 12.02.2021 -RUH on target to achieve, SFT and GWH not on target to achieve by March 21. GWH delayed rollout of CoC teams from above 35%. SFT between 9- 12% and GWH not Feb to April 12th - 2 teams planned with model for further teams requiring business case agreement from GWH. SFT decision to stop collecting data currently. pilot team due to system pressures and to revisit whole strategy. trusts have not provided data for Nov 2021 yet BSW Capacity and Moderate Lack of 14/07/2020 Elizabeth Shelley Watson, 11-Feb-21 20 6 Treat As a result of Covid and the increased impact of Winter illnesses combined with a Limited LEEP service in SFT offering care for 90 patients share across Wiltshire, 1. Bid for potential NHSE funding in January 2021. 1. 31st January 2021 1.Shelley Watson Analysis requested to support paper On target 4312 42 capability community Disney, Senior historical gap in respiratory services in South Wiltshire, there is a risk that the Dorset and Hampshire 2. Further mapping work is to take place across BSW to - No funding from 2. Shelley Watson Winter funding plan being drawn up, awaiting decision on funding request. Staffing is likely to be challenging for a 6 month pilot respiratory Chief Operating Commissioning Wiltshire locality is unable to support the current demand of care required to Primary Care provision. understand gaps in service provision before next steps NHSE Mapping exercise to take place across BSW services in Officer Manager manage respiratory patients safely in South Wiltshire alongside any additional BSW respiratory task and finish group reviewing pathways of care. can be agreed. 2. Underway. Not yet 15/12/2020 - Following a review of services it was identified that some respiratory services do exist in South Wiltshire, they are limited South Wiltshire demand post Covid-19. The result is an inequitable service for patients, an Discussion held with current community provider to explore if there are any complete and don't provide the service that patients in the North East and West receive. Winter funding was considered however as non recurrent increased risk of deterioration of conditions and an increased demand on options to expand service from North of the county. funding WHC cannot recruit staff. A digital pilot is being considered to support with some of the gaps in service provision in order that secondary care services, and primary care will become overwhelmed. There is A digital pilot is being considered to support with some of the gaps in service WHC can repurpose some of their current services across a wider geography. Further mapping work is to take place across BSW to also an inability for the wider CCG to meet its requirements in its strategic plan provision in order that WHC can repurpose some of their current services understand gaps in service provision before next steps can be agreed across a wider geography. 11/02/2021 - HDP funding requested for WHC for Quarter 1 21/22. Additional recurrent funding requested from CCG and await decision Completed HDP funding (non-recurrent) has been made available to WHC in through the prioritisation process. SPACE licences to be bought by WHC which is a self management programme for patients with 2020/21. COPD

BSW Quality and Moderate Mental Health 19-Dec-19 Lucy Baker, Georgina 15-Feb-21 16 12 Treat There is a risk that current infrastructure gaps in all age MH crisis pathways will Crisis is one of the six strategic work streams for BSW MH programme. This is Action plan in place being monitored via weekly BSW Action plans monitored Caroline Mellers Action plan in place and on track. Potentially Off 3412 24 Patient Crisis Director of Ruddle, impact on people and outcomes; BSW has an inequity of crisis early intervention our priority work stream. COVID-19 meets and monthly MH recovery meets. through Programme Target Experience Transformational Assistant and prevention, as well as crisis management services which are resulting from Crisis helplines in place along with virtual crisis cafes/ places of calm in each of Whole system work shop held and feedback received Board. BSW 136 Contingency plan to be revisited Jan 2021 following recent system pressures. deep dive case review using QI methodology Programmes Director Mental historic siloed commissioning, pathway dispersment across multiple providers and the localities from people with lived experience, carers, families and being undertaken by end of Nov to identify opportunities for earlier intervention and prevention. Healthwatch section 136 detainees Health workforce pressures. supporters. Successful winter bid and crisis alternative survey now launched bids ( total £500k) to improve access to early intervention Covid cost pressures reflective of crisis pathway resource requirements submitted to NHS E. and crisis alternatives - being implemented from Dec 2020 to support resilience for traditional MH surge post Additional mitigations in place including restart of 111 pilot, hence score reduction. Monthly monitoring via BSW MH recovery Christmas workstream.

Capital monies allocated in Q4 to enable the purchase of an additional crisis accommodation house. Revenue investment proposal submitted to CCG. All funding for existing crisis accommodation provision ceases 31/3/21 (all schemes included in prioritisation proposal) - without this privision out of area admissions will increased, and admission avoidance opportunities will be limited to in reach options in an individuals own home/placement only.

Page 173 of 210 BSW Key NHS Moderate Capacity across 29-Nov-19 Tracey Cox, Corrine 09-Feb-20 20 10 Treat There is a risk that due to COVID-19 prevalence and social distancing measures, A whole system capacity tracker and sitrep. 1. 'Early Warning' system to be developed for the On-going COOs Significant oversight and delivery of this work within localities. On target 3412 02 Constitutional the Health and Chief Executive Edwards, together with Winter demands and elective activity backlogs, there will be capacity A triggers report showing activity data and COVID prevalence data widely potential impact of a 2nd Wave of COVID infections - Urgent Care and Flow Board and Elective Care Board clear on initial tasks. targets Social Care Officer Chief Operating pressures and flow issues across all levels of the health and social care system. circulated to system partners, and reviewed by CCG Exec meeting three times ongoing review of the triggers data COOs to discuss proactive approach with DPHs and Comms teams. Sector Officer (BaNES) There is a risk that pressures will have an impact on patient safety due to the risk per week 2. Localities to develop Phase 3 comprehensive plans for Learning from Local Outbreaks that have occurred to test and strengthen information and data links. of untimely access to care (ambulance waiting times increase, ambulance An ethical framework including thresholds for discharge and admission Winter, including the potential of a 2nd Wave of COVID David Freeman stacking at ED, ED overcrowding, increased DTOCs and +21 day LoS patients, avoidance. infections. Suggest this risk is closed as this related to the first wave of the pandemic and the on-going risks are now adequately Chief Operating lack of social care assessment and community team capacity, lack of primary care Locality surge plans based on peak surge scenarios - demand model and 3. Conversations at the Oversight and Delivery Group re captured in the system risk register. Officer capacity, lack of mental health beds) additional capacity set up. how to manage system over winter with reduced bed (Swindon) Discharge hubs active in each locality. capacity, and the potential to move staffing resource Out of hospital demand modelling work completed to support winter planning. between providers to support areas of highest pressure Elizabeth Disney Continued implementation of national guidance on service models for hospital 4. Discussion with PH teams around proactive approach Chief Operating discharge and primary care. to minimise risk of outbreaks using population health data Officer Potential to re-provide 'Hot' care home sites queries for targeted and appropriate messaging for (Wiltshire) Public Health-led Local Outbreak Management Plans have been developed for community groups each LA area overseen by respective COVID-19 Health Protection Boards with 5. Joint working with PH and PH England on Local respective LA Engagement Boards in place. PH teams engaging in locality Outbreak Management Plans (LOMP), including Test and hub/alliance meetings. Trace to support efforts to minimise spread and/or to get Urgent Care and Flow Board and Elective Care Boards set up - focussed on early warning of potential surge(s) in cases. specific activities around winter planning and addressing demand backlog. Revised BSW team structure and function to manage urgent care and flow issues - 3xlocality leads and overall Head of Urgent Care. BSW demand & capacity modelling work has factored in Covid planning scenarios. RUH is opening the social distancing beds previously closed in a phased way. LA’s working with CCGs and community partners about the implementation of the DHSC designated setting guidance. BSW Information Low Information 27-Feb-20 Caroline Yvonne Knight, 17-Feb-21 12 8 Treat There is a risk that an information governance breach due to human error occurs The Corporate Affairs team oversee mandatory training for all staff which 1. Upload new IG intranet pages. 31/03/2021 Information Delayed due to capacity to upload intranet pages. Training within the team undertaken which should allow action to be completed. Action Potentially Off 3412 27 Governance Governance Gregory Head of Risk that is reportable to the ICO, especially as colleagues are currently working from includes appropriate IG training annually and on induction. There is additional Governance date re-vised to reflect this. target Breaches Chief Finance and Information home. training for specific teams who handle special category data. Managers via IGSG Once new Intranet pages have been uploaded, suggest reducing the risk score to 8 (target score) and recommend to RMP to Officer Governance Information Governance Steering Group (IGSG) receive regular training close this risk. The general risk can then be regarded as a 'watching brief'. compliance reports. IGSG receives briefing on incidents and share learning. Cyber security controls are in place. CCG is not entitled to receive some data due to DSCRO controls. Role specific access in place. Physical security controls in place. Lessons learnt on future near misses have been discussed at IGSG and SLT and further actions suggested to strengthen training offered on this area and reinforce roles and responsibilities of IAOs. Reformatted incident log in place overseen by CSU IG Manager. IG Home Working briefing at Colleague meeting on 30 June ‘20 BSW Key NHS Moderate Mental Health 19-Dec-19 Lucy Baker, Georgina 15-Feb-21 12 9 Treat There is a risk that BSW CCG will not deliver the MH performance targets in 1) Dedicated work streams in place for both elements to focus on remedial 1) DDR post created and implemented. SMI physical To be co-ordinated George Ruddle New clinical delivery model agreed. Additional nursing and HCA support sourced to create 'superteam' - pilot team commissioned - Potentially Off 4312 23 Constitutional Performance Director of Ruddle, relation to SMI physical health checks, Learning Disability annual health checks actions. health check actions agreed across BSW. across BSW expected to commence by end of Feb 21. Target targets Targets Transformational Assistant and dementia diagnosis rates. 2) SMI and LD checks pilot team commissioned BSW LDA clinical lead commissioned to support undertaking of checks [and to manage waiting lists] from Q4. Programmes Director Mental BSW DDR post ceased due to NHS E funding period concluding. Health BSW Capacity and Moderate Primary Care 04-Dec-19 Jo Cullen, Tracey 19-Feb-21 12 6 Treat The workforce age profile over the next five years indicates a number of GPs, BSW Primary Care Strategy 1) Obtain up to date workforce data for BaNES including Ongoing development BSW Training Hub 1) Primary Care Workforce lead assigned for BSW with plan and draft strategy completed. Alignment of CCG workforce activities across Potentially Off 4312 13 capability Workforce Director of Strachan, practice nurses and practice managers will retire during that period which may BSW Training Hubs age profiles of all staff, with support from NHSE / HEE to of plans CCG and trajectories considered as part of operational plan submission. target Primary Care Deputy Director threaten the resilience and sustainability of Primary Care. Primary Care Commissioning Committee (PCCC) develop STP led strategy. 2) Commissioning Alliance wide-bid submitted - 1 GP recruited in to BaNES from Devon scheme, new prospectus updated for future of Primary Care Primary Care Operational Group (PCOG) 2) Taking part in the International recruitment of GPs with recruitment rounds. Primary Care Network Meeting / Forum Swindon, Wiltshire and Glos. 3) Regular meetings in place with Training Hubs regarding current future workforce needs. Longer term planning requiring further 3) GPFV Delivery Plan and BSW / CCG Primary Care support from NHSE / HEE. Local funding to support training networks / GPsWI and GP Integrators, along with GP Chambers model Strategy. 4) Local facilitation to support workforce / previous cluster visions and values.PCN BSW Clinical Director meetings. PCN engagement 4) Continued support of delivery at scale to support and development of BSW support offer continues. sustainability. Primary Networks approved with guidance 5) PCN workforce returns submitted October 2020, supporting PCNs in planning for future roles and potential impact post Covid and contract specifications released by BMA and NHSE.

BSW Quality and Moderate Delay of 29-Nov-19 Lucy Baker, Sandra 12-Feb-21 9 3 Treat There is a risk that the delivery of community hubs for maternity transformation Targeted workstream with identified stakeholders to progress pilot maternity 1) Link with PCN's in each area to identify opportunities Review 10.03.2021 Sandra Richards, LMS agreement to fund some set up costs for community maternity hubs On target 4312 10 Patient community hubs Director of Richards, may be delayed due to capacity ( available suitable space) and complexity of community hubs for collaborative planning for community hubs and co- LMS Project Pilot hub identified for each provider area. Experience for maternity Transformational LMS Project multi-agency working ( including estates) alignment of timescales with possible Continuing to use GP bases and birth units as current base for community location of services Midwife SFT first community hub launched December 2020 in Millstream ( city centre) transformation Programmes Midwife impact of delaying continuity of carer models who require bases to work from and midwives but limited spaces. 2) Link with Estates CCG and Councils Meetings planned for Feb 2020 with Swindon local authority, estates, public health, health visiting and maternity to progress work for may be delayed service changes due to Covid- 19 related changes to available working space for Mapping of BSW area to identify current demographics, current venues for 3) 05.08.2020 - LB to escalate to Executive team re possible co-location of services. midwives. maternity care and associated services Swindon Community hub due to decreasing availability of Potential hub for Bath city centre identified, requires financial support from LMS for pilot. SFT launched first pilot hub temporary hubs in GP surgeries as services resuming. 09.06.2020 Millstream hub funded for first quarter by Covid funding and use expanded to other midwives working in Salisbury City Produced map of possible community hub sites across BSW. 4)Go ahead from NHS property services to progress Centre. SBC have made space available for co-location office space for midwives in Rueben George and Meadows in Swindon. Linked with Swindon LA to discuss possible council sites. feasbility study of potential changes to the Meadow site Temporary community hub in Meadows agreed to see women face to face commencing. Work continues to locate suitable hubs and BSW Staff Moderate Development of 02/12/2020 Tracey Cox, Alison Kingscott 12-Feb-21 12 6 Treat NHSE/I have issued an engagement document setting out two options for the The CCG has strong internal communications processes and had a focused 1. Engagement and information sharing with colleagues 1. By April 2022. 1. Executives and On target 3412 46 Wellbeing ICS' and future Chief Executive / Sheridan development of ICS's. One of the options identified as 'preferred' would result in discussion at the Colleague Briefing on 8th December 2020. on the plans and impact of the NHSE/I proposals for Communications of the CCG Officer Flavin, the demise of the CCG with current statutory responsibilities passing to a new ICS This issue will be a regular topic for discussion at all colleague and team ISCs to become legal entitities. Team. Interim Organisation. meetings. Executive The risk is that, despite the fact this is an engagement document not yet Communications and Engagement Plan developed for colleagues to support the Directors for approved, and the assurances provided regarding future employment security, CCGs response to the NHSE/I proposals. People & OD some colleagues will be concerned about their jobs and this could lead to increases in turnover, productivity and sickness levels.

BSW 16 Corporate Low Impact of EU 29-Nov-19 Julie-Anne Lisa Samak 12-Feb-21 12 8 Treat New rules came into effect on 1 January 2021. The Department of Health and Social Care have published a Serious Shortage 1) To submit a Daily SitRep to the National online system On-going Deputy Director Previous activity included: On target 4312 governance Exit Wales, Deputy Director Despite our predictions we did leave the EU with a Trade Deal. Protocol Arrangement in relation to the Supply of Medicines and consumables. highlighting any local issues. Contracts and •PHE Business Continuity exercise completed end of February 19. Director of Contracts and Professor Keith Willetts is the National Director for D20 (December 2020 more Performance/SRO •Senior Responsible Officers briefing by Keith Willets, NHSE, on 4th Nov 20, 25 Nov 20 Corporate Affairs Performance/SR commonly known as EU Exit) and has been and remains responsible for steering A command and coordination structure has been put in place with a local BSW EU Transition •System assurance NHSX Data return completed End Oct 20 - BSW System compliant O EU Transition the National Assurance programme. EU Exit manual written detailing what providers need to do should there be an •Local BSW NHS Readiness Assurance submitted 4th Dec 2020 all RAG rated Green The National team have already carried out a considreable amount of work on the impact and confirming what coordination arrangements are in place should an • Assurance update to Exec Team 23 Nov 20 & 14 Dec 20 supply chain for medicines and consumables. The Department of Health and issue arise. • Briefing to Governing Body 17th December 20 Social Care (DHSC), which has overall responsibility for medicines supply, has • SITREP daily reporting starts 23 Dec 20 taken actions to help ensure medicines continue to be available and that any The CCG continues to to submit a daily SitRep to the National team to highlight supply disruptions are mitigated. Given the enhanced infection prevention any issues across the 7 workstreams on behalf of itself and all providers of This risk was first added in November 2019. It was taken off the register and treated as a 'watching brief' due to the risk score being measures in place to deal with the COVID pandemic and the additional pull for the healthcare (including PCN's but Excluding the 3 Acutes who submit their own). reduced to the target score following developments. As a 'no deal' now seems more likely, the score has been increased and the risk Mass Vaccination Programme it has increased the use of PPE and associated added back onto the register. consumables which will undoubtedly impact supplies. The National Team publishes a Common Operating Picture every Monday All stakeholders were asked not to stock pile PPE, medicines, consumables highlighting any National Issues and what has been put in place to minimise or medical devices and were asked to keep stock levels to cover a 6 week period. mitigate the risk/issue. We are now approaching the end of that 6 week period.

BSW Capacity and Moderate EPRR 29-Nov-18 Julie-Anne Louise Cadle, 12-Feb-21 10 10 Tolerate Each CCG is a Category 2 responder and, as such, needs to act as a local A 24/7 on-call rota is in place. All existing controls and assurances remain in place and Ongoing Director of It is intended to review all CCG processes against the EPRR Core Standards, some compliance will be delayed as we move into further Potentially off 2510 18 capability Readiness to Wales, EPPR Manager responder as part of the wider health and multi-agency response to an incident The CCGs Plan for response and recovery and a robust training and exercising alignment is underway. Business Continuity plans will Corporate Affairs COVID response phases and also restart the recovery process which will mean a complete review of the CCG's business continuity target cope with Director of and support NHS England in their duties as a Category 1 responder. We must regime in place. These plans, training and exercising programme are annually need to be reviewed at some point as part of the Phase 3 management plan. significant Corporate Affairs show that we have plans in place to respond and demonstrate our emergency assessed by NHSEI as part of the EPRR Annual Assurance process. activity and aligned to new service delivery. Business incidents preparedness, resilience and response (EPRR) and staff must be trained to The CCGs participate in the Local Health Resilience Partnership (health and Continuity remains outstanding but as stock take in respond within key roles identified in our on-call pack. In the event of a flu social care forum) and the Local Resilience Forum – multi-agency arena for advance of the IG toolkit completion has meant epidemic/pandemic or a mass casualties event, we would potentially need to emergency preparedness resilience response and recovery at both an confidence levels in the CCG's ability to respond to such divert staff from normal duties including delivery of key services and other operational and strategic level. This includes Avon & Somerset and Wiltshire an event have been raised. Work will commence March business as usual responsibilities to support. There could also be a financial and Swindon. to refine and bring the 3 CCGs plans into one BCP. The impact The impact of these conseq ences is likel to se erel increase if the There are plans in place for dealing ith a fl epidemic/pandemic CCG and s stem ere ass red b NHSEI in October and

Page 174 of 210 BSW Information Low IT / Cyber 25-Nov-19 Caroline Steve 05-Feb-21 12 8 Treat If an IT Security or Cyber Attack incident occurs, this may negatively impact on the IT security service is provided within CSU SLA for Wiltshire and B&NES.CCG 1) Ongoing monitoring as cyber risk evolves 1) Ongoing Steve Mapleston, 1) New NHS SW Cyber Peer to Peer group set up Steve M attending for CCG. Potentially Off 339 14 governance Security risk for Gregory Mapleston, services that the CCG and member practices delivers. Such an incident could and GP IT inhouse for Swindon 2) Ensure all machines on NHS Microsoft ATP and 2) Completed Assistant Director of 2)National reports reviewed monthly. Server 2008 removed in Swindon (CSU will complete removal for Wilts & B&NES in Nov) - target BSW Chief Finance Assistant include ransom ware, cyber fraud or other breaches of IT systems that have a monitor risk scores 3) Completed 99.7% IM&T Completed NHSD ATP stats repoting 0 server 2008 (Jan 2020) Officer Director of IM&T reputational, financial or privacy impact that detrimentally effects the CCG and NHS Microsoft ATP (Advanced Threat Protection) Installed on all workstations 3) Ensure all machines upgraded to Windows 10 & single 4)April 2021 3) Swindon 100%, Wilts 99.6%, B&NES 99.5% (NHSD ATP stats Jan 2020) member practices in carrying out their responsibilities. domain solution 5) April 2021 10. Kit Webb 4) NHSE speaking to CSU to do all CSU customers in one go, monitoring progress via SW NHSE Cyber lead and picking up via DPST NHS DPST compliance 4) NHS IT Health check for CSU (Completed for Swindon (Swindon) Corby 5) Swindon IT Health check completed KW remediation plan now completed and follow up audit completed resulting in no high or critical As per NCSC bulletin 08/04/2020:- 5) Cyber security essentials Plus accreditation or CCG IT) Thomas / Ken left in line with CCE+, CSU have CCE+ for infrastructure but not end user end points. NB CE+ will now be assessed by NHSE via 20/21 HSCN practice network now completed with NHS secure boundary equivalent 6) Sept 2020 (Business Saunders (CSU DSPT. The NHS is at an increased risk of Cyber attack due to Covid, with the largest 6) Future BSW wide IT arrangements moving to expand case agreed by NHSE) Wilts & B&NES) 6) Business cased submitted to NHSE but delayed to Sept by NHSE due to Covid, Richard Smale now escalating threat likely to come from ransomware. Vast majority of practices now migrated to Windows 10 & Single Domain current Swindon Model 7) April 2021 7) Covid phase 2 capital still not confirmed, NHSD now looking at a national solution NHSE SW cyber lead providing updates and networks 7) Procure and deploy PAM (Privilege access 8) July 2020 11. Kit Webb advised us to wait. Covid will also make maintaing high levels of cyber security challenging as many management) 9) July 2020 (Start of (Swindon), Corby 8) Solution in place and Swindon primary care connected, awaiting NHSE to add reporting, NB CSU out of scope and Swindon CCG IT systems will not have been designed for a home first approach and also the rapid Existing Cyber security processes in place e.g. monitoring of ATP Threat scores 8) Procure and deploy SIEM (Systems Information Event programme) Thomas (CSU Wilts not added due to move to new BSW domain and will connect up then. need to deploy new solutions. and response to NHS Digital Cyber alerts Monitoring) 10) HSCN Completed - & B&NES), Steve 9) Funding in place, network switches purchased, now rolling out across practices. 9)Resolve GP practice network cabinet issues July 2020, Single Mapleston across 10) HSCN completed across BSW, Swindon Single domain completed, B&NES completed, CSU on target for Wilts by Dec External 3rd party Pen test completed on Swindon GP IT network no medium, 10) Attempt to restart planned practice network Domain migration on wider system 11) Completed high or crital risks found. migrations (HSCN and One Domain) during Covid (this target for Nov 2020 12) Ongoing comms have been going out maybe challenging due to practice disruption required 11) Completed - April 12. Steve 13) TDA back in place post Covid and strain on resources due to Covid response) 2020 Mapleston via CCG 11)Check Backups and provide information requested by 12) Ongoing Coms Team NHSE for Primary Care 13) Completed April 12) Increase awareness and reminders around cyber 2020 13. Steve alerts. Mapleston 13) Restart BSW Technical Design authority to ensure system wide approach including progress with Secure Boundary, PAM & SIEM BSW Information Low Data Protection 27-Feb-20 Caroline Yvonne Knight, 17-Feb-21 12 6 Treat There is a risk that a BSW colleague will commence a project with elements that DPIAs are a recognised component of project documentation across BSW. 1. Upload new IG intranet pages, to include new DPIA 1. End February 2021 IG Team Delayed due to capacity to upload intranet pages. Training within the team undertaken which should allow action to be completed. Action Potentially Off 339 28 Governance Impact Gregory Head of Risk need to comply with data protection legislation or change existing arrangements DPIAs discussed at each IGSG meeting. process and documentation. Corporate date re-vised to reflect this. target Assessment Chief Finance and Information without completing a Data Protection Impact Assessment (DPIA) and so fail to DPIA Register in place. Governance Team Once new Intranet pages have been uploaded, suggest reducing the risk score to 6 (target score) and recommend to RMP to (DPIA) Process Officer Governance appropriately identify how the project will comply with legislation. The CSU IG Team and CCG Corporate Affairs team have documented the DPIA close this risk. The general risk can then be regarded as a 'watching brief'. process and agreed by IGSG. New DPIA template and guidance promulgated as part of Project Initiation Documentation and published on the intranet.

BSW Quality and Moderate Delay in 16-Jun-20 Lucy Baker, Sandra 12-Feb-21 9 3 Treat Maternity Transformation project plan schedule for implementation of redesign of 1.Service Redesign Implementation group with identified lead agreed. 1.To convene maternity service redesign implementation 01/03/2021 Sandra Richards, SR to liaise with Implementation lead to organise meeting. On target 339 07 Patient Maternity Director of Richards, Maternity services including provision of Alongside Midwife Led Birth Units at RUH 2. Regular updates regarding progress of AMU planning and build project from group by September 15th 2020. LMS Project 10.08.2020 Ruh leading implementation group. SFT update on Maternity weekly call that possible delay in Salisbury Hospital Alongside Experience Transformation Transformational LMS Project and SFT will be delayed due to Covid - 19 pandemic. RUH and SFT 2. To monitor progress of project along identified time Midwife Birth Unit which may be delayed again - This may impact on winter planning work and Phase 3 planning due to need for the identified Plan Programmes Midwife scales work in Day Assessment Unit 4 beds to have taken place prior to winter as planned if not to impact on maternity bed capacity over the winter. 20.10.2020 Plans now back on revised track. 15.12.2020 Plans remain on track

BSW Quality and Moderate Maternity 29-Nov-19 Lucy Baker, Sandra 12-Feb-21 9 3 Treat Risk that Maternity IT systems will not be compliant with ISDN standard to submit Aligned work with BSW digital board and interoperability groups. 1. LMS project midwife to explore interim IG agreements 1. End of October 2020 Sandra Richards, National maternity digital lead contacted and telephone conversation with lead took place Potentially off 339 08 Patient records Director of Richards, data to MSDSv26 and that national target for rollout of maternity digital care Women have handheld paper maternity records currently. with neighbouring provider maternity services for ICE 2. End of October 2020 LMS Project STP digital lead advice requested regarding options for maternity digital project lead and scoping. Support provided. target Experience interoperability Transformational LMS Project records with all women in BSW being able to access records through hand-held Successful BSW bid for Wi-Fi enabled laptops - currently being built by provider access to results for women with cross boundary care revised date 30.03.21 Midwife 12.02.20 - West of England AHSN offer to contribute support to joint maternity/mental health project lead for BSW digital project may be delayed Programmes Midwife electronic devices by 23/24 may not be achieved due to financial costs and work trusts. provision. manager. required to identify solution for interoperability between the three provider LMS agreement to fund maternity digital project manager to scope project and 2. TPP hub for maternity access to system One for 09.06.20 - Project lead now commissioned to scope BSW Maternity and Mental Health digital options ( shared support also working 1 maternity systems. recommend solutions (interim and longer term). midwives working in community hubs to be investigated day per week for West of England AHSN. Has commenced scoping but initially delayed by Covid situation and unavailability of staff. Amendment to action plan- digital lead suggested short term outsource for initial 3. SR to discuss with SFT IT lead to identify provider own National digital team are not actively progressing ICE solution for blood results sharing for maternity services. LMS project midwife mapping of interdependencies between BSW draft digital strategy and maternity out for rollout- exploring potential IG agreements with bordering Provider trusts including Glos to make results available as interim solution. digital requirements prior to recruiting maternity digital project manager- 4. Funding for Initial PHR /Personalised care plan record TPP community hub solution for access to System One for Midwives in community hubs being progressed. considering options. agreed at LMS programme board Dec 2020 10.08.2020 - Delayed by provider availability to discuss specification and admin support. Revised target date o 15.09.2020. 20.20.2020 Maternity national digital team contacted regarding possible national ICE TPP not yet in place due to no aggreement yet from provider to own module to support rollout. solution for blood results sharing between maternity services. 20.10.2020 - PHR pilot scoping progressing with planned presentation to Population and Health board November 2020. Working groups in progress- Potential funding issue identified as money allocated may not be sufficient for integration costs. 30.10.2020 - PHBoard presentation delayed to Dec 2020 board 09.11.20 - discussed with deputy business manager Maternty SFt- to organise meeting with IT manager 15.12.2020 - No update from SFT yet regarding IT lead to support rollout 12.02.2021 - No updae from SFT - please can this be escalated ( need for IT lead to support set up of TPP module for SFT

Page 175 of 210 Appendix 2 Map of BSW Risks ‐ February 2021

Legend: High ‐ Risk Score 16‐25 Mod (moderate) ‐ Risk Score 9‐15 Low—Risk Score 1‐8 01 ‐ Unique Risk Idenﬁer

Capacity and Capability Key NHS Constuonal Targets Quality /Paent Experience High 47 Ambulance Response Delays & ED Handovers Mod 02 Capacity across the Health and Social Care Sector

High 11 Demands on Primary Care / GP Pracces Mod 23 Mental Health Performance Targets Mod 24 Mental Health Crisis High 22 Mental Health & LD/ASD Workforce Mod 09 BSW Local Maternity system will not meet the target for Mod 13 Primary Care Workforce women booked on to a connuity of carer pathway Key NHS Constuonal Targets Mod 18 EPRR Readiness to cope with signiﬁcant incidents Mod 07 Delay in Maternity Transformaon Plan Mod 33 Capacity in Primary Care Mod 08 Maternity records interoperability may be delayed Quality / Mod 10 Mod 42 Lack of Community Respiratory Services in South Wiltshire Delay of community hubs for maternity transformaon may Paent be delayed

3 Experience Capacity and Top Risks Informaon Governance Capability Corporate Governance Mod 14 IT / Cyber Security risk for BSW High 47 Ambulance Response Delays & ED Handovers Mod 16 Impact of EU Exit Corporate Mod 27 Informaon Governance (IG) Breaches High 11 Demands on Primary Care / GP Pracces Governance Informaon Mod 28 Data Protecon Impact Assessment (DPIA) Process High 22 Mental Health & LD/ASD Workforce Governance High 31 Financial Pressures

Risk statistics Mod High Low Total High 25 Mental Health Estate Finance

High 26 COVID‐19 Second Peak of Infecon High 31 Financial Pressures on Partner Organisaons Having an Corporate Governance 1 0 0 1 High 32 Mental Health of the Populaon Finance Adverse Eﬀect on CCG

Inequality / risk of greater impact on Mod 41 Delay in commissioning decision in relaon to commis‐ High 35 disadvantaged groups Capacity and Capability 4 3 0 7 1 Low 17 Primary & Community Hospital Estate Requiring Urgent 44 Preparaons for Winter High Improvement

Staff Wellbeing 2 0 0 2 High 45 Delivery of COVID Vaccine to BSW Populaon Low 29 COVID Financial Claims May Not Be Fully Covered Finance 1 1 3 5 Public, Paent Low 30 Financial Posion: New Naonal Guidance and Subse‐ quent Changes to CCG’s Allocaons & Staﬀ Safety Information Governance 3 0 0 3 including

Key NHS Constitutional Targets 2 0 0 2 Staff Wellbeing Clinical 6 Harm Public, Paent and Staff Safety including Clinical Harm Public, Patient and Staff 2 6 0 High 25 Mental Health Estate Safety including Clinical Harm 8 High 26 COVID‐19 Second Peak of Infecons High 32 Mental Health of the Populaon Quality/Patient Experience 5 0 0 5 High 35 Inequality / risk of greater impact on disadvantaged groups Staff Wellbeing Total 20 10 3 33 High 44 Preparaons for Winter Mod 38 CCG Offices re‐opening High 45 Delivery of COVID Vaccine to BSW Populaon Mod 46 NEW Development of ICS and the future of the CCG Mod 06 Provider Elecve Performance Mod 01 Diabetes

Page 176 of 210 BSW Commissioning Alliance Board Assurance Framework 2020‐21 Feb‐21 Summary

Strength of Strength of Executive owner(s) of risk BSW Priority Overall risk rating Risk appe te controls assurance

1 BSW Approach to resetting the System

Create the environment for supporting delivery during 20/21 Capturing transformational work enacted at pace in collaboration to Richard Smale, Director of Strategy help us enter new norm and Transformation; Lucy Baker, Co‐ordinate plans at BSW where appropriate Director of Service Delivery; Jo Cullen Ruth Grabham, Medical Director; Build on the energy and joint working in each locality 8: Low risk 1‐8: Low risk No gaps Some gaps Corinne Edwards; Elizabeth Disney; David Freeman; Chief Operating Embed Population Health and Care Design Officers: B&NES; Wiltshire and Develop the role of Primary Care Networks to support transformation Swindon Develop System Architecture and Local System Working

Recruit BSW Clinical Leads

Establish Health and Care Networks and Health and Care Delivery Group 2 Realising the benefits of our merger Many of our merger benefits will be delivered through delivery of the strategic objectives 1, 3, 4 and 5 and these elements are highlighted in Tracey Cox, Chief Executive and blue. Catherine Phillips, BSW Programme The Governing Body will receive separate reports regarding realising the 6: Low risk 1‐8: Low risk No gaps No gaps Lead for Transition benefits of our merger but these reports should be complementary.

3 Improving Patient Quality and Safety and moving towards a system approach Improving quality of care for patients and improving patient experience of care System approach to BAU ‐ winter planning; diagnostics; immunisations + Gill May, Director of Nursing and arrangements for safeguarding, CHC Quality; Ruth Grabham Medical Moving towards a system approach to performance management in 6: Low risk 1‐8: Low risk Some gaps Some gaps Director and Richard Smale, Director BSW of Strategy and Transformation Maintaining access to services for patients and restarting services in a measured way to recognise constraints

Reducing the impact of our COVID response on inequalities Systems to be in place to manage and monitor infection prevention and control standards as a BSW system. 4 Ensuring Financial Sustainability

Robust control mechanisms Caroline Gregory Chief Financial Embedding the interim financial regime to ensure all organisations costs Officer; Matthew Hawkins, Associate are being covered 6: Low risk 9‐15: Moderate risk No gaps No gaps Director of Finance. Understanding drivers underpinning systems financial challenge and refreshing sustainability programme

Delivering the efficiency benefits associated with new ways of working 5 Preparing to become a Strategic Commissioner in the Alison Kingscott and Sheridan Flavin, context of the developing ICS ‐ Workforce Elements Directors for People and OD; Tracey Develop and implement a People Strategy for BSW CCG Cox, Chief Executive; Richard Smale, Director of Strategy and Developing System Capability to ensure we have a skilled CCG workforce 12: Moderate risk 1‐8: Low risk Some gaps Some gaps Transformation; Corinne Edwards; that contributes to BSW becoming an ICS Elizabeth Disney; David Freeman; Actively drive the equality agenda in relation to CCG workforce Chief Operating Officers: B&NES; Wiltshire and Swindon Drive colleague satisfaction and engagement Developing our leaders to work collaboratively across the BSW system

Key:

Likelihood of Occurrence Risk rating 12345 Rare Unlikely Possible Likely Very likely Controls or Assurances 5 Critical 5 10 15 20 25 Significant gaps Significant gaps in controls or assurances

4 Major 4 8 12 16 20 Some gaps Some gaps in controls or assurances

3 Moderate 3 6 9 12 15 No Gaps No gaps in controls or assurances Impact 2 Minor246810

1 Negligible12345

Page 177 of 210 BSW Commissioning Alliance Board Assurance Framework 2020‐21 BSW Priority: BSW Approach to resetting the system 1) Governing Governing Body Meeting Create the environment for supporting delivery in 20/21 ‐ Formation of BSW Oversight and Delivery Group, Urgent Care and Flow Body: 18th March 2021 Board and Elective Care Board. Capturing the transformational work enacted at pace in collaboration to help us enter a new norm ‐ Lessons learned activities held at a locality and system level and used to inform principles behind our approach to transformation. Further evaluation work being scoped with the WEAHSN. Co‐ordinate plans at a BSW level where appropriate ‐ work with providers and Locality Teams to commence service delivery in an Executive integrated manner across BSW. Develop frameworks/templates and provide coordination for planning and performance Richard Smale, Director of Strategy and Transformation Owner(s): management activities across BSW. Build on the energy and joint working in each locality ‐ recognise the value of and support the delivery of integrated working at the Locality/Place level. Operating model defined as part of ICS submission, development work ongoing to support implementation. Embed Population health and care design ‐ establish the BSW wide framework under which transformation activities are coordinated across BSW. Population Health & Care Group is co‐ordinating the development of a population health management approach across BSW. Audit Committee Develop the role of Primary Care Networks to support transformation. Programme of PCN development underway within localities. 4th March 2021 Date last reviewed: Develop System architecture and local system working ‐ Develop a framework for combined Locality/System working and support the Risk Management Panel development of Integrated Care Partnerships. Revised system architecture for service delivery and transformation defined as part of 1st February 2021 our ICS submission. Recruit BSW Clinical Leads. Successful recruitment of Clinical Leads. Establish health and Care Networks and care Delivery Group. Professional Leadership networks established in all 3 localities. Framework for Co‐ordinating Group agreed at BSW level.

B&NES contribution Swindon contribution Wiltshire contribution Assess the needs of the local population. Assess the needs of the local population Assess the needs of the local population Integrated working between system partners. Integrated working between system partners Integrated working between system partners Inclusion of Wiltshire and Somerset representatives in RUH flow Inclusion of Gloucestershire, Wiltshire and Oxford Inclusion of Dorset representatives in SFT flow conversations. conversations. representatives in GWH flow conversations. Leadership on restart and delivery of locality services. Leadership on restart and delivery of locality services. Leadership on restart and delivery of locality services. Local leadership on Winter Planning Local leadership on Winter Planning Integrated working between system partners. Design and delivery local transformation of services Design and delivery local transformation of services Local leadership on Winter Planning Collaboration and sharing of good practice and learning across BSW. Collaboration and sharing of good practice and learning across Design and delivery local transformation of services Joint working with BSW colleagues on System lead activities relating to BSW. Collaboration and sharing of good practice and learning planning, delivery and transformation. Joint working with BSW colleagues on System lead activities across BSW. relating to planning, delivery and transformation. Joint working with BSW colleagues on System lead activities relating to planning, delivery and transformation.

What is the risk to delivering this priority? The effectiveness of strategic relationships will impact on our delivery of this priority: ‐ NHSEI ‐ICS relationship with regards to the empowerment of the system to respond to the local challenges faced. ‐ BSW System and our three localities, ensuring we address the right challenges at the right level ‐ Collaboration between partners across BSW. Our ability to transition from the Commissioner‐ Provider model to an integrated care model will be critical. Capacity ‐ capacity to manage the reset following COVID whilst also developing our ICS approach. Transformation funding is not made available to resource the transformation work that is required.

What controls are in place to manage the risk to delivering the priority? What assurance do we have that our controls are working? New Governance Frameworks being established at the BSW and locality levels to provide effective These are just being established, but have been co‐created with colleagues across BSW so collective coordination of both delivery and transformation. These reflect our desired way of working ‐ ownership will help make them successful. collaboration rather than competition. Distributed leadership and wide engagement being ICS application has been completed. Initial feedback is very positive. Awaiting formal approval at the start encouraged across BSW, with strong emphasis on clinical and professional leadership. of December 2020. New governance arrangements for service delivery and transformation now implemented. Locality operating model defined as part of ICS submission, development work ongoing to support implementation. Population Health & Care Group is co‐ordinating the development of a population health management approach across BSW.

Are there any gaps in our controls (and what are we doing about them)? Are there any gaps in our assurance (and what are we doing about them)? System wide structure allows for effective and timely oversight, escalation and resolution of issues. Monitoring of pace of changes across BSW and levels of ongoing commitment to the way of working. Gaps in the degree to which our ICS approach is understood within partner organisations. Formal approval of our ICS approach being conducted with each organisation. Programme of Board / senior leaders briefing sessions being held within each organisation. Communication: limited capacity for effective system wide communications. Work ongoing with communications leads across BSW to optimise the use of current resources.

Actions to mitigate risk and to fill the gaps in controls and assurance Overall risk rating: Likelihood Impact Action By whom? When? Progress 8: Low risk 2: Unlikely 4: Major Overview of transformation Prog Dir 30‐Nov‐20 Overviews of programmes being collated programme & Locality and initiatives underway. Strength of controls: Strength of assurance: Risk appetite: COOs Locality programmes being developed 1 through professional leadership networks No gaps Some gaps 1‐8: Low risk and BSW wide programmes being reset in November 2020.

Rationale for overall risk rating: Clarify transformation funding Dir of 01‐Dec‐20 Initial indications that Transformation We have already demonstrated significant progress in working as a CCG through the for 20/21 Strategy funding will not be forthcoming. COVID‐19 pandemic and this is reflected in a number of benefits to our stakeholders. & Arrangements for transformation funding However, some risk is possible due to the ongoing COVID response which may distract Develop, being reviewed in the context of the Phase from other planned projects. 2 Dir of 3 financial regime. Significant progress has been made in working together across BSW. This has been reflect Finance in our strong ICS submission.

System reset activities being Locality 31‐Oct‐20 Incremental service restarts being Change in overall risk (with risk appetite) Overall risk rating: coordinated at Locality and COOs and commenced inline with dynamic Jun‐20 9 System level Director constraints. 2525 3 of Phase 3 planning conducted for period Sep‐20 9 25 Commissi October 2020 ‐ March 2021. 2020 8 oning, 2015 1515 Nov‐20 Dir. Of 10 Jan‐21 Board briefing sessions to be 30‐Nov‐20 Programme of briefing sessions underway. 101510 Mar‐21 conducted. 5 55 Target date for 100 reducing to risk 00 43983 44075 44136 44197 appetite 4 5 44075 44136Overall 44197 risk rating:44256 Jun 43983‐20

0 31‐Mar‐21 Jun‐20 Sep‐20 Nov‐20 Jan‐21 Mar‐21

Page 178 of 210 BSW Commissioning Alliance Board Assurance Framework 2020‐21 BSW Priority: 2) Realising the Benefits of our Merger Governing Governing Body Meeting Improved quality of care for patients Body: 18th March 2021 Improved patient experience of care Increased consistency of health outcomes Executive Tracey Cox, Chief Executive Owner(s): Improved value for money in commissioned services Increased patient/public confidence in services Better ways of working Audit Committee Improved delivery of the Long Term Plan Date last 4th March 2021 Reduced running costs reviewed: Improved engagement with one point of contact Risk Management Panel Colleague benefits 1st February 2021

What is the risk to delivering this priority? We have agreed benefits and measures as a programme group, at Senior Leadership Team and Board in October. The environment in which we are operating has shifted due to COVID‐19 and this needs to be recognised as a risk in terms of our delivery. There may be changes in delivery rather than under‐delivery but this will be monitored and articulated. We have included "Response to COVID‐19" as a new and separate benefit which is indicative of many of the other planned benefits to be measured.

What controls are in place to manage the risk to delivering the priority? What assurance do we have that our controls are working? The merger of BaNES, Swindon and Wiltshire CCGs took place on 1st April 2020, the We have an agreed set of benefits we are measuring via quantitative and qualitative ongoing action is to monitor the benefits from merging, so that we can articulate this to a metrics. We are articulating the changed environment in which we are working post‐ range of stakeholders, including our communities, NHSE and our colleagues. The benefits COVID19. we are measuring were agreed at the point of merger. Programme manager is responsible for creating the reporting and monitoring the benefits delivery, presenting this to SLT and Board.

Are there any gaps in our controls (and what are we doing about them)? Are there any gaps in our assurance (and what are we doing about them)? The Programme Manager for the merger is continuing to monitor progress and will report SLT / Board reporting in place. to the Senior Leadership Team (July, September, November, January, March) and Board Colleagues have been encouraged to provide case studies of successful joint working (September and January) with an agreed report format that describes our progress using a and any learning opportunities. range of quantitative measures, qualitative analysis and feedback from stakeholders. Our ability to deliver the proposed benefits will be monitored through these mechanisms, recognising both the impact of COVID‐19 and the financially challenged environment we are operating in. During March/April, the Programme Manager, together with BI team will finalise the report in readiness for submission to Board and NHSE.

Actions to mitigate risk and to fill the gaps in controls and assurance Overall risk rating: Likelihood Impact Action By whom? When? Progress 6: Low risk 2: Unlikely 3: Moderate Monitoring Program Alternate Report developed, this is an me months. iterative report that will Strength of controls: Strength of assurance: Risk appetite: Manager continue to collect evidence No gaps No gaps 1‐8: Low risk / SLT / throughout 2020/21 and 1 Board will be finalised March/April 2021 before submission to Board and NHSE.

Rationale for overall risk rating: End of Year report in Prog Report to e completed by We have already demonstrated good progress in working as a single CCG preparation Manager end of April building upon through the COVID‐19 pandemic and this is reflected in a number of benefits to / SLT / existing measures and the 2 our stakeholders. However, some risk is possible due to the ongoing COVID Board benefits realisation response which may distract from other planned projects. framework

Change in overall risk (with risk appetite) Overall risk rating: Jun‐20 6 3 25 Sep‐20 6 20 20 Nov‐20 6 15 15 Jan‐21 6 10 10 Mar‐21 6 5 5 Target date for 4 0 reducing to risk 0 Jun43983‐20 Se 44075p‐20 Nov 44136‐20 Jan44197‐21 appetite Jun‐20 Sep‐20 NovOverall‐20 risk Jan rating:‐21 Jun Mar‐20‐21 31‐Mar‐21

Page 179 of 210 BSW Commissioning Alliance Board Assurance Framework 2020‐21 BSW Priority:

3) Improving Patient Quality and Safety and moving towards a system approach Governing Improving quality of Care for patients and improving patient experience of care Body: Governing Body Meeting System approach to BAU ‐ winter planning; diagnostics; immunisations and arrangements for safeguarding and CHC 18th March 2021 Moving towards a system approach for performance management in BSW Maintaining access to services for patients and restarting services in a measured way to recognise constraints Executive Gill May, Director of Nursing and Quality Reducing the impact of our COVID response on inequalities Owner(s): Systems to be in place to manage and monitor infection prevention and control standards as a BSW System Audit Committee 4th March 2021 Date last reviewed: Risk Management Panel 1st February 2021

What is the risk to delivering this priority? Pace of change and approach may be delayed as the system re‐introduces services. Workforce capacity to be released to codesign quality assurance going forward may be reduced. Use of the quality impact assessment is not routinely used. Quality Survillance Group now established.

What controls are in place to manage the risk to delivering the priority? What assurance do we have that our controls are working? Quality indicators in place reporting across BSW and shared across all organisations. Key meetings with lead in time to ensure colleagues can join meetings. Each organisation signing up to a system wide approach to developing a QA framework . Reviewing over all workforce capacity to deliver priorities. QPAC now meeting monthly rather than bi monthly, this allows for timely escalation or identification of Agreeing with providers how the CCG can support QA processes. unwarranted variation. Setting up BSW oversight of all quality and patient safety performance and measures to triangulate and identify learning, Priority assurance framework capturing key patient safety assurances as part of CCG COVID response. trends and themes. Meetings commenced to reintroduce quality assurance meetings with providers. BSW medical director Establishing a BSW QSG‐ this will provide the forum for system wide oversight. and Director of Nursing now meetings provider MDs and Chief Nurses and professional leads fortnightly Revised (and BSW aligned) quality impact assessment as signed off by CCG GB May 2020. Development and for informal peer discussions. implementation of an agreed quality assurance framework, supported by matrix working. Quality Surveillace Group ToR signed off and BSW held its second meeting in November 2020. Close collaborative working with stakeholders, including providers and LA, to support system priorities / outcomes. Quality/Equality/DPAI impact assessment signed off at May 2020 GB and on website. Communication and launch now completed.

Are there any gaps in our controls (and what are we doing about them)? Are there any gaps in our assurance (and what are we doing about them)? Workforce capacity lean in some areas and in need of ongoing review and gap analysis including Reduced reporting schedules due to COVID. Infection Prevention and Control and Children's Complex and Continuing Care. Joint assurance processes via provider quality standards committees not yet in place.

Actions to mitigate risk and to fill the gaps in controls and assurance Overall risk rating: Likelihood Impact Action By whom? When? Progress 6: Low risk 3: Possible 2: Minor Workforce review of BSW IPC SP Jan‐21 Initial scope completed . Review of BSW CCG IPC resource capacity in train. Delayed due to increase IPC Strength of controls: Strength of assurance: Risk appetite: resourse to support covid outbreak managment. Some gaps Some gaps 1‐8: Low risk 1 CCG have agreed additional external support to assisit with considering ICS and ICA development including IPC workforce model . Rationale for overall risk rating: Moderate risk at this point but further review on risk will be considered early July following first BSW CCG and provider meeting. Whole system call planned to review GM Completed ToR signed off and BSW held its second QSG Quality Surveillance Group ToR and meeting in November‐ complete. scope to develop a BSW QA 2 framework. Change in overall risk (with risk appetite) Overall risk rating: Jun‐20 6 25 Sep‐20 6 20 20 Nov‐20 6 Quality/Equality/DPAI impact GM Completed Signed off at May 2020 GB and on website. 15 15 Jan‐21 6 assessment for use across BSW. Communication and launch now completed. 10 Equality and Diversity Strategy going 10 Mar‐21 5 3 to Governing Body. 5 Target date for 0 reducing to risk 0 Jun‐20 Sep‐20 Nov‐20 Jan‐21 appetite Jun‐20 Sep‐20 Nov‐20 Jan‐21 Mar‐21 31‐Mar‐21 4

Page 180 of 210 BSW Commissioning Alliance Board Assurance Framework 2020‐21 BSW Priority: 4) Ensuring Financial Stability Robust control mechanisms Governing Governing Body Meeting Embedding the interim financial regime to ensure all organisations costs are being covered Body: 18th March 2021 Understanding drivers underpinning systems financial challenge and refreshing sustainability programme Delivering the efficiency benefits associated with new ways of working

Executive Caroline Gregory, Chief Financial Officer Owner(s):

Audit Committee 4th March 2021 Date last reviewed: Risk Management Panel 1st February 2021

What is the risk to delivering this priority? Interim financial arrangements have been put in place this year to manage the challenges of covid‐19. This has resulted in NHSEI determining how much funding the CCG requires to cover business as usual activities and adjusting the allocations accordingly. Alongside a separate process to reclaim for costs of any covid‐19 related spend. Although NHSEI have stated that they will be covering any additional costs CCG's incur, they have stated that as long as they are considered to be reasonable . There is a risk that not all of these extra costs will be covered. The CCG has analysed the impact of the changes made by NHSEI and determined that there is a cost pressure which will need to be addressed to enable it to breakeven. Furthermore, some of the CCGs key partners, such as Local Authorities and Hospices are experiencing significant financial challenges through lost income and are implementing financial recovery programmes; some are likely to impact on healthcare services, which could increase the costs that the CCG will need to cover.

What controls are in place to manage the risk to delivering the priority? What assurance do we have that our controls are working? The CCG has undertaken a detailed review of the adjustments made by NHSEI and reported an The CCG has had all of its covid costs reimbursed up to month 06 and is awaiting sign off for adverse variance through to its Finance Committee and Governing Body. This process of review, this last month pending changes to the national regime which will mean that for the latter 6 reconciliation and reporting of variances will continue on a monthly basis to ensure additional costs months of the year, it will have an overall financial envelope to manage within. the CCG has are covered. Internally, the CCG has set up a specific process to consolidate and analyse covid‐19 robustv controls in place to assess the impact of the funding it has received and has forecast costs to ensure they are reasonable and externally benchmarking is happening across a wider SW that funding will not be sufficient to cover income levels and costs, which will mean by the end footprint. Concerns regarding impact of costs from partners are being raised and discussed with of this year it is forecasting a deficit. this is in line with all of the other STP across the SW. the BSW FDs and Regionally through SW STP FDs to understand size of impact, work through mitigating CCG has put a revised plan in place and will be monitoring its position each month, reporting actions and ensure consistency of treatment. The financial pressure to the CCG has increased through to the Finance Committee and Governing Body and highlighting any variations against significantly with the allocation it has received for the second half of the financial year. adjustments plan. have been made to this allocation to reflect nationally what they deem necessary to cover BAU costs; however further analysis has highlighted that not all of their assumptions can be delivered, there are technical issues with their calculations and the cost base due to underlying financial challenges cannot be reduced to the level required tro enable break even to be achieved this year. Understanding the situation and having this accepted by NHSEI means that the CCG has an agreed plan to work to for the remainder of this year.

Are there any gaps in our controls (and what are we doing about them)? Are there any gaps in our assurance (and what are we doing about them)? Recognising that BSW still has a underlying financial pressure, the system has commissioned a Development of the recovery plan across BSW to ensure longer term financial sustainability; review of its financial position to understand what is causing this. The outcome of which is due later though a process has been agreed and a timeline. Ability to achieve further short term this summer. However, there is a concern about the ability of the system to move forward on any efficiencies this year to reduce forecast deficit given competing pressures with second surge of sizeable invest to save programmes to instigate the necessary transformational change to enable covid, winter and mass vacc programme. Draft Financial strategy being developed for the efficiencies to be achieved; changes to CCG funding by NHSEI means it no longer holds any longer term financial recovery plan and additional internal resource identified to take this investment monies or reserves. The outcome of the system wide review has been received; it will be forward. Further analysis undertaken to identify financial opportunities and address cost shared with the Finance Committee and Governing Body during September with a view to pressures to enable the CCG to achieve break even by year end. determining how best to take forward programme of efficiencies to ensure financial sustainability. Agreement has been reached on key steps that need to be undertkane to produce the recovery plan by 31st March 2021 with additional resource to be identified to enable dedication and committment to ensuring its achieved.

Actions to mitigate risk and to fill the gaps in controls and assurance Overall risk rating: Likelihood Impact Action By whom? When? Progress 8: Low risk 2: Unlikely 3: Moderate Development of the systemwide BSW FD 31‐Mar‐21 Draft financial strategy financial recovery plan. Process in produced for the Jnauary Strength of controls: Strength of assurance: Risk appetite: place agreed by the BSW Executives Finance Committee and No gaps No gaps 9‐15: Moderate risk 1 with further resource being proposed additional internal resource to ensure dedicated team are focused identified to take this on delivering this forward Rationale for overall risk rating: Moderate risk and higher at this point because CCG has recognised financial pressure as a result of the national changes and its not yet received confirmation that this will be covered by NHSEI Approval of last covid claim submitted BSW FD 31‐Mar‐21 All covid costs recovered to NHSEI under the old financial through H1 and contingency regime and reimbursement of the still in place for H2. NHSEI 2 Change in overall risk (with risk appetite) Overall risk rating: costs incurred through the vaccination have stated that vaccination Jun‐20 9 programme costs will be reimbursed 25 Sep‐20 9 20 20 Nov‐20 16 Analysis undertaken of the impact of BSW FD 31‐Mar‐21 Completed and 15 15 Jan‐21 12 the national financial regime for the opportunities identified to 10 latter part of the year; renewed and address the financial 10 Mar‐21 6 5 continued focus on identifying pressure in year Target date for 3 5 efficiencies which can drive costs 0 reducing to risk down and reduce deficit 0 Jun43983‐20 Se 44075p‐20 Nov 44136‐20 Jan44197‐21 appetite Jun‐20 Sep‐20 NovOverall‐20 risk Jan rating:‐21 Jun Mar‐20‐21 31‐Mar‐21 5

Page 181 of 210 BSW Commissioning Alliance Board Assurance Framework 2020‐21 BSW Priority:

5) Preparing to become a Strategic Commissioner ‐ Workforce Elements Governing Governing Body Meeting Body: 18th March 2021 Develop and implement a People Strategy for BSW CCG

Developing system capability to ensure we have a skilled CCG workforce that contributes to BSW becoming an ICS Alison Kingscott / Sheridan Flavin Actively drive the equality agenda in relation to CCG workforce Executive Interim BSW Executive Directors for Owner(s): People and Organisational Development

Drive colleague satisfaction and engagement

Developing our leaders to work collaboratively across the BSW system. Audit Committee 4th March 2021 Date last reviewed: Risk Management Panel 1st February 2021

What is the risk to delivering this priority? Not having the capacity or capability regarding workforce to support system partners in delivery of the services to become an Integrated Care System

What controls are in place to manage the risk to delivering the priority? What assurance do we have that our controls are working? Bi‐monthly meetings with Colleague Partnership ForumWorkforce r (CPF). Monthly Workforce Feedback from colleague briefings and CPF that drive changes in behaviour and Dashboard to executive team and Quarterly Workforce Report to Exec, SLT and GB. Regular colleague approach ‐ positive impact on culture. Workforce reports data showing positive briefings to drive and support engagement. Frequent line manager only briefings. A suite of Leadership trends and improvement in areas of workforce management. E.g. sickness, turnover Development Programmes aimed at CCG and system partners to drive collaborative working. Coaching etc. Increased take up of leadership development opportunities and reduction on and mentoring offer to Exec and SLT members. negative employee relations issues e.g. disciplinary, grievance etc. CCG Peoples Strategy approved by Governing Body 15 October 2020. CCG WRES report and action plan approved by Governing Body 15 October 2020. Workforce Report, containing Equality data, presented to Governing Body November 2020. WRES Action Plan approved by Governing Body November 2020. CCG Colleague Engagement Survey results and analysis and action plan presented to Governing Body, November 2020. WRES Action Plan was reviewed by Directors for PeopleOD in February 2021 to monitor progress. Participated in the national NHS Staff Survey from October to November 2020. Developed a Communications and Engagement Plan for colleagues to support the CCGs response to the NHSE/I proposals. Are there any gaps in our controls (and what are we doing about them)? Are there any gaps in our assurance (and what are we doing about them)? How we actively drive the equality agenda in relation to CCG workforce is still to be determined. Lack of reporting on equality data will be mitigated through the completion and Actions to be taken; complete the Workforce Race Equality Standard (WRES) and Workforce Disability production of the WRES and WDES action plans that will be shared with Exec, SLT Standard (WDES) to identify actions to embrace equality across the organisation. Presenting equality and wider organisation through colleague briefings and CPF. We will have a data in the Workforce Reports to provide higher visibility to Exec and SLT and the wider workforce. workforce that is increasingly reflective of the communities we serve. Driving Positive promotion for Leadership Development for underrepresented groups using resources with the towards having a diverse workforce at all levels in the organisation. Leadership Academy. Actions to mitigate risk and to fill the gaps in controls and assurance Overall risk rating: Likelihood Impact Action By whom? When? Progress 12: Moderate risk 3: Possible 4: Major NHS Staff Survey: Develop an SF / AK March 2021 Plan to be presented to action plan to drive colleague Governing Body, 18th Strength of controls: Strength of assurance: Risk appetite: satisfaction. March 2021. Some gaps Some gaps 1‐8: Low risk Testing of actions and March & April 1 priorities with CCG Colleagues. 2021 Rationale for overall risk rating: Ethnic diversity of the CCG workforce is unlikely to have an impact on our ability to support Implementing action plan system partners in delivery of the services to become an ICS. However, this may impact on priorities. August 2021 our ability to attract talent from under‐represented groups

Engagement and information SF / AK / By April 2022 On‐going sharing with colleagues on the RS / TM communication plans and impact of the NHSE/I 2 proposals for ISCs to become legal entitities. Change in overall risk (with risk appetite) Overall risk rating: Jun‐20 9 25 Sep‐20 9 20 Nov‐20 9 Report to CCG Governing Body SF / AK / Mar‐21 Report to be presented 15 Jan‐21 12 on progress with the CCG's RS / TM to Governing Body. Mar‐21 12 People Strategy. 10 Target date for 3 5 reducing to risk 0 appetite Jun‐20 Sep‐20 Nov‐20 Jan‐21 Mar‐21 31st March 2021

Page 182 of 210

Meeting of the BSW CCG Governing Body Report Summary Sheet

Report Title White Paper Briefing & Update on BSW Agenda item 17 Position Date of meeting 18 March 2021

Purpose Approve Discuss Inform x Assure x

Executive lead, Tracey Cox contact for enquiries BSW BaNES Swindon Wiltshire This report concerns CCG locality locality locality This report was Stephanie Elsy, ICS Chair, Ricard Smale, Director of Strategy and reviewed by Transformation Executive summary The publication of the recent White Paper for NHS Reform and November’s publication of Integrating Care: Next Steps to building strong and effective integrated care systems across England have implications for how we work as a system and the BSW ICS Development Programme.

This paper has been prepared for the CCG Governing Body and the BSW Partnership Board and sets out an overview of the key legislative proposals, our current position against 7 areas of focus for how ICSs will function in the future:

• Place based Partnerships • Clinical & Professional Leadership • Provider Collaboration • Governance & Accountability • Financial Frameworks • Data & Digital • How commissioning will change

In this regard the paper is focussed on elements of ‘Form’ rather than ‘Function’, but explicitly makes the link to the BSW Principles that were agreed as part of our ICS submission. In this context we are seeking to align our form to deliver our function.

An overview of the anticipated work programme to support the transition to April 2022 is described and areas where involvement and support from system partners will be critical. These include (but are not limited to) engagement and co-production on what Clinical and Professional

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 1 of 21

Page 183 of 210

Report Title White Paper Briefing & Update on BSW Agenda item 17 Position Leadership across BSW might look like in the future, support for a system wide review of where commissioning functions should sit in the future, what strategic commissioning will look like and confirmation about the level of budgetary delegation we might propose for our emergent Integrated Care Alliances (ICAs).

Our overall assessment is that we are well placed to respond to the core national policy expectations on what it takes to be a mature ICS, although there is significant work to do over the next 6 months to ensure we are fully ready.

This review of our current BSW ICS Development programme is at a point in time. Over the coming months further guidance is anticipated that will further shape the programme of work and the evolution of our ICS. The current national approach to the implementation of ICSs and White Paper proposals is permissive, enabling systems to develop arrangements tailored to suit our local needs. It is therefore important that we are clear on our own desired preferences on how the legislative proposals are implemented for BSW. We will need to confirm our timeline to be in shadow form but would anticipate that this would be from September 2021 onwards.

Regular updates will be provided at both the BSW ICS Executive and BSW Partnership Board. We will also commit to holding quarterly briefing sessions with the Non-Executive Directors, Governors, Lay Members and Elected Members. From the beginning of April we will also provide a monthly dedicated written briefing to partner organisations on the progress of the work programme to support system wide understanding of our transition to an ICS on a statutory basis.

Equality Impact An Equality Impact Assessment of the proposed changes and its impact Assessment on health inequalities will need to be undertaken when further policy guidance and implementation arrangements are known. Public and patient The CCG will need to engage with the public and other key stakeholders engagement on the proposed changes to future working arrangements. A Communications and Engagement plan will be developed to underpin out future approach. Recommendation(s) The BSW CCG Governing Body is invited to:

1. Note and comment on the update of the BSW ICS working arrangements in response to the White Paper for NHS Reform and November’s publication Integrating Care: Next Steps to building strong and effective integrated care systems across England

2. Comment on any areas where it would like to see a further focus or strengthening of our arrangements

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 2 of 21 Page 184 of 210

Report Title White Paper Briefing & Update on BSW Agenda item 17 Position 3. Note the key areas where involvement and support from system partners will be critical and specifically:

• Ongoing involvement in the defining and implementation of our future models of care within BSW • Engagement and co-production on what good Clinical, Professional and Managerial Leadership across BSW will be • Support for a system wide review of where commissioning functions should sit in the future and what a shift towards strategic commissioning should look like for BSW • The further work that is being undertaken in relation to Place in terms of future Place Based Leadership arrangements, ICA Maturity and our progress towards delegated shadow budgets. • The creation of our ICS NHS Board and ICS Health and Care Partnership approach • The ongoing integration of our developing BSW Academy with the developments laid out in this paper

4. Note that from April regular monthly dedicated briefings to partner organisations will be provided on our progress against the ICS Development programme.

Link to Board Assurance Framework or High-level Risk(s) Risk (associated with High Medium x Low N/A the proposal / recommendation) Key risks The short timescales (April 2022) and the work plan associated with the transition to ICSs as statutory entities is extensive. We will manage these risks by building and refining on the existing ICS work programme and dedicating and redeploying further programme capacity to support the transition process.

Impact on quality The White Paper Proposals have implications for how we undertake quality assurance and oversight in the future. These are described in the paper. Impact on finance As with the CCG merger it is likely that we will need to identify a budget to manage the transition and change process associated with the transfer of CCG functions into the ICS and the establishment of the new ICS NHS body. At this time we have not made an assessment of the potential resource implications.

Conflicts of interest None identified

This report supports ☐ BSW approach to resetting the system the delivery of the

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 3 of 21 Page 185 of 210

Report Title White Paper Briefing & Update on BSW Agenda item 17 Position following CCG’s ☐ Realising the benefits of merger strategic objectives: ☒ Improving patient quality and safety ☒ Ensuring financial sustainability ☒ Preparing to become a strategic commissioner This report supports ☒ Improving the Health and Wellbeing of Our Population the delivery of the ☒ Developing Sustainable Communities following BSW ☒ Sustainable Secondary Care Services System Priorities: ☒ Transforming Care Across BSW ☒ Creating Strong Networks of Health and Care Professionals to Deliver the NHS Long Term Plan and BSW’s Operational Plan

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 4 of 21 Page 186 of 210

White Paper Discussion and Review of Implications for the BSW ICS Development Programme

Executive Summary

1) The publication of the recent White Paper for NHS Reform and November’s publication of Integrating Care: Next Steps to building strong and effective integrated care systems across England have implications for how we work as a system and the BSW ICS Development Programme.

2) This paper sets out an overview of the key legislative proposals, our current position against 7 areas of focus for how ICSs will function in the future:

1) Place based Partnerships 2) Clinical & Professional Leadership 3) Provider Collaboration 4) Governance & Accountability 5) Financial Frameworks 6) Data & Digital 7) How commissioning will change

3) In this regard the paper is focussed on elements of ‘Form’ rather than ‘Function’, but explicitly makes the link to the BSW Principles that were agreed as part of our ICS submission. In this context we are seeking to align our form to deliver our function.

4) An overview of the anticipated work programme to support the transition to April 2022 is described and areas where involvement and support from system partners will be critical. These include (but are not limited to) engagement and co-production on what Clinical and Professional Leadership across BSW might look like in the future, support for a system wide review of where commissioning functions should sit in the future; what strategic commissioning will look like and confirmation about the level of budgetary delegation we might propose for our emergent Integrating Care Alliances (ICAs).

5) Our overall assessment is that we are well placed to respond to the core national policy expectations on what it takes to be a mature ICS, although there is significant work to do over the next 6 months to ensure we are fully ready.

6) This review of our current BSW ICS Development programme is at a point in time, over the coming months further guidance is anticipated that will further shape the programme of work and the evolution of our ICS. The current national approach to the implementation of the ICS Development Programme and White Paper proposals is permissive, enabling systems to develop

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 5 of 21 Page 187 of 210

arrangements tailored to suit our local needs. It is therefore important that we are clear on our own desired preferences on how the legislative proposals are implemented for BSW. We will need to confirm our timelines to be in shadow form but at this point anticipate that it will be from September 2021.

7) Regular updates will be provided at both the BSW ICS Executive and BSW Partnership Board. We will also commit to holding quarterly briefing sessions with the Non-Executive Directors, Governors, Lay Members and Elected Members. From the beginning of April we will also provide a monthly dedicated written briefing to partner organisations on the progress of the work programme to support wide understanding of our transition to an ICS on a statutory basis.

Introduction

8) The Next Steps for Integrated Care Paper published at the end of November and the White Paper for NHS Reform published on the 11th February set out a vision to strengthen Integrated Care going forward and to put Integrated Care Systems (ICSs) on a statutory footing. They represent an exciting vision of the future building on ways of working during the pandemic and some of the work we have been doing together as a system over the last couple of years.

9) This paper provides an overview of the proposals within the White Paper for NHS Reform and the 7 of the 8 themes and areas of focus set out within the Next Steps for Integrated care. This paper does not cover the eighth area: Regulation and Oversight pending the publication of the future System Oversight Framework.

10) An overview of our current system position against the 7 areas: Place based Partnerships, Clinical & Professional Leadership, Provider Collaboration, Governance & Accountability, Financial Frameworks, Data & Digital and Commissioning is described and the implications on the future ICS Development Programme for BSW.

Legislative Proposals for Health & Care Bill

11) The proposals are the most important set of reforms that the NHS has seen for nearly a decade and signal a significant move from the Health and Social Care Act of 2012 with the overarching aim of moving away from competition and a reinforcement of the importance of integration and collaboration between services.

12) Some of the key points contained within the White Paper include:

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 6 of 21 Page 188 of 210

• Integrated Care Systems are to be established on a statutory footing through both an ICS NHS Board and a separate ICS Health and Care Partnership.

• The ICS NHS body will be accountable for the health outcomes for its population, NHS spend and performance within the system, strategic planning, and taking on the commissioning functions of Clinical Commissioning Groups and some of those of NHS England within its footprint.

• ICS Health and Care Partnerships will be required to develop a plan that addresses the wider health, public health and social care needs of the system, with the ICS Board and LAs having regard to that plan when making decisions. The formation of these partnerships will be left to the discretion of local areas although guidance will be developed with NHSE/I and the Local Government Association.

• Health and wellbeing boards (HWBs) will remain in place and will retain responsibility for developing a Joint Strategic Needs Assessment and a Joint health and Wellbeing Strategy which both HWBs and ICS will have to regard.

• There will be a duty to collaborate across health and social care. This will apply to all partners within the systems including Local Authorities with a shared duty to the triple aim of better health and wellbeing for everyone, better care for all people and sustainable use of resources.

• Provision will be made for the formation of joint Committees between ICSs and NHS providers and also for NHS Providers to be permitted to form their own joint committees. There will also be proposal to support the development of joint appointments.

• Proposals to ensure that cultural behavioural and legislative barriers to data sharing are resolved.

• New powers for the Secretary of State for Health and Social Care over the NHS and other arm’s length bodies. This includes the power to intervene in service reconfiguration changes without the need for a referral from a Local Authority.

• New duties on the Secretary of State for Health including a report to parliament on workforce planning responsibilities across primary, secondary and community care.

• Changes to procurement arrangements with Section 75 of the Health and Social Care Act 2012 including the Procurement, Patient Choice and Competition Regulations (2013) being repealed and replaced with a new procurement regime. The proposals for procurement will be subject to a consultation process.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 7 of 21 Page 189 of 210

13) The legislative proposals set out the minimum consistent requirements and allow for some flexibility in terms of how systems will adopt these arrangements in accordance with local requirements. Place based arrangements between the NHS and between providers of health and care will be left to local determination. It is acknowledged that the key aims of ICSs do not in fact require legislative changes but can be delivered through policy frameworks and guidance to systems.

Implications of these Proposals for how we work across BSW

Vison & Purpose of ICSs

14) The aim remains that all systems become self-managing Partnership entities by April 2022 and the 4 core aims of ICSs are to:

• Improve Population health and healthcare • Tackle inequalities and achieve better outcomes and access for everyone • Enhance productivity and value for money • Help the NHS to support broader social and economic development

15) These proposals align closely with the 5 key strategic aims that we established for our ICS in 2020 as part of our ICS development and designation process (set out below).

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 8 of 21 Page 190 of 210

16) At the heart of achieving these aims lies our commitment to redesign the way care is delivered within BSW and to realign our resources to enable this. Table 1 illustrates how in our ICS Submission we described the principles that will underpin the transition in care. Our response to the White Paper, in the form of our ICS Development Programme, must clearly demonstrate how it is aligned to the delivery of these principles.

No Design Principle Assumptions and Notes

1 We work as one system • We operate as one system to plan and with parity of esteem deliver high quality, value for money health between social care & & social care for our population in BSW. wellbeing, mental and • Operating as one system, we approach social care & wellbeing, mental and physical physical wellbeing. health with equal importance, recognising the interdependency between them. • Subsidiarity, transparency and distributed leadership are embedded in how we work. 2 Prevention first, and • Our professionals focus on health & wellbeing; recognition of the Wider this starts with prevention determinants of health • We focus on the wider determinants of health in the way that we design and deliver services with partners. • Our approach is asset and strength-based with the capacity and capabilities of individuals, neighbourhoods and communities at the centre of what we do. 3 Care designed around • Health & Care services are designed with individuals. and around individuals and their needs: right approach/ service, right place, right time based on a personalised approach and ‘no decision about me without me’. • Teams strive for continual improvement in model of care. • Only essential staff are based in healthcare facilities 4 Home is Best • Wherever possible people are supported at home including discharge from hospital to home • Assessments at home • Virtual wards 5 Digital by default • Digital by default whilst protecting equality of access • Information will be shared safely and efficiently • Decision-making & direct care will be supported through a population health lens • A digital workforce supported through consistent tools and infrastructure • New care models are supported through digital enablers

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 9 of 21 Page 191 of 210

• Cyber security is a fundamental enabler

6 Flexible workforce • Workforce operates in multidisciplinary teams beyond organisational boundaries • Co-located teams & community hubs • Community and voluntary sector workforce as a vital part of BSW team 7 7-day provision • Hours to be optimised to enable timely decision-making and support.

17) The national ICS System Design and Implementation Guidance is set around 7 themes – Place, Provider Collaboration, Clinical & Professional Leadership, Leadership & Governance, Strategic Commissioning, Financial Frameworks, Data and Data and Information Sharing. The current position for BSW is summarised below

18) Place: Overview of Areas of Focus

 Place based partnership building with the full involvement of all partners who contribute to health and care  Focusing on: joining up local services, population health management, coordinating the local contribution to health, social and economic development  Integrated commissioning arrangements  Leading role for primary care through Primary Care Networks  Clear strategic relationship with Health and Wellbeing Boards  Appropriate autonomy, resources and decision making responsibilities

Position in BSW

19) In BSW we are developing an approach that recognises the need to operate effectively at different levels – we describe this as operating at neighbourhood, place and system level.

20) We have 3 defined Places that are coterminous with our 3 Local Authorities boundaries. These are forming the basis of place based partnership building working across the statutory and non-statutory sectors. (We also recognise that at other times and for specific issues we may need work on footprints relating to patient flows to our 3 Acute Hospitals).

21) Each of our 3 Places have emergent Integrated Care Alliances (ICAs) which provide a forum for these partnerships to come together to agree priority areas for focus and action.

22) We have developed a local ICA Maturity Matrix which sets out the potential development path for our ICAs over the course of 2021/22. This includes

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 10 of 21 Page 192 of 210

proposals to strengthen this arrangement through developing Memorandums of Understanding and the potential to take on shadow capitated budgets arrangements. Over the next few months, each of the ICAs will be supported by some Organisational development support tailored to their local needs.

23) Leadership and programme management of our ICAs currently comes from the CCG’s 3 Chief Operating Officers, Locality Chairs and their teams. Integrated Care: Next Steps for building strong and effective integrated care systems across England referred to the role of “Place leaders” on behalf of the NHS who would be responsible for delivering the actions set out in paragraph 18. We are awaiting further guidance and are working with other ICSs to develop some proposals on what these roles could look like for BSW.

Clinical & Professional Leadership: Overview of Areas of Focus  Embedded system wide clinical and professional leadership through all aspects of ICS governance  Primary care leadership at neighbourhood, place & system level  Specialised clinical leadership across secondary and tertiary services  Clinical networks at system, regional and national level  Wider clinical and professional leadership

Position in BSW

24) We currently have some Clinical and Professional leadership representation at both the BSW ICS Executive and Partnership Board but these arrangements will need to be reviewed to strengthen our clinical and professional representation from across BSW, in response to the White Paper Proposals.

25) The White Paper proposes the migration of the functions of the CCG into the ICS NHS Board. This would see the cessation of the CCG Governing Body and the membership arrangements for GP Practices that have been in operation since 2013. Consideration as to the impact of these changes on the Clinical and Professional Leadership will need to be considered as part of our future arrangements.

26) Across BSW we currently have a range of multi-disciplinary, clinical and professional leadership with a wide range of forums where our clinical and professional leaders come together. These include:

• BSW Quality Surveillance group • BSW Clinical Reference Group with Medical Directors, Directors of Nurses and Primary Care Clinical Directors • BSW Allied Health professional Network • BSW Area Prescribing Committee

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 11 of 21 Page 193 of 210

• 3 Clinical and Professional Leadership Networks (aligned to the 3 ICAs) • Primary Care Network Meetings and Monthly Webinars • BSW Population Health and Care Group

27) We also have good clinical and professional leadership linked to our transformation and development programmes. The CCG has circa 25 GPs supporting areas of focus, including clinical pathways, safeguarding, clinical policies, exceptional funding requests and medicines management. We also have leadership coming from primary, community and secondary care clinicians. For example Dr Robin Fackrell has been leading the BSW Ageing well programme, Peter Collins is leading on the development of the BSW Elective Care Strategy and Gemma Pugh from WHC chairs the BSW AHP Council.

28) The thread of clinical leadership should be visible at every level across our collective organisations with a strong blend of Nursing, AWP leadership alongside the medical workforce.

29) Clinical and professional leadership is central to safeguarding. We are working across the BSW system sharing resources and expertise offering peer review to support continuous learning and improvement. Early discussions are taking place to scope future policy direction that supports further integrated federated working whilst still complying with our respective statutory responsibilities.

30) The Chief Nurses and Directors of Nursing are planning to set up a rapid learning event bringing together our Infection Prevention Control Teams to map our collective capacity and scope how we can work differently with in the alliances in the future but co create the future strategic direction.

31) Over the next few months, we will develop a set of proposals for our future system architecture for Clinical and Professional Leadership at all levels. We would welcome nominations for a group of clinical, professional and managerial colleagues, to co-develop and test proposals.

32) The new BSW Academy will have an important role to play in developing, embedding and sustaining the leadership skills and cultures that we wish to see.

Provider Collaboration: Overview of Areas of Focus  Provider organisations active and strong leadership role in systems  Different models of provider collaboration at system level (e.g. between places) and at place level between providers to support place based partnerships  Provider collaborations spanning systems  Provider collaborations role in service delivery and mutual aid

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 12 of 21 Page 194 of 210

Position in BSW

33) Throughout the pandemic response, there has been clear evidence of strong collaboration between providers across our system and including with partners in the voluntary sector. There have been many examples of mutual aid and support e.g. critical care transfers between our 3 Acutes and mutual aid between all partners with shared support for PPE, equipment and vaccinations.

34) GWH, RUH and SFT formed an Acute Hospitals’ Alliance (AHA) in spring 2018. This has become a catalyst for improvement in corporate and clinical areas. AHA current activities include:

 BSW Procurement Collaboration  Back office finance programme – also exploring other corporate opportunities  BSW Elective Care Strategy  Network Prime Provider Model  BSW Virtual Clinical Teams  Common EPR  GIRFT: AHA Joined-Up Approach in BSW  AHA Common Improvement Approach

35) The three acute Trusts have planned a series of workshops in March, April and May, to help focus the vision and next steps for the Acute Alliance; having adopted a Horizontal Collaboration and Vertical Integration approach early in 2020, the Alliance is well-placed to respond to Provider Collaboration expectations in White Paper for NHS Reform. This series of workshops is intended to confirm the AHA’s response and to building upon and strengthening AHA collaboration arrangements. An AHA governance review has begun, exploring options for Committee in Common arrangements.

36) AWP are part of the South West Provider Collaborative which has eight partners, comprising five NHS organisations, one community interest organisation and two independent sector companies. Devon Partnership NHS Trust acts as the Lead provider with the Collaborative taking on responsibility for an £80m budget, alongside responsibility for the commissioning of care and treatment for around 350 adults with medium and low secure mental health needs. The geographical area covered by the Collaborative is extensive – from Cornwall up to Gloucester, covering 22,000 square kilometres and a population of five million people. The plan is to expand the collaboration to include other specialised mental health, learning disability and autism services in due course.

37) We have established successful provider/commissioner collaboration including the two Cancer Alliances that serve BSW and the Local Maternity

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 13 of 21 Page 195 of 210

System.

38) The White Paper makes provision for greater collaboration between Providers in the future through provision for the potential of joint Committees and joint appointments between NHS providers. Further guidance is anticipated on the range of potential models for provider collaborations. Our current understanding is that these will be on a voluntary basis.

39) BSW benefits from the contribution of a range of other providers who are not currently part of a collaborative arrangement. It is proposed that discussions are held with these organisations to consider whether creating a more formal collaborative arrangement between them would bring value.

Governance & Accountability: Overview of Areas of Focus

 System and place leadership arrangements  Clear governance and decision making arrangements  Quality governance arrangements  Public engagement and transparency

Position in BSW

40) We currently have Chairs, Chief Executives, Elected Members, Local Authority representatives and colleagues from other key partner organisations such as the AHSN and Health watch who are represented on our ICS Partnership Board. The White Paper sets out the minimum requirements for System Leadership in the future to include a Chair, Chief Executive, representatives from NHS Trusts, Primary Care and Local Authority representatives with other representatives to be determined locally.

41) A separate paper sets out a review of the current Memorandum of Understanding that operates between Partner organisations and underpins our current Partnership Board. It proposes a refresh of this for April 2021 and considers the potential options on how leadership and governance arrangements of our ICS could evolve over the coming year in response to the White Paper.

42) The way we wish to develop our ICS NHS Board and ICS Health and Care Partnership will need careful consideration and input from partners across BSW. One area of important consideration will be how the ICS Health and Care Partnership approach can best be configured to operate at both a Place and System level. This is significant given the pre-eminence of partnership working at Place level in BSW.

43) Although the Partnership has a range of mechanism to engage Chairs including through a bi- weekly informal forum, there remains the opportunity

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 14 of 21 Page 196 of 210

to strengthen engagement with NEDs, Governors, Lay and Elected Members. We engaged with this group through a one off briefing event in November 2020 and as an outcome of this event have captured skills audit of 20 members from this group. We are proposing to hold further engagement events with them. We will also need to consider how this group is represented as part of our future governance arrangements and in response to any further national guidance.

44) Paragraph 23 describes the work that we need to undertake to confirm what Place based Leadership might look like for BSW in the future.

45) In relation to Quality Governance, we have established a BSW Quality Surveillance group for BSW. Gill May, Director of Nursing for BSW CCG is working with clinical colleagues from partner organisations to describe and agree a future model and landscape for quality assurance. We will bring this model to a future Partnership Board for consideration.

46) We are committed to the principle of co-production with our local population to ensure that the voice and views of local people are clearly understood. We have a BSW wide Citizen panel with over 800 members. The active involvement of members of the local population will be an essential element in the way services are redesigned and resources are redistributed across the system.

47) Finally, as a general principle over the course of the past 12 months we have further embedded an approach of distributed leadership across BSW. Chief Executives, Managing Directors, Executive Directors and Clinical leaders from across our partner organisations share the responsibility for the leadership of different programmes of work.

Financial Frameworks: Overview of Areas of Focus  System based allocation of funding, shared control total and management of risk  Move away from national tariff regime to a cost based approach  Fair share distribution of funding based on population needs formula  Creation and delegated Place based Budgets  Implications of new powers to enable joint budgets with local authorities including public health  Enhancing benefits from services closely aligned with our LA partners through use of the Better Care Fund

Position in BSW

48) Over the past year we have been working in a more collaborative way across system partners on financially related matters: i. Part driven by changes in the way funds are now allocated to heath systems (STPs)

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 15 of 21 Page 197 of 210

ii. Building from the creation of a single CCG: opportunities to commission at scale, sharing best practice and reducing duplication iii. Acute trusts coming together to form stronger alliances and take advantage of mutual aid especially through Covid iv. Stronger locality partnership working across social care, primary and community providers v. Larger networks and alignment of services for mental health services across geographies vi. Working through a system wide financial recovery plan focusing on developing our financial strategy and principles vii. Moving towards one financial control total across the health system and joint risk sharing arrangements with NHS bodies viii. Agreeing a single prioritisation process across health and social care system for cost pressures and investments

49) Progress towards a system wide control total: it has been proposed by the BSW Finance Directors that from April 2021, the BSW system moves to a more collective approach to managing its finances; in response to: The Integrated Care consultation document which references a single pot of money for each ICS from April 2022. This will mean partner organisations working to a system control total representing the aggregated income and expenditure position for trusts and the CCG across BSW and moving away from reporting performance against their own control totals during planning and in year. Trust Boards and the CCG Governing Body will need to formally sign up to approach and this may require them worsening their financial position if it benefits the wider system.

50) As BSW system is financially challenged, it is likely that in 2021/22 the system will be planning a deficit and consideration should be given on where it is best placed for this deficit to sit with clear set of principles underpinning this. Trusts and the CCG may also be required to agree to in-year movements to offset financial cost pressures or overspends in one organisation against financial surpluses (where identified) in another.

51) There will need to be an understanding of the intended outcomes of the BSW Financial Recovery Plan and agreement on where the expected benefits should reside. Furthermore, the system might choose to combine organisation respective nationally mandated contingencies (set at 0.5%) to create a central risk reserve to fund any cost pressures that rise in year.

52) Financial performance will be measured on a cost basis to facilitate this and will require a move away from payment by results to a nominal contract value. There will need to be collective financial risk sharing arrangements across the system to underpin this. Inevitably, from a financial perspective there are risks that arise in year which were not anticipated. Some of these

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 16 of 21 Page 198 of 210

risks will be best managed individually, but particularly where they become material cost pressures it may be more effective to manage these across the wider system.

53) If we are managing finances collectively across BSW it makes sense to apply the same approach to risk. There will need to be some assumptions underpinning this collective approach to risk management to ensure equity across the system and these should include:

• greater transparency and understanding of costs between BSW partners • alignment of plans underpinned by common financial planning assumptions on income and expenditure between providers and commissioners • understanding through BSW Prioritisation Process of issues that could have a material impact on finances in year • definitions of what these costs are; to be agreed by all partners in advance • distinguishing different types of risk such as demand related • demonstrating value for money; and • no party to derive unreasonable advantage or suffer unreasonable disadvantage.

54) We are currently working through the development of a BSW Financial Sustainability Plan which focuses on our financial strategy and a set of principles to govern our approach to 2021/22. Prior to the Covid pandemic we identified we were spending £1.05 for every £1 that we receive, during 2020/21 our underlying financial positon has deteriorated further and we are now spending £1.07 for every £1. Our challenge is not just about the financial gap we face but also about aligning the proportion of spend in different service areas relative to the needs of the population and the principles that we have defined. Addressing these two challenges together will be an essential element of our long-term financial sustainability.

55) We are currently developing the work programme for the coming year of the key opportunities based on benchmarking and other data which will help us to begin to address our challenges. The aim will be to agree some priority schemes for us take forward and ensuring that this work is integrated with other pieces of work such as the development of our Integrated Care Alliances and our transformation priorities. We are also working through a single system wide prioritisation process to agree our management of cost pressures and investments for the coming year.

56) BSW will need to decide whether it will formally delegate budgets with financial responsibility and accountability to ICAs from April 2022. This will be a step on from managing finances across the system to specifically allocating

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 17 of 21 Page 199 of 210

a proportion of the systems financial envelope to the ICAs. There are several factors to consider:

• The benefit of the ICA being able to consider the optimum use of all resources in meeting the needs of the population. • ICS and Trusts will have statutory legal financial responsibilities and not ICAs • Overall financial accountability will rest at the ICS level • Should we give ICA delegated responsibility to commit new monies • Should a contingency to manage any financial risks or pressures that arise in year is held at an ICS level • Oversight of financial performance and system wide governance with the ICS

57) We are also developing our thinking on the different approaches and options we could apply to setting financial envelopes that each ICA could work to; these range from looking at the needs and/or size of the population, historic spend, target spend and current relative share of spend whilst noting that there is an inherent difference in the level of funding that the three legacy CCGs have received from DHSC; so any alternative models could result in significant shifts of funding across the localities.

58) Over the coming months the BSW Directors of Finance Group will work through these issues and make a set of recommendations for partners to consider.

59) We have historically adopted joint Budgetary arrangements with Local Authority Partners through the Better Care Fund arrangements and Section 75 agreements which gives Local authorities and clinical commissioning groups opportunities to establish and maintain pooled funds for designated areas of service provision. There are opportunities to extend these arrangements in response to our joint assessment of local needs and priorities and to make best use of our collective resources.

Digital & Data: Overview of Areas of Focus

 Data and digital to be at the heart of these new arrangements  Creating the right conditions for people centred digital channels, remote monitoring at home

Position in BSW

60) The Covid pandemic highlighted the potential for digital innovations in the way that care services operate. Our current focus is on creating the infrastructure that is needed to enable effective integrated care, including the development of our shared care record, the right governance and information

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 18 of 21 Page 200 of 210

sharing protocols, the development of reporting and information flows which support population health management, the procurement of systems which enable collaboration (e.g. Advice and Guidance, Acute Electronic patient Record) and the development of digital skills within our workforce. The BSW Academy will have an integral role in supporting both the innovation and skills development associated with this digital transformation.

61) A number of initiatives have been underway across BSW to review the future demand and capacity for services within our care system. These are all helpful and provide some of the information needed to inform future investments, but there is not currently sufficient read across between these individual pieces of work and our Principles for how we want care to operate in the future to generate a shared set of assumptions and agreements. We are therefore in the process of defining how we can quickly bring these elements of demand and capacity modelling together to generate an output that is shared by partners.

62) Development of an effective system performance framework is going to be an essential element of success as a Partnership. Whilst this work has continued during the pandemic providing important and timely information on the way BSW has responded to the situation, we now need to take a more strategic approach to designing a framework that provides meaningful information on the outcomes we are seeking to achieve for the population of BSW. Initial conversations have already begun amongst our Business intelligence specialists regarding the way our collective resources could be redeployed to support this.

How Commissioning will Change: Overview of Areas of Focus  Clearer focus on population level health outcomes and inequalities  Reduction in transaction and contractual exchanges  Single system wide approach to strategic commissioning  Partnerships at place and provider collaborations become principle engine for service transformation  Strategic commissioning for specialised services to be led and integrated at the most appropriate level: ICS, Multi ICS or National

Position in BSW

63) Through our Placed based working and our joint commissioning arrangements with Local Authorities we are developing our model of subsidiarity and commissioning at a BSW ICS level where it makes sense to do so e.g. Urgent care services such as NHS 111 First and the development of our support models for Covid e.g. Long Covid clinics and the development of Home Oximetry Services.

64) With the proposed transfer of commissioning functions into the ICS this provides a further opportunity to re-assess and review of where

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 19 of 21 Page 201 of 210

commissioning functions should sit in the future i.e. at neighbourhood, place and system level. From a CCG perspective we will want to be confident that all commissioning functions safely transition.

65) During the pandemic and to reflect the national financial framework and arrangements in 2020/21 we reduced our transactional commissioning approach and took more of a risk based approach to contract management, reducing the frequency and scope of contract meetings. We will re-affirm this approach for 2021/22 and set new ways of working.

66) We need to further extend our vision for commissioning so that it is part of everyone’s role and to embed a strong focus to reducing health inequalities – acting as a golden thread through all of our work. We need to create a development programme for staff to support the shift and focus to outcomes based commissioning – supporting the moving from historically transactional and quantitative and activity counting as being the measure of success.

67) BSW is participating in a national programme, which aims to support the adoption of Population Health Management (PHM) approaches. This is a 20- week externally supported action learning programme which works to link local data, build analytical skills, design and deliver new models of care, risk stratify the elective backlog and explore alternative models, develop new population based blended payment models and evaluate impact of interventions. We are in the process of recruiting some Primary Care Networks to take part. All of these actions are important in ensuring we move to a greater focus on tackling inequalities in outcomes that have been highlighted during the Covid pandemic.

68) We have also began some exploratory work with the Regional Team and the other 6 systems across the South West to explore how as ICSs we support the transition to managing those commissioning functions that currently falls within the remit of NHS England such as Dentistry, Optometry and Specialised Services and to develop a shared understanding at what should be commissioned at ICS, Multi ICS or National level in the future.

Recommendations & Next Steps

69) Over the coming months we will use our existing system architecture and governance structures to progress the programme of work. The BSW CCG Governing Body and Partnership Board is invited to:

70) a) Note and comment on the update of the BSW ICS Working arrangements in response to the White Paper for NHS Reform and November’s publication Integrating Care: Next Steps to building strong and effective integrated care systems across England

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 20 of 21 Page 202 of 210 71) b) Comment on any areas where it would like to see a further focus or strengthening of our arrangements

72) c) Note the key areas where involvement and support from system partners will be critical and specifically:

d) Note from April regular monthly dedicated briefings to partner organisations will

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 21 of 21 Page 203 of 210

Meeting of the BSW CCG Governing Body Report Summary Sheet

Report Title Summary Report from Governing Body Agenda item 18 Committees Date 18 March 2021 Purpose Approve Discuss Inform x Assure x Author Sharon Woolley, Board Secretary This report BSW CCG x BaNES x Swindon x Wiltshire x concerns locality locality locality Executive summary This summary report provides an update of meetings of Governing Body committees and other committees since the last meeting of the Governing Body in public.

The minutes of Governing Body committees’ meetings in public are enclosed with this report where available. The minutes of Governing Body committees’ meetings held in private will be made available to Governing Body Members only.

Committee Terms of Reference can be found in the BSW CCG’s Constitution and the BSW CCG’s Governance Handbook, Link to CCG Key Documents: https://bswccg.nhs.uk/about- us/governance/key-documents

Recommendation(s) The Governing Body is asked to note the contents of this report. Appendices None

CCG Governing Body Committees

1. BSW CCG Audit Committee

1.1 The Audit Committee of the BaNES, Swindon and Wiltshire (BSW) CCG Governing Body is a statutory committee.

1.2 The Committee is responsible for critically reviewing the Clinical Commissioning Group’s financial reporting and internal control principles. It ensures that an appropriate relationship with both internal and external auditors is maintained, and seeks positive assurances regarding the overall arrangements for governance, risk management and internal control.

1.3 The meeting of the BSW CCG Audit Committee held on 4 March 2021 was chaired by the Lay Member for Audit, Peter Lucas. The Committee undertook the following business:

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 1 of 7 Page 204 of 210

• BSW CCG Audit Committee Terms of Reference • External Audit Progress Report • Mental Health Investment Standard Review • Informing the Audit Risk Assessment • Internal Audit Progress Report and Recommendation Tracker • Internal Audit Reports: a) Delegated Commissioning b) Financial Systems c) Personal Health Budgets d) System Wide Recovery Planning • Draft Internal Audit Plan – 2021/22 - Extract • Local Counter Fraud and Security Management Progress Report - Including Draft Work Plans for 2021-22 • Risk Management • Draft Head of Internal Audit Opinion • First Draft of BSW CCG Annual Report 2020-21 • Going Concern Principle • Items for information • BSW CCG Audit Committee Meeting Dates and Forward Planner 2021-22 • Review of Services: a) Internal Audit b) External Audit c) Local Counter Fraud and Security Management • Competitive Tender Waiver - Tendering of External Audit Services

1.4 The next meeting of the BSW CCG Audit Committee will be held on 22 April 2021.

2 BSW CCG Quality and Performance Assurance Committee

2.1 The BSW CCG Quality and Performance Assurance Committee (QPAC) has an oversight function at both system and locality level, setting the strategic direction for quality and performance of commissioning for the BSW CCG, and reviewing the quality, performance, and value for money of services commissioned by the CCG to provide assurance regarding the delivery of all of these areas to the Governing Body.

2.2 The meetings held on 18 February 2021 and 11 March 2021 were chaired by Julian Kirby, Lay Member for Patient and Public Engagement. The Committee considered the following business:

18 February 2021: • Extraordinary QPAC meeting to consider the BSW All Age ASD and ADHD waiting times Options Appraisal

11 March 2021: • Update on the Harm Review • BSW Performance and Quality Report • Infection Prevention and Control Update • Guidance for supporting educational and community settings to meet the needs of children and young people with medical conditions • Risks Identified / Matters to be Escalated • External Agencies Reports / Updates

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 2 of 7 Page 205 of 210

2.3 The next meeting of the BSW CCG Quality and Performance Assurance Committee will be held on 15 April 2021.

3 BSW CCG Finance Committee

3.1 The BSW CCG Finance Committee has a strategic, planning, and assurance function towards the Governing Body.

3.2 The Committee’s remit extends to setting the strategic direction for finance for the BSW CCG, and to monitor the delivery of the financial strategy across the CCG. Within this remit, the Committee shall cover financial planning, monitoring performance, demonstrating value for money, delivery of the productivity plan, risk identification and management and development of financial policies.

3.3 The meeting held on 4 March 2021 was chaired by Ian James, Lay Member for Finance. The Committee considered the following business:

4 March 2021: • COVID-19 - Monitoring Spend and Financial Position • COVID-19 Vaccination Programme Financial Update • BSW CCG Financial Position for Month 10 – including Prescribing Benchmarking Data • BSW CCG 2020-21 Year End Position • TUPE and Stranded Costs in relation to CSU Business Case • Approval of the BSW CCG Data Security and Protection Toolkit • 2021/22 Development of BSW Financial Framework • BSW System Financial Planning Position Update: 2019/20 Exit Run Rate • Approved Minutes from the Information Governance Steering Group meeting held 13 January 2021

3.4 The next meeting of the BSW CCG Finance Committee will be held on 8 April 2021

4 BSW CCG Primary Care Commissioning Committee

4.1 The BSW CCG Primary Care Commissioning Committee (PCCC) is a mandatory committee. Its meetings are normally held in public.

4.2 NHS England has delegated to BSW CCG authority to exercise primary care commissioning functions. The PCCC was set up to function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers.

4.3 The meeting held on 11 March 2021 was chaired by Suzannah Power, Lay Member for Primary Care Commissioning. The Committee considered the following business:

• Internal Audit – Primary Care Delegated Commissioning Report • Report on Out of Committee Decision – Final Allocation of COVID General Practice Expansion Funding • Operational Report a. Update on COVID-19 Vaccination Programme • Primary Care Operational Group Recommendations for Discussion and Approval a. BSW Safeguarding Contract Proposal b. Special Allocation Service Contract Extension April 2021

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 3 of 7 Page 206 of 210

c. BSW CCG Standard Operating Procedure (SOP) for the Special Allocation Scheme Appeal Panel d. BSW COVID-19 Response Primary Care Offer Primary Care Premises: e. Minor Improvement Grants 2020-22 f. Patford House Additional Revenue Request g. Victoria Cross Branch Surgery (Eldene Health Centre) move to Eldene Surgery h. The Lawn Medical Centre New Lease Request i. General Medical Services Expansion Programme within existing Three Chequers Medical Practice Personal Medical Services (PMS) j. PMS Growth Reinvestments k. PMS Review of BaNES Contracts BaNES Resilience l. Health Inequalities Budget – Proposal for BaNES Practices’ m. University Medical Centre resilience funding for atypical patient population n. GP practices serving significant student populations • Primary Care Quality Report • Finance Report • Primary Care Risk Register • Primary Care Commissioning Committee Meeting Dates and Forward Plan 2021/22

4.4 The next meeting of the BSW CCG Primary Care Commissioning Committee in public will be held on 15 April 2021. At that point in time, the Committee will formally approve the minutes of its meeting held in public on 11 March 2021. Following that approval, the minutes will be published on the CCG website.

5 BSW CCG Remuneration Committee

5.1 The Remuneration Committee of the BSW CCG Governing Body is a statutory committee.

5.2 The Remuneration Committee supports the CCG’s Governing Body and Chief Executive by making recommendations regarding remuneration, fees and other allowances (including pension schemes) for employees and other individuals who provide services to the CCG, ensuring the consistent application of relevant national guidance and local policies.

5.3 The meeting held on 2 March 2021 was chaired by Suzannah Power, Lay Member for Primary Care Commissioning. Members considered proposals regarding BSW CCG Governing Body Chair and Members Appraisals, BSW CCG Governing Body and Committees Effectiveness Review and the remuneration and conditions of service for a senior employee of the BSW CCG.

6 Ambulance Joint Commissioning Committee

6.1 A collaborative commissioning model is in place for the commissioning of ambulance services across the South West. The Ambulance Joint Commissioning Committee (AJCC) has been established to jointly commission emergency ambulance services across the south west and to manage the commissioning contract with the provider of emergency ambulance services. The CCGs covered by these joint commissioning arrangements are BSW CCG; Bristol, North Somerset and South Gloucestershire CCG; Devon CCG; Dorset CCG; Gloucestershire CCG; Kernow CCG and Somerset CCG.

6.2 The next meeting of the AJCC is scheduled for 23 March 2021.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 4 of 7 Page 207 of 210

7 COVID-19 Governance

7.1 From April 2020, structures were put into place to govern the BSW-wide COVID-19 response. Regular meetings were held of the Strategic Clinical Reference Group, Local Clinical Reference Group, Ethics Advisory Group and Medicines Optimisation Group.

7.2 The Strategic Clinical Reference Group has since morphed into the BSW Partnership Population Health and Care Group (PHCG), as part of the BSW system’s journey to becoming an Integrated Care System. The PHCG continues to meet monthly, looking at the ambitions as a system and a BSW integrated care model. The remit of the PHCG is to lead on the use of population health analytics across the BSW system, to support how we provide care and in particular, the inequalities in our area and what that means for our services.

7.3 An informal BSW Clinical Reference Group has been established during this third wave of COVID-19 cases, providing a place for clinical discussion.

7.4 The Ethical Advisory Group was reconvened for one meeting in December. The BSW CCG Medical Director has been involved in the South West Ethical Reference Group, which has largely looked at its position in terms of governance and support from the South West Clinical Senate.

Committees with a Locality Focus

The committees below have a focus on the respective localities. Summaries of their recent meetings are provided in this section of the report.

8 B&NES Locality Commissioning Group

8.1 The BaNES Locality Commissioning Group (BLCG) is responsible for the BSW CCG’s commissioning activities in the BaNES locality, including collaborative and joint commissioning arrangements, as permitted, with Bath and North East Somerset Council. The Group operates in common with the relevant committee within the Council.

8.2 At the BLCG meeting held on 4 March 2021, the Group considered the following business:

• Better Care Fund Update • Direct Payments Standard Price Model • Specialist mental health care and support for adults (18-64): system procurement • Perinatal Emotional Wellbeing Service • CCG and Council Finance Update

8.3 The next meeting of the BaNES Locality Commissioning Group will be held on 6 May 2021.

9 BaNES Health and Wellbeing Board

9.1 The BaNES Health and Wellbeing Board is a committee of the B&NES Council. It oversees, monitor and make recommendations in respect of the development of strategy and performance management of adult health and social care, children’s health and social care and public health in the Bath & North East Somerset Council area (including services for those living outside the area where the services are provided by any one of the Partners), on behalf of NHS Bath & North East Somerset and Bath & North East Somerset Council.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 5 of 7 Page 208 of 210

9.2 Meeting papers and minutes can be found on the B&NES Council website here: https://democracy.bathnes.gov.uk/mgCommitteeDetails.aspx?ID=492

9.3 The next meeting is scheduled for 30 March 2021.

10 BaNES Health and Care Board

10.1 The BaNES Health and Care Board has currently been stood down; therefore, no future meetings dates have been scheduled.

11 BaNES Your Health Your Voice

11.1 Your Health, Your Voice is regularly held for members of the public to provide feedback on the CCG’s plans for improving local health services.

11.2 The next meeting of the BaNES Your Health Your Voice forum will be held on 1 April 2021.

12 Swindon Locality Commissioning Group

12.1 The Swindon Locality Commissioning Group (SLCG) is responsible for the BSW CCG’s commissioning activities in the Swindon locality, including collaborative and joint commissioning arrangements, as permitted, with Swindon Borough Council (SBC). The Group operates in common with the relevant committee within the Council.

12.2 The next meeting of the SLCG is to be held on 16 March 2021.

13 Swindon Health and Wellbeing Board

13.1 The Swindon Health and Wellbeing Board is made up of a collection of people from different organisations (including the NHS, the local authority officers and elected members, the Clinical Commissioning Group and the voluntary sector), who will work together on issues to do with being healthy and feeling well. The Board aims to find out what people in Swindon need to be healthy and feel well and work together to agree a strategy (plan) that will promote positive change towards making things happen. The Board also aims to reduce the health differences between poorer and better off groups across Swindon (health inequalities).

13.2 Meeting papers and minutes can be found on the Swindon Borough Council website here: http://ww5.swindon.gov.uk/moderngov/mgCommitteeDetails.aspx?ID=933

14 Swindon Patient and Public Engagement Forum

14.1 The Swindon Patient and Public Engagement Forum is regularly held with patient engagement group members to provide feedback on the CCG’s plans for improving local health services.

14.2 The Forum held on 10 March 2021 considered the following business:

• Public questions • Update on the Swindon Locality • Update on the COVID-19 Vaccination • CCG E-newsletter • Integrated Care System Meeting • Update on the Flu Vaccinations for 202-21

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 6 of 7 Page 209 of 210 14.3 The next meeting of the Swindon Patient and Public Engagement Forum will be held on 7 April 2021

15 Wiltshire Locality Commissioning Group

15.1 The Wiltshire Locality Commissioning Group (WLCG) is responsible for the BSW CCG’s commissioning activities in the Wiltshire locality, including collaborative and joint commissioning arrangements, as permitted, with Wiltshire Council. The Group operates in common with the relevant committee within the Council.

15.2 The next meeting of the Wiltshire Locality Commissioning Group will be held on 22 March 2021.

16 Wiltshire Health and Wellbeing Board

16.1 The Wiltshire Health and Wellbeing Board oversees the preparation of the Joint Strategic Assessment (JSNA); the Pharmaceutical Needs Assessment (PNA) and Joint Health and Wellbeing Strategy (JHWS) for Wiltshire. The Board has a duty to encourage integrated working between health and social care commissioners in connection with the provision of health and social care services.

16.2 Meeting papers and minutes can be found on the Wiltshire Council website here: https://cms.wiltshire.gov.uk/mgCommitteeDetails.aspx?ID=1163

16.3 The next meeting is scheduled for 16 March 2021.

NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group Page 7 of 7 Page 210 of 210